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Darmour CA, Luk JW, LaCroix JM, Perera KU, Goldston DB, Soumoff AA, Weaver JJ, Ghahramanlou-Holloway M. Social Support and Social Stress Among Suicidal Inpatients at Military Treatment Facilities: A Multidimensional Investigation. J Nerv Ment Dis 2024; 212:261-269. [PMID: 38416406 DOI: 10.1097/nmd.0000000000001761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
ABSTRACT The associations between social support and stress with internalizing symptoms (depressive symptoms and hopelessness) and hazardous drinking were tested in an inpatient sample of suicidal military personnel. Baseline data from a randomized clinical trial were analyzed. Different sources of support and stressors in the social context of military personnel were differentially linked to internalizing symptoms and hazardous drinking. In the full sample ( n = 192), family and nonfamily support were both inversely associated with internalizing symptoms but not hazardous drinking. Family stress was positively associated with internalizing symptoms. In a subsample of service members who had a history of deployment ( n = 98), postdeployment social support was protective against internalizing symptoms, whereas deployment harassment was associated with increased odds of hazardous drinking. Results underscore the need for assessment of various dimensions of social support and stress to guide case formulation and optimize strategies to support patients' mental well-being and adaptive coping.
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Affiliation(s)
- Charles A Darmour
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jeremy W Luk
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jessica M LaCroix
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Kanchana U Perera
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Alyssa A Soumoff
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - Marjan Ghahramanlou-Holloway
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Knippler ET, Martinez AJ, Amiri I, Madundo K, Mmbaga BT, Goldston DB, Relf MV, Knettel BA. Challenges and opportunities for improving mental health care and preventing suicide among people living with HIV: Perspectives of mental health professionals in Tanzania. PLOS Glob Public Health 2024; 4:e0002762. [PMID: 38363789 PMCID: PMC10871509 DOI: 10.1371/journal.pgph.0002762] [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] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/17/2024] [Indexed: 02/18/2024]
Abstract
People living with HIV (PLWH) experience unique stressors that contribute to emotional distress, and PLWH are more than twice as likely to die by suicide when compared to the general population. In countries like Tanzania, there is a relatively high burden of HIV but few resources to support mental health needs. To gain a better understanding of mental health challenges experienced by PLWH in northern Tanzania and identify opportunities for intervention, we interviewed 12 mental health professionals working in the Kilimanjaro region. Thematic analysis was used to explore drivers and impacts of emotional distress, community influences on mental health, and gaps and barriers to existing mental health care. Perspectives from mental health workers highlight the compounding effects of stress related to HIV status, family conflict, finances, and other social challenges, which can lead to poor HIV treatment outcomes and suicidal ideation. Cultural beliefs and stigma surrounding both mental health and HIV limit care-seeking behavior for mental health issues. Those who do seek care often encounter barriers related to poor mental health infrastructure, including a lack of providers, limited financial resources, and little integration into other health services. There is a clear need for investment in the mental health care system, as well as interventions to improve knowledge and perceptions of mental health and comprehensively address stressors. We describe feedback on a proposed telehealth counseling intervention integrated into routine HIV services, which shows strong potential to mitigate barriers to mental health treatment, reduce suicidal ideation, and support the wellbeing of PLWH.
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Affiliation(s)
- Elizabeth T. Knippler
- Duke Center for AIDS Research, Durham, North Carolina, United States of America
- Duke University School of Nursing, Durham, North Carolina, United States of America
| | - Alyssa J. Martinez
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Ismail Amiri
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Kim Madundo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - David B. Goldston
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, North Carolina, United States of America
| | - Michael V. Relf
- Duke University School of Nursing, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Brandon A. Knettel
- Duke University School of Nursing, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
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Grove JL, Young JR, Chen Z, Blakey SM, Beckham JC, Calhoun PS, Dedert EA, Goldston DB, Pugh MJ, Kimbrel NA. Experiential Avoidance, Pain, and Suicide Risk in a National Sample of Gulf War Veterans. Arch Suicide Res 2024; 28:295-309. [PMID: 36573028 PMCID: PMC10291004 DOI: 10.1080/13811118.2022.2160681] [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] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Pain confers risk for suicidal thoughts and behaviors. Experiential avoidance (EA), which is relevant to both pain and suicide risk, has not been studied as a potential mechanism for this relationship. The present study tested the hypothesis that pain indirectly impacts suicide risk through EA in a national sample of Gulf War veterans. METHODS Participants included a stratified random sample of United States veterans (N = 1,012, 78% male) who had served in the Gulf War region between August 1990 and July 1991. Validated scales were used to quantify levels of pain, EA, and suicide risk. RESULTS Regression analyses indicated independent associations between pain, EA, and suicide risk; moreover, the association between pain and suicide risk was no longer significant once EA was included in model. Bootstrapping analyses confirmed that EA partially accounted for the cross-sectional association between pain and suicide risk, independent of common co-occurring problems, such as depression, PTSD, and alcohol use disorder symptoms. CONCLUSIONS EA could be a key modifiable risk factor to target in people experiencing pain.
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Affiliation(s)
- Jeremy L. Grove
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
| | - Jonathan R. Young
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
| | - Zhengxi Chen
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
| | - Shannon M. Blakey
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
- Dr. Shannon Blakey is now affiliated with RTI International
| | - Jean C. Beckham
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
| | - Patrick S. Calhoun
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)
| | - Eric A. Dedert
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)
| | - David B. Goldston
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
| | - Mary J. Pugh
- VA Salt Lake City Healthcare System
- University of Utah, School of Medicine, Department of Medicine
| | - Nathan A. Kimbrel
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)
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Ottino-González J, Cupertino RB, Cao Z, Hahn S, Pancholi D, Albaugh MD, Brumback T, Baker FC, Brown SA, Clark DB, de Zambotti M, Goldston DB, Luna B, Nagel BJ, Nooner KB, Pohl KM, Tapert SF, Thompson WK, Jernigan TL, Conrod P, Mackey S, Garavan H. Brain structural covariance network features are robust markers of early heavy alcohol use. Addiction 2024; 119:113-124. [PMID: 37724052 PMCID: PMC10872365 DOI: 10.1111/add.16330] [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: 03/28/2023] [Accepted: 07/27/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND AND AIMS Recently, we demonstrated that a distinct pattern of structural covariance networks (SCN) from magnetic resonance imaging (MRI)-derived measurements of brain cortical thickness characterized young adults with alcohol use disorder (AUD) and predicted current and future problematic drinking in adolescents relative to controls. Here, we establish the robustness and value of SCN for identifying heavy alcohol users in three additional independent studies. DESIGN AND SETTING Cross-sectional and longitudinal studies using data from the Pediatric Imaging, Neurocognition and Genetics (PING) study (n = 400, age range = 14-22 years), the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) (n = 272, age range = 17-22 years) and the Human Connectome Project (HCP) (n = 375, age range = 22-37 years). CASES Cases were defined based on heavy alcohol use patterns or former alcohol use disorder (AUD) diagnoses: 50, 68 and 61 cases were identified. Controls had none or low alcohol use or absence of AUD: 350, 204 and 314 controls were selected. MEASUREMENTS Graph theory metrics of segregation and integration were used to summarize SCN. FINDINGS Mirroring our prior findings, and across the three data sets, cases had a lower clustering coefficient [area under the curve (AUC) = -0.029, P = 0.002], lower modularity (AUC = -0.14, P = 0.004), lower average shortest path length (AUC = -0.078, P = 0.017) and higher global efficiency (AUC = 0.007, P = 0.010). Local efficiency differences were marginal (AUC = -0.017, P = 0.052). That is, cases exhibited lower network segregation and higher integration, suggesting that adjacent nodes (i.e. brain regions) were less similar in thickness whereas spatially distant nodes were more similar. CONCLUSION Structural covariance network (SCN) differences in the brain appear to constitute an early marker of heavy alcohol use in three new data sets and, more generally, demonstrate the utility of SCN-derived metrics to detect brain-related psychopathology.
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Affiliation(s)
- Jonatan Ottino-González
- Division of Endocrinology, The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Renata B. Cupertino
- Department of Genetics, University of California San Diego, San Diego, CA, USA
| | - Zhipeng Cao
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Sage Hahn
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Devarshi Pancholi
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Matthew D. Albaugh
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Ty Brumback
- Department of Psychological Science, Northern Kentucky University, Highland Heights, KY, USA
| | - Fiona C. Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Sandra A. Brown
- Departments of Psychology and Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Duncan B. Clark
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - David B. Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bonnie J. Nagel
- Departments of Psychiatry and Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, USA
| | - Kate B. Nooner
- Department of Psychology, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Kilian M. Pohl
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Susan F. Tapert
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Wesley K. Thompson
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Terry L. Jernigan
- Center for Human Development, University of California, San Diego, CA, USA
| | - Patricia Conrod
- Department of Psychiatry, Université de Montreal, CHU Ste Justine Hospital, Montreal, Québec, Canada
| | - Scott Mackey
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Hugh Garavan
- Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT, USA
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Cheek SM, Kudinova AY, Kuzyk EG, Goldston DB, Liu RT. Cognitive inflexibility and suicidal ideation among adolescents following hospitalization: The moderating role of life stress. J Affect Disord 2023; 339:698-705. [PMID: 37463644 PMCID: PMC10878321 DOI: 10.1016/j.jad.2023.07.075] [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: 03/20/2023] [Revised: 06/23/2023] [Accepted: 07/14/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Cognitive inflexibility has recently been investigated as potential vulnerability factor for suicidal ideation (SI), but the context in which it may convey risk is unclear. Life stress has also been reliably associated with SI among adolescents, and following a stress-diathesis model, may be a factor that moderates the relationship between cognitive inflexibility and SI. METHODS Psychiatrically hospitalized adolescents (N = 259) at high risk for future SI were followed for 18 months after discharge. Interviews assessing life stress and SI and a neurocognitive task assessing cognitive inflexibility were conducted at six- and 12-months. SI was also assessed at 18-month post-discharge. Linear mixed models were used to determine the moderating effect of stress on the relationship between cognitive inflexibility and SI, accounting for relevant clinical and demographic covariates. RESULTS Chronic stress moderated the association between cognitive inflexibility and SI, with a stronger association found among youth with greater levels compared to lower levels of chronic stress. This finding was maintained after statistically adjusting for depressive symptoms and relevant demographic covariates. No prospective associations between cognitive inflexibility, life stress, and SI were found. LIMITATIONS SI was measured at 6-month intervals, precluding evaluation of the relationship on a more proximal timescale. CONCLUSIONS Cognitively inflexible adolescents under conditions of high chronic stress are more likely to experience increased SI severity, supporting a cognitive inflexibility stress-diathesis model of SI in adolescents. The findings highlight the importance of assessing these modifiable factors among adolescents at a high risk for SI.
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Affiliation(s)
- Shayna M Cheek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America.
| | - Anastacia Y Kudinova
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Eva G Kuzyk
- Massachusetts General Hospital, Boston, MA, United States of America
| | - David B Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - Richard T Liu
- Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, United States of America
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Minja L, Knettel BA, Pan W, Madundo K, Amiri I, Joel L, Knippler E, Relf MV, Vissoci JRN, Staton CA, Msoka EF, Tarimo CS, Katiti V, Mmbaga BT, Goldston DB. Validation of a culturally sensitive, Swahili-translated instrument to assess suicide risk among adults living with HIV in Tanzania. Glob Ment Health (Camb) 2023; 10:e67. [PMID: 38024799 PMCID: PMC10643229 DOI: 10.1017/gmh.2023.59] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/05/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023] Open
Abstract
In Tanzania, there are high rates of suicidal thoughts and behavior among people living with HIV (PLWH), yet few instruments exist for effective screening and referral. To address this gap, we developed and validated Swahili translations of the Columbia Suicide Severity Rating Scale (C-SSRS) Screen Version and two accompanying scales assessing self-efficacy to avoid suicidal action and reasons for living. We administered a structured survey to 80 PLWH attending two HIV clinics in Moshi, Tanzania. Factor analysis of the items revealed four subscales: suicide intensity, self-efficacy to avoid suicide, fear and social concern about suicide, and family and spirituality deterrents to suicide. The area under the receiver operating curve showed only suicide intensity, and fear and social concern met the prespecified cutoff of ≥0.7 in accurately identifying patients with a plan and intent to act on suicidal thoughts. This study provides early evidence that brief screening of intensity of suicidality in the past month, assessed by the C-SSRS Screen Version, is a strong, resource-efficient strategy for identifying suicide risk in the Tanzanian setting. Patients who report little fear of dying and low concern about social perceptions of suicide may also be at increased risk.
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Affiliation(s)
- Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Brandon A. Knettel
- Duke University School of Nursing, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Wei Pan
- Duke University School of Nursing, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Kim Madundo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Ismail Amiri
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Louise Joel
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Elizabeth Knippler
- Duke University School of Nursing, Durham, NC, USA
- Duke Center for AIDS Research, Duke University, Durham, NC, USA
| | - Michael V. Relf
- Duke University School of Nursing, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Joao Ricardo N. Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Department of Emergency Medicine, Durham, NC, USA
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Department of Emergency Medicine, Durham, NC, USA
| | - Elizabeth F. Msoka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Victor Katiti
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - David B. Goldston
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA
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Jones SA, Morales AM, Harman G, Dominguez-Savage KA, Gilbert S, Baker FC, de Zambotti M, Goldston DB, Nooner KB, Clark DB, Luna B, Thompson WK, Brown SA, Tapert SF, Nagel BJ. Associations between alcohol use and sex-specific maturation of subcortical gray matter morphometry from adolescence to adulthood: Replication across two longitudinal samples. Dev Cogn Neurosci 2023; 63:101294. [PMID: 37683327 PMCID: PMC10497992 DOI: 10.1016/j.dcn.2023.101294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 05/04/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Subcortical brain morphometry matures across adolescence and young adulthood, a time when many youth engage in escalating levels of alcohol use. Initial cross-sectional studies have shown alcohol use is associated with altered subcortical morphometry. However, longitudinal evidence of sex-specific neuromaturation and associations with alcohol use remains limited. This project used generalized additive mixed models to examine sex-specific development of subcortical volumes and associations with recent alcohol use, using 7 longitudinal waves (n = 804, 51% female, ages 12-21 at baseline) from the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA). A second, independent, longitudinal dataset, with up to four waves of data (n = 467, 43% female, ages 10-18 at baseline), was used to assess replicability. Significant, replicable non-linear normative volumetric changes with age were evident in the caudate, putamen, thalamus, pallidum, amygdala and hippocampus. Significant, replicable negative associations between subcortical volume and alcohol use were found in the hippocampus in all youth, and the caudate and thalamus in female but not male youth, with significant interactions present in the caudate, thalamus and putamen. Findings suggest a structural vulnerability to alcohol use, or a predisposition to drink alcohol based on brain structure, with female youth potentially showing heightened risk, compared to male youth.
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Affiliation(s)
- Scott A Jones
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Angelica M Morales
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Gareth Harman
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA; Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | | | - Sydney Gilbert
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | | | - David B Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kate B Nooner
- Department of Psychology, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Duncan B Clark
- Departments of Psychiatry, Psychology and Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Beatriz Luna
- Departments of Psychiatry, Psychology and Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wesley K Thompson
- Population Neuroscience and Genetics Lab, University of California, San Diego, CA, USA
| | - Sandra A Brown
- Department of Psychology and Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Susan F Tapert
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Bonnie J Nagel
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
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Knettel BA, Amiri I, Minja L, Martinez AJ, Knippler ET, Madundo K, Staton C, Vissoci JRN, Mwobobia J, Mmbaga BT, Kaaya S, Relf MV, Goldston DB. Brief Report: Task-Shifting "Gold Standard" Clinical Assessment and Safety Planning for Suicide Risk Among People Living With HIV: A Feasibility and Fidelity Evaluation in Tanzania. J Acquir Immune Defic Syndr 2023; 93:374-378. [PMID: 37159427 PMCID: PMC10524299 DOI: 10.1097/qai.0000000000003217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 11/04/2022] [Accepted: 04/28/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Suicide is a leading cause of death among people living with HIV (PLWH) worldwide, with suicide deaths occurring twice as frequently among PLWH than among the general public. In Tanzania, resources for mental health care are sorely lacking, with 55 psychiatrists and psychologists providing treatment for 60 million people. In light of this shortage, nonspecialists play a crucial role. The objective of this study was to assess feasibility of implementing task-shifted screening, assessment, and safety planning for suicide risk among PLWH. SETTING Two adult HIV clinics in Kilimanjaro, Tanzania. METHODS Registered professional nurses in the HIV clinics were trained to administer brief screening of suicidal ideation in the past month. Patients experiencing suicidal ideation were referred to bachelor's-level counselors for further assessment and safety planning, supervised by specialist providers who reviewed audio recordings for quality assurance. RESULTS During 180 days of implementation, nurses screened patients attending 2745 HIV appointments. Sixty-one (2.2%) endorsed suicidal ideation and were linked to further assessment and safety planning. We cross-checked screening with clinic attendance logs on 7 random days and found high fidelity to screening (206 of 228 screened, 90%). Quality assurance ratings demonstrated key assessment pieces were consistently completed (mean = 9.3/10 possible), with "Good" to "Excellent" counseling skills (mean = 23.7/28) and "Good" to "Excellent" quality (mean = 17.1/20), including appropriate referral for higher levels of care. CONCLUSIONS Brief screening can be implemented and paired with task-shifted counseling to facilitate high-quality assessment of suicide risk. This model shows excellent potential to extend mental health services for PLWH in low-resource settings.
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Affiliation(s)
- Brandon A. Knettel
- Duke University School of Nursing, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Ismail Amiri
- Duke Global Health Institute, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Elizabeth T. Knippler
- Duke University School of Nursing, Durham, NC, USA
- Duke Center for AIDS Research, Durham, NC, USA
| | - Kim Madundo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Catherine Staton
- Duke Global Health Institute, Durham, NC, USA
- Duke Department of Emergency Medicine, Durham, NC, USA
| | - Joao Ricardo N. Vissoci
- Duke Global Health Institute, Durham, NC, USA
- Duke Department of Emergency Medicine, Durham, NC, USA
| | | | - Blandina T. Mmbaga
- Duke Global Health Institute, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Michael V. Relf
- Duke University School of Nursing, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - David B. Goldston
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA
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Knettel BA, Knippler ET, Amiri I, Joel L, Madundo K, Msoka EF, Boshe J, Tarimo CS, Katiti V, Rwakilomba J, Turner EL, Minja L, Staton CA, Vissoci JRN, Mmbaga BT, Relf MV, Goldston DB. Protocol for a pilot randomized controlled trial of a telehealth-delivered counseling intervention to reduce suicidality and improve HIV care engagement in Tanzania. PLoS One 2023; 18:e0289119. [PMID: 37498916 PMCID: PMC10374000 DOI: 10.1371/journal.pone.0289119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Suicidal ideation is strikingly common among people living with HIV (PLWH) worldwide, leading to higher burden of disease, poor HIV care engagement, and loss of life. In low- and middle-income countries such as Tanzania, mental health resources are scarce, requiring innovative strategies for treatment. We describe the protocol for a clinical trial of a three-session telehealth counseling intervention to reduce suicidality and improve HIV care engagement in Tanzania. METHODS In a pilot randomized controlled trial, we will assess the feasibility, acceptability, and potential efficacy of a new telehealth intervention, termed "IDEAS for Hope". A total of 60 PLWH will be enrolled from two HIV clinics in the Kilimanjaro region and connected to telehealth counsellors based at a large regional hospital. Participants will be ≥18 years old and speak either Kiswahili or English. Patient screening will occur during routine HIV clinical care to identify PLWH experiencing suicidal ideation. Baseline surveys will be administered upon enrollment and participants will be randomized 1:1 to receive either IDEAS for Hope or the comparison condition, a brief safety planning session. All participants will receive an additional referral for psychiatric treatment. Follow-up assessment will occur at three months. IDEAS for Hope is informed by a Motivational Interviewing-enhanced safety planning intervention (MI-SafeCope) and our formative work in Tanzania. The model consists of Four Pillars: living healthy with HIV, managing HIV stigma, seeking social support, and meeting basic needs. Together, these mechanisms serve as a foundation for developing a sense of safety and hope for the future. Outcome measures will include intervention feasibility, acceptability, participant suicidality, and HIV care engagement. SIGNIFICANCE Innovative, telehealth-based counseling represents a promising treatment for suicidality among PLWH in low-resource settings. Results from this pilot trial will inform intervention refinement and parameter estimates for a future clinical trial powered to evaluate effectiveness.
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Affiliation(s)
- Brandon A Knettel
- Duke University School of Nursing, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - Elizabeth T Knippler
- Duke University School of Nursing, Durham, NC, United States of America
- Duke Center for AIDS Research, Durham, NC, United States of America
| | - Ismail Amiri
- Duke Global Health Institute, Durham, NC, United States of America
| | - Louise Joel
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Kim Madundo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Elizabeth F Msoka
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Judith Boshe
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Victor Katiti
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | | | - Elizabeth L Turner
- Duke Global Health Institute, Durham, NC, United States of America
- Duke Department of Biostatistics & Bioinformatics, Durham, NC, United States of America
| | - Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Catherine A Staton
- Duke Global Health Institute, Durham, NC, United States of America
- Duke Department of Emergency Medicine, Durham, NC, United States of America
| | - Joao Ricardo N Vissoci
- Duke Global Health Institute, Durham, NC, United States of America
- Duke Department of Emergency Medicine, Durham, NC, United States of America
| | - Blandina T Mmbaga
- Duke Global Health Institute, Durham, NC, United States of America
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | - Michael V Relf
- Duke University School of Nursing, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - David B Goldston
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, United States of America
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10
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Knettel BA, Knippler E, Martinez A, Sardana S, Agor D, Mwobobia J, Ledbetter L, Amiri I, Relf MV, Goldston DB. A scoping review of counseling interventions for suicide prevention in Africa: Few studies address this life-saving aspect of mental health treatment. J Affect Disord 2023; 328:183-190. [PMID: 36806597 PMCID: PMC10068682 DOI: 10.1016/j.jad.2023.02.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Received: 08/31/2022] [Revised: 02/05/2023] [Accepted: 02/11/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Nearly 800,000 people die by suicide each year, with 77 % occurring in low- and middle-income countries. Suicide is underestimated in many African settings due to challenges in data collection, stigma, and policies that promote silence; nonetheless, rates of suicide in Africa are consistently higher than global averages. METHODS We conducted a scoping review of counseling interventions assessing suicide outcomes among adults in Africa using MEDLINE, Embase, PsycINFO, African Index Medicus, CABI Global Health, and Proquest databases. Study screening and data extraction was informed by the JBI Manual for Evidence Synthesis. RESULTS Of 2438 abstracts reviewed, 33 studies met criteria for full-text review and 13 were included in the analysis. Interventions served several populations, including people living with HIV, out of school youth, university students, and women undergoing obstetric fistula repair. There was a near-equal split in individual versus group counseling modalities and the use of professional versus lay counselors. The majority of interventions had primary outcomes focused on other mental health or social variables with a secondary focus on suicide. Mechanisms of change for suicide prevention were poorly articulated. LIMITATIONS The review was limited to English-language studies conducted after 2001 and excluded qualitative studies and those with fewer than 10 participants. CONCLUSIONS There is a clear paucity of research in this area, particularly in the lack of randomized clinical trials and studies with suicide prevention as their primary outcome. Researchers should seek to develop or adapt evidence-based, culturally-resonant interventions to reduce the burden of suicide on the African continent.
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Affiliation(s)
- Brandon A Knettel
- Duke University School of Nursing, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Elizabeth Knippler
- Duke University School of Nursing, Durham, NC, USA; Duke Center for AIDS Research, Duke University, Durham, NC, USA
| | - Alyssa Martinez
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Srishti Sardana
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA
| | - David Agor
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
| | - Judith Mwobobia
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Leila Ledbetter
- Duke University Medical Center Library and Archives, Durham, NC, USA
| | - Ismail Amiri
- Duke Global Health Institute, Duke University, Durham, NC, USA; Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Michael V Relf
- Duke University School of Nursing, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - David B Goldston
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA
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11
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Alzueta E, Podhajsky S, Zhao Q, Tapert SF, Thompson WK, de Zambotti M, Yuksel D, Kiss O, Wang R, Volpe L, Prouty D, Colrain IM, Clark DB, Goldston DB, Nooner KB, De Bellis MD, Brown SA, Nagel BJ, Pfefferbaum A, Sullivan EV, Baker FC, Pohl KM. Risk for depression tripled during the COVID-19 pandemic in emerging adults followed for the last 8 years. Psychol Med 2023; 53:2156-2163. [PMID: 34726149 PMCID: PMC10260372 DOI: 10.1017/s0033291721004062] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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] [Indexed: 12/23/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has significantly increased depression rates, particularly in emerging adults. The aim of this study was to examine longitudinal changes in depression risk before and during COVID-19 in a cohort of emerging adults in the U.S. and to determine whether prior drinking or sleep habits could predict the severity of depressive symptoms during the pandemic. METHODS Participants were 525 emerging adults from the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA), a five-site community sample including moderate-to-heavy drinkers. Poisson mixed-effect models evaluated changes in the Center for Epidemiological Studies Depression Scale (CES-D-10) from before to during COVID-19, also testing for sex and age interactions. Additional analyses examined whether alcohol use frequency or sleep duration measured in the last pre-COVID assessment predicted pandemic-related increase in depressive symptoms. RESULTS The prevalence of risk for clinical depression tripled due to a substantial and sustained increase in depressive symptoms during COVID-19 relative to pre-COVID years. Effects were strongest for younger women. Frequent alcohol use and short sleep duration during the closest pre-COVID visit predicted a greater increase in COVID-19 depressive symptoms. CONCLUSIONS The sharp increase in depression risk among emerging adults heralds a public health crisis with alarming implications for their social and emotional functioning as this generation matures. In addition to the heightened risk for younger women, the role of alcohol use and sleep behavior should be tracked through preventive care aiming to mitigate this looming mental health crisis.
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Affiliation(s)
- Elisabet Alzueta
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Simon Podhajsky
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Qingyu Zhao
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Susan F. Tapert
- Departments of Psychology and Psychiatry, University of California, San Diego, CA, USA
| | - Wesley K. Thompson
- Departments of Psychology and Psychiatry, University of California, San Diego, CA, USA
- Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | | | - Dilara Yuksel
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Orsolya Kiss
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Rena Wang
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Laila Volpe
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Devin Prouty
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Ian M. Colrain
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Duncan B. Clark
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - David B. Goldston
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kate B. Nooner
- Psychology Department, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Michael D. De Bellis
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Sandra A. Brown
- Departments of Psychology and Psychiatry, University of California, San Diego, CA, USA
| | - Bonnie J. Nagel
- School of Medicine, Oregon Health & Sciences University, Portland, OR, USA
| | - Adolf Pfefferbaum
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Edith V. Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Fiona C. Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Kilian M. Pohl
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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12
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Novak LA, LaCroix JM, Perera KU, Stivers M, Schvey NA, Goodie JL, Olsen C, Sbrocco T, Goldston DB, Soumoff A, Weaver J, Ghahramanlou-Holloway M. Help-seeking among psychiatrically hospitalized military personnel at risk for suicide. Suicide Life Threat Behav 2023; 53:75-88. [PMID: 36369831 DOI: 10.1111/sltb.12923] [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] [Received: 01/04/2022] [Revised: 07/20/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Promoting help-seeking is a key suicide prevention strategy. Yet, research on help-seeking patterns by high-risk individuals is limited. This study examined help-seeking among United States military Service members admitted for psychiatric inpatient care. METHODS Participants were active duty Service members (N = 111) psychiatrically hospitalized for a suicide-related event. Data were collected as part of a larger randomized controlled trial. Reported types and perceived helpfulness of resources sought 30 days before hospitalization were examined. Hierarchical binary logistic regressions were used to examine associations among types of helping resources, mental health treatment stigma, and perceived social support. RESULTS Approximately 90% of participants sought help prior to hospitalization, most frequently from behavioral health providers and friends. Accessed resources were generally considered helpful. Adjusting for covariates, mental health treatment stigma was not associated with seeking help from any resource type. Higher perceived social support was associated with greater likelihood of help-seeking from a friend (OR = 1.08, p = 0.013 [95% CI = 1.02, 1.14]). Marital status, education level, and organizational barriers were associated with specific types of resources, and/or not seeking help. CONCLUSION Help-seeking is a complex human behavior. Promoting help-seeking among vulnerable subgroups requires further understanding of multiple interconnected factors.
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Affiliation(s)
- Laura A Novak
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jessica M LaCroix
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kanchana U Perera
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Max Stivers
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Natasha A Schvey
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Jeffrey L Goodie
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Cara Olsen
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tracy Sbrocco
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - David B Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alyssa Soumoff
- Directorate for Behavioral Health, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Jennifer Weaver
- Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | - Marjan Ghahramanlou-Holloway
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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13
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Abstract
The Garrett Lee Smith (GLS) Memorial Act, continuously funded since 2004, has supported comprehensive, community-based youth suicide prevention efforts throughout the United States. Compared to matched communities, communities implementing GLS suicide prevention activities have lower population rates of suicide attempts and lower mortality among young people. Positive outcomes have been more pronounced with continuous years of implementation and in less densely populated communities. Cost analyses indicate that implementation of GLS suicide prevention activities more than pays for itself in reduced health care costs associated with fewer emergency department visits and hospitalizations. Although findings are encouraging, the heterogeneity of community suicide prevention programs and the lack of randomized trials preclude definitive determination of causal effects associated with GLS. The GLS initiative has never been brought fully to scale (e.g., simultaneously impacting all communities in the United States), so beneficial effects on nationwide suicide rates have not been realized. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 19 is May 2023. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- David B Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA;
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14
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Zhao Q, Wang K, Kiss O, Yuksel D, de Zambotti M, Clark DB, Goldston DB, Nooner KB, Brown SA, Tapert SF, Thompson WK, Nagel BJ, Pfefferbaum A, Sullivan EV, Pohl KM, Baker FC. Earlier Bedtime and Effective Coping Skills Predict a Return to Low-Risk of Depression in Young Adults during the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19:ijerph191610300. [PMID: 36011934 PMCID: PMC9408272 DOI: 10.3390/ijerph191610300] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 05/24/2023]
Abstract
To determine the persistent effects of the pandemic on mental health in young adults, we categorized depressive symptom trajectories and sought factors that promoted a reduction in depressive symptoms in high-risk individuals. Specifically, longitudinal analysis investigated changes in the risk for depression before and during the pandemic until December 2021 in 399 young adults (57% female; age range: 22.8 ± 2.6 years) in the United States (U.S.) participating in the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA) study. The Center for Epidemiologic Studies Depression Scale (CES-D-10) was administered multiple times before and during the pandemic. A score ≥10 identified individuals at high-risk for depression. Self-reported sleep behavior, substance use, and coping skills at the start of the pandemic were assessed as predictors for returning to low-risk levels while controlling for demographic factors. The analysis identified four trajectory groups regarding depression risk, with 38% being at low-risk pre-pandemic through 2021, 14% showing persistent high-risk pre-pandemic through 2021, and the remainder converting to high-risk either in June 2020 (30%) or later (18%). Of those who became high-risk in June 2020, 51% were no longer at high-risk in 2021. Logistic regression revealed that earlier bedtime and, for the older participants (mid to late twenties), better coping skills were associated with this declining risk. Results indicate divergence in trajectories of depressive symptoms, with a considerable number of young adults developing persistent depressive symptoms. Healthy sleep behavior and specific coping skills have the potential to promote remittance from depressive symptoms in the context of the pandemic.
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Affiliation(s)
- Qingyu Zhao
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA
| | - Kevin Wang
- Department of Computer Science, Stanford University, Stanford, CA 94305, USA
| | - Orsolya Kiss
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA
| | - Dilara Yuksel
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA
| | | | - Duncan B. Clark
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - David B. Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27708, USA
| | - Kate B. Nooner
- Department of Psychology, University of North Carolina Wilmington, Wilmington, NC 28403, USA
| | - Sandra A. Brown
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
| | - Susan F. Tapert
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
| | - Wesley K. Thompson
- Population Neuroscience and Genetics Lab, University of California, San Diego, CA 92093, USA
- Department of Radiology, University of California, San Diego, CA 92093, USA
| | - Bonnie J. Nagel
- Departments of Psychiatry and Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA
| | - Adolf Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA
| | - Edith V. Sullivan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA
| | - Kilian M. Pohl
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94304, USA
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA
| | - Fiona C. Baker
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA
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15
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Grove JL, Kimbrel NA, Griffin SC, Halverson T, White MA, Blakey SM, Beckham JC, Dedert EA, Goldston DB, Pugh MJ, Calhoun PS. Cannabis use and suicide risk among Gulf War veterans. Death Stud 2022; 47:618-623. [PMID: 35939644 PMCID: PMC9905335 DOI: 10.1080/07481187.2022.2108944] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Cannabis use has been indicated as a risk factor for suicide in veterans. This study of Gulf War veterans tested the relationship between self-report past year cannabis use and (a) past year suicidal ideation and (b) risk for suicidal behavior. Data were from a national sample (N = 1126) of Gulf War veterans. Logistic regression models indicated cannabis use was associated with past year suicidal ideation and elevated risk for suicidal behavior, independent of key covariates. In corroboration with research on other military populations, this study indicates a potentially concerning association between cannabis use and suicide risk in Gulf War veterans.
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Affiliation(s)
- Jeremy L. Grove
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
| | - Nathan A. Kimbrel
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)
| | - Sarah C. Griffin
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
| | - Tate Halverson
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
| | | | | | - Jean C. Beckham
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
| | - Eric A. Dedert
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)
| | - David B. Goldston
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
| | - Mary J. Pugh
- VA Salt Lake City Healthcare System
- University of Utah, School of Medicine, Department of Medicine
| | - Patrick S. Calhoun
- Duke University School of Medicine Department of Psychiatry and Behavioral Sciences
- Durham Veterans Affairs Health Care System
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC)
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)
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16
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Pelham WE, Yuksel D, Tapert SF, Baker FC, Pohl KM, Thompson WK, Podhajsky S, Reuter C, Zhao Q, Eberson-Shumate SC, Clark DB, Goldston DB, Nooner KB, Brown SA. Did the acute impact of the COVID-19 pandemic on drinking or nicotine use persist? Evidence from a cohort of emerging adults followed for up to nine years. Addict Behav 2022; 131:107313. [PMID: 35413486 PMCID: PMC8949842 DOI: 10.1016/j.addbeh.2022.107313] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/03/2022] [Accepted: 03/23/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study examined the impact of the COVID-19 pandemic on drinking and nicotine use through June of 2021 in a community-based sample of young adults. METHOD Data were from 348 individuals (49% female) enrolled in a long-term longitudinal study with an accelerated longitudinal design: the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) Study. Individuals completed pre-pandemic assessments biannually from 2016 to early 2020, then completed up to three web-based, during-pandemic surveys in June 2020, December 2020, and June 2021. Assessments when individuals were 18.8-22.4 years old (N = 1,458) were used to compare drinking and nicotine use pre-pandemic vs. at each of the three during-pandemic timepoints, adjusting for the age-related increases expected over time. RESULTS Compared to pre-pandemic, participants were less likely to report past-month drinking in June or December 2020, but there was an increase in drinking days among drinkers in June 2020. By June 2021, both the prevalence of past-month drinking and number of drinking days among drinks were similar to pre-pandemic levels. On average, there were no statistically significant differences between pre-pandemic and during-pandemic time points for binge drinking, typical drinking quantity, or nicotine use. Young adults who reported an adverse financial impact of the pandemic showed increased nicotine use while their peers showed stable or decreased nicotine use. CONCLUSION Initial effects of the pandemic on alcohol use faded by June 2021, and on average there was little effect of the pandemic on nicotine use.
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Affiliation(s)
- William E. Pelham
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA,Corresponding author at: Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr. (MC 0603), La Jolla, CA 92093-0603, USA
| | - Dilara Yuksel
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA
| | - Susan F. Tapert
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA
| | - Fiona C. Baker
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA
| | - Kilian M. Pohl
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA 94305, USA
| | - Wesley K. Thompson
- Department of Biostatistics and Radiology, Population Neuroscience and Genetics Lab, University of California San Diego, La Jolla, CA 92093, USA
| | - Simon Podhajsky
- Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA
| | - Chase Reuter
- Department of Biostatistics and Radiology, Population Neuroscience and Genetics Lab, University of California San Diego, La Jolla, CA 92093, USA
| | - Qingyu Zhao
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA 94305, USA
| | | | - Duncan B. Clark
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - David B. Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27705, USA
| | - Kate B. Nooner
- Department of Psychology, University of North Carolina Wilmington, Wilmington, NC 28403, USA
| | - Sandra A. Brown
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA,Department of Psychology, University of California San Diego, La Jolla, CA 92093, USA
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17
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Ranapurwala SI, Miller VE, Carey TS, Gaynes BN, Keil AP, Fitch CV, Swilley-Martinez ME, Kavee AL, Cooper T, Dorris S, Goldston DB, Peiper LJ, Pence BW. Innovations in suicide prevention research (INSPIRE): a protocol for a population-based case-control study. Inj Prev 2022; 28:injuryprev-2022-044609. [PMID: 35701110 PMCID: PMC10213808 DOI: 10.1136/injuryprev-2022-044609] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/28/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Suicide deaths have been increasing for the past 20 years in the USA resulting in 45 979 deaths in 2020, a 29% increase since 1999. Lack of data linkage between entities with potential to implement large suicide prevention initiatives (health insurers, health institutions and corrections) is a barrier to developing an integrated framework for suicide prevention. OBJECTIVES Data linkage between death records and several large administrative datasets to (1) estimate associations between risk factors and suicide outcomes, (2) develop predictive algorithms and (3) establish long-term data linkage workflow to ensure ongoing suicide surveillance. METHODS We will combine six data sources from North Carolina, the 10th most populous state in the USA, from 2006 onward, including death certificate records, violent deaths reporting system, large private health insurance claims data, Medicaid claims data, University of North Carolina electronic health records and data on justice involved individuals released from incarceration. We will determine the incidence of death from suicide, suicide attempts and ideation in the four subpopulations to establish benchmarks. We will use a nested case-control design with incidence density-matched population-based controls to (1) identify short-term and long-term risk factors associated with suicide attempts and mortality and (2) develop machine learning-based predictive algorithms to identify individuals at risk of suicide deaths. DISCUSSION We will address gaps from prior studies by establishing an in-depth linked suicide surveillance system integrating multiple large, comprehensive databases that permit establishment of benchmarks, identification of predictors, evaluation of prevention efforts and establishment of long-term surveillance workflow protocols.
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Affiliation(s)
- Shabbar I Ranapurwala
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Vanessa E Miller
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Timothy S Carey
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alexander P Keil
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Catherine Vinita Fitch
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Monica E Swilley-Martinez
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Andrew L Kavee
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Toska Cooper
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Samantha Dorris
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David B Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lewis J Peiper
- Division of Adult Correction - Prisons, North Carolina Department of Public Safety, Raleigh, North Carolina, USA
| | - Brian W Pence
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Thompson MF, Luk JW, LaCroix JM, Perera KU, Goldston DB, Weaver JJ, Soumoff A, Ghahramanlou-Holloway M. Understanding the clinical characteristics of lesbian, gay, and bisexual military service members and adult beneficiaries within an inpatient psychiatric sample. Suicide Life Threat Behav 2022; 52:268-279. [PMID: 34889465 DOI: 10.1111/sltb.12819] [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] [Received: 12/21/2020] [Revised: 08/26/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Limited knowledge exists regarding targets for suicide-focused care among high-risk United States (U.S.) civilian and military sexual minorities. PURPOSE This study aimed to understand the demographic and clinical characteristics of a suicidal sexual minority sample, psychiatrically hospitalized in military treatment facilities, to advance future targeted care for this vulnerable subgroup. METHODS Secondary analysis of baseline data from a multisite psychotherapy randomized controlled trial was performed comparing those who self-identified as lesbian, gay, or bisexual (LGB; n = 39) to heterosexual participants (n = 170). RESULTS LGB participants were more likely than heterosexual participants to be younger, female, never married, and enlisted rank. LGB participants reported significantly lower family support, higher perceived burdensomeness, lower acquired capability for suicide, and were twice as likely to report that they could not control their suicidal thoughts. LGB and heterosexual participants reported similar levels of other suicide risk indicators and similar lifetime suicidal ideation and attempt histories. CONCLUSIONS Compared to heterosexual participants, LGB participants reported increased risk indicators for suicide yet similar lifetime suicidal ideation and attempt histories. Suicide prevention programs should address the unique needs of this vulnerable subgroup. Interventions targeting family support, perceived burdensomeness, and controllability of suicidal thoughts may be promising.
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Affiliation(s)
- Matthew F Thompson
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA
| | - Jeremy W Luk
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA
| | - Jessica M LaCroix
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA
| | - Kanchana U Perera
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA
| | - David B Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | | | - Alyssa Soumoff
- Walter Reed National Military Medical Center, National Intrepid Center of Excellence, Bethesda, Maryland, USA
| | - Marjan Ghahramanlou-Holloway
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA
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19
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Curry JF, Kaminer Y, Goldston DB, Chan G, Wells KC, Burke RH, Inscoe AB, Meyer AE, Cheek SM. Adaptive Treatment for Youth With Substance Use and Depression: Early Depression Response and Short-term Outcomes. J Am Acad Child Adolesc Psychiatry 2022; 61:508-519. [PMID: 34371102 PMCID: PMC8818057 DOI: 10.1016/j.jaac.2021.07.807] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/22/2021] [Accepted: 07/30/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate prevalence and predictors of early depression response (EDR) in adolescents with substance use and depression receiving cognitive-behavioral therapy (CBT) for substance use and to test the efficacy of supplemental CBT targeting depression (CBT-D) for non-EDR adolescents in an adaptive treatment approach. METHOD At 2 sites, 95 youths (ages 14-21, mean [SD] = 17.4 [1.8]) with alcohol or cannabis use and depressive symptoms received up to 12 sessions of CBT for substance use over 14 weeks. Assessments were at baseline and weeks 4, 9, and 14. The Children's Depression Rating Scale-Revised was the primary depression measure, with a reduction of 50% or more on this scale at week 4 defining EDR. The primary substance use outcomes of alcohol use, heavy alcohol use, and cannabis use frequency were assessed via interview report on the Alcohol Consumption Questionnaire and the Drug Checklist. Urinalysis provided a secondary measure of cannabis use. Non-EDR adolescents were randomly assigned to supplemental CBT-D or enhanced treatment as usual (ETAU). RESULTS Thirty-five adolescents (37%; 95% CI, 27%-47%) demonstrated EDR. Fewer days of cannabis use (odds ratio 0.977; 95% CI, 0.961-0.992) and absence of conduct disorder (odds ratio 0.149; 95% CI, 0.031-0.716) predicted EDR. Frequency of drinking (F1,82 = 11.09, η2 = 0.119, p = .001), heavy drinking (F1,82 = 19.91, η2 = 0.195, p < .0001), and cannabis use (F1,220 = 35.01, η2 = 0.137, p < .001) decreased over time for EDR, CBT-D, and ETAU adolescents, with EDR adolescents evidencing earlier lower cannabis use (F2,220 = 4.16, η2 = 0.036, p = .0169). Negative (clean) urine screens increased over time (F1,219 = 5.10, η2 = 0.023, p = .0249). Comparison of CBT-D and ETAU indicated that depression significantly decreased over time in both groups (F1,48 = 64.20, η2 = 0.572, p < .001), with no advantage for CBT-D. CONCLUSION Approximately one-third of adolescents with substance use and depression attain EDR during substance use treatment. Less frequent cannabis use facilitates depression response. The relatively small sample may have precluded identification of additional EDR predictors. CLINICAL TRIAL REGISTRATION INFORMATION Treatment for Teens With Alcohol Abuse and Depression; https://clinicaltrials.gov/; NCT02227589.
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Affiliation(s)
- John F Curry
- Duke University School of Medicine, Durham, North Carolina.
| | - Yifrah Kaminer
- Alcohol Research Center, University of Connecticut, Farmington
| | | | - Grace Chan
- Alcohol Research Center, University of Connecticut, Farmington
| | - Karen C Wells
- Duke University School of Medicine, Durham, North Carolina
| | | | | | - Allison E Meyer
- At the time of the study, Duke University, Durham, North Carolina; University of Michigan, Ann Arbor, Michigan
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20
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Asarnow JR, Zullo L, Ernestus SM, Venables CW, Goldston DB, Tunno AM, Betz ME. "Lock and Protect": Development of a Digital Decision Aid to Support Lethal Means Counseling in Parents of Suicidal Youth. Front Psychiatry 2021; 12:736236. [PMID: 34690841 PMCID: PMC8528190 DOI: 10.3389/fpsyt.2021.736236] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/27/2021] [Indexed: 12/31/2022] Open
Abstract
Objective: Reducing access to lethal methods is an effective suicide prevention strategy that is often neglected in routine care. Digital interventions have shown promise for addressing such gaps in care; and decision aids have proven useful for supporting complicated health-related decisions, like those involving lethal means restriction. This article describes a parent/caregiver-facing web-based decision aid, the development process, and user testing. Method: A user-centered, participatory, mixed methods development design was employed. Beginning with an adult-focused decision aid developed by members of our team, we assessed ten iterations of the parent/caregiver decision aid with stakeholders (N = 85) using qualitative interviews and quantitative surveys. Stakeholders included: parents/caregivers whose children had histories of suicidal episodes before age 25, young adults with histories of suicidal thoughts/behaviors, firearm owners/representatives from firearm stores/ranges/groups, mental and medical health care providers, and emergency responders. Results: The final "Lock and Protect" decision aid was viewed as "useful for changing access to lethal means" by 100% of participants. Ninety-four percent of participants rated the information on reducing access to lethal means as good to excellent, and 91% rated the information on storage options as good to excellent. Qualitative feedback underscored a preference for offering this digital tool with a "human touch," as part of safety and discharge planning. Conclusions: "Lock and Protect" is a user-friendly web-based tool with potential for improving rates of lethal means counseling for parents/caregivers of suicidal youth and ultimately reducing pre-mature deaths by suicide.
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Affiliation(s)
- Joan R Asarnow
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lucas Zullo
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Chase W Venables
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - David B Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Angela M Tunno
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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21
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Luk JW, Bond AE, Gabrielli J, LaCroix JM, Perera KU, Lee-Tauler SY, Goldston DB, Soumoff A, Ghahramanlou-Holloway M. A latent class analysis of physical, emotional, and sexual abuse history among suicidal inpatients. J Psychiatr Res 2021; 142:9-16. [PMID: 34311282 DOI: 10.1016/j.jpsychires.2021.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/11/2021] [Revised: 06/23/2021] [Accepted: 07/05/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Physical, emotional, and sexual abuse are subtypes of childhood abuse that may persist into adulthood. This study applied latent class analysis to describe the pattern of co-occurrence of these three abuse subtypes during childhood and adulthood and examined latent class differences in psychosocial characteristics and three types of suicide attempt history (aborted, interrupted, and actual). METHODS Data were drawn from a high-risk sample of 115 military service members and adult beneficiaries who were psychiatrically hospitalized following a suicide-related crisis. RESULTS Three latent classes were identified: Multiple and Persistent Abuse (Class One: 29.6%), Childhood Physical and Persistent Emotional Abuse (Class Two: 27.0%), and Minimal Abuse (Class Three: 43.5%). Females were more likely than males to report a history of Multiple and Persistent Abuse. After controlling for gender, the Multiple and Persistent Abuse Class had higher scores of depressive symptoms and hazardous drinking, poorer sleep quality, and increased social stress than the Minimal Abuse Class. Moreover, the Multiple and Persistent Abuse Class was associated with increased likelihood of lifetime interrupted suicide attempt (Odds Ratio [OR] = 3.81, 95% CI = 1.20, 12.07) and actual suicide attempt (OR = 3.65, 95% CI = 1.23, 10.85), and had the greatest number of total actual suicide attempt (1.82 times on average). CONCLUSION Co-occurrence of multiple subtypes of abuse across development is associated with higher psychosocial risk and history of suicide attempt. The assessment of specific subtypes of abuse and their timing may inform case conceptualization and the management of suicide risk among psychiatric inpatients.
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Affiliation(s)
- Jeremy W Luk
- National Institute on Alcohol Abuse and Alcoholism, Office of the Clinical Director, Building 10 - CRC, Room 1-5340, Bethesda, MD, 20892, USA
| | - Allison E Bond
- The University of Southern Mississippi, Department of Psychology, 118 College Dr., Hattiesburg, MS, 39406, USA
| | - Joy Gabrielli
- University of Florida, Department of Clinical and Health Psychology, 1225 Center Dr., Rm. 3130, Gainesville, FL, 32610-0165, USA
| | - Jessica M LaCroix
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Kanchana U Perera
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Su Yeon Lee-Tauler
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - David B Goldston
- Duke University School of Medicine, Box 3527 Med Ctr, Durham, NC, 27710, USA
| | - Alyssa Soumoff
- Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, 20889, USA
| | - Marjan Ghahramanlou-Holloway
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
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22
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Inscoe AB, Donisch K, Cheek S, Stokes C, Goldston DB, Asarnow JR. Trauma-informed care for youth suicide prevention: A qualitative analysis of caregivers' perspectives. Psychol Trauma 2021; 14:653-660. [PMID: 34166044 DOI: 10.1037/tra0001054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Research shows elevated rates of trauma exposure and traumatic stress among youth with suicidal thoughts and behaviors, underscoring the need for a trauma-informed approach to suicide prevention and intervention. The purpose of this study was to identify, from the perspective of caregivers, clinical practices that are sensitive to the needs of youth with co-occurring traumatic stress and suicidal thoughts and behaviors, as well as common barriers to receiving care. METHOD Qualitative interviews were conducted with 13 caregivers of youth with trauma histories and comorbid suicidal thoughts and/or behaviors. Interviews were analyzed using a grounded theory approach. RESULTS Qualitative analysis of interviews revealed themes related to the need for caregiver involvement in treatment, the impact of therapist and relationship characteristics such as authenticity and genuineness, and the importance of provider education about trauma. Common barriers included difficulties navigating the mental health system and cost. CONCLUSIONS Findings provide guidance on how mental health providers can effectively recognize and respond to traumatic stress among youth presenting with suicidal thoughts and behaviors. System-level issues related to accessibility also are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | - Shayna Cheek
- Department of Psychiatry and Behavioral Sciences
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23
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Lee-Tauler SY, LaCroix JM, Carter SP, Perera KU, Goldston DB, Stivers M, Soumoff A, Sapyta JJ, Weller BE, Inscoe AB, Weaver JJ, Ghahramanlou-Holloway M. Perceived changes in social interactions following military psychiatric hospitalization for a suicidal crisis. Military Psychology 2021. [DOI: 10.1080/08995605.2021.1902182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Su Yeon Lee-Tauler
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland
| | - Jessica M. LaCroix
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland
| | - Sarah P. Carter
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland
| | - Kanchana U. Perera
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland
| | - David B. Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Max Stivers
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland
| | - Alyssa Soumoff
- Directorate for Behavioral Health, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Jeffrey J. Sapyta
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Bridget E. Weller
- School of Social Work, Western Michigan University, Kalamazoo, Michigan
| | - Adrienne Banny Inscoe
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Jennifer J. Weaver
- Inpatient Behavioral Health Service, Fort Belvoir Community Hospital, Fort Belvoir, Virginia
| | - Marjan Ghahramanlou-Holloway
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland
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24
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Cheek SM, Goldston DB, Erkanli A, Massing-Schaffer M, Liu RT. Social Rejection and Suicidal Ideation and Attempts among Adolescents Following Hospitalization: a Prospective Study. Res Child Adolesc Psychopathol 2021; 48:123-133. [PMID: 31440932 DOI: 10.1007/s10802-019-00580-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/01/2023]
Abstract
Despite research indicating that stressful life events are associated with subsequent suicidal ideation (SI) and behavior, there is a lack of clarity regarding whether specific types of life events are differentially related to SI and attempts. The current prospective study examines whether social rejection related life events are proximally related to SI and suicide attempts in a clinically acute sample of adolescents. Adolescents aged 12 to 18 (n = 219) were followed for 6 months after discharge from inpatient hospitalization. A contextual threat interview of stressful life events between index admission and 6-month follow-up was administered. Participants were also assessed for current SI and suicide attempts at baseline and 6-month follow-up. Results from a multiple linear regression model indicated a significant prospective association between number of social rejection stressors and SI, even after controlling for baseline depressive symptoms, SI at study entry, gender, age, and number of non-social rejections stressors. An Anderson-Gill recurrent events model was conducted to examine the relationship between SR stressors and suicide attempts. Results demonstrated that the 31 days following a major social rejection stressor were associated with heightened risk for prospective suicide attempts. However, social rejection stressors were not more strongly related to risk for suicide attempt than non-social rejection stressors. These findings help clarify the role of social rejection as a precipitant of suicidal crises and have potential to inform more accurate, targeted risk assessment.
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Affiliation(s)
- Shayna M Cheek
- Department of Psychology and Neuroscience, Duke University, 417 Chapel Drive, Durham, NC, 27705, USA.
| | - David B Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University Medical School, Durham, NC, USA
| | - Alaattin Erkanli
- Department of Biostatistics and Bioinformatics, Duke University Medical School, Durham, NC, USA
| | - Maya Massing-Schaffer
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Richard T Liu
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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25
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Goldston DB, Curry JF, Wells KC, Kaminer Y, Daniel SS, Esposito-Smythers C, Doyle O, Sapyta J, Tunno AM, Heilbron NC, Roley-Roberts M. Feasibility of an Integrated Treatment Approach for Youth with Depression, Suicide Attempts, and Substance Use Problems. Evid Based Pract Child Adolesc Ment Health 2021; 6:155-172. [PMID: 35692895 PMCID: PMC9186420 DOI: 10.1080/23794925.2021.1888664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Depression, suicidal behaviors and substance use problems frequently co-occur, and treatment for youth with these co-occurring problems is often fragmented and challenging. An integrated cognitive-behavioral treatment approach that builds upon a relapse prevention framework and applies common core skills, language, and approach for treating these related problems may be clinically beneficial. Following a description of the integrated approach, we present results of a pilot trial (n = 13) to examine the acceptability and feasibility of the Cognitive-Behavioral Therapy - Relapse Prevention (CBT-RP) intervention plus enhanced treatment as usual (TAU) compared to enhanced TAU alone. The feasibility of the CBT-RP + TAU intervention was reflected by high rates of retention (86%). The acceptability was reflected in positive evaluations regarding the helpfulness of the intervention by adolescents and families. The majority of youth in both CBT-RP + TAU and TAU alone groups evidenced reductions in depression and suicide ideation from study entry to Week 20. Patterns of reduction were more consistent, however, for youth receiving CBT-RP + TAU, and reductions were slower to emerge for some youth receiving TAU alone. Reductions in alcohol and marijuana problems were similar, but half of the youth in TAU alone (and none in the CBT-RP + TAU group) had emergency department visits related to psychiatric crises or substance related problems. These findings, although based on a small sample, underscore the feasibility and acceptability of an integrated cognitive-behavioral relapse prevention approach for youth with depression, suicide attempt histories, and substance use problems.
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Affiliation(s)
- David B. Goldston
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - John F. Curry
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Karen C. Wells
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Yifrah Kaminer
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | - Stephanie S. Daniel
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Otima Doyle
- Jane Addams School of Social Work, University of Illinois Chicago, Chicago, IL, USA
| | - Jeffrey Sapyta
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Angela M. Tunno
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Nicole C. Heilbron
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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26
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Conner KR, Kearns JC, Esposito EC, Pizzarello E, Wiegand TJ, Britton PC, Michel K, Gysin-Maillart AC, Goldston DB. Pilot RCT of the Attempted Suicide Short Intervention Program (ASSIP) adapted for rapid delivery during hospitalization to adult suicide attempt patients with substance use problems. Gen Hosp Psychiatry 2021; 72:66-72. [PMID: 34304029 PMCID: PMC8448954 DOI: 10.1016/j.genhosppsych.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/30/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The Attempted Suicide Short Intervention Program (ASSIP) was adapted for hospital delivery and to address substance use problems as well as evaluated for feasibility, acceptability, and therapist fidelity in a series of preparatory steps (n = 28) and in a pilot randomized controlled trial, RCT (n = 34). METHOD In the RCT, patients with suicide attempts and substance use problem(s) with sufficient lengths of stay to deliver three ASSIP therapy sessions in hospital were randomized to adapted ASSIP or treatment as usual control. A blinded assessor identified suicide reattempts over 6-month follow-up with the Columbia-Suicide Severity Rating Scale (C-SSRS) and a comprehensive multi-source method. Treatment process measures and the Scale for Suicidal Ideation (SSI) were also administered. RESULTS Median hospital stay was 13 days. ASSIP subjects reported high satisfaction with the treatment and high therapeutic alliance. Study therapists showed high fidelity to the modified ASSIP intervention. Repetition of suicide attempt was common in both study groups including a combined 9 (26%) subjects with reattempt based on C-SSRS and 13 (38%) subjects with reattempt based on multiple sources. CONCLUSIONS Adult suicide attempt patients with substance use problems who require lengthy hospitalizations are at exceptionally high risk and may require additional strategies to lower risk.
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Affiliation(s)
| | - Jaclyn C. Kearns
- Department of Psychology, University of Rochester, Rochester, NY, USA
| | - Erika C. Esposito
- Department of Psychology, University of Rochester, Rochester, NY, USA
| | | | | | - Peter C. Britton
- University of Rochester Medical Center, Rochester, NY, USA,Center of Excellence for Suicide Prevention, Finger Lakes VA Healthcare System, Canandaigua, NY, USA
| | - Konrad Michel
- University Hospital of Psychiatry, Bern, Switzerland
| | - Anja C. Gysin-Maillart
- Translational Research Centre, University Hospital of Psychiatry, University of Bern, Switzerland,Unit for Clinical Suicide Research, Department of Clinical Sciences, Psychiatry, Faculty of Medicine, Lund University, Sweden,University of Leipzig Department of Medical Psychology and Medical Sociology
| | - David B. Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Cheek SM, Reiter-Lavery T, Goldston DB. Social rejection, popularity, peer victimization, and self-injurious thoughts and behaviors among adolescents: A systematic review and meta-analysis. Clin Psychol Rev 2020; 82:101936. [PMID: 33128964 DOI: 10.1016/j.cpr.2020.101936] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/09/2020] [Accepted: 10/13/2020] [Indexed: 11/19/2022]
Abstract
Self-injurious thoughts and behaviors (SITBs) are significant public health problems in adolescence. The current article provides a comprehensive systematic review examining the relationship between events leading to perceived low relational evaluation (e.g. social rejection) and SITBs among adolescents. Theoretical work posits that low relational evaluation is experienced as psychologically painful, a known correlate of SITBs. Therefore, events leading to low relational evaluation may be particularly informative in understanding the context of SITBs. The current review examines how experiences of low relational evaluation that are hypothesized to elicit psychological pain, such as social rejection, low popularity, and peer victimization are related to engagement in SITBs in adolescence. A total of 56 articles meeting inclusion criteria were identified. The hypothesis of an association between indicators of low relational evaluation and SITBs was generally supported throughout the literature, with more consistency found among studies examining suicidal ideation specifically. However, interpretation of the findings is constrained by various methodological limitations of studies. The present review concludes with a theoretical conceptualization of the relationship between perceived relational value and SITBs, leveraging social and evolutionary psychological theory, to guide future research into this topic.
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Affiliation(s)
- Shayna M Cheek
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, United States of America.
| | - Theresa Reiter-Lavery
- Department of Psychological Science, University of Vermont, Burlington, Vermont, United States of America
| | - David B Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University Medical School, Durham, North Carolina, United States of America
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Knettel BA, Mwamba RN, Minja L, Goldston DB, Boshe J, Watt MH. Exploring patterns and predictors of suicidal ideation among pregnant and postpartum women living with HIV in Kilimanjaro, Tanzania. AIDS 2020; 34:1657-1664. [PMID: 32701584 PMCID: PMC7416579 DOI: 10.1097/qad.0000000000002594] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Pregnant and postpartum women living with HIV face disproportionate risk of depression and suicide, particularly in low-income and middle-income countries. This study examined patterns and predictors of suicidal ideation among women living with HIV in antenatal care in Kilimanjaro, Tanzania. DESIGN We conducted a longitudinal cohort study of 200 pregnant women living with HIV, with surveys conducted during pregnancy and 6 months postpartum. METHODS Pregnant women were recruited during HIV and antenatal care visits at nine clinics. A structured questionnaire was verbally administered in Kiswahili by a trained study nurse. We used simple frequencies and t-tests to measure patterns of suicidal ideation and logistic regression to assess factors associated with suicidal ideation. RESULTS Suicidal ideation was endorsed by 12.8% of women during pregnancy and decreased significantly to 3.9% by 6 months postpartum. Ideation was not significantly greater among participants newly diagnosed with HIV. In univariable analyses, suicidal ideation was associated with depression, anxiety, HIV stigma, single relationship status, unknown HIV status of the father of the baby, negative attitudes about antiretroviral medication, and low social support. In the multivariable model, women experiencing anxiety and HIV stigma were significantly more likely to endorse suicidal ideation during pregnancy. CONCLUSION Suicidal ideation and associated feelings of hopelessness are a critical challenge in antenatal care among women living with HIV, with important implications for quality of life, care engagement, and survival. To better support patients, targeted approaches to address anxiety, depression, stigma, and hopelessness must be prioritized, including crisis support for suicide prevention.
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Newman SE, Hall AD, Ramseur CJ, Foster DJ, Goldston DB, Decamp BL, Granberry-hager SP, Lockhart JL, Sawyer WL, White JE. Factors Affecting the Learning of Braille. Journal of Visual Impairment & Blindness 2020. [DOI: 10.1177/0145482x8207600205] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In three experiments, the subjects’ task was to learn the names of the first 10 symbols of the braille alphabet. In Experiments 1 and 2, visual examination of the symbols during the study trials and during the test trials enhanced learning. Of particular interest was the finding that subjects who studied the items visually but were tested haptically learned faster than did those who studied the items haptically and were also tested haptically. In Experiment 3, similar results were obtained when standard-size braille symbols were used during the study trials. When large braille symbols were used, visual study of the symbols had no effect. The authors discuss some implications of these results for braille training.
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Affiliation(s)
| | | | | | | | | | - Burney L. Decamp
- Department of Psychology, North Carolina State University, Raleigh, North Carolina 27650
| | | | - Jackie L. Lockhart
- Department of Psychology, North Carolina State University, Raleigh, North Carolina 27650
| | - Wilson L. Sawyer
- Department of Psychology, North Carolina State University, Raleigh, North Carolina 27650
| | - James E. White
- Department of Psychology, North Carolina State University, Raleigh, North Carolina 27650
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Conner KR, Wiegand TJ, Goldston DB. A hospital-based treatment of suicide attempt patients with problematic alcohol use: Rationale and treatment development. Gen Hosp Psychiatry 2020; 63:30-32. [PMID: 30765239 DOI: 10.1016/j.genhosppsych.2019.02.001] [Citation(s) in RCA: 4] [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] [Received: 02/12/2018] [Revised: 01/25/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Problematic alcohol use (PAU) is a potent risk factor for suicidal behavior yet individuals with PAU presenting to hospital with suicidal risk may receive less intensive hospital-based treatment than suicidal patients without PAU. Developing efficacious interventions for at-risk patients with PAU that may be delivered in hospital is critical, particularly for those hospitalized following a suicide attempt, a group at marked risk. METHOD The authors identified the Attempted Suicide Short Intervention Program (ASSIP) for adaption for hospitalized suicide attempt patients with PAU because of its flexibility, brevity, and evidence of efficacy to reduce risk for suicide reattempt. After consulting with the developers of ASSIP, clinical research experts in the treatment of suicidal risk and PAU, and treatment providers of hospitalized suicide attempt patients, the authors made modifications to ASSIP to tailor it to hospitalized suicide attempt patients with PAU. Results and conclusion Our modifications to ASSIP include highlighting links between PAU and the timing of the attempt; integrating such links into the narrative story of the attempt, the written case formulation, and the homework task; and identifying concrete strategies to address PAU-related risk in the prevention plan. These modifications are the focus of an ongoing treatment development study.
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Affiliation(s)
- Kenneth R Conner
- University of Rochester Medical Center, United States of America.
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Asarnow JR, Goldston DB, Tunno AM, Inscoe AB, Pynoos R. Suicide, Self-Harm, & Traumatic Stress Exposure: A Trauma-Informed Approach to the Evaluation and Management of Suicide Risk. Evid Based Pract Child Adolesc Ment Health 2020; 5:483-500. [PMID: 35573031 DOI: 10.1080/23794925.2020.1796547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In accordance with Taylor & Francis policy and their ethical obligation as researchers, the authors of this paper report the following disclosures. Dr. Asarnow receives grant, research, or other support from the National Institute of Mental Health, the Substance Abuse and Mental Health Services Administration (SAMHSA), the American Foundation for Suicide Prevention, the American Psychological Foundation, the Society of Clinical Child and Adolescent Psychology (Division 53 of the APA), and the Association for Child and Adolescent Mental Health. She has consulted on quality improvement for suicide/self-harm prevention and depression, serves on the Scientific Council of the American Foundation for Suicide Prevention, and the Scientific Advisory Board of the Klingenstein Third Generation Foundation. Drs. Asarnow, Goldston, Tunno, and Inscoe receive funding from a SAMHSA UCLA-Duke National Child Traumatic Stress Network Center grant, the purpose of which is to train, implement, and disseminate the intervention described in this report. There are no commercial conflicts of interest. Drs. Pynoos and Tunno receive funding from the National Center of the National Child Traumatic Stress Network, SAMHSA. Lastly, Dr. Robert Pynoos is the Chief Medical Officer of Behavioral Health Innovations, LLC, which licenses and receives payment for the use of the UCLA PTSD Reaction Index for DSM-5.
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Affiliation(s)
- Joan Rosenbaum Asarnow
- UCLA-Duke Center for Trauma-Informed Adolescent Suicide, Self-Harm & Substance Abuse Treatment & Prevention (ASAP), Partner in the National Child Traumatic Stress Network, Los Angeles, CA.,David Geffen School of Medicine, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, CA
| | - David B Goldston
- UCLA-Duke Center for Trauma-Informed Adolescent Suicide, Self-Harm & Substance Abuse Treatment & Prevention (ASAP), Partner in the National Child Traumatic Stress Network, Los Angeles, CA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Angela M Tunno
- UCLA-Duke Center for Trauma-Informed Adolescent Suicide, Self-Harm & Substance Abuse Treatment & Prevention (ASAP), Partner in the National Child Traumatic Stress Network, Los Angeles, CA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC.,UCLA-Duke National Center, National Child Traumatic Stress Network, Los Angeles, CA
| | - Adrienne Banny Inscoe
- UCLA-Duke Center for Trauma-Informed Adolescent Suicide, Self-Harm & Substance Abuse Treatment & Prevention (ASAP), Partner in the National Child Traumatic Stress Network, Los Angeles, CA.,David Geffen School of Medicine, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, CA
| | - Robert Pynoos
- UCLA-Duke Center for Trauma-Informed Adolescent Suicide, Self-Harm & Substance Abuse Treatment & Prevention (ASAP), Partner in the National Child Traumatic Stress Network, Los Angeles, CA.,UCLA-Duke National Center, National Child Traumatic Stress Network, Los Angeles, CA
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Ribeiro SP, LaCroix JM, De Oliveira F, Novak LA, Lee-Tauler SY, Darmour CA, Perera KU, Goldston DB, Weaver J, Soumoff A, Ghahramanlou-Holloway M. The Link between Posttraumatic Stress Disorder and Functionality among United States Military Service Members Psychiatrically Hospitalized Following a Suicide Crisis. Healthcare (Basel) 2018; 6:E95. [PMID: 30087239 PMCID: PMC6164520 DOI: 10.3390/healthcare6030095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 07/18/2018] [Accepted: 07/30/2018] [Indexed: 11/25/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is one of the most commonly diagnosed psychiatric disorders in the United States and has been linked to suicidal thoughts and behaviors, yet the role of a PTSD diagnosis on functional impairment among suicidal individuals remains unknown. This study examined the association between PTSD status and functional impairment among military psychiatric inpatients admitted for acute suicide risk (N = 166) with a lifetime history of at least one suicide attempt. Measures of functionality included: (1) alcohol use; (2) sleep quality; (3) social problem-solving; and (4) work and social adjustment. Thirty-eight percent of the sample met criteria for PTSD. Women were more likely than men to meet criteria for PTSD (p = 0.007), and participants who met PTSD criteria had significantly more psychiatric diagnoses (p < 0.001). Service members who met PTSD criteria reported more disturbed sleep (p = 0.003) and greater difficulties with work and social adjustment (p = 0.004) than those who did not meet PTSD criteria. However, functionality measures were not significantly associated with PTSD status after controlling for gender and psychiatric comorbidity. Gender and number of psychiatric comorbidities other than PTSD were significant predictors of PTSD in logistic regression models across four functionality measures. Future studies should assess the additive or mediating effect of psychiatric comorbidities in the association between impaired functioning and PTSD. Clinicians are encouraged to assess and address functionality during treatment with suicidal individuals, paying particular attention to individuals with multiple psychiatric diagnoses.
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Affiliation(s)
- Sissi Palma Ribeiro
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Jessica M LaCroix
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Fernanda De Oliveira
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Laura A Novak
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Su Yeon Lee-Tauler
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Charles A Darmour
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - Kanchana U Perera
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
| | - David B Goldston
- Department of Psychiatry, Duke University, Durham, NC 27708, USA.
| | - Jennifer Weaver
- Inpatient Psychiatry, Fort Belvoir Community Hospital, VA 22060, USA.
| | - Alyssa Soumoff
- Department of Psychiatry, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
| | - Marjan Ghahramanlou-Holloway
- Suicide Care, Prevention, and Research Initiative, Department of Medical & Clinical Psychology, Uniformed Services University, Bethesda, MD 20814, USA.
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Godoy Garraza L, Peart Boyce S, Walrath C, Goldston DB, McKeon R. An Economic Evaluation of the Garrett Lee Smith Memorial Suicide Prevention Program. Suicide Life Threat Behav 2018; 48:3-11. [PMID: 27982449 DOI: 10.1111/sltb.12321] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 06/17/2016] [Accepted: 10/11/2016] [Indexed: 11/27/2022]
Abstract
For more than a decade, the Garrett Lee Smith Youth Suicide Prevention Program has provided funding for community-based suicide prevention programs to states, tribes, and colleges across the United States. Recent studies provided evidence of the program's effectiveness in reducing suicide mortality and suicide attempts among youth. This study compares the cost of implementing the program with the estimated savings resulting from avoided hospitalization and emergency department visits associated with the averted suicide attempts. The findings suggest that the cost of implementing multifaceted community-based suicide prevention strategies may be more than outweighed by savings in the health sector.
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Affiliation(s)
| | | | | | | | - Richard McKeon
- Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
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34
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Copeland WE, Goldston DB, Costello EJ. Adult Associations of Childhood Suicidal Thoughts and Behaviors: A Prospective, Longitudinal Analysis. J Am Acad Child Adolesc Psychiatry 2017; 56:958-965.e4. [PMID: 29096778 PMCID: PMC6501553 DOI: 10.1016/j.jaac.2017.08.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/09/2017] [Accepted: 09/07/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Suicidal thoughts and behavior (STBs) have their peak period of onset in adolescence, but little is known about how such behavior is associated with later functioning. The aim of this study is to test whether childhood STBs are related to adult psychiatric, suicidal, and functional outcomes. METHOD This is a prospective, population-based community study of 1,420 participants assessed with structured interviews up to 7 times in childhood/adolescence (ages 9-16 years; 6,674 observations) for STBs including passive and active ideation, plans, and attempts. Participants were then assessed 4 times in young adulthood (ages 19, 21, 24, and 30 years; 4,556 observations of 1,273 participants) for psychiatric diagnoses, STBs, and functional outcomes. RESULTS By age 16 years, 7.0% of participants had reported some type of STBs, with 3.9% reporting an attempt. Both ideation only and suicide attempts were associated with higher levels of anxiety disorders and STBs in adulthood, as well as poor functioning across financial, health, risky/illegal, and social domains. These observed effects generally were attenuated after adjusting for other psychiatric and psychosocial factors that predict childhood STBs (particularly maltreatment, depression, and disruptive behavior disorders). The exception was adult suicidal behavior, which was predicted by both childhood ideation and attempts, even in the fully adjusted model. Children and adolescents with STBs were more likely to have had a disrupted transition to adulthood. CONCLUSION Childhood STBs are a marker for a multitude of poor psychiatric and functional outcomes in adulthood, but these effects are largely accounted for by other factors. In contrast, childhood STBs are a robust risk factor for adult suicidal thoughts and behavior.
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Daniel SS, Goldston DB, Erkanli A, Heilbron N, Franklin JC. Prospective Study of Major Loss Life Events and Risk for Suicidal Thoughts and Behaviors Among Adolescents and Young Adults. Suicide Life Threat Behav 2017; 47:436-449. [PMID: 27862201 PMCID: PMC6485934 DOI: 10.1111/sltb.12305] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 09/30/2015] [Accepted: 06/03/2016] [Indexed: 11/28/2022]
Abstract
This prospective, naturalistic study examined the association between major loss life experiences, other psychiatric risk factors (depression, hopelessness, and anxiety), and suicidal thoughts and behaviors (STBs) among adolescents followed through young adulthood for up to 14 years. Major loss life events were related to subsequent increases in STBs. Major loss life events were primarily related to increases in suicide ideation in the presence of lower levels of other risk factors. There was a bidirectional relationship between major losses and other risk factors. Implications for the association between loss experiences, other risk factors, and future STBs are discussed.
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Affiliation(s)
- Stephanie S. Daniel
- Family and Community Medicine; Wake Forest School of Medicine; Winston-Salem NC USA
| | - David B. Goldston
- Psychiatry and Behavioral Sciences; Duke University School of Medicine; Durham NC USA
| | | | - Nicole Heilbron
- Psychiatry and Behavioral Sciences; Duke University School of Medicine; Durham NC USA
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Doyle O, Magan I, Cryer-Coupet QR, Goldston DB, Estroff SE. “Don’t wait for it to rain to buy an umbrella:” The transmission of values from African American fathers to sons. Psychology of Men & Masculinity 2016. [DOI: 10.1037/men0000028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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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Goldston DB, Erkanli A, Daniel SS, Heilbron N, Weller B, Doyle O. Developmental Trajectories of Suicidal Thoughts and Behaviors From Adolescence Through Adulthood. J Am Acad Child Adolesc Psychiatry 2016; 55:400-407.e1. [PMID: 27126854 PMCID: PMC5035543 DOI: 10.1016/j.jaac.2016.02.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/08/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Little is known about the patterns among individuals in the long-term course of suicidal thoughts and behaviors (STBs). The objective of this study was to identify developmental trajectories of STBs from adolescence through young adulthood, as well as risk and protective covariates, and nonsuicidal outcomes associated with these trajectories. METHOD A total of 180 adolescents (ages 12-18 years at recruitment) were repeatedly assessed over an average of 13.6 years (2,273 assessments) since their psychiatric hospitalization. Trajectories were based on ratings of STBs at each assessment. Covariates included psychiatric risk factors (proportion of time in episodes of psychiatric disorders, hopelessness, trait anxiety, impulsivity, and aggression in adulthood, sexual and physical abuse, parental history of suicidal behavior), protective factors (survival and coping beliefs, social support in adulthood, parenthood), and nonsuicidal outcomes (social adjustment and functional impairment in adulthood, school drop-out, incarcerations). RESULTS Using a Bayesian group-based trajectory model, 4 trajectories of STBs were identified: an increasing risk class (11%); a highest overall risk class (12%); a decreasing risk class (33%); and a low risk class (44%). The 4 classes were associated with distinct patterns of correlates in risk and protective factors and nonsuicidal outcomes. CONCLUSION Adolescents and young adults have heterogeneous developmental trajectories of STBs. These trajectories and their covariates may inform strategies for predicting STBs and targeting interventions for individuals at risk for suicidal behavior.
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Godoy Garraza L, Walrath C, Goldston DB, Reid H, McKeon R. Effect of the Garrett Lee Smith Memorial Suicide Prevention Program on Suicide Attempts Among Youths. JAMA Psychiatry 2015; 72:1143-9. [PMID: 26465226 DOI: 10.1001/jamapsychiatry.2015.1933] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [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: 11/14/2022]
Abstract
IMPORTANCE Youth suicide prevention is a major public health priority. Studies documenting the effectiveness of community-based suicide prevention programs in reducing the number of nonlethal suicide attempts have been sparse. OBJECTIVE To determine whether a reduction in suicide attempts among youths occurs following the implementation of the Garrett Lee Smith Memorial Suicide Prevention Program (hereafter referred to as the GLS program), consistent with the reduction in mortality documented previously. DESIGN, SETTING, AND PARTICIPANTS We conducted an observational study of community-based suicide prevention programs for youths across 46 states and 12 tribal communities. The study compared 466 counties implementing the GLS program between 2006 and 2009 with 1161 counties that shared key preintervention characteristics but were not exposed to the GLS program. The unweighted rounded numbers of respondents used in this analysis were 84 000 in the control group and 57 000 in the intervention group. We used propensity score-based techniques to increase comparability (on background characteristics) between counties that implemented the GLS program and counties that did not. We combined information on program activities collected by the GLS national evaluation with information on county characteristics from several secondary sources. The data analysis was performed between April and August 2014. P < .05 was considered statistically significant. EXPOSURES Comprehensive, multifaceted suicide prevention programs, including gatekeeper training, education and mental health awareness programs, screening activities, improved community partnerships and linkages to service, programs for suicide survivors, and crisis hotlines. MAIN OUTCOMES AND MEASURES Suicide attempt rates for each county following implementation of the GLS program for youths 16 to 23 years of age at the time the program activities were implemented. We obtained this information from the National Survey on Drug Use and Health administered to a large national probabilistic sample between 2008 and 2011. RESULTS Counties implementing GLS program activities had significantly lower suicide attempt rates among youths 16 to 23 years of age in the year following implementation of the GLS program than did similar counties that did not implement GLS program activities (4.9 fewer attempts per 1000 youths [95% CI, 1.8-8.0 fewer attempts per 1000 youths]; P = .003). More than 79 000 suicide attempts may have been averted during the period studied following implementation of the GLS program. There was no significant difference in suicide attempt rates among individuals older than 23 years during that same period. There was no evidence of longer-term differences in suicide attempt rates. CONCLUSIONS AND RELEVANCE Comprehensive GLS program activities were associated with a reduction in suicide attempt rates. Sustained suicide prevention programming efforts may be needed to maintain the reduction in suicide attempt rates.
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Affiliation(s)
| | | | | | - Hailey Reid
- Public Health Division, ICF International, New York, New York
| | - Richard McKeon
- Substance Abuse and Mental Health Services Administration, Rockville, Maryland
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Susanne Condron D, Garraza LG, Walrath CM, McKeon R, Goldston DB, Heilbron NS. Identifying and Referring Youths at Risk for Suicide Following Participation in School-Based Gatekeeper Training. Suicide Life Threat Behav 2015; 45:461-76. [PMID: 25442731 DOI: 10.1111/sltb.12142] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [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: 12/05/2013] [Accepted: 09/12/2014] [Indexed: 11/27/2022]
Abstract
Gatekeeper training is a core strategy of the Garrett Lee Smith Memorial Suicide Prevention Act of 2004. Using data gathered from school-based gatekeeper trainings implemented by GLS grantees, this analysis examines training and gatekeeper factors associated with (1) identification and referral patterns and (2) services at-risk youths receive. Time spent interacting with youths was positively correlated with the number of gatekeeper identifications and knowledge about service receipt. Gatekeepers who participated in longer trainings identified proportionately more at-risk youths than participants in shorter trainings. Most gatekeeper trainees referred the identified youths to services regardless of training type.
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Affiliation(s)
| | | | | | - Richard McKeon
- Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
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Doyle O, Clark TT, Cryer-Coupet Q, Nebbitt VE, Goldston DB, Estroff SE, Magan I. Unheard Voices: African American Fathers Speak about their Parenting Practices. Psychol Men Masc 2015; 16:274-283. [PMID: 26366126 DOI: 10.1037/a0038730] [Citation(s) in RCA: 22] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Researchers have called for qualitative investigations into African American fathers' parenting practices that consider their social context and identify specific practices. Such investigations can inform the way we conceptualize African American fathers' parenting practices, which can in turn contribute to prevention interventions with at-risk youth. We conducted semi-structured, qualitative interviews about parenting with 30 self-identified, African American, biological fathers of pre-adolescent sons at-risk for developing aggressive behaviors, depressive symptoms, or both. Fathers provided descriptions of their parenting practices, which were at times influenced by their environmental context, fathers' residential status, and masculine ideologies. Our systematic analysis revealed four related themes that emerged from the data: managing emotions, encouragement, discipline, and monitoring. Of particular note, fathers in the current sample emphasized the importance of teaching their sons to manage difficult emotions, largely utilized language consistent with male ideologies (i.e., encouragement rather than love or nurturance), and engaged in high levels of monitoring and discipline in response to perceived environmental challenges and the developmental needs of their sons. The findings provide deeper insight into the parenting practices of African American fathers who are largely understudied, and often misunderstood. Further, these findings highlight considerations that may have important implications for father-focused prevention interventions that support African American fathers, youth, and families.
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Affiliation(s)
- Otima Doyle
- University of Illinois, Chicago, Jane Addams College of Social Work (Drs. Doyle, Nebbitt, Mrs. Cryer-Coupet, and Ms. Magan); Duke University Medical Center, Department of Psychiatry and Behavioral Sciences (Drs. Doyle, Goldston); University of North Carolina, Chapel Hill, School of Social Work (Dr. Clark); University of North Carolina, Chapel Hill, Departments of Social Medicine, Psychiatry, and Anthropology (Dr. Estroff)
| | - Trenette T Clark
- University of Illinois, Chicago, Jane Addams College of Social Work (Drs. Doyle, Nebbitt, Mrs. Cryer-Coupet, and Ms. Magan); Duke University Medical Center, Department of Psychiatry and Behavioral Sciences (Drs. Doyle, Goldston); University of North Carolina, Chapel Hill, School of Social Work (Dr. Clark); University of North Carolina, Chapel Hill, Departments of Social Medicine, Psychiatry, and Anthropology (Dr. Estroff)
| | - Qiana Cryer-Coupet
- University of Illinois, Chicago, Jane Addams College of Social Work (Drs. Doyle, Nebbitt, Mrs. Cryer-Coupet, and Ms. Magan); Duke University Medical Center, Department of Psychiatry and Behavioral Sciences (Drs. Doyle, Goldston); University of North Carolina, Chapel Hill, School of Social Work (Dr. Clark); University of North Carolina, Chapel Hill, Departments of Social Medicine, Psychiatry, and Anthropology (Dr. Estroff)
| | - Von E Nebbitt
- University of Illinois, Chicago, Jane Addams College of Social Work (Drs. Doyle, Nebbitt, Mrs. Cryer-Coupet, and Ms. Magan); Duke University Medical Center, Department of Psychiatry and Behavioral Sciences (Drs. Doyle, Goldston); University of North Carolina, Chapel Hill, School of Social Work (Dr. Clark); University of North Carolina, Chapel Hill, Departments of Social Medicine, Psychiatry, and Anthropology (Dr. Estroff)
| | - David B Goldston
- University of Illinois, Chicago, Jane Addams College of Social Work (Drs. Doyle, Nebbitt, Mrs. Cryer-Coupet, and Ms. Magan); Duke University Medical Center, Department of Psychiatry and Behavioral Sciences (Drs. Doyle, Goldston); University of North Carolina, Chapel Hill, School of Social Work (Dr. Clark); University of North Carolina, Chapel Hill, Departments of Social Medicine, Psychiatry, and Anthropology (Dr. Estroff)
| | - Sue E Estroff
- University of Illinois, Chicago, Jane Addams College of Social Work (Drs. Doyle, Nebbitt, Mrs. Cryer-Coupet, and Ms. Magan); Duke University Medical Center, Department of Psychiatry and Behavioral Sciences (Drs. Doyle, Goldston); University of North Carolina, Chapel Hill, School of Social Work (Dr. Clark); University of North Carolina, Chapel Hill, Departments of Social Medicine, Psychiatry, and Anthropology (Dr. Estroff)
| | - Ifrah Magan
- University of Illinois, Chicago, Jane Addams College of Social Work (Drs. Doyle, Nebbitt, Mrs. Cryer-Coupet, and Ms. Magan); Duke University Medical Center, Department of Psychiatry and Behavioral Sciences (Drs. Doyle, Goldston); University of North Carolina, Chapel Hill, School of Social Work (Dr. Clark); University of North Carolina, Chapel Hill, Departments of Social Medicine, Psychiatry, and Anthropology (Dr. Estroff)
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Abstract
OBJECTIVE A systematic literature review was conducted to assess the impact of patients' psychiatric hospitalizations on caregivers. METHODS A systematic search of the Web of Knowledge, PsycINFO, and MEDLINE (PubMed) was conducted for peer-reviewed articles published in English before August 31, 2013. Qualitative, quantitative, and mixed-methods studies were included if they focused on the outcomes of caregivers of either adult or youth patients and presented data collected directly from caregivers of patients who had been psychiatrically hospitalized. RESULTS Twenty-nine articles met the inclusion criteria. The review found that caregivers are heterogeneous in their reaction to patients' psychiatric hospitalization; however, many report distress. Many caregivers have reported experiencing stigma, disruptions in daily life, worse general medical health, economic strain, and changes in relationships after hospitalization. Negative reactions to the hospitalization may decrease over time, but distress can remain elevated compared with the general population. Nonetheless, many caregivers have also reported experiencing positive changes as a result of the hospitalization. The reaction of caregivers may be influenced by the severity of the patient's psychiatric problems as well as the caregiver's demographic characteristics and style of coping. CONCLUSIONS Caregivers experience a range of reactions to psychiatric hospitalizations. Providing caregivers with psychoeducation about their possible reaction to hospitalization and teaching them coping techniques may improve clinical outcomes for patients. Future research is needed to understand the heterogeneity in caregivers' reactions to patients' psychiatric hospitalization.
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Affiliation(s)
- Bridget E Weller
- Dr. Weller and Dr. Goldston are with the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (e-mail: ). Ms. Faulkner and Dr. Daniel are with the Center for Youth, Family, and Community Partnerships, University of North Carolina at Greensboro. Dr. Doyle is with Jane Addams College of Social Work, University of Illinois at Chicago
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Walrath C, Garraza LG, Reid H, Goldston DB, McKeon R. Impact of the Garrett Lee Smith youth suicide prevention program on suicide mortality. Am J Public Health 2015; 105:986-93. [PMID: 25790418 DOI: 10.2105/ajph.2014.302496] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether a reduction in youth suicide mortality occurred between 2007 and 2010 that could reasonably be attributed to Garrett Lee Smith (GLS) program efforts. METHODS We compared youth mortality rates across time between counties that implemented GLS-funded gatekeeper training sessions (the most frequently implemented suicide prevention strategy among grantees) and a set of matched counties in which no GLS-funded training occurred. A rich set of background characteristics, including preintervention mortality rates, was accounted for with a combination of propensity score-based techniques. We also analyzed closely related outcomes that we did not expect to be affected by GLS as control outcomes. RESULTS Counties implementing GLS training had significantly lower suicide rates among the population aged 10 to 24 years the year after GLS training than similar counties that did not implement GLS training (1.33 fewer deaths per 100 000; P = .02). Simultaneously, we found no significant difference in terms of adult suicide mortality rates or nonsuicide youth mortality the year after the implementation. CONCLUSIONS These results support the existence of an important reduction in youth suicide rates resulting from the implementation of GLS suicide prevention programming.
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Affiliation(s)
- Christine Walrath
- Christine Walrath, Lucas Godoy Garraza, and Hailey Reid are with the Public Health Division, ICF International, New York, NY. David B. Goldston is with the Duke University School of Medicine, Durham, NC. Richard McKeon is with the Substance Abuse and Mental Health Services Administration, Rockville, MD
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Goldston DB, Daniel SS, Erkanli A, Heilbron N, Doyle O, Weller B, Sapyta J, Mayfield A, Faulkner M. Suicide attempts in a longitudinal sample of adolescents followed through adulthood: Evidence of escalation. J Consult Clin Psychol 2015; 83:253-64. [PMID: 25622200 DOI: 10.1037/a0038657] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study was designed to examine escalation in repeat suicide attempts from adolescence through adulthood, as predicted by sensitization models (and reflected in increasing intent and lethality with repeat attempts, decreasing amount of time between attempts, and decreasing stress to trigger attempts). METHOD In a prospective study of 180 adolescents followed through adulthood after a psychiatric hospitalization, suicide attempts, and antecedent life events were repeatedly assessed (M = 12.6 assessments, SD = 5.1) over an average of 13 years 6 months (SD = 4 years 5 months). Multivariate logistic, multiple linear, and negative binomial regression models were used to examine patterns over time. RESULTS After age 17-18, the majority of suicide attempts were repeat attempts (i.e., made by individuals with prior suicidal behavior). Intent increased both with increasing age, and with number of prior attempts. Medical lethality increased as a function of age but not recurrent attempts. The time between successive suicide attempts decreased as a function of number of attempts. The amount of precipitating life stress was not related to attempts. CONCLUSIONS Adolescents and young adults show evidence of escalation of recurrent suicidal behavior, with increasing suicidal intent and decreasing time between successive attempts. However, evidence that sensitization processes account for this escalation was inconclusive. Effective prevention programs that reduce the likelihood of individuals attempting suicide for the first time (and entering this cycle of escalation), and relapse prevention interventions that interrupt the cycle of escalating suicidal behavior among individuals who already have made attempts are critically needed. (PsycINFO Database Record
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Affiliation(s)
| | - Stephanie S Daniel
- Center for Youth, Family, and Community Partnerships, University of North Carolina at Greensboro
| | | | | | - Otima Doyle
- Jane Addams College of Social Work, University of Illinois
| | | | | | - Andrew Mayfield
- Center for Youth, Family, and Community Partnerships, University of North Carolina at Greensboro
| | - Madelaine Faulkner
- Center for Youth, Family, and Community Partnerships, University of North Carolina at Greensboro
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Conner KR, Wyman P, Goldston DB, Bossarte RM, Lu N, Kaukeinen K, Tu XM, Houston RJ, Lamis DA, Chan G, Bucholz KK, Hesselbrock VM. Two Studies of Connectedness to Parents and Suicidal Thoughts and Behavior in Children and Adolescents. J Clin Child Adolesc Psychol 2014; 45:129-40. [PMID: 25310350 DOI: 10.1080/15374416.2014.952009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We tested hypotheses that greater connectedness to parent(s) is associated with lower risk for nonlethal suicidal thoughts and behavior (STB), termed direct protective effects, and that parent connectedness serves to moderate (lower) the risk for STB associated with psychopathology including major depressive episode (MDE), termed moderating protective effects. Independent samples of children and adolescents recruited for a multicenter study of familial alcoholism were studied. Generalized estimating equation models were used that adjusted for age, sex, and youth psychopathology variables. The sample for Study 1 was assessed at baseline and about 2- and 4-year follow-ups, with baseline characteristics of n = 921, M age = 14.3 ± 1.8 years, and 51.8% female. The sample for Study 2 was assessed at baseline and about 5-year follow-up, with baseline characteristics of n = 867, M age = 12.0 ± 3.2 years, and 51.0% female. In both studies, increased perceived connectedness to father but not mother was associated with lower risk for measures of STB, consistent with direct protective effects. In Study 1, measures of parent connectedness were associated with lower risk for STB but only for youth that did not experience MDE (or alcohol use disorder), inconsistent with moderating protective effects. Study 2 showed that connectedness to fathers was associated with lower risk for suicide plans or attempts (severe STB) but not frequent thoughts of death or dying (nonsevere STB). Improved connectedness to fathers may lower risk for STB in children and adolescents, consistent with direct protective effects. Hypotheses about moderating protective effects were not supported.
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Affiliation(s)
- Kenneth R Conner
- a Department of Psychiatry , University of Rochester Medical Center , Rochester , New York , USA.,b VA VISN 2 Center of Excellence for Suicide Prevention , Canandaigua VA Medical Center , Canandaigua , New York , USA
| | - Peter Wyman
- a Department of Psychiatry , University of Rochester Medical Center , Rochester , New York , USA
| | - David B Goldston
- c Department of Psychiatry and Behavioral Sciences , Duke University School of Medicine , Durham , North Carolina , USA
| | - Robert M Bossarte
- a Department of Psychiatry , University of Rochester Medical Center , Rochester , New York , USA.,b VA VISN 2 Center of Excellence for Suicide Prevention , Canandaigua VA Medical Center , Canandaigua , New York , USA
| | - Naiji Lu
- d Department of Biostatistics , University of Rochester Medical Center , Rochester , New York , USA
| | - Kimberly Kaukeinen
- d Department of Biostatistics , University of Rochester Medical Center , Rochester , New York , USA
| | - Xin M Tu
- d Department of Biostatistics , University of Rochester Medical Center , Rochester , New York , USA
| | - Rebecca J Houston
- e Research Institute on Addictions , State University of New York at Buffalo , Buffalo , New York , USA
| | - Dorian A Lamis
- f Department of Psychiatry and Behavioral Sciences , Emory University School of Medicine , Atlanta , Georgia , USA
| | - Grace Chan
- g Department of Psychiatry , University of Connecticut Health Center , Farmington , Connecticut , USA
| | - Kathleen K Bucholz
- h Department of Psychiatry and Midwest Alcoholism Research Center , Washington University School of Medicine, Washington University , St. Louis , Missouri , USA
| | - Victor M Hesselbrock
- g Department of Psychiatry , University of Connecticut Health Center , Farmington , Connecticut , USA
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Doyle O, Goldston DB, Dzirasa E, Fontes M, Estroff S, Burriss A. “You gotta have a good help mate”: African American fathers’ co-parenting experiences. Psychology of Men & Masculinity 2014. [DOI: 10.1037/a0034732] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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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46
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Conner KR, Bossarte RM, Lu N, Kaukeinen K, Chan G, Wyman P, Tu XM, Goldston DB, Houston RJ, Bucholz KK, Hesselbrock VM. Parent and child psychopathology and suicide attempts among children of parents with alcohol use disorder. Arch Suicide Res 2014; 18:117-30. [PMID: 24716789 PMCID: PMC4059391 DOI: 10.1080/13811118.2013.826154] [Citation(s) in RCA: 11] [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] [Indexed: 10/25/2022]
Abstract
Parents with psychopathology such as alcohol use disorder (AUD) that confers risk for suicide attempt (SA) may have children who are more likely to develop such psychopathