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Oquendo MA, Galfalvy HC, Choo TH, Herzog S, Burke AK, Sublette ME, Mann JJ, Stanley BH. Occurrence and characteristics of suicidal ideation in psychiatrically healthy individuals based on ecological momentary assessment. Mol Psychiatry 2024:10.1038/s41380-024-02560-2. [PMID: 38729992 DOI: 10.1038/s41380-024-02560-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 05/12/2024]
Abstract
Decedents with no known mental disorder comprise 5-40% of suicides, suggesting that suicide ideation (SI) and behavior may occur in the psychiatrically healthy with important implications for suicide risk screening. Healthy Volunteers (HV) and patients with Major Depressive Disorder (MDD) provided 7 days of Ecological Momentary Assessment (EMA) data about SI and stressors. Longitudinal mixed effects logistic regression models compared HV and patient SI and stressors. Mixed effects linear regression models compared HVs' and patients' SI score change from the previous epoch's SI score when each stressor occurred. HVs (n = 42) reported less frequent (p < 0.001) and less intense SI (p < 0.003) than patients (n = 80), yet did endorse SI and/or SI-related items in 44% of EMA epochs, endorsing SI items in 25% of epochs with non-zero SI scores. For 7 of 8 stressors, patients reported stressors more often than HVs (all p < 0.001) responding to them with increased SI (0.0001 < p < 0.0472). HVs were relatively resilient to stressors, reporting SI increases only in response to neglect (p < 0.0147). Although SI and SAs are documented among psychiatrically healthy individuals, scientific attention to these observations has been scant. Real-time SI measurement showed that HVs' SI was less pronounced than MDD patients', but was endorsed, nonetheless. Patients were more likely to report stressors than HVs, perhaps due to greater sensitivity to the environment, and reported SI in response to stressors, which was less common in HVs. Both MDD patients and HVs most often manifested passive SI (viz, "decreased wish to live"). However, passive SI (viz, "desire for death"), may predict suicide, even absent SI per se (thinking about killing yourself). This study validates the utility of real-time SI assessment, showing that HVs endorse SI items in 11% of epochs, which implies that suicide risk screening focused on those with mental disorders may be too narrow an approach.
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Affiliation(s)
- Maria A Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Hanga C Galfalvy
- Vagelos College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Tse-Hwei Choo
- Vagelos College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Sarah Herzog
- Vagelos College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Ainsley K Burke
- Vagelos College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - M Elizabeth Sublette
- Vagelos College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - J John Mann
- Vagelos College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Barbara H Stanley
- Vagelos College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York, NY, USA
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Daglas Z, Lu S, Gresham D, Tatnell R, Stanley BH, Melvin GA. Classifying coping strategies from suicide prevention safety plans. Suicide Life Threat Behav 2024; 54:275-285. [PMID: 38300145 DOI: 10.1111/sltb.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 08/18/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Understanding the specific strategies individuals use to cope with their suicidal thoughts may have implications for suicide prevention. This study developed a classification system of coping strategies and applied this system to individual coping behaviors documented in a safety planning intervention smartphone application called Beyond Now. METHOD 725 Beyond Now safety planning app users, aged 16 to over 55 years, entered coping strategies that were used to develop a classification system through content analysis. Entries were either user generated or selected from a list of suggested coping strategies, and 2960 entries were classified using the system. RESULTS Our classification system featured 11 distinct descriptive categories, with media consumption being the most popular coping strategy among Beyond Now users, followed by relaxation and self-care activities, exercise and creative activities. More than half (57%) of the entries were suggested coping strategies with the remainder being user-generated entries (43%). CONCLUSION A wide range of coping strategies were entered into safety plans, with activities that aim to either distract or provide reductions in emotional arousal common. Future research is needed to evaluate the efficacy of the coping strategies listed in safety plans.
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Affiliation(s)
- Zoe Daglas
- School of Psychology, SEED Lifespan, Deakin University, Geelong, Victoria, Australia
| | - Sinh Lu
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Daniel Gresham
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Ruth Tatnell
- School of Psychology, SEED Lifespan, Deakin University, Geelong, Victoria, Australia
| | - Barbara H Stanley
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Glenn A Melvin
- School of Psychology, SEED Lifespan, Deakin University, Geelong, Victoria, Australia
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Herzog S, Galfalvy H, Keilp JG, Mann JJ, Sublette ME, Burke A, Oquendo MA, Stanley BH. Relationship of stress-reactive cortisol to suicidal intent of prior attempts in major depression. Psychiatry Res 2023; 327:115315. [PMID: 37542793 PMCID: PMC10530442 DOI: 10.1016/j.psychres.2023.115315] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/02/2023] [Accepted: 06/16/2023] [Indexed: 08/07/2023]
Abstract
Higher intent suicide attempts carry elevated risk of future suicidal behavior. Abnormal functioning of the hypothalamic-pituitary-adrenal (HPA) axis is both linked to nonfatal suicidal behavior and suicide deaths in major depressive disorder. Few studies, however, have identified biological markers of a high-intent suicidal subgroup. We examined HPA axis output and reactivity to the Trier Social Stress Test (TSST) via salivary cortisol in depressed individuals (N=68) with a suicide attempt (SA) history. A median split of higher and lower suicidal intent scores was used to define groups. Individuals with high intent SA had attenuated total cortisol output (AUCg), F(1,60)=10.04, SE=5.095, p=.003, and lower HPA-axis stress responsivity to the TSST (AUCi), F(1,60)=4.50, SE=4.604, p=.039, compared with the low intent SA group. The high intent group also reported more pronounced negative affect than the low intent group (F[1,61]=6.413, SE=10.55, p=.014) both at baseline (meandiff=22.32, p=.038) and in response to the stressor task (meandiff=37.62, p=.003). Vulnerability to suicidal behavior in high-intent individuals may be related to the combined profile of impaired physiological responses to stress and greater negative affectivity. This clinical and biologic subgroup may benefit from targeted suicide prevention interventions.
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Affiliation(s)
- Sarah Herzog
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY; Mental Health Data Science Division, New York State Psychiatric Institute, New York, NY; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - John G Keilp
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - J John Mann
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - M Elizabeth Sublette
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Ainsley Burke
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara H Stanley
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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Myers CE, Dave CV, Callahan M, Chesin MS, Keilp JG, Beck KD, Brenner LA, Goodman MS, Hazlett EA, Niculescu AB, St. Hill L, Kline A, Stanley BH, Interian A. Improving the prospective prediction of a near-term suicide attempt in veterans at risk for suicide, using a go/no-go task. Psychol Med 2023; 53:4245-4254. [PMID: 35899406 PMCID: PMC9883589 DOI: 10.1017/s0033291722001003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/01/2022] [Accepted: 03/28/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Neurocognitive testing may advance the goal of predicting near-term suicide risk. The current study examined whether performance on a Go/No-go (GNG) task, and computational modeling to extract latent cognitive variables, could enhance prediction of suicide attempts within next 90 days, among individuals at high-risk for suicide. METHOD 136 Veterans at high-risk for suicide previously completed a computer-based GNG task requiring rapid responding (Go) to target stimuli, while withholding responses (No-go) to infrequent foil stimuli; behavioral variables included false alarms to foils (failure to inhibit) and missed responses to targets. We conducted a secondary analysis of these data, with outcomes defined as actual suicide attempt (ASA), other suicide-related event (OtherSE) such as interrupted/aborted attempt or preparatory behavior, or neither (noSE), within 90-days after GNG testing, to examine whether GNG variables could improve ASA prediction over standard clinical variables. A computational model (linear ballistic accumulator, LBA) was also applied, to elucidate cognitive mechanisms underlying group differences. RESULTS On GNG, increased miss rate selectively predicted ASA, while increased false alarm rate predicted OtherSE (without ASA) within the 90-day follow-up window. In LBA modeling, ASA (but not OtherSE) was associated with decreases in decisional efficiency to targets, suggesting differences in the evidence accumulation process were specifically associated with upcoming ASA. CONCLUSIONS These findings suggest that GNG may improve prediction of near-term suicide risk, with distinct behavioral patterns in those who will attempt suicide within the next 90 days. Computational modeling suggests qualitative differences in cognition in individuals at near-term risk of suicide attempt.
