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Brown SL, Marshall AJ, Mitchell SM, Roush JF, Mumma GH, Jahn DR, Ribeiro JD, Joiner TE, Cukrowicz KC. Suicide Ideation and Thwarted Interpersonal Needs among Psychiatric Inpatients: A Network Approach. Clin Psychol Sci 2022; 9:1080-1094. [PMID: 35070498 DOI: 10.1177/21677026211000670] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/26/2022]
Abstract
We aimed to demonstrate the utility of an item-level network analysis approach to suicide risk by testing the interpersonal psychological theory of suicide (IPTS) among 402 psychiatric inpatients. We hypothesized specific thwarted belongingness (TB) or perceived burdensomeness (PB; Interpersonal Needs Questionnaire items) facets would positively relate to passive or active suicide ideation, and these facets would positively relate to each other and form distinct clusters. We also tested TB and PB facets central to the networks as predictors of suicide ideation compared to the full TB and PB subscales. Face-valid items congruent with latent constructs proposed by the IPTS (i.e., feelings of burden on society, feeling that one does not belong) were the only two facets uniquely predictive of passive and active suicide ideation. Facets of TB and PB did not form distinct clusters. Item-level network analysis may have important conceptual, assessment, predictive, and clinical implications for understanding suicide risk.
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Affiliation(s)
- Sarah L Brown
- Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051
| | - Andrew J Marshall
- Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051.,Department of Family & Protective Services, State of Texas, 701 W 51st St, Austin, TX 78751
| | - Sean M Mitchell
- Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051.,Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Box Psych, Rochester, NY 14642
| | - Jared F Roush
- Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051
| | - Gregory H Mumma
- Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051
| | - Danielle R Jahn
- Mental Health Center for Acute Recovery Empowerment, Orlando VA Medical Center, 13800 Veterans Way, Orlando, FL 32827
| | - Jessica D Ribeiro
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306
| | - Thomas E Joiner
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL 32306
| | - Kelly C Cukrowicz
- Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051
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2
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Jahn DR, Leith J, Muralidharan A, Brown CH, Drapalski AL, Hack S, Lucksted A. The influence of experiences of stigma on recovery: Mediating roles of internalized stigma, self-esteem, and self-efficacy. Psychiatr Rehabil J 2020; 43:97-105. [PMID: 31233321 PMCID: PMC6928452 DOI: 10.1037/prj0000377] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Experiencing stigmatization regarding mental illness has harmful effects on recovery from serious mental illness (SMI). Stigma experiences can also lead to internalized stigma, the cognitive and emotional internalization of negative stereotypes, and application of those stereotypes to one's self. Internalized stigma may lead to additional harms, including decrements in self-esteem and self-efficacy. Therefore, this study examined the effects of stigmatization experiences on recovery-related outcomes through internalized stigma, self-esteem, and self-efficacy in a single comprehensive model. METHODS Adults with SMI (n = 516) completed standardized measures assessing the variables of interest during baseline assessments for 2 randomized controlled trials. In a secondary analysis of the trial data, separate serial mediation models were tested for recovery orientation, perceived quality of life, and social withdrawal as outcomes, with experiences of stigma as the predictor variable and internalized stigma, self-esteem, and self-efficacy as serial mediators in that order. Alternate order and parallel mediation models were also tested to evaluate directionality. RESULTS The serial mediation model was the best fit, although self-efficacy was not found to be a critical mediator. Experiences of stigma led to internalized stigma, which influenced self-esteem and recovery-related outcomes, consistent with the social-cognitive model of internalized stigma. CONCLUSION This indicates that internalized stigma is an essential target for reducing the negative impact of stigmatization on recovery. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Danielle R Jahn
- Center for Acute Recovery Empowerment, Orlando VA Medical Center
| | | | - Anjana Muralidharan
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), U.S. Department of Veterans Affairs
| | - Clayton H Brown
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), U.S. Department of Veterans Affairs
| | - Amy L Drapalski
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), U.S. Department of Veterans Affairs
| | - Samantha Hack
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), U.S. Department of Veterans Affairs
| | - Alicia Lucksted
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), U.S. Department of Veterans Affairs
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Ryan AT, Phalen P, Jahn DR, Wastler H, Bennett M, Ghahramanlou-Holloway M, Schwartz B. Cognitive impairment and depression symptoms are independently associated with suicidal ideation in US Veterans. Psychiatry Res 2020; 286:112833. [PMID: 32062520 DOI: 10.1016/j.psychres.2020.112833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 08/30/2019] [Revised: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Abstract
Depression is associated with cognitive impairment and suicidality. The independent association between cognitive impairment and suicidality is less clear. We examined the relationship between suicidal ideation and cognitive impairment in a sample of 50 veterans with depressive disorder diagnoses. Using zero-inflated Poisson regression, the severity of suicidal ideation was negatively associated with attention (incidence rate ratio [IRR] = 0.78, p < .001), memory (IRR = 0.87, p < .001), and total cognition (IRR = 0.90, p = .007) index scores as measured by the Dementia Rating Scale 2 (DRS-2). These three indices continued to significantly predict suicidal ideation severity once depression symptoms were controlled for.
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Affiliation(s)
- Arthur T Ryan
- Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD, USA; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Peter Phalen
- Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD, USA; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Danielle R Jahn
- Mental Health Center for Acute Recovery Empowerment, Orlando Veterans Affairs Medical Center, Orlando, FL, USA
| | - Heather Wastler
- Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD, USA
| | - Melanie Bennett
- Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD, USA; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marjan Ghahramanlou-Holloway
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD, USA
| | - Barbara Schwartz
- Mental Health Service, Washington DC Veterans Affairs Medical Center, Washington, DC, USA
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Mitchell SM, Taylor NJ, Jahn DR, Roush JF, Brown SL, Ries R, Quinnett P. Suicide-Related Training, Self-Efficacy, and Mental Health Care Providers' Reactions Toward Suicidal Individuals. Crisis 2020; 41:359-366. [PMID: 31918586 DOI: 10.1027/0227-5910/a000647] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Mental health care providers commonly encounter suicide ideation and suicidal behaviors among their patients despite a frequent lack of adequate knowledge and competence regarding suicide risk management. Aims: This study examined the associations among self-perceived sufficiency of training, self-efficacy, anxiety, and attitudes related to working with suicidal individuals. Method: Participants were 289 mental health care providers who completed a self-report survey. Results: Path analysis results indicated that perceived sufficiency of training was indirectly associated with negative attitudes (i.e., avoidance and discomfort) and cognitive and somatic anxiety about working with suicidal individuals through assessment self-efficacy. Limitations: The current study utilized cross-sectional data, and there were occupational heterogeneity and geographical homogeneity among the mental health care providers sampled. Conclusion: These findings suggest that sufficient suicide-related training focused on risk assessment may decrease mental health professionals' negative and anxious reactions toward suicidal individuals and enhance confidence in suicide risk management.
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Affiliation(s)
- Sean M Mitchell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.,Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Nathanael J Taylor
- Denver Health Medical Center, Adult Psychiatric Inpatient Unit, Denver, CO, USA.,University of Colorado Denver, School of Medicine, Aurora, CO, USA
| | - Danielle R Jahn
- Mental Health Center for Acute Recovery Empowerment, Orlando VA Medical Center, Orlando, FL, USA
| | - Jared F Roush
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Sarah L Brown
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
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Conti EC, Jahn DR, Simons KV, Edinboro LPC, Jacobs ML, Vinson L, Stahl ST, Van Orden KA. Safety Planning to Manage Suicide Risk with Older Adults: Case Examples and Recommendations. Clin Gerontol 2020; 43:104-109. [PMID: 31096885 PMCID: PMC6858938 DOI: 10.1080/07317115.2019.1611685] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 10/26/2022]
Abstract
Adults age 65 and older have high rates of suicide, despite recent efforts to reduce the suicide rate in this population. One suicide prevention strategy with burgeoning empirical support is safety planning; however, there is a lack of information and resources on safety planning for older adults to support uptake of this evidence-based practice in clinical settings where older adults are commonly seen. Safety plans can address risk factors for suicide in older adults, including social isolation, physical illness, functional limitations, and use of highly lethal means. Safety plans also promote relevant protective factors, including increasing use of coping strategies, social support, and help-seeking. Clinicians may encounter challenges and barriers to safety planning with older adults. This paper describes a collaborative, creative approach to safety planning that is relevant and useful for this vulnerable population. Using two case examples, we illustrate how to engage older adults in safety planning, including ways to minimize barriers associated with the aging process.
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Affiliation(s)
- Elizabeth C Conti
- Michael E. DeBakey VA Medical Center, , Houston, TX, USA.,Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | | | - Kelsey V Simons
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, New York, USA.,Department of Psychiatry, University of Rochester School of Medicine, Rochester, New York, USA
| | - Lenis P Chen Edinboro
- School of Health and Applied Human Sciences, University of North Carolina, Wilmington, North Carolina, USA
| | - M Lindsey Jacobs
- Geriatric Mental Health Clinic, VA Boston Healthcare System, Brockton Division, Brockton, Massachusetts, USA.,Department of Psychiatry Harvard Medical School, Boston, Massachusetts, USA
| | - Latrice Vinson
- Office of Geriatrics and Extended Care Services, Department of Veterans Affairs, Washington, District of Columbia, USA.,VISN 5 Mental Illness Research, Education, and Clinical Center, Baltimore VA Medical Center, Baltimore, Maryland, USA
| | - Sarah T Stahl
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kimberly A Van Orden
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, New York, USA
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6
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Reich CM, Hack SM, Klingaman EA, Brown CH, Fang LJ, Dixon LB, Jahn DR, Kreyenbuhl JA. Consumer satisfaction with antipsychotic medication-monitoring appointments: the role of consumer-prescriber communication patterns. Int J Psychiatry Clin Pract 2018; 22:89-94. [PMID: 28920491 PMCID: PMC5909968 DOI: 10.1080/13651501.2017.1375530] [Citation(s) in RCA: 2] [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] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The study was designed to explore patterns of prescriber communication behaviors as they relate to consumer satisfaction among a serious mental illness sample. METHODS Recordings from 175 antipsychotic medication-monitoring appointments between veterans with psychiatric disorders and their prescribers were coded using the Roter Interaction Analysis System (RIAS) for communication behavioral patterns. RESULTS The frequency of prescriber communication behaviors (i.e., facilitation, rapport, procedural, psychosocial, biomedical, and total utterances) did not reliably predict consumer satisfaction. The ratio of prescriber to consumer utterances did predict consumer satisfaction. CONCLUSIONS Consistent with client-centered care theory, antipsychotic medication consumers were more satisfied with their encounters when their prescriber did not dominate the conversation. PRACTICE IMPLICATIONS Therefore, one potential recommendation from these findings could be for medication prescribers to spend more of their time listening to, rather than speaking with, their SMI consumers.
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Affiliation(s)
- Catherine M Reich
- a Department of Psychology , University of Minnesota Duluth , Duluth , MN , USA
| | - Samantha M Hack
- b VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education and Clinical Center (MIRECC) , Baltimore , MD , USA.,c Department of Psychiatry , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Elizabeth A Klingaman
- b VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education and Clinical Center (MIRECC) , Baltimore , MD , USA.,c Department of Psychiatry , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Clayton H Brown
- b VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education and Clinical Center (MIRECC) , Baltimore , MD , USA.,c Department of Psychiatry , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Li Juan Fang
- b VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education and Clinical Center (MIRECC) , Baltimore , MD , USA.,c Department of Psychiatry , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Lisa B Dixon
- d New York State Psychiatric Institute , New York , NY , USA.,e Department of Psychiatry , Columbia University , New York , NY , USA
| | | | - Julie A Kreyenbuhl
- b VA Capitol Healthcare Network (VISN 5), Mental Illness Research, Education and Clinical Center (MIRECC) , Baltimore , MD , USA.,c Department of Psychiatry , University of Maryland School of Medicine , Baltimore , MD , USA
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Roush JF, Brown SL, Jahn DR, Mitchell SM, Taylor NJ, Quinnett P, Ries R. Mental Health Professionals' Suicide Risk Assessment and Management Practices. Crisis 2017; 39:55-64. [PMID: 28914092 DOI: 10.1027/0227-5910/a000478] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Approximately 20% of suicide decedents have had contact with a mental health professional within 1 month prior to their death, and the majority of mental health professionals have treated suicidal individuals. Despite limited evidence-based training, mental health professionals make important clinical decisions related to suicide risk assessment and management. AIMS The current study aimed to determine the frequency of suicide risk assessment and management practices and the association between fear of suicide-related outcomes or comfort working with suicidal individuals and adequacy of suicide risk management decisions among mental health professionals. METHOD Mental health professionals completed self-report assessments of fear, comfort, and suicide risk assessment and management practices. RESULTS Approximately one third of mental health professionals did not ask every patient about current or previous suicidal thoughts or behaviors. Further, comfort, but not fear, was positively associated with greater odds of conducting evidence-based suicide risk assessments at first appointments and adequacy of suicide risk management practices with patients reporting suicide ideation and a recent suicide attempt. LIMITATIONS The study utilized a cross-sectional design and self-report questionnaires. CONCLUSION Although the majority of mental health professionals report using evidenced-based practices, there appears to be variability in utilization of evidence-based practices.
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Affiliation(s)
- Jared F Roush
- 1 Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Sarah L Brown
- 1 Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | | | - Sean M Mitchell
- 1 Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Nathanael J Taylor
- 1 Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
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Abstract
IMPORTANCE Although electroconvulsive therapy (ECT) is considered the most efficacious treatment available for individuals with severe affective disorders, ECT's availability is limited and declining, suggesting that information about the population-level effects of ECT is needed. OBJECTIVE To examine whether inpatient treatment with ECT is associated with a reduction in 30-day psychiatric readmission risk in a large, multistate sample of inpatients with severe affective disorders. DESIGN, SETTING, AND PARTICIPANTS A quasi-experimental instrumental variables probit model of the association correlation of ECT administration with patient risk of 30-day readmission was estimated using observational, longitudinal data on hospital inpatient discharges from US general hospitals in 9 states. From a population-based sample of 490 252 psychiatric inpatients, a sample was drawn that consisted of 162 691 individuals with a principal diagnosis of major depressive disorder (MDD), bipolar disorder, or schizoaffective disorder. The key instrumental variable used in the analysis was ECT prevalence in the prior calendar year at the treating hospital. To examine whether ECT's association with readmissions was heterogeneous across population subgroups, analyses included interactions of ECT with age group, sex, race/ethnicity, and diagnosis group. The study was conducted from August 27, 2015, to March 7, 2017. MAIN OUTCOME AND MEASURES Readmission within 30 days of being discharged. RESULTS Overall, 2486 of the 162 691 inpatients (1.5%) underwent ECT during their index admission. Compared with other inpatients, those who received ECT were older (mean [SD], 56.8 [16.5] vs 45.9 [16.5] years; P < .001) and more likely to be female (65.0% vs 54.2%; P < .001) and white non-Hispanic (85.3% vs 62.1%; P < .001), have MDD diagnoses (63.8% vs 32.0%; P < .001) rather than bipolar disorder (29.0% vs 40.0%; P < .001) or schizoaffective disorder (7.1% vs 28.0%; P < .001), have a comorbid medical condition (31.3% vs 26.6%; P < .001), have private (39.4% vs 21.7%; P < .001) or Medicare (49.2% vs 39.4%; P < .001) insurance coverage, and be located in urban small hospitals (31.2% vs 22.3%; P < .001) or nonurban hospitals (9.0% vs 7.6%; P = .02). Administration of ECT was associated with a reduced 30-day readmission risk among psychiatric inpatients with severe affective disorders from an estimated 12.3% among individuals not administered ECT to 6.6% among individuals administered ECT (risk ratio [RR], 0.54; 95% CI, 0.28-0.81). Significantly larger associations with ECT on readmission risk were found for men compared with women (RR, 0.44; 95% CI, 0.20-0.69 vs 0.58; 95% CI, 0.30-0.88) and for individuals with bipolar disorder (RR, 0.42; 95% CI, 0.17-0.69) and schizoaffective disorder (RR, 0.44; 95% CI, 0.11-0.79) compared with those who had MDD (RR, 0.53; 95% CI, 0.26-0.81). CONCLUSIONS AND RELEVANCE Electroconvulsive therapy may be associated with reduced short-term psychiatric inpatient readmissions among psychiatric inpatients with severe affective disorders. This potential population health effect may be overlooked in US hospitals' current decision making regarding the availability of ECT.
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Affiliation(s)
- Eric P. Slade
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore,US Department of Veterans Affairs, Veterans Affairs Capitol Healthcare Network, Mental Illness Research, Education, and Clinical Center, Baltimore, Maryland
| | | | - William T. Regenold
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore
| | - Brady G. Case
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island,Pediatric Anxiety Research Center, Bradley Hospital, East Providence, Rhode Island
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Mitchell SM, Brown SL, Roush JF, Bolaños AD, Littlefield AK, Marshall AJ, Jahn DR, Morgan RD, Cukrowicz KC. The clinical application of suicide risk assessment: A theory-driven approach. Clin Psychol Psychother 2017; 24:1406-1420. [PMID: 28421644 DOI: 10.1002/cpp.2086] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/08/2017] [Accepted: 03/15/2017] [Indexed: 01/09/2023]
Abstract
The interpersonal theory of suicide posits that thwarted belongingness (TB) and perceived burdensomeness (PB) increase suicide ideation; however, studies have found mixed results regarding this hypothesis among psychiatric inpatients. This study aimed to (a) demonstrate how assessing TB and PB using the Interpersonal Needs Questionnaire (INQ) can provide clinically useful information and (b) investigate how statistical methodology may impact the clinical application of the INQ. Participants were 139 (Sample 1) and 104 (Sample 2) psychiatric inpatients. In both samples, ordinal logistic regression results indicated TB and PB, separately, were significant predictors of suicide ideation-related outcomes; however, when examined as simultaneous predictors, TB was no longer a significant predictor. The interaction between TB and PB was not significant for either sample. Despite this, TB and PB scores provided clinically relevant information about suicide ideation-related outcomes. For example, the highest scores on TB and PB indicated a 93% and 95% chance of having some level of distress due to suicide ideation (Sample 1), a 91% and 92% chance of having some level of desire for death, and a 79% and 84% chance of having some level of desire for suicide, respectively (Sample 2). This study also proposes clinical cutoff scores for the INQ (for TB and PB, respectively, cutoff scores were 22 and 17 for distress due to suicide ideation, 33 and 17 for desire for death, and 31 and 22 for desire for suicide). Although these results indicate that multicollinearity between TB and PB may create interpretational ambiguity for clinicians, TB and PB may each be useful separate predictors of suicide ideation-related outcomes in psychiatric inpatient settings and should be incorporated into suicide risk assessment. KEY PRACTITIONER MESSAGE The 15-item Interpersonal Needs Questionnaire (an assessment of thwarted belongingness and perceived burdensomeness) should be incorporated into suicide risk assessment. Among psychiatric inpatients, greater thwarted belongingness and perceived burdensomeness, as separate predictors, were associated with increased levels of distress due to suicide ideation, desire for death, and desire for suicide. The highest scores on thwarted belongingness and perceived burdensomeness indicated a 79% to 95% chance of experiencing an elevated level of distress due to suicide ideation, desire for death, or desire for suicide. Recommended clinical cutoff scores were provided. For example, thwarted belongingness cutoff score of 31 and perceived burdensomeness cutoff score of 22 maximized the sensitivity and specificity of the INQ to detect some level of desire for suicide.
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Affiliation(s)
- Sean M Mitchell
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Sarah L Brown
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Jared F Roush
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Angelea D Bolaños
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | | | - Andrew J Marshall
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | | | - Robert D Morgan
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Kelly C Cukrowicz
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
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Khazem LR, Jahn DR, Cukrowicz KC, Anestis MD. Health conditions, physical disabilities, perceived burdensomeness, and depressive symptoms influence suicidal ideation. Death Stud 2017; 41:220-225. [PMID: 27824298 DOI: 10.1080/07481187.2016.1251509] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The roles of perceived burdensomeness and depressive symptoms in the relationship between physical disabilities or health conditions and suicidal ideation warrant examination. The authors examined indirect effects using cross-sectional data from adults who answered questions online. The serial indirect effect of the number of physical disabilities on suicidal ideation through perceived burdensomeness and depressive symptoms was not significant, but the serial indirect effects of the combined number of physical disabilities and health conditions and number of health conditions on suicidal ideation through perceived burdensomeness and depression were each significant. For those with disabilities or health conditions, perceived burdensomeness may precede depressive symptoms in the development of suicidal ideation.
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Affiliation(s)
- Lauren R Khazem
- a Department of Psychology , University of Southern Mississippi , Hattiesburg , Mississippi , USA
| | - Danielle R Jahn
- b VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center, Department of Psychiatry , University of Maryland School of Medicine , Baltimore , Maryland , USA
| | - Kelly C Cukrowicz
- c Department of Psychological Sciences , Texas Tech University , Lubbock , Texas , USA
| | - Michael D Anestis
- a Department of Psychology , University of Southern Mississippi , Hattiesburg , Mississippi , USA
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11
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Jahn DR, Muralidharan A, Drapalski AL, Brown CH, Fang LJ, Lucksted A. Differences in suicide and death ideation among veterans and nonveterans with serious mental illness. Psychol Serv 2017; 15:31-39. [PMID: 28287770 DOI: 10.1037/ser0000127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 11/08/2022]
Abstract
Individuals with serious mental illness and veterans are two populations at elevated risk for suicide; however, research has not examined whether veterans with serious mental illness may be at higher suicide risk than nonveterans with serious mental illness. Additionally, overlapping risk factors for suicide in these populations may account for differences in suicide-related outcomes between these groups. Therefore, the aim of this study was to identify differences in death ideation and suicide ideation among veterans and nonveterans with serious mental illness. We also aimed to explore these effects after adjusting for potentially shared risk factors. We found that veterans with serious mental illness reported death ideation and suicide ideation more than twice as often as nonveterans with serious mental illness. After adjusting for demographic, psychiatric, and theory-driven risk factors, the effect of veteran status on death ideation remained significant, though the effect on suicide ideation was no longer significant. Depressive and psychotic symptoms were significant predictors of death ideation; depressive symptoms and hostility were significant predictors of suicide ideation. Clinicians should particularly monitor death ideation and suicide ideation in veterans with serious mental illness, as well as associated clinical risk factors such as depression, psychotic symptoms, and hostility. (PsycINFO Database Record
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Affiliation(s)
- Danielle R Jahn
- Department of Psychiatry, University of Maryland School of Medicine
| | | | - Amy L Drapalski
- Department of Psychiatry, University of Maryland School of Medicine
| | - Clayton H Brown
- Department of Psychiatry, University of Maryland School of Medicine
| | - Li Juan Fang
- Department of Psychiatry, University of Maryland School of Medicine
| | - Alicia Lucksted
- Department of Psychiatry, University of Maryland School of Medicine
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12
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Affiliation(s)
- Katie E. Despeaux
- Department of Psychology, Loyola University Maryland, Baltimore, Maryland, USA
| | - Danielle R. Jahn
- VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center, Baltimore, Maryland, USA
- University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Primary Care Institute, Gainesville, Florida, USA
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13
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Muralidharan A, Schaffner RM, Hack S, Jahn DR, Peeples AD, Lucksted A. “I Got to Voice What’s in My Heart”: Participation in the Cultural Formulation Interview—Perspectives of Consumers with Psychotic Disorders. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s40737-017-0076-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Taylor NJ, Mitchell SM, Roush JF, Brown SL, Jahn DR, Cukrowicz KC. Thwarted interpersonal needs and suicide ideation: Comparing psychiatric inpatients with bipolar and non-bipolar mood disorders. Psychiatry Res 2016; 246:161-165. [PMID: 27697657 DOI: 10.1016/j.psychres.2016.09.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 02/05/2016] [Revised: 08/29/2016] [Accepted: 09/18/2016] [Indexed: 10/21/2022]
Abstract
Psychiatric inpatients are at heightened risk for suicide, and evidence suggests that psychiatric inpatients with bipolar mood disorders may be at greater risk for suicide ideation compared to those with non-bipolar mood disorders. There is a paucity of research directly comparing risk factors for suicide ideation in bipolar versus non-bipolar mood disorders in an inpatient sample. The current study sought to clarify the association between two constructs from the interpersonal theory of suicide (i.e., perceived burdensomeness and thwarted belongingness) in leading to suicide ideation among psychiatric inpatients with bipolar and non-bipolar mood disorders. Participants were (N=90) psychiatric inpatients with a bipolar (n = 20) or non-bipolar mood disorder (n=70; per their medical charts). Perceived burdensomeness, but not thwarted belongingness, was significantly associated with suicide ideation after adjusting for other covariates. This suggests perceived burdensomeness may play a key role in suicide ideation among psychiatric inpatients with any mood disorder and highlights the importance of assessment and intervention of perceived burdensomeness in this population. Contrary to our hypothesis, mood disorder group (i.e., bipolar versus non-bipolar) did not moderate the relations between perceived burdensomeness/thwarted belongingness and suicide ideation.
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Affiliation(s)
- Nathanael J Taylor
- Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051, USA
| | - Sean M Mitchell
- Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051, USA
| | - Jared F Roush
- Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051, USA
| | - Sarah L Brown
- Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051, USA
| | - Danielle R Jahn
- Department of Psychiatry, University of Maryland School of Medicine, USA; The VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center, USA
| | - Kelly C Cukrowicz
- Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051, USA.
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Jahn DR, DeVylder JE, Hilimire MR. Explanatory risk factors in the relations between schizotypy and indicators of suicide risk. Psychiatry Res 2016; 238:68-73. [PMID: 27086213 DOI: 10.1016/j.psychres.2016.02.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 05/26/2015] [Revised: 12/15/2015] [Accepted: 02/12/2016] [Indexed: 01/07/2023]
Abstract
Schizotypy has been linked to suicide risk, but it is not known whether established suicide-related risk factors mediate this relation. The aim of this study was to assess the mediating effects of depressive symptoms, social anxiety, self-esteem, and intimate disclosure in peer relationships in the relation between interpersonal schizotypy and suicide ideation or lifetime suicide attempts. This aim was tested in 590 young adults using a nonparametric bootstrapping procedure. After inclusion of the mediators, interpersonal schizotypy was no longer directly associated with either suicide ideation or lifetime suicide attempts. Depression and self-esteem mediated the relation between interpersonal schizotypy and suicide ideation. No variables mediated the relation between interpersonal schizotypy and lifetime suicide attempts, and there were no significant direct relations when mediators were included. Schizotypy appears to be a distal risk factor for suicidal behavior; assessing depressive symptoms and self-esteem may provide more proximal information about suicide risk, and may be targets for mitigating suicide risk in individuals with schizotypy.
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Affiliation(s)
- Danielle R Jahn
- VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center, Baltimore, MD, USA; University of Maryland School of Medicine, Baltimore, MD, USA.
| | | | - Matthew R Hilimire
- Department of Psychology, The College of William and Mary, Williamsburg, VA, USA
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16
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Jahn DR, Bennett ME, Park SG, Gur RE, Horan WP, Kring AM, Blanchard JJ. The interactive effects of negative symptoms and social role functioning on suicide ideation in individuals with schizophrenia. Schizophr Res 2016; 170:271-7. [PMID: 26746862 PMCID: PMC4762008 DOI: 10.1016/j.schres.2015.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 05/13/2015] [Revised: 12/09/2015] [Accepted: 12/12/2015] [Indexed: 11/30/2022]
Abstract
Findings regarding the protective effect of social role functioning on suicide ideation in individuals with schizophrenia have been mixed. One reason for such inconsistencies in the literature may be that individuals with prominent negative symptoms of schizophrenia may not experience a desire for social closeness, and therefore social role functioning may not influence suicide risk in these individuals. The aim of this study was to examine the moderating effects of self-reported desire for social closeness and interviewer-rated negative symptoms on the relationship between social role functioning and suicide ideation. Our sample consisted of 162 individuals who had been diagnosed with schizophrenia-spectrum disorders; all participants completed self-report questionnaires and clinician-administered interviews, and moderation hypotheses were tested with a non-parametric procedure. The results indicated that motivation and pleasure-related negative symptoms moderated the relationship between social role functioning and suicide ideation; self-reported desire for social closeness and negative symptoms related to expression did not have such a moderating effect. Specifically, better social role functioning was associated with less suicide ideation only in those individuals who had low motivation and pleasure-related negative symptoms; no significant relationship was observed between social role functioning and suicide ideation among those with elevated motivation and pleasure-related negative symptoms. These findings suggest that assessing for negative symptoms and social role functioning may inform suicide risk assessments in individuals with schizophrenia, and improving social role functioning may reduce suicide ideation among those with few motivation and pleasure-related negative symptoms.
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Affiliation(s)
- Danielle R. Jahn
- VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center; VA Maryland Health Care System, 10 N. Greene St. (Annex Room 723A), Baltimore, MD, USA 21201.
,Department of Psychiatry, University of Maryland School of Medicine; 737 W. Lombard St., Suite 551, Baltimore, MD, USA 21201
| | - Melanie E. Bennett
- VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center; VA Maryland Health Care System, 10 N. Greene St. (Annex Room 723A), Baltimore, MD, USA 21201.
,Department of Psychiatry, University of Maryland School of Medicine; 737 W. Lombard St., Suite 551, Baltimore, MD, USA 21201
| | - Stephanie G. Park
- VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center; VA Maryland Health Care System, 10 N. Greene St. (Annex Room 723A), Baltimore, MD, USA 21201.
,Department of Psychiatry, University of Maryland School of Medicine; 737 W. Lombard St., Suite 551, Baltimore, MD, USA 21201
| | - Raquel E. Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania; 10th Floor Gates Building, Philadelphia, PA, USA 19104
| | - William P. Horan
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles; Jane & Terry Semel Institute for Neuroscience & Human Behavior, 760 Westwood Plaza, Los Angeles, CA, USA 90095.
,VA Greater Los Angeles Healthcare System; 11301 Wilshire Blvd., Bldg. 210, Mail Code: 210A, Rm. 115, Los Angeles, CA, USA 90073
| | - Ann M. Kring
- Department of Psychology, University of California, Berkeley; 3210 Tolman Hall, Berkeley, CA, USA 94720-1650
| | - Jack J. Blanchard
- Department of Psychology, University of Maryland; 1147 Biology/Psychology Building, College Park, MD, USA 20742
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Jahn DR, Quinnett P, Ries R. The influence of training and experience on mental health practitioners’ comfort working with suicidal individuals. ACTA ACUST UNITED AC 2016. [DOI: 10.1037/pro0000070] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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DeVylder JE, Jahn DR, Doherty T, Wilson CS, Wilcox HC, Schiffman J, Hilimire MR. Social and psychological contributions to the co-occurrence of sub-threshold psychotic experiences and suicidal behavior. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1819-30. [PMID: 26493307 DOI: 10.1007/s00127-015-1139-6] [Citation(s) in RCA: 32] [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: 07/09/2015] [Accepted: 10/13/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE Psychotic experiences and suicidal behavior commonly co-occur in the general population, which can have implications for suicide prevention approaches. However, little is known about the nature of this relation in non-clinical samples. This cross-sectional study aimed to address a research gap by testing whether the relation between psychotic experiences and suicide-related outcomes (ideation, intent, and attempts) is explained by common social and psychological factors. METHODS Young adult college students (N = 590) were assessed for psychotic experiences, suicidal behavior, and a comprehensive set of 24 potential shared risk factors selected through review of past epidemiological studies and meta-analyses. Nonparametric bootstrapped regression models were used to examine whether these factors attenuated or eliminated the associations between psychotic experiences and suicide-related outcomes. RESULTS Psychotic experiences were associated with greater risk for suicidal ideation and behaviors. Adjustment for psychosocial factors, particularly those contributing to cumulative stress, accounted for the associations between psychotic experiences and suicide-related outcomes, except broadly defined suicidal ideation. CONCLUSIONS These results suggest that the robust associations between psychotic experiences and suicidal behavior demonstrated in past studies may be primarily explained by shared risk factors, rather than by causal relations. In our sample, suicidal behavior and sub-threshold psychosis appear to be trans diagnostic clinical outcomes that share common causes, notably cumulative stress, but do not cause one another.
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Affiliation(s)
- Jordan E DeVylder
- School of Social Work, University of Maryland, 525 W Redwood Street, Baltimore, MD, 21201, USA.
| | - Danielle R Jahn
- VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center, Baltimore, MD, USA.,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tracie Doherty
- School of Social Work, University of Maryland, 525 W Redwood Street, Baltimore, MD, 21201, USA
| | - Camille S Wilson
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Holly C Wilcox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Matthew R Hilimire
- Department of Psychology, The College of William and Mary, Williamsburg, VA, USA
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Mitchell SM, Jahn DR, Guidry ET, Cukrowicz KC. The Relationship Between Video Game Play and the Acquired Capability for Suicide: An Examination of Differences by Category of Video Game and Gender. Cyberpsychology, Behavior, and Social Networking 2015; 18:757-62. [DOI: 10.1089/cyber.2015.0171] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Sean M. Mitchell
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas
| | - Danielle R. Jahn
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas
| | - Evan T. Guidry
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas
| | - Kelly C. Cukrowicz
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas
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Abstract
Interpersonal Theory of Suicide constructs were examined in individuals with physical disabilities, a population identified as having heightened suicidal ideation. Students (N = 184) answered online-based self-report questionnaires. Students with physical disabilities (n = 49) were expected to endorse higher levels of constructs relative to other students (n = 133). Analyses of covariance indicated that those with disabilities reported higher perceived burdensomeness, but not thwarted belongingness, fearlessness about death, or suicidal ideation. Suicide prevention efforts, particularly in university settings, may benefit from focusing on reducing perceived burdensomeness in this population, as these individuals may be at heightened risk.
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Affiliation(s)
- Lauren R Khazem
- a Department of Psychology, University of Southern Mississippi , Hattiesburg , Mississippi , USA
| | - Danielle R Jahn
- b Department of Psychological Sciences, Texas Tech University , Lubbock , Texas , USA
| | - Kelly C Cukrowicz
- b Department of Psychological Sciences, Texas Tech University , Lubbock , Texas , USA
| | - Michael D Anestis
- a Department of Psychology, University of Southern Mississippi , Hattiesburg , Mississippi , USA
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Jahn DR, Cukrowicz KC, Mitchell SM, Poindexter EK, Guidry ET. The Mediating Role of Perceived Burdensomeness in Relations Between Domains of Cognitive Functioning and Indicators of Suicide Risk. J Clin Psychol 2015; 71:908-19. [PMID: 26016884 DOI: 10.1002/jclp.22190] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Psychiatric inpatients are at elevated risk for suicide, but there are mixed findings regarding cognitive functioning (i.e., executive functioning and problem-solving abilities) and suicide risk in this population. We hypothesized that a mediating variable (i.e., perceived burdensomeness) may explain these mixed findings. METHOD This hypothesis was tested in a sample of psychiatric inpatients admitted for suicide-related concerns (N = 110; 58.18% female, M(age) = 36.45) using a nonparametric bootstrapping procedure. RESULTS Perceived burdensomeness did not act as a mediator between any domain of cognitive functioning and current suicide ideation nor presence of recent suicide attempts. However, perceived burdensomeness was the strongest predictor of suicide ideation and mediated the relation between objective problem-solving skill and suicide risk (a weighted variable comprising current ideation and previous attempts). CONCLUSIONS Perceived burdensomeness may be associated with elevated suicide ideation, suggesting that perceived burdensomeness should be assessed to inform suicide risk decisions.
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Poindexter EK, Mitchell SM, Jahn DR, Smith PN, Hirsch JK, Cukrowicz KC. PTSD symptoms and suicide ideation: Testing the conditional indirect effects of thwarted interpersonal needs and using substances to cope. Personality and Individual Differences 2015. [DOI: 10.1016/j.paid.2014.12.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Jahn DR, Dressel JA, Gavett BE, O'Bryant SE. An item response theory analysis of the Executive Interview and development of the EXIT8: A Project FRONTIER Study. J Clin Exp Neuropsychol 2015; 37:229-42. [PMID: 25748691 DOI: 10.1080/13803395.2014.1002757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The Executive Interview (EXIT25) is an effective measure of executive dysfunction, but may be inefficient due to the time it takes to complete 25 interview-based items. The current study aimed to examine psychometric properties of the EXIT25, with a specific focus on determining whether a briefer version of the measure could comprehensively assess executive dysfunction. METHOD The current study applied a graded response model (a type of item response theory model for polytomous categorical data) to identify items that were most closely related to the underlying construct of executive functioning and best discriminated between varying levels of executive functioning. Participants were 660 adults ages 40 to 96 years living in West Texas, who were recruited through an ongoing epidemiological study of rural health and aging, called Project FRONTIER. The EXIT25 was the primary measure examined. Participants also completed the Trail Making Test and Controlled Oral Word Association Test, among other measures, to examine the convergent validity of a brief form of the EXIT25. RESULTS Eight items were identified that provided the majority of the information about the underlying construct of executive functioning; total scores on these items were associated with total scores on other measures of executive functioning and were able to differentiate between cognitively healthy, mildly cognitively impaired, and demented participants. In addition, cutoff scores were recommended based on sensitivity and specificity of scores. CONCLUSION A brief, eight-item version of the EXIT25 may be an effective and efficient screening for executive dysfunction among older adults.
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Affiliation(s)
- Danielle R Jahn
- a Department of Psychological Sciences , Texas Tech University , Lubbock , TX , USA
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Abstract
Background: Suicide is the third leading cause of death among college students. The interpersonal theory of suicide may provide a way to conceptualize suicide risk in this population. Aims: We sought to examine relations between illegal behaviors that may act as risk factors for suicide and the acquired capability for suicide. Method: College students (N = 758) completed assessments of acquired capability and previous exposure to painful and provocative events, including illegal risk behaviors (IRBs). Linear regression, a nonparametric bootstrapping procedure, and two-tailed partial correlations were employed to test our hypotheses. Results: There was no significant relation between IRBs and acquired capability after controlling for legal painful and provocative experiences. A significant positive relation was identified between IRBs and fear/anxiety, contradicting the expected relation between increased painful and provocative experiences and lower fear/anxiety. Acquired capability explained variance in the relation between IRBs and history of suicide attempt or self-injury history. Conclusion: Further research is needed to examine links between IRBs and painful and provocative events, particularly to identify the point at which habituation begins to increase acquired capability, as our unexpected results may be due to a lack of habituation to risky behaviors or low variability of scores in the sample.
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Affiliation(s)
- Sean M. Mitchell
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Danielle R. Jahn
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Kelly C. Cukrowicz
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
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Jahn DR, Spencer-Thomas S. Continuing Bonds Through After-Death Spiritual Experiences in Individuals Bereaved by Suicide. Journal of Spirituality in Mental Health 2014. [DOI: 10.1080/19349637.2015.957612] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lamis DA, Leenaars LS, Jahn DR, Lester D. Intimate partner violence: are perpetrators also victims and are they more likely to experience suicide ideation? J Interpers Violence 2013; 28:3109-3128. [PMID: 23697865 DOI: 10.1177/0886260513488691] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The current study examined the relations among several risk factors--hopelessness, depressive symptoms, perceived burdensomeness, thwarted belongingness, alcohol-related problems, and intimate partner violence (victimization and perpetration)--and suicide ideation, as measured by the Modified Scale for Suicide Ideation, in college students (n = 994). In addition, the overlap between being a victim and perpetrator of various types of intimate partner violence was examined. Results indicated substantial overlap in the victim and perpetrator roles, up to 96.6% for negotiation. In the negative binomial regression analysis, reports of hopelessness, depressive symptoms, perceived burdensomeness, thwarted belongingness, and alcohol-related problems all significantly predicted suicide ideation in the expected direction. However, none of the revised Conflict Tactics Scale subscales predicted suicide ideation above and beyond the established risk factors. Implications are offered for the improved identification and treatment of suicidal thoughts and behaviors among college students.
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Cukrowicz KC, Jahn DR, Graham RD, Poindexter EK, Williams RB. Suicide risk in older adults: Evaluating models of risk and predicting excess zeros in a primary care sample. Journal of Abnormal Psychology 2013; 122:1021-1030. [DOI: 10.1037/a0034953] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jahn DR, Mauer CB, Menon CV, Edwards ML, Dressel JA, O'Bryant SE. A brief Spanish-English equivalent version of the Boston Naming Test: a Project FRONTIER study. J Clin Exp Neuropsychol 2013; 35:835-45. [PMID: 23998641 DOI: 10.1080/13803395.2013.825234] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The Boston Naming Test is a neuropsychological measure of confrontation naming, short forms of which can be advantageous with various populations. The purpose of this study was to establish a Spanish-English equivalent version of the BNT using item response theory. Data were analyzed from 380 Project FRONTIER participants; 27 items differed between groups and were removed from the measure. Additionally, 18 items did not differ between groups but were poor items. The current 15-item Spanish-English equivalent version of the BNT offers significant advantages. Future work is required to validate the diagnostic utility of the instrument in various settings and populations.
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Affiliation(s)
- Danielle R Jahn
- a Department of Psychology , Texas Tech University , Lubbock , TX , USA
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29
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Menon C, Westervelt HJ, Jahn DR, Dressel JA, O’Bryant SE. Normative performance on the Brief Smell Identification Test (BSIT) in a multi-ethnic bilingual cohort: a Project FRONTIER study. Clin Neuropsychol 2013; 27:946-61. [PMID: 23634698 PMCID: PMC3742676 DOI: 10.1080/13854046.2013.796406] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The Brief Smell Identification Test (BSIT) is a commonly used measure of olfactory functioning in elderly populations. Few studies have provided normative data for this measure, and minimal data are available regarding the impact of sociodemographic factors on test scores. This study presents normative data for the BSIT in a sample of English- and Spanish-speaking Hispanic and non-Hispanic Whites. A Rasch analysis was also conducted to identify the items that best discriminated between varying levels of olfactory functioning, as measured by the BSIT. The total sample included 302 older adults seen as part of an ongoing study of rural cognitive aging, Project FRONTIER. Hierarchical regression analyses revealed that BSIT scores require adjustment by age and gender, but years of education, ethnicity, and language did not significantly influence BSIT performance. Four items best discriminated between varying levels of smell identification, accounting for 59.44% of total information provided by the measure. However, items did not represent a continuum of difficulty on the BSIT. The results of this study indicate that the BSIT appears to be well-suited for assessing odor identification deficits in older adults of diverse backgrounds, but that fine-tuning of this instrument may be recommended in light of its items' difficulty and discrimination parameters. Clinical and empirical implications are discussed.
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Affiliation(s)
- Chloe Menon
- Department of Psychology, Texas Tech University, Lubbock, Texas
| | - Holly James Westervelt
- Rhode Island Hospital, Providence, Rhode Island
- Alpert Medical School of Brown University, Providence, Rhode Island
| | | | | | - Sid E. O’Bryant
- Institute for Aging and Alzheimer’s Disease Research, University of North Texas Health Science Center, Fort Worth, Texas
- University of North Texas Health Science Center, Department of Internal Medicine, Fort Worth, Texas
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Abstract
This study was designed to assess relations among alcohol use, alcohol-related problems, negative-life events, depressive symptoms, and suicide proneness in a cross-sectional sample of undergraduate college students (N = 1100). Alcohol use was assumed to be causally prior to alcohol-related problems and negative life events, which were in turn modeled as occurring prior to depressive symptoms, which were in turn modeled as prior to suicide proneness. Results revealed that, as expected, suicide proneness was positively related to depressive symptoms, alcohol-related problems, negative life events, and alcohol use, and depressive symptoms were positively associated with alcohol-related problems and negative life events. Additionally, the relation between alcohol use and depressive symptoms was partially mediated by alcohol-related problems and negative life events; and the alcohol use-suicide proneness link was significantly mediated by alcohol-related problems, negative life events, and depressive symptoms. Implications are offered for the improved identification and treatment of at-risk young adults.
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Menon CV, Jahn DR, Mauer CB, O'Bryant SE. Executive functioning as a mediator of the relationship between premorbid verbal intelligence and health risk behaviors in a rural-dwelling cohort: a Project FRONTIER study. Arch Clin Neuropsychol 2013; 28:169-79. [PMID: 23192834 PMCID: PMC3569949 DOI: 10.1093/arclin/acs102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2012] [Indexed: 12/23/2022] Open
Abstract
Limited research is available regarding the impact of neuropsychological functioning on health risk behaviors in rural-dwelling elderly populations. This cross-sectional study examined the relationships between estimated premorbid verbal IQ (AMNART), executive functioning impairment (EXIT25), and health risk behaviors including alcohol use (AUDIT), smoking, compliance with recommended cancer screenings, and obesity (BMI). The total sample included 456 English-speaking adults and older adults of non-Hispanic White and Hispanic origin seen as part of an ongoing study of rural cognitive aging, Project FRONTIER. Regression analyses revealed significant independent effects of AMNART and EXIT25 on most health risk behaviors, and supported the hypothesized mediating role of EXIT25 on the relationships between AMNART and smoking, cancer screenings, and BMI in both cognitively impaired and healthy subgroups. This study clarifies the relationships between executive functioning, premorbid IQ, and health risk behaviors in diverse groups, and confirms that premorbid IQ represents an important determinant of health behaviors and neurocognitive outcomes.
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Affiliation(s)
- Chloe V. Menon
- Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Danielle R. Jahn
- Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Cortney B. Mauer
- Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Sid E. O'Bryant
- Department of Internal Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
- Institute for Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, TX, USA
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Abstract
Prison inmates are exposed to a number of adverse conditions prior to and during incarceration that place them at risk for suicide. The interpersonal theory of suicide may prove useful in better understanding suicide in prisons, allowing for more effective prevention and treatment programs. However, no studies of the interpersonal theory have been conducted in prison populations. Further, there have been no studies examining the factor structure of the assessment of one of the theory's main constructs: the acquired capability for suicide. The current study examined the factor structure of the Acquired Capability for Suicide Scale in a sample of male prison inmates. We found that a 4-factor model provided the best statistical and conceptual fit, though only 3 of these factors were meaningful with an additional method-factor. The 3 resulting factors were each associated with previous exposure to painful and provocative events, but none differentiated suicide attempter status. Results suggest that the interpersonal theory has promise in application to suicide in prison populations, but more work is needed to develop a self-report measure of acquired capability, particularly as it relates to prisoners.
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Lamis DA, Jahn DR. Parent-child conflict and suicide rumination in college students: the mediating roles of depressive symptoms and anxiety sensitivity. J Am Coll Health 2013; 61:106-113. [PMID: 23409860 DOI: 10.1080/07448481.2012.754758] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Parent-child conflict, depressive symptoms, and anxiety sensitivity have each been identified as risk factors for suicide ideation in college students. This study examined the relations among these risk factors and suicide rumination utilizing transition theory to guide the hypothesized relations. PARTICIPANTS Undergraduate college students participated in this study in the spring of 2012 (January to May). METHODS Participants completed self-report measures of parent-child conflict, depressive symptoms, anxiety sensitivity, and suicide rumination, among other measures. Hypothesized pathways and mediation were tested using path analysis. RESULTS Suicide rumination was positively and uniquely predicted by depressive symptoms, anxiety sensitivity, and parent-child conflict. The relation between parent-child conflict and suicide rumination was, in part, accounted for by depressive symptoms and anxiety sensitivity. CONCLUSIONS Results suggest that it would be advisable for clinicians to assess for students' conflicts with their parents in conjunction with their levels of depression and anxiety when assessing for suicide risk.
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Affiliation(s)
- Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
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Abstract
Older adults are at high risk of suicide, and perceived burdensomeness is an important suicide risk factor in this population. Additionally, previous research indicates that older adults feel like a burden on their spouses most often, though perceptions of burden on younger generations were associated with greater overall perceived burdensomeness. The current study sought to clarify this complex pattern of results, and found that perceptions of burden on a spouse were linked to the most severe form of perceived burdensomeness-belief that others would be better off if one were gone-though perceptions of burden on a child were not significantly associated with this most severe form of perceived burdensomeness in the current sample. These results indicate that older adults' perceptions of burdensomeness on a spouse may be especially harmful. Clinical implications, including the need to assess not only whether older adults perceive themselves to be a burden on others, but also who is perceived to be burdened, and the importance of targeting perceived burdensomeness through cognitive restructuring, are discussed.
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Jahn DR, Poindexter EK, Graham RD, Cukrowicz KC. The moderating effect of the negative impact of recent life events on the relation between intrinsic religiosity and death ideation in older adults. Suicide Life Threat Behav 2012; 42:589-601. [PMID: 22934958 DOI: 10.1111/j.1943-278x.2012.00114.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [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: 11/27/2022]
Abstract
Researchers tested the hypothesis that the negative impact of recent life events would moderate the relationship between intrinsic religiosity and death ideation in older adults. Participants (n = 272) completed assessments of death ideation, intrinsic religiosity, and negative impact of recent life events. We confirmed the presence of concurrent moderation and found that older adults with greater negative impact of recent life events and high intrinsic religiosity reported greater death ideation. These relatively surprising findings may be due to reduced fear of death in intrinsically religious older adults, an explanation consistent with previous research.
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Affiliation(s)
- Danielle R Jahn
- Department of Psychology, Texas Tech University, Lubbock, TX 79409-2051, USA
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Abstract
OBJECTIVES The purpose of this study was to examine the relation between functional impairment, self-rated health, and depressive symptoms. Independently, self-rated health and functional impairment each contribute to depressive symptoms; however, it remains unknown how these variables are related to depression in combination. It was hypothesized that self-rated health would moderate the relation between functional impairment and depressive symptoms in a sample of older adults. METHOD A community sample of adults aged 60 and above was recruited from primary care clinics (n = 106); 98 of these participants had usable data. Participants completed self-report questionnaires that assessed depressive symptoms, functional impairment, and self-rated physical health. RESULTS Self-rated health moderated the relation between functional impairment and depressive symptoms. For participants with poor self-rated health, greater functional impairment was associated with greater depressive symptoms. CONCLUSION It appears that patient perceptions of health may be protective against depressive symptoms for those with functional impairment.
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Affiliation(s)
- Danielle R Jahn
- Department of Psychology, Texas Tech University, Lubbock, USA
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Schmitz WM, Allen MH, Feldman BN, Gutin NJ, Jahn DR, Kleespies PM, Quinnett P, Simpson S. Preventing suicide through improved training in suicide risk assessment and care: an American Association of Suicidology Task Force report addressing serious gaps in U.S. mental health training. Suicide Life Threat Behav 2012; 42:292-304. [PMID: 22494118 DOI: 10.1111/j.1943-278x.2012.00090.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [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] [Indexed: 11/29/2022]
Abstract
There are twice as many suicides as homicides in the United States, and the suicide rate is rising. Suicides increased 12% between 1999 and 2009. Mental health professionals often treat suicidal patients, and suicide occurs even among patients who are seeking treatment or are currently in treatment. Despite these facts, training of most mental health professionals in the assessment and management of suicidal patients is surprisingly limited. The extant literature regarding the frequency with which mental health professionals encounter suicidal patients is reviewed, as is the prevalence of training in suicide risk assessment and management. Most importantly, six recommendations are made to address the longstanding insufficient training within the mental health professions regarding the assessment and management of suicidal patients.
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Affiliation(s)
- William M Schmitz
- Southeast Louisiana Veterans Healthcare System, Baton Rouge, LA, USA.
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Abstract
Suicidology and suicide prevention are relatively new fields of study in the United States, but they have made significant progress since their beginnings. This study aimed to identify the most impactful theories in the history of science and suicidology and the most impactful events in the suicide prevention movement. These theories and events were identified through expert nomination. The most impactful theories were those of Shneidman, Durkheim, and Joiner. The most impactful events included the opening of the first suicide prevention center and hotline, the founding of the American Association of Suicidology, and national publications (e.g., National Strategy for Suicide Prevention).
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Affiliation(s)
- Sally Spencer-Thomas
- Sally Spencer-Thomas, Carson J Spencer Foundation, Denver, CO, USA; and Danielle R. Jahn, Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Danielle R Jahn
- Sally Spencer-Thomas, Carson J Spencer Foundation, Denver, CO, USA; and Danielle R. Jahn, Department of Psychology, Texas Tech University, Lubbock, TX, USA
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Abstract
Rural-dwelling adults face different health concerns and risks than do adults living in urban areas, with reduced assess to care. Studies examining the associations between anxiety and/or depression and blood pressure have yielded mixed results. This study addressed this by examining the association of these symptoms to blood pressure in men compared to women, and for differing racial groups in a rural population in the western United States. Analyses indicate the association between depression and blood pressure differs by race. Further, depressive symptoms were associated with higher diastolic blood pressure for participants at or above the mean of anxiety.
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Affiliation(s)
| | | | - James Hall
- University of North Texas Health Sciences Center, USA
| | - Sid O’Bryant
- Department of Internal Medicine University of North Texas Health Science Center Fort Worth, Texas, USA
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Jahn DR, Cukrowicz KC. The impact of the nature of relationships on perceived burdensomeness and suicide ideation in a community sample of older adults. Suicide Life Threat Behav 2011; 41:635-49. [PMID: 22145823 DOI: 10.1111/j.1943-278x.2011.00060.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [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: 11/27/2022]
Abstract
Older adults die by suicide at very high rates, and previous research indicates that perceived burdensomeness may contribute to deaths by suicide. In this study, the impact of the nature of relationships on perceived burdensomeness and suicide ideation was examined. Results indicated that older adults' perceptions of burden on younger generations were associated with greater overall perceived burdensomeness and suicide ideation when compared to the older adults' own or older generations. Thus, clinicians should examine general perceived burdensomeness as well as the types of relationships the older adult perceives himself or herself to be a burden on.
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Affiliation(s)
- Danielle R Jahn
- Department of Psychology, Texas Tech University, Lubbock, TX 79409-2051, USA
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Jahn DR, Cukrowicz KC, Linton K, Prabhu F. The mediating effect of perceived burdensomeness on the relation between depressive symptoms and suicide ideation in a community sample of older adults. Aging Ment Health 2011; 15:214-20. [PMID: 20967639 DOI: 10.1080/13607863.2010.501064] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [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: 10/18/2022]
Abstract
OBJECTIVES Suicide is a prevalent problem in older adults. One of the best predictors of suicide in older adults is suicide ideation; suicide ideation has been frequently associated with depression. However, suicide ideation is not always present when an older adult is depressed and is sometimes present when an older adult is not depressed. Perceived burdensomeness, a recently proposed risk factor [Joiner Jr, T.E. (2005)], has been linked to suicide ideation in depressed samples and in older adults. Thus, perceived burdensomeness may be the necessary risk factor for suicide ideation. METHOD The Geriatric Suicide Ideation Scale (GSIS; [Heisel et al. (2006)]), Center for Epidemiologic Studies Depression (CES-D; [Radloff, L.S. (1977)]) scale, and Suicide Cognitions Scale (SCS; [Rudd, M.D., Schmitz, B., McClenen, R., Joiner, T., Elkins, G., & Claassen, C.A. (n.d.)]) were completed by a community sample of older adults recruited from primary care clinics (n = 106). A regression analysis was conducted following Baron and Kenny's [1986] guidelines to test the hypothesis that perceived burdensomeness (measured by the SCS perceived burdensomeness subscale) mediates the relation between depression (assessed with the CES-D) and suicide ideation (measured by the GSIS suicide ideation subscale) in older adults. RESULTS Perceived burdensomeness mediated the relation between depression and suicide ideation, accounting for 68.3% of the variance in suicide ideation. CONCLUSION Perceived burdensomeness may explain the relation between depression and suicide ideation. Clinicians seeing older adults should assess for depression and perceived burdensomeness when determining suicide risk. Future research directions include treatment studies for perceived burdensomeness as a way to reduce suicide ideation.
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Affiliation(s)
- Danielle R Jahn
- Department of Psychology, Texas Tech University, Lubbock, TX 79409-2051, USA
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