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Affiliation(s)
- 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
| | - Chintan V. Dave
- Research Service, VA New Jersey Health Care System, East Orange, NJ, USA
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research; Rutgers University, New Brunswick, NJ, USA
| | - Michael Callahan
- Mental Health and Behavioral Sciences, VA New Jersey Health Care System, Lyons, NJ, USA
| | - Megan S. Chesin
- Department of Psychology, William Patterson University, Wayne, NJ, USA
| | - John G. Keilp
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, 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
| | - Marianne S. Goodman
- VISN 2 Mental Illness, Research, Education and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin A. Hazlett
- VISN 2 Mental Illness, Research, Education and Clinical Center (MIRECC), James J. Peters VA Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexander B. Niculescu
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indianapolis Veterans Affairs Medical Center, Indianapolis, IN, USA
| | - Lauren St. Hill
- Mental Health and Behavioral Sciences, VA New Jersey Health Care System, Lyons, NJ, USA
| | - Anna Kline
- Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Barbara H. Stanley
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, 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
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Herzog S, Keilp JG, Galfalvy H, Mann JJ, Stanley BH. Attentional control deficits and suicidal ideation variability: An ecological momentary assessment study in major depression. J Affect Disord 2023; 323:819-825. [PMID: 36549341 PMCID: PMC10448451 DOI: 10.1016/j.jad.2022.12.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Suicidal behavior is associated with deficits in cognitive control; however, suicidal ideation (SI), a key precursor to suicidal behavior, has been less consistently linked to neuropsychological functioning. Additionally, no study to date has examined attentional control capacities in relation to variability in suicidal ideation, defined as fluctuation in SI intensity and duration across short periods of time. Prior research suggests that suicidal individuals with highly variable SI experience greater stress-responsive increases in SI and cortisol, potentially raising risk for suicidal behavior. Here, we examined attentional control capacities associated with SI variability and severity in ninety-five subjects with major depressive disorder. Variability and severity of SI and depressive affect were quantified using Ecological Momentary Assessment (EMA) over a 7-day period. Participants completed the Continuous Performance Task (CPT) and a computerized Stroop task for assessment of attentional control. EMA SI variability was associated with greater attentional interference on the Stroop task, and this was not accounted for by severity of SI, concurrently assessed depressive affect, or baseline depression. CPT performance was not related to SI variability or intensity. Findings highlight the utility of EMA methods in characterizing patterned experiences of SI and suggest that attentional control deficits may contribute to these characteristic patterns.
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Affiliation(s)
- Sarah Herzog
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA.
| | - John G Keilp
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - J John Mann
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - Barbara H Stanley
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, NY, USA; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
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Itzhaky L, Davaasambuu S, Ellis SP, Cisneros-Trujillo S, Hannett K, Scolaro K, Stanley BH, Mann JJ, Wainberg ML, Oquendo MA, Sublette ME. Twenty-six years of psychosocial interventions to reduce suicide risk in adolescents: Systematic review and meta-analysis. J Affect Disord 2022; 300:511-531. [PMID: 34974074 PMCID: PMC11085995 DOI: 10.1016/j.jad.2021.12.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND During adolescence, suicide risk increases; effective treatments are needed to reduce risk. METHODS Databases were searched (1995-2020) for randomized controlled trials (RCTs) concerning psychosocial treatments for suicide prevention in adolescents (10-18 yrs). Data were extracted from the timepoint closest to 6 months. Cohen's ds were estimated for reducing suicidal ideation (SI), self-harming behaviors (SHB) excluding strictly non-suicidal self-injury, and suicide attempts (SA) and analyzed using generalized least square regression. Meta-analytic innovations included within-person correlations to reflect trait suicidality; annualization to control for exposure; estimated lifetime risk based on ages; and modeling inclusion/exclusion criteria. Alternate approaches included relative risk and comparison of intervention and control treatments to baseline. RESULTS Of 30 RCTs, 6 assessing SHB (4 measuring SA), and 7 assessing SI demonstrated treatment effectiveness. Overall, interventions decreased SI (n = 25) with low effect size (d = 0.08, p = 0.01), non-significant after controlling for publication bias (d = 0.05, p = 0.1); interventions were non-significant for SHB (n = 25, d = 0.001, p = 0.97) or SA (n = 18, d = 0.03, p = 0.52). To prevent one SHB, the number needed to treat (NNT) was 45[26,156]; for SA, NNT=42[24,149]. Non-superiority may relate to effectiveness of control treatments. Thus, experimental and control treatments also were compared to baseline: both reduced SI (p < 0.0001), and effectiveness improved for SHB (NNT=12) and SA (NNT=11). LIMITATIONS Study heterogeneity and inconsistent statistical reporting limited meta-analysis. CONCLUSIONS Psychosocial interventions for suicide risk in adolescents showed little effectiveness compared with control treatments; suicide outcomes improved in both groups compared to baseline. Different approaches may be needed, including precision medicine methodologies and standardized statistical reporting criteria.
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Affiliation(s)
- Liat Itzhaky
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA; Geha Mental Health Center, Petah-Tikva, Israel
| | - Sara Davaasambuu
- Department of Psychiatry, Columbia University, New York, NY 10032, USA
| | - Steven P Ellis
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA
| | | | - Katrina Hannett
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA
| | | | - Barbara H Stanley
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA
| | - J John Mann
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA; Department of Radiology, Columbia University, New York, NY, USA
| | - Milton L Wainberg
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M Elizabeth Sublette
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY, USA.
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Oquendo MA, Galfalvy HC, Choo TH, Kandlur R, Burke AK, Sublette ME, Miller JM, Mann JJ, Stanley BH. Highly variable suicidal ideation: a phenotypic marker for stress induced suicide risk. Mol Psychiatry 2021; 26:5079-5086. [PMID: 32576966 PMCID: PMC7755748 DOI: 10.1038/s41380-020-0819-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/31/2020] [Accepted: 06/10/2020] [Indexed: 11/24/2022]
Abstract
Suicidal behavior (SB) can be impulsive or methodical; violent or not; follow a stressor or no obvious precipitant. This study tested whether childhood trauma, affective lability, and aggressive and impulsive traits predicted greater SI variability. We also assessed whether affective lability, aggressive or impulsive traits explain childhood trauma's effects on SI variability and whether those with highly variable SI respond to stressful events with increases in SI. Finally, we assessed variable SI's trajectory over 2 years. Depressed participants (n = 51) had ecological momentary assessments (EMA) over 7 days at baseline, 3, 6, 12, 18, and 24 months. SI variability was assessed using the square Root of the Mean Square of Successive Deviations. Mixed Effects Models were fit as appropriate. Childhood trauma was associated with subsequent aggression. Physical abuse predicted both aggression and affective lability as well as SI variability, but not impulsivity. In two-predictor models, physical abuse's effect on SI variability was no longer significant, when controlling for the effect of higher aggression and impulsivity. Those with high SI variability exhibited greater increases in SI after stressors compared with those with less variability. We did not find that SI variability changed over time, suggesting it might be trait-like, at least over 2 years. Variable SI predisposes to marked SI increases after stressful events and may be a trait increasing risk for impulsive SB, at least over 2 years.
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Affiliation(s)
- Maria A Oquendo
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
| | - Hanga C Galfalvy
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Tse-Hwei Choo
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Ainsley K Burke
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - M Elizabeth Sublette
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jeffrey M Miller
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - J John Mann
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Barbara H Stanley
- Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
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Interian A, Myers CE, Chesin MS, Kline A, Hill LS, King AR, Miller R, Latorre M, Gara MA, Stanley BH, Keilp JG. Towards the objective assessment of suicidal states: Some neurocognitive deficits may be temporally related to suicide attempt. Psychiatry Res 2020; 287:112624. [PMID: 31727438 PMCID: PMC7165019 DOI: 10.1016/j.psychres.2019.112624] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 02/03/2023]
Abstract
Neurocognitive detection of suicidal states has the potential to significantly advance objective risk assessment. This goal requires establishing that neurocognitive deficits fluctuate around the time of a suicide attempt. The current study therefore evaluated whether neurocognitive performance is temporally related to suicide attempt, in a sample at highrisk for suicide (n = 141). Evaluations consisted of a clinician-administered interview, self-report questionnaires, and neurocognitive tasks assessing response inhibition, attentional control, and memory recognition. Analyses examined whether neurocognitive scores significantly differed according to the following temporal suicide attempt categories: (a) past-week attempt; (b) past-year attempt (not in past week); and (c) no past-year attempt. Univariate results showed that response inhibition and memory recognition were significantly related to suicide attempt recency. Post-hoc pairwise tests showed that participants with a past-week suicide attempt showed greater impairments than those without a past-year attempt. Multivariate tests showed the same pattern of results, adjusting for age, suicide attempts prior to past year, mood disturbance, and suicidal ideation. These results show that neurocognitive assessment of response inhibition and memory recognition shows sensitivity to the recency of a suicide attempt. While future prospective studies are needed, results suggest that phasic neurocognitive deficits may serve as objective markers of short-term suicide risk.
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Affiliation(s)
- Alejandro Interian
- Mental Health and Behavioral Sciences, VA New Jersey Healthcare System, 151 Knollcroft Road, Lyons, NJ 07939, USA; Department of Psychiatry, Robert Wood Johnson Medical School, The State University of New Jersey, Piscataway, NJ, USA.
| | - Catherine E Myers
- Research and Development Service, VA New Jersey Healthcare System, East Orange, NJ, USA; Department of Pharmacology, Physiology, and Neuroscience, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Megan S Chesin
- Department of Psychology, William Paterson University, Wayne, NJ, USA
| | - Anna Kline
- Department of Psychiatry, Robert Wood Johnson Medical School, The State University of New Jersey, Piscataway, NJ, USA
| | - Lauren St Hill
- War Related Illness and Injury Study Center, VA New Jersey Healthcare System, East Orange, NJ, USA
| | - Arlene R King
- Mental Health and Behavioral Sciences, VA New Jersey Healthcare System, 151 Knollcroft Road, Lyons, NJ 07939, USA
| | - Rachael Miller
- Mental Health and Behavioral Sciences, VA New Jersey Healthcare System, 151 Knollcroft Road, Lyons, NJ 07939, USA
| | - Miriam Latorre
- Mental Health and Behavioral Sciences, VA New Jersey Healthcare System, 151 Knollcroft Road, Lyons, NJ 07939, USA
| | - Michael A Gara
- Department of Psychiatry, Robert Wood Johnson Medical School, The State University of New Jersey, Piscataway, NJ, USA
| | - Barbara H Stanley
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
| | - John G Keilp
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
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Itzhaky L, Galfalvy H, Keilp JG, Gratch I, Brodsky BS, Stanley BH. Stress Response in Suicide Attempters with Borderline Personality Disorder: The Role of Behavioral Problems in Childhood. Psychiatry 2020; 83:221-230. [PMID: 32069167 PMCID: PMC8721090 DOI: 10.1080/00332747.2020.1716439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Suicidal individuals are a heterogeneous population and may differ in systematic ways in their responsiveness to stress. The primary aim of the present study was to identify whether a different pattern of physiological stress response exists among adult suicide attempters with a history of behavioral problems during childhood and adolescence, which earlier studies have related to both decreased activity of the HPA axis and to suicidal behaviors. Method: Seventy-eight participants with Borderline Personality Disorder were assessed using the SCID-II, and completed self-report measures assessing their history of suicide attempts, history of aggressive behaviors, depressive symptoms, history of lifetime abuse and demographics. Participants' cortisol reactivity was assessed using the Trier Social Stress Test. Results: Analyses indicated that suicide attempters with a history of behavioral problems in youth (n = 30) had a significantly lower response to stress than both suicide attempters without such a history (n = 26) and non-attempters (n = 22), when controlling for lifetime history of abuse. The groups did not differ in basal cortisol. Conclusions: These findings suggest a unique subtype of suicide attempter among those with Borderline Personality Disorder, characterized by a blunted physiological stress response.
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Affiliation(s)
- Liat Itzhaky
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Hanga Galfalvy
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - John G. Keilp
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Ilana Gratch
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Beth S. Brodsky
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Barbara H. Stanley
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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10
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Mehlum L, Ramleth RK, Tørmoen AJ, Haga E, Diep LM, Stanley BH, Miller AL, Larsson B, Sund AM, Grøholt B. Long term effectiveness of dialectical behavior therapy versus enhanced usual care for adolescents with self-harming and suicidal behavior. J Child Psychol Psychiatry 2019; 60:1112-1122. [PMID: 31127612 DOI: 10.1111/jcpp.13077] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Knowledge is lacking on the long-term outcomes of treatment for adolescents with repetitive suicidal and self-harming behavior. Furthermore, the pathways through which treatment effects may operate are poorly understood. Our aims were to investigate enduring treatment effects of dialectical behavior therapy adapted for adolescents (DBT-A) compared to enhanced usual care (EUC) through a prospective 3-year follow-up and to analyze possible mediators of treatment effects. METHODS Interview and self-report data covering the follow-up interval were collected from 92% of the adolescents who participated in the original randomized trial. TRIAL REGISTRATION NUMBER NCT01593202 (www.ClinicalTrials.gov). RESULTS At the 3-year follow-up DBT-A remained superior to EUC in reducing the frequency of self-harm, whereas for suicidal ideation, hopelessness and depressive and borderline symptoms and global level of functioning there were no inter-group differences, with no sign of symptom relapse in either of the participant groups. A substantial proportion (70.8%) of the effect of DBT-A on self-harm frequency over the long-term was mediated through a reduction in participants' experience of hopelessness during the trial treatment phase. Receiving more than 3 months follow-up treatment after completion of the trial treatment was associated with further enhanced outcomes in patients who had received DBT-A. CONCLUSIONS There were on average no between-group differences at the 3-year follow-up in clinical outcomes such as suicidal ideation, hopelessness, depressive and borderline symptoms. The significantly and consistently larger long-term reduction in self-harm behavior for adolescents having received DBT-A compared with enhanced usual care, however, suggests that DBT-A may be a favorable treatment alternative for adolescents with repetitive self-harming behavior.
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Affiliation(s)
- Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ruth-Kari Ramleth
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anita J Tørmoen
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Egil Haga
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lien M Diep
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Barbara H Stanley
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry, Columbia University, New York, NY, USA
| | - Alec L Miller
- Albert Einstein College of Medicine, Yeshiva University, New York, NY, USA
| | - Bo Larsson
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne M Sund
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Child and Adolescent Psychiatry, St. Olav's Hospital, Trondheim, Norway
| | - Berit Grøholt
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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11
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Steinberg LJ, Rubin-Falcone H, Galfalvy HC, Kaufman J, Miller JM, Sublette ME, Cooper TB, Min E, Keilp JG, Stanley BH, Oquendo MA, Ogden RT, Mann JJ. Cortisol Stress Response and in Vivo PET Imaging of Human Brain Serotonin 1A Receptor Binding. Int J Neuropsychopharmacol 2019; 22:329-338. [PMID: 30927011 PMCID: PMC6499240 DOI: 10.1093/ijnp/pyz009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/07/2018] [Accepted: 02/15/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Abnormalities in the hypothalamic-pituitary-adrenal axis, serotonergic system, and stress response have been linked to the pathogenesis of major depressive disorder. State-dependent hyper-reactivity of the hypothalamic-pituitary-adrenal axis is seen in major depressive disorder, and higher binding to the serotonin 1A receptor is observed as a trait in both currently depressed and remitted untreated major depressive disorder. Here, we sought to examine whether a relationship exists between cortisol secretion in response to a stressor and serotonin 1A receptor binding throughout the brain, both in healthy controls and participants with major depressive disorder. METHODS Research participants included 42 medication-free, depressed subjects and 31 healthy volunteers. Participants were exposed to either an acute, physical stressor (radial artery catheter insertion) or a psychological stressor (Trier Social Stress Test). Levels of serotonin 1A receptor binding on positron emission tomography with [11C]WAY-100635 were also obtained from all participants. The relationship between [11C]WAY-100635 binding and cortisol was examined using mixed linear effects models with group (major depressive disorder vs control), cortisol, brain region, and their interactions as fixed effects and subject as a random effect. RESULTS We found a positive correlation between post-stress cortisol measures and serotonin 1A receptor ligand binding levels across multiple cortical and subcortical regions, independent of diagnosis and with both types of stress. The relationship between [11C]WAY-100635 binding and cortisol was homogenous across all a priori brain regions. In contrast, resting cortisol levels were negatively correlated with serotonin 1A receptor ligand binding levels independently of diagnosis, except in the RN. There was no significant difference in cortisol between major depressive disorder participants and healthy volunteers with either stressor. Similarly, there was no correlation between cortisol and depression severity in either stressor group. CONCLUSIONS This study suggests that there may be a common underlying mechanism that links abnormalities in the serotonin system and hypothalamic-pituitary-adrenal axis hyper-reactivity to stress. Future studies need to determine how hypothalamic-pituitary-adrenal axis dysfunction affects mood to increase the risk of suicide in major depression.
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Affiliation(s)
- Louisa J Steinberg
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY,Correspondence: Louisa J. Steinberg, MD, PhD, 1051 Riverside Drive, New York, NY 10032 ()
| | - Harry Rubin-Falcone
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY
| | - Hanga C Galfalvy
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Joshua Kaufman
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY
| | - Jeffrey M Miller
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY
| | - M Elizabeth Sublette
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY
| | - Thomas B Cooper
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY,Nathan S. Kline Institute for Psychiatric Research, New York, NY
| | - Eli Min
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY
| | - John G Keilp
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY
| | - Barbara H Stanley
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY
| | - Maria A Oquendo
- Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - R Todd Ogden
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - J John Mann
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY,Department of Radiology, Columbia University, New York, NY
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12
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Bernanke J, Galfalvy HC, Mortali MG, Hoffman LA, Moutier C, Nemeroff CB, Stanley BH, Clayton P, Harkavy-Friedman J, Oquendo MA. Suicidal ideation and behavior in institutions of higher learning: A latent class analysis. J Psychiatr Res 2017; 95:253-259. [PMID: 28923719 PMCID: PMC5826724 DOI: 10.1016/j.jpsychires.2017.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/08/2017] [Accepted: 09/01/2017] [Indexed: 11/29/2022]
Abstract
Suicide is the second leading cause of death among undergraduate students, with an annual rate of 7.5 per 100,000. Suicidal behavior (SB) is complex and heterogeneous, which might be explained by there being multiple etiologies of SB. Data-driven identification of distinct at-risk subgroups among undergraduates would bolster this argument. We conducted a latent class analysis (LCA) on survey data from a large convenience sample of undergraduates to identify subgroups, and validated the resulting latent class model on a sample of graduate students. Data were collected through the Interactive Screening Program deployed by the American Foundation for Suicide Prevention. LCA identified 6 subgroups from the undergraduate sample (N = 5654). In the group with the most students reporting current suicidal thoughts (N = 623, 66% suicidal), 22.5% reported a prior suicide attempt, and 97.6% endorsed moderately severe or worse depressive symptoms. Notably, LCA identified a second at-risk group (N = 662, 27% suicidal), in which only 1.5% of respondents noted moderately severe or worse depressive symptoms. When graduate students (N = 1138) were classified using the model, a similar frequency distribution of groups was found. Finding multiple replicable groups at-risk for suicidal behavior, each with a distinct prevalence of risk factors, including a group of students who would not be classified as high risk with depression-based screening, is consistent with previous studies that identified multiple potential etiologies of SB.
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Affiliation(s)
- Joel Bernanke
- Department of Psychiatry, Columbia University, NY, USA,New York State Psychiatric Institute, NY, USA
| | - Hanga C. Galfalvy
- Department of Psychiatry, Columbia University, NY, USA,Department of Biostatistics, Columbia University, NY, USA
| | | | | | | | | | - Barbara H. Stanley
- Department of Psychiatry, Columbia University, NY, USA,New York State Psychiatric Institute, NY, USA
| | | | | | - Maria A. Oquendo
- Department of Psychiatry, Columbia University, NY, USA,New York State Psychiatric Institute, NY, USA
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13
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Affiliation(s)
- J A Bernanke
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - B H Stanley
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - M A Oquendo
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
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14
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Mehlum L, Ramberg M, Tørmoen AJ, Haga E, Diep LM, Stanley BH, Miller AL, Sund AM, Grøholt B. Dialectical Behavior Therapy Compared With Enhanced Usual Care for Adolescents With Repeated Suicidal and Self-Harming Behavior: Outcomes Over a One-Year Follow-Up. J Am Acad Child Adolesc Psychiatry 2016; 55:295-300. [PMID: 27015720 DOI: 10.1016/j.jaac.2016.01.005] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 01/06/2016] [Accepted: 01/21/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We conducted a 1-year prospective follow-up study of posttreatment clinical outcomes in adolescents with recent and repetitive self-harm who had been randomly allocated to receive 19 weeks of either dialectical behavior therapy adapted for adolescents (DBT-A) or enhanced usual care (EUC) at community child and adolescent psychiatric outpatient clinics. METHOD Assessments of self-harm, suicidal ideation, depression, hopelessness, borderline symptoms, and global level of functioning were made at the end of the 19-week treatment period and at follow-up 1 year later. Altogether 75 of the 77 (97%) adolescents participated at both time points. Frequencies of hospitalizations, emergency department visits and other use of mental health care during the 1-year follow-up period were recorded. Change analyses were performed using mixed effects linear spline regression and mixed effect Poisson regression with robust variance. RESULTS Over the 52-week follow-up period, DBT-A remained superior to EUC in reducing the frequency of self-harm. For other outcomes such as suicidal ideation, hopelessness, and depressive or borderline symptoms and for the global level of functioning, inter-group differences apparent at the 19-week assessment were no longer observed, mainly due to participants in the EUC group having significantly improved on these dimensions over the follow-up year, whereas DBT-A participants remained unchanged. CONCLUSION A stronger long-term reduction in self-harm and a more rapid recovery in suicidal ideation, depression, and borderline symptoms suggest that DBT-A may be a favorable treatment alternative for adolescents with repetitive self-harming behavior. CLINICAL TRIAL REGISTRATION INFORMATION Treatment for Adolescents With Deliberate Self Harm; http://clinicaltrials.gov/; NCT00675129.
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Affiliation(s)
- Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Maria Ramberg
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anita J Tørmoen
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Egil Haga
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lien M Diep
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital
| | | | - Alec L Miller
- Montefiore Medical Center and Albert Einstein College of Medicine, New York, USA
| | - Anne M Sund
- Norwegian University of Science and Technology and St. Olav's University Hospital, Trondheim, Norway
| | - Berit Grøholt
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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15
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Keilp JG, Stanley BH, Beers SR, Melhem NM, Burke AK, Cooper TB, Oquendo MA, Brent DA, John Mann J. Further evidence of low baseline cortisol levels in suicide attempters. J Affect Disord 2016; 190:187-192. [PMID: 26519639 DOI: 10.1016/j.jad.2015.10.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/25/2015] [Accepted: 10/10/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many, but not all studies of suicide attempters' cortisol response to stress-either social stress or pharmacological challenge-report an exaggerated response. Recent studies of resting baseline cortisol in past suicide attempters, however, have found lower baseline levels. METHODS In this study, baseline salivary cortisols were obtained prior to a stress procedure from adults with lifetime diagnoses of a mood disorder (N=69), 31.9% of whom had made a prior suicide attempt. Data were collected during the piloting of this stress procedure, at various times of day and with/without an additional confederate in the room. RESULTS Adjusting for procedural, demographic and clinical variables that affect salivary cortisol levels-including time of day of sampling, order of procedure with respect to other assessments, past alcohol abuse, current medication use, and bipolar diagnosis-past suicide attempters had lower baseline cortisol levels compared to non-attempters. LIMITATIONS This is a pilot study with modest sample sizes using statistical, rather than experimental control of numerous variables affecting salivary cortisol levels. CONCLUSIONS Results confirm previous studies. Low baseline cortisol levels have been associated with childhood adversity and externalizing disorders, suggesting a potential role in reducing inhibitions for risky and dangerous behaviors. Further research is needed to more fully characterize these associations and their role in suicidal behavior risk.
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Affiliation(s)
- John G Keilp
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, United States; Department of Psychiatry, Columbia University College of Physicians and Surgeons, United States.
| | - Barbara H Stanley
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, United States; Department of Psychiatry, Columbia University College of Physicians and Surgeons, United States
| | - Sue R Beers
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States; Western Psychiatric Institute and Clinic, United States
| | - Nadine M Melhem
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States; Western Psychiatric Institute and Clinic, United States
| | - Ainsley K Burke
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, United States; Department of Psychiatry, Columbia University College of Physicians and Surgeons, United States
| | - Thomas B Cooper
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, United States; Department of Psychiatry, Columbia University College of Physicians and Surgeons, United States
| | - Maria A Oquendo
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, United States; Department of Psychiatry, Columbia University College of Physicians and Surgeons, United States
| | - David A Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States; Western Psychiatric Institute and Clinic, United States
| | - J John Mann
- Department of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, United States; Department of Psychiatry, Columbia University College of Physicians and Surgeons, United States
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16
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Abstract
OBJECTIVE Suicide, a major cause of death worldwide, has distinct biological underpinnings. The authors review and synthesize the research literature on biomarkers of suicide, with the aim of using the findings of these studies to develop a coherent model for the biological diathesis for suicide. METHOD The authors examined studies covering a large range of neurobiological systems implicated in suicide. They provide succinct descriptions of each system to provide a context for interpreting the meaning of findings in suicide. RESULTS Several lines of evidence implicate dysregulation in stress response systems, especially the hypothalamic-pituitary-adrenal axis, as a diathesis for suicide. Additional findings related to neuroinflammatory indices, glutamatergic function, and neuronal plasticity at the cellular and circuitry level may reflect downstream effects of such dysregulation. Whether serotonergic abnormalities observed in individuals who have died by suicide are independent of stress response abnormalities is an unresolved question. CONCLUSIONS The most compelling biomarkers for suicide are linked to altered stress responses and their downstream effects, and to abnormalities in the serotonergic system. Studying these systems in parallel and in the same populations may elucidate the role of each and their interplay, possibly leading to identification of new treatment targets and biological predictors.
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17
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Mehlum L, Tørmoen AJ, Ramberg M, Haga E, Diep LM, Laberg S, Larsson BS, Stanley BH, Miller AL, Sund AM, Grøholt B. Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial. J Am Acad Child Adolesc Psychiatry 2014; 53:1082-91. [PMID: 25245352 DOI: 10.1016/j.jaac.2014.07.003] [Citation(s) in RCA: 278] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 07/03/2014] [Accepted: 07/18/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We examined whether a shortened form of dialectical behavior therapy, dialectical behavior therapy for adolescents (DBT-A) is more effective than enhanced usual care (EUC) to reduce self-harm in adolescents. METHOD This was a randomized study of 77 adolescents with recent and repetitive self-harm treated at community child and adolescent psychiatric outpatient clinics who were randomly allocated to either DBT-A or EUC. Assessments of self-harm, suicidal ideation, depression, hopelessness, and symptoms of borderline personality disorder were made at baseline and after 9, 15, and 19 weeks (end of trial period), and frequency of hospitalizations and emergency department visits over the trial period were recorded. RESULTS Treatment retention was generally good in both treatment conditions, and the use of emergency services was low. DBT-A was superior to EUC in reducing self-harm, suicidal ideation, and depressive symptoms. Effect sizes were large for treatment outcomes in patients who received DBT-A, whereas effect sizes were small for outcomes in patients receiving EUC. Total number of treatment contacts was found to be a partial mediator of the association between treatment and changes in the severity of suicidal ideation, whereas no mediation effects were found on the other outcomes or for total treatment time. CONCLUSION DBT-A may be an effective intervention to reduce self-harm, suicidal ideation, and depression in adolescents with repetitive self-harming behavior. Clinical trial registration information-Treatment for Adolescents With Deliberate Self Harm; http://ClinicalTrials.gov/; NCT00675129.
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Affiliation(s)
- Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway.
| | - Anita J Tørmoen
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway
| | - Maria Ramberg
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway
| | - Egil Haga
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway
| | - Lien M Diep
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway
| | - Stine Laberg
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway
| | - Bo S Larsson
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Barbara H Stanley
- Columbia University, New York City, and the University of Oslo, Norway
| | - Alec L Miller
- Montefiore Medical Center and Albert Einstein College of Medicine, New York City
| | - Anne M Sund
- Norwegian University of Science and Technology and St Olav's University Hospital, Trondheim, Norway
| | - Berit Grøholt
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway
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18
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Cox LJ, Stanley BH, Melhem NM, Oquendo MA, Birmaher B, Burke A, Kolko DJ, Zelazny JM, Mann JJ, Porta G, Brent DA. A longitudinal study of nonsuicidal self-injury in offspring at high risk for mood disorder. J Clin Psychiatry 2012; 73:821-8. [PMID: 22687609 PMCID: PMC3563355 DOI: 10.4088/jcp.11m07250] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 09/21/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To determine the demographic and clinical predictors of nonsuicidal self-injury and to examine the longitudinal relationship between nonsuicidal self-injury and suicide attempt. METHOD This was a longitudinal cohort study of the familial transmission of suicidal behavior. The sample consisted of probands with DSM-IV mood disorder (n = 212), 54.2% of whom were suicide attempters, and their offspring aged at least 10 years (n = 352), followed for a mean of 3.8 years. Personal, parental, and familial characteristics were assessed annually to identify the most parsimonious subset of these variables associated with nonsuicidal self-injury, the primary outcome. Data were collected between August 1998 and August 2007. RESULTS Of 352 offspring, 7.4% (n = 26) engaged in nonsuicidal self-injury during follow-up. In the final model examining predictors at baseline, the most severe time point, and the time point prior to nonsuicidal self-injury, only predictors from the most proximal time point were significant, namely younger age (odds ratio [OR] = 0.75, P = .002), diagnosis of current major depression (OR = 5.09, P < .001), and suicidal ideation (OR = 1.46, P = .02). In 2 of the 3 single time point models, baseline nonsuicidal self-injury was the most significant predictor of nonsuicidal self-injury during follow-up. Suicide attempt was predicted by both baseline nonsuicidal self-injury and suicide attempt, but when both were included in the model, nonsuicidal self-injury was a significant predictor (OR = 7.50, P = .009), but suicide attempter was not (OR = 3.78, P = .08); offspring aggression (OR = 1.11, P = .01) predicted suicide attempt but not nonsuicidal self-injury. Parental histories of nonsuicidal self-injury, suicide attempt, and abuse were not predictive of nonsuicidal self-injury. CONCLUSIONS Nonsuicidal self-injury may be an earlier manifestation of a shared diathesis with suicide attempt, consisting of depression and suicidal ideation, and that diathesis may lead to suicidal behavior in the face of greater offspring aggression and family pathology. The apparent bidirectional temporal relationship between nonsuicidal self-injury and suicide attempt may be explained by this shared diathesis.
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Affiliation(s)
- Lara J. Cox
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania (Drs Cox, Melhem, Birmaher, Kolko, and Brent and Mss Porta and Zelazny); New York State Psychiatric Institute, New York (Drs Stanley, Burke, and Mann); and Department of Psychiatry, Columbia University Medical Center, New York, New York (Drs Stanley, Oquendo, and Mann). Dr Cox is now with the New York University School of Medicine, New York
| | - Barbara H. Stanley
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania (Drs Cox, Melhem, Birmaher, Kolko, and Brent and Mss Porta and Zelazny); New York State Psychiatric Institute, New York (Drs Stanley, Burke, and Mann); and Department of Psychiatry, Columbia University Medical Center, New York, New York (Drs Stanley, Oquendo, and Mann). Dr Cox is now with the New York University School of Medicine, New York
| | - Nadine M. Melhem
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania (Drs Cox, Melhem, Birmaher, Kolko, and Brent and Mss Porta and Zelazny); New York State Psychiatric Institute, New York (Drs Stanley, Burke, and Mann); and Department of Psychiatry, Columbia University Medical Center, New York, New York (Drs Stanley, Oquendo, and Mann). Dr Cox is now with the New York University School of Medicine, New York
| | - Maria A. Oquendo
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania (Drs Cox, Melhem, Birmaher, Kolko, and Brent and Mss Porta and Zelazny); New York State Psychiatric Institute, New York (Drs Stanley, Burke, and Mann); and Department of Psychiatry, Columbia University Medical Center, New York, New York (Drs Stanley, Oquendo, and Mann). Dr Cox is now with the New York University School of Medicine, New York
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania (Drs Cox, Melhem, Birmaher, Kolko, and Brent and Mss Porta and Zelazny); New York State Psychiatric Institute, New York (Drs Stanley, Burke, and Mann); and Department of Psychiatry, Columbia University Medical Center, New York, New York (Drs Stanley, Oquendo, and Mann). Dr Cox is now with the New York University School of Medicine, New York
| | - Ainsley Burke
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania (Drs Cox, Melhem, Birmaher, Kolko, and Brent and Mss Porta and Zelazny); New York State Psychiatric Institute, New York (Drs Stanley, Burke, and Mann); and Department of Psychiatry, Columbia University Medical Center, New York, New York (Drs Stanley, Oquendo, and Mann). Dr Cox is now with the New York University School of Medicine, New York
| | - David J. Kolko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania (Drs Cox, Melhem, Birmaher, Kolko, and Brent and Mss Porta and Zelazny); New York State Psychiatric Institute, New York (Drs Stanley, Burke, and Mann); and Department of Psychiatry, Columbia University Medical Center, New York, New York (Drs Stanley, Oquendo, and Mann). Dr Cox is now with the New York University School of Medicine, New York
| | - Jamie M. Zelazny
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania (Drs Cox, Melhem, Birmaher, Kolko, and Brent and Mss Porta and Zelazny); New York State Psychiatric Institute, New York (Drs Stanley, Burke, and Mann); and Department of Psychiatry, Columbia University Medical Center, New York, New York (Drs Stanley, Oquendo, and Mann). Dr Cox is now with the New York University School of Medicine, New York
| | - J. John Mann
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania (Drs Cox, Melhem, Birmaher, Kolko, and Brent and Mss Porta and Zelazny); New York State Psychiatric Institute, New York (Drs Stanley, Burke, and Mann); and Department of Psychiatry, Columbia University Medical Center, New York, New York (Drs Stanley, Oquendo, and Mann). Dr Cox is now with the New York University School of Medicine, New York
| | - Giovanna Porta
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania (Drs Cox, Melhem, Birmaher, Kolko, and Brent and Mss Porta and Zelazny); New York State Psychiatric Institute, New York (Drs Stanley, Burke, and Mann); and Department of Psychiatry, Columbia University Medical Center, New York, New York (Drs Stanley, Oquendo, and Mann). Dr Cox is now with the New York University School of Medicine, New York
| | - David A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania (Drs Cox, Melhem, Birmaher, Kolko, and Brent and Mss Porta and Zelazny); New York State Psychiatric Institute, New York (Drs Stanley, Burke, and Mann); and Department of Psychiatry, Columbia University Medical Center, New York, New York (Drs Stanley, Oquendo, and Mann). Dr Cox is now with the New York University School of Medicine, New York
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Cox LJ, Stanley BH, Melhem NM, Oquendo MA, Birmaher B, Burke A, Kolko DJ, Zelazny JM, Mann JJ, Porta G, Brent DA. Familial and individual correlates of nonsuicidal self-injury in the offspring of mood-disordered parents. J Clin Psychiatry 2012; 73:813-20. [PMID: 22795206 PMCID: PMC3545478 DOI: 10.4088/jcp.11m07196] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 10/14/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine the demographic and clinical correlates of nonsuicidal self-injury. METHOD This is a cross-sectional analysis of a longitudinal cohort study of the familial transmission of suicidal behavior, conducted at referral centers in Pittsburgh, Pennsylvania, and New York, New York. Participants included 291 probands with DSM-IV mood disorder, one-half of whom had attempted suicide, and 507 of their offspring. The primary outcome assessed was nonsuicidal self-injury in offspring. Psychosocial correlates of nonsuicidal self-injury were determined by comparing personal, parental, and familial characteristics of offspring with and without nonsuicidal self-injury, assessed using a variety of interview and self-report measures at study entry. Data were collected between August 1998 and August 2007. RESULTS Of 507 offspring, 7.7% (n=39) had engaged in nonsuicidal self-injury. The most salient correlates of nonsuicidal self-injury on multivariate logistic regression were diagnosis of depression (OR=3.78, P<.001) and greater aggression (OR=1.07, P=.01), depressive symptoms (OR=1.59, P=.009), and suicidal ideation (OR=1.24, P=.004). Parental history of abuse, as well as family histories of suicide attempt and nonsuicidal self-injury, was noncontributory. CONCLUSIONS Nonsuicidal self-injury is associated with the presence and severity of depression, suicidal ideation, and behavioral dysregulation. On multivariate analysis, only individual predictors remained significant; this result is distinct from that for correlates of suicide attempt reported in this sample, for which familial variables played a significant role.
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Affiliation(s)
- Lara J Cox
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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20
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Abstract
Blunted neurohormonal responses to serotonergic agents are found in major depression and suicidal behavior, but there have been no prospective studies of their relationship to later suicide attempt. In this study, healthy volunteers and depressed subjects were administered a fenfluramine (FEN) and placebo challenge test at baseline and then followed for 2 years. Seven subjects made suicide attempts within the follow-up period. Healthy volunteers, depressed non-attempters, depressed past suicide attempters, and depressed future attempters were compared on plasma prolactin and cortisol responses, as well as on mood (Profile of Mood States; POMS) and behavioral measures that were assessed at baseline and at the end of each challenge testing day. Both past and future attempters had lower total prolactin output (area under the curve) in response to FEN relative to non-patients. Future attempters had lower cortisol response relative to all other groups. All subject groups reported a decrease in POMS Fatigue subscale score and increase in finger tapping rate after receiving FEN. Depressed subjects reported a significant decline in POMS Total, Depression, and Tension/Anxiety scores, but future attempters' did not, showing a slight mean increase. Lower cortisol response correlated with greater suicidal ideation 3 months and 1 year post-study. Logistic regression revealed that blunting of cortisol response and worsening of mood after FEN, and younger age could be used to predict later suicide attempt in the majority of cases (4/7). Results suggest that blunted cortisol and unfavorable acute mood response to serotonergic challenge, in the context of the general activating effects of these drugs, may be a risk factor for later suicide attempt.
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Affiliation(s)
- John G Keilp
- Department of Neuroscience, New York State Psychiatric Institute, New York, NY, USA.
| | - Maria A Oquendo
- Department of Neuroscience, New York State Psychiatric Institute, New York, NY, USA,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Barbara H Stanley
- Department of Neuroscience, New York State Psychiatric Institute, New York, NY, USA,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ainsley K Burke
- Department of Neuroscience, New York State Psychiatric Institute, New York, NY, USA,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Thomas B Cooper
- Department of Neuroscience, New York State Psychiatric Institute, New York, NY, USA,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Kevin M Malone
- Department of Neuroscience, New York State Psychiatric Institute, New York, NY, USA,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - J John Mann
- Department of Neuroscience, New York State Psychiatric Institute, New York, NY, USA,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Sher L, Oquendo MA, Richardson-Vejlgaard R, Makhija NM, Posner K, Mann JJ, Stanley BH. Effect of acute alcohol use on the lethality of suicide attempts in patients with mood disorders. J Psychiatr Res 2009; 43:901-5. [PMID: 19246050 PMCID: PMC3767468 DOI: 10.1016/j.jpsychires.2009.01.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 01/16/2009] [Indexed: 10/21/2022]
Abstract
Acute alcohol use is an important risk factor for attempted and completed suicide. We evaluated the effect of acute alcohol intake on the lethality of suicide attempts to test the hypothesis that acute alcohol intoxication is associated with more lethal suicide attempts. This retrospective study included 317 suicide attempters enrolled in mood disorders protocols. Demographic and clinical parameters were assessed. The use of alcohol at the time of the most lethal suicide attempt was determined. On the basis of their responses participants were classified into three groups: participants who reported "Enough alcohol intake to impair judgment, reality testing and diminish responsibility" or "Intentional intake of alcohol in order to facilitate implementation of attempt" were included in the group "Alcohol" (A); participants who reported "Some alcohol intake prior to but not related to attempt, reportedly not enough to impair judgment, reality testing" were included in the group "Some Alcohol" (SA); and participants who reported "No alcohol intake immediately prior to attempt" were included in the group "No Alcohol" (NA). Lethality of the most lethal suicide attempts was higher in the A group compared to the SA and NA groups. Prevalence of patients with alcohol use disorders was higher in the A group compared to the SA and NA groups. SA participants reported more reasons for living and lower suicide intent scores at the time of their most lethal suicide attempt compared to the A and NA groups. Acute alcohol use increases the lethality of suicide attempts in individuals with mood disorders.
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Affiliation(s)
- Leo Sher
- Department of Psychiatry, Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Suite 2917, Box 42, New York, NY 10032, USA.
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22
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Bongiovi-Garcia ME, Merville J, Almeida MG, Burke A, Ellis S, Stanley BH, Posner K, Mann JJ, Oquendo MA. Comparison of clinical and research assessments of diagnosis, suicide attempt history and suicidal ideation in major depression. J Affect Disord 2009; 115:183-8. [PMID: 18814917 PMCID: PMC3785082 DOI: 10.1016/j.jad.2008.07.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 07/30/2008] [Accepted: 07/30/2008] [Indexed: 11/30/2022]
Abstract
A number of studies have compared clinical diagnostic and suicide assessments to standardized schedules to determine the level of agreement. At best there is only moderate diagnostic agreement, but most often it is fair. There are only a few reports comparing clinical assessments for suicidal behavior with standardized schedules. We present the data from 201 inpatient admissions for major depression that had both clinical diagnostic and suicide evaluations by PGYII resident physicians under supervision from an attending psychiatrist and research evaluations using standardized schedules for diagnosis and suicide by at least masters' level clinicians. There was moderate agreement for diagnosis and suicide attempt history but only fair agreement for the presence of suicidal ideation using Cohen's kappa statistic. In regards to suicide attempt history a cross-tabulation demonstrated that 18.7% of those patients identified by a research schedule as having a past suicide attempt were not identified as such by the clinicians. A cross-tabulation demonstrated that 29.7% of those patients identified by structured interview as having suicidal ideation were not identified as such by the clinician. There was a statistically significant difference in the level of agreement for suicide attempt history between clinical and research assessments for attempts within a year of admission and those beyond a year. These findings suggest the importance of adding a structured diagnostic and suicide assessment to routine clinical care to improve the reliability and validity of clinical evaluations and to inform treatment planning to benefit our patients.
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Affiliation(s)
- Mary E Bongiovi-Garcia
- New York State Psychiatric Institute and Columbia University 1051 Riverside Drive NY, NY 10032, United States.
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Sher L, Stanley BH, Cooper TB, Malone KM, Mann JJ, Oquendo MA. Serotonergic responses in depressed patients with or without a history of alcohol use disorders and healthy controls. Eur Neuropsychopharmacol 2008; 18:692-9. [PMID: 18590952 PMCID: PMC3785085 DOI: 10.1016/j.euroneuro.2008.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Revised: 05/13/2008] [Accepted: 05/19/2008] [Indexed: 01/21/2023]
Abstract
Dysfunction of serotonergic neurotransmission has been implicated in the etiopathogenesis of major depression (MDD) and alcohol use disorders (AUD). To compare serotonin function in MDD with co-occurring AUD (MDD/AUD), MDD without co-occurring AUD (MDD only) and healthy controls (HC) we sought to study differences in prolactin responses to fenfluramine administration in patients with MDD/AUD, patients with MDD only and HC. In all, 169 subjects (62 MDD/AUD, 75 MDD only, and 32 HC) were entered into the study. Controlling for gender, prolactin responses were lower in the MDD/AUD group compared to the MDD only or the HC group. Controlling for gender and aggression, prolactin responses in the MDD/AUD group remained significantly lower compared to the HC group but the difference between the MDD/AUD and the MDD only groups disappeared. The difference in prolactin responses between MDD/AUD and MDD only could be attributed to higher aggression scores in the MDD/AUD group compared to the MDD group.
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Affiliation(s)
- Leo Sher
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY 10032, USA.
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Sher L, Stanley BH, Harkavy-Friedman JM, Carballo JJ, Arendt M, Brent DA, Sperling D, Lizardi D, Mann JJ, Oquendo MA. Depressed patients with co-occurring alcohol use disorders: a unique patient population. J Clin Psychiatry 2008; 69:907-15. [PMID: 18422397 DOI: 10.4088/jcp.v69n0604] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Alcohol use and depressive disorders are frequently comorbid. Few studies have assessed the impact of comorbid alcohol use disorders (AUDs) on clinical aspects of major depression. We compared depressed subjects with and without co-occurring AUDs with respect to demographic and clinical parameters. METHOD 505 individuals participated. 318 subjects had DSM-IV major depressive disorder (MDD) without a history of any alcohol or substance abuse/dependence (MDD only), and 187 individuals had MDD and a history of alcohol abuse/dependence (MDD/AUD). Demographic, clinical, and psychiatric history measures of patients in the 2 groups were examined and compared. The study was conducted from January 1990 to June 2005. RESULTS MDD/AUD patients were younger at their first psychiatric hospitalization (p = .014), their first major depressive episode (p = .041), and their first suicide attempt (p = .001). They reported more previous major depressive episodes (p = .001), suicide attempts (p = .001), and recent life events (p = .001); and had higher lifetime aggression (p < .001), impulsivity (p < .001), and hostility (p < .001) scores. MDD/AUD patients were also more likely to report tobacco smoking (p < .001), a lifetime history of abuse (p = .004), and a history of AUD among first-degree relatives (p < .001) compared to MDD only patients. MDD/AUD individuals also had higher childhood (p < .001), adolescent (p < .001), and adult (p < .001) aggression scores and reported more behavioral problems during their childhood compared to their counterparts. Logistic regression analysis demonstrates that the number of previous depressive episodes, lifetime aggression, and smoking drive the difference between the groups. CONCLUSIONS Our findings suggest that comorbid MDD/AUD may result from worse antecedents and lead to early onset, more comorbidity, and a more severe course of illness.
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Affiliation(s)
- Leo Sher
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY 10032, USA.
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Abstract
Multiple lines of evidence suggest that endogenous opioids are involved in the pathogenesis of non-suicidal self-injury (NSSI). Evidence for such a role is based on the partial success of opioid antagonist treatment to ameliorate NSSI, reports of altered pain sensitivity during episodes of NSSI, and findings of altered endogenous opioid levels in individuals with NSSI. While suicidal behavior (SB) and NSSI are distinct behaviors, NSSI is a significant risk factor for suicide attempts and suicide. The high co-occurrence of SB and NSSI suggests that they may share a common biology. Available data indicate that endogenous opioids may be involved in the pathophysiology of SB. Future studies of the role of opioids in the biological mechanisms of NSSI and SB are merited and may lead to the development of new treatment modalities.
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Affiliation(s)
- Leo Sher
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York, NY 10032, USA.
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Abstract
Adolescent suicide is the 3rd leading cause of death in the United States and alcohol consumption is estimated to cause adolescent males to be up to 17 times more likely to attempt suicide, and females three times more likely to attempt suicide. Suicide and suicide attempt rates vary across different ethnicities. Also, associated psychopathology, stressors and substance use differ across ethnic groups in adolescents. In an exhaustive review of the literature, we found that depressed Asian-American youth were four times more likely to display suicidal behavior when compared to other Asian youths with other diagnoses; and depressed African-American females were more likely to report suicidal ideation than male adolescents. We also found that Asian-Americans who experience high parental conflict are 30 times more likely to engage in suicidal behavior when compared to Asian-American youths with low parental conflict. African-American adolescents are 6.4 times more likely to attempt suicide as a result of parental conflict. With respect to alcohol use and dependence, Caucasian adolescents were twice as likely as the African American victims to have used alcohol before committing suicide. Alcohol use among adolescents was associated with increased suicidal behavior. Cultural differences in alcohol consumption may account for disparities, however future research is needed to further examine cultural trends in suicidal behavior and alcoholism.
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Affiliation(s)
- Shelly A Groves
- Department of Neuroscience, New York State Psychiatric Institute, New York, NY 10032, USA.
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Sher L, Sperling D, Stanley BH, Carballo JJ, Shoval G, Zalsman G, Burke AK, Mann JJ, Oquendo MA. Triggers for suicidal behavior in depressed older adolescents and young adults: do alcohol use disorders make a difference? Int J Adolesc Med Health 2007; 19:91-8. [PMID: 17458328 DOI: 10.1515/ijamh.2007.19.1.91] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
UNLABELLED Adolescent suicide is a major social and medical problem. Alcohol use disorders with comorbid major depression represent an especially high-risk profile for suicidal behavior, repeated suicidal behavior and completed suicide. We compared demographic and clinical characteristics, prevalence of interpersonal triggers and the number of triggers for suicidal behavior in depressed late adolescents and young adults with or without comorbid alcohol use disorders. METHODS 18-26-year-old subjects were recruited through advertising and referrals and participated in mood disorders research in a university hospital. Thirty-eight depressed suicide attempters without a history of any alcohol or substance abuse/dependence and 29 depressed suicide attempters with comorbid alcohol abuse or dependence participated in the study. Demographic and clinical parameters including parameters related to suicidal behavior were examined and recorded. RESULTS There was no difference with regard to demographic parameters between the two groups. Depressed suicide attempters with comorbid alcohol use disorders had higher aggression and impulsivity scale scores and were more likely to be tobacco smokers compared to their counterparts without alcohol use disorders. Additionally, there was a trend towards higher lethality of suicide attempts in subjects with alcohol use disorders compared to the other group. We found no difference in the prevalence of interpersonal triggers or in the number of triggers for suicidal behavior between the two groups. CONCLUSION It appears that among 18-26-year-old depressed suicide attempters, individuals with comorbid alcohol use disorders are more impaired with regard to aggressiveness and impulsivity compared to persons without comorbid alcohol abuse/dependence.
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Affiliation(s)
- Leo Sher
- Division of Neuroscience, Department of Psychiatry, Columbia University, New York, NY 10032, USA.
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Sher L, Mann JJ, Traskman-Bendz L, Winchel R, Huang YY, Fertuck E, Stanley BH. Lower cerebrospinal fluid homovanillic acid levels in depressed suicide attempters. J Affect Disord 2006; 90:83-9. [PMID: 16310257 DOI: 10.1016/j.jad.2005.10.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Revised: 10/06/2005] [Accepted: 10/10/2005] [Indexed: 01/20/2023]
Abstract
BACKGROUND Studies suggest that the dopaminergic system is involved in the pathogenesis of major depression, Axis II disorders, and suicidal behavior. Depressed suicide attempters constitute a heterogenous group and important differences may exist between depressed suicide attempters with or without Axis II disorders. Therefore, we compared demographic and clinical parameters, and cerebrospinal fluid (CSF) homovanillic acid (HVA) levels in depressed suicide attempters without comorbid Axis II disorders, depressed non-attempters without comorbid Axis II disorders, and normal controls. METHODS Thirty-one depressed subjects with a history of a suicide attempt, 27 depressed subjects without a history of a suicide attempt, and 50 healthy controls were included in the study. Subjects with comorbid Axis II disorders were excluded. Demographic and clinical parameters, and CSF HVA levels were examined. RESULTS The two depressed groups did not differ with regard to depression, aggression, hopelessness, and total hostility scale scores. Depressed suicide attempters had higher current suicidal ideation scores compared to depressed non-attempters. Depressed suicide attempters had lower CSF HVA levels compared to depressed non-attempters (t = 4.4, df = 56, p < 0.0001) and to controls (t = -4.09, df = 79, p < 0.0001). There was no difference in CSF HVA levels between depressed non-attempters and controls (t < 1, df = 75, NS). CONCLUSIONS Dopaminergic abnormalities are associated with suicidality but not with depression. The variability in the rates of comorbid Axis II disorders and in the prevalence of suicide attempters in different patient populations may affect both clinical and biological results of studies of mood disorders.
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Affiliation(s)
- Leo Sher
- Division of Neuroscience, Department of Psychiatry, Columbia University, New York State Psychiatric Institute, Box 42, New York, NY 10032, USA.
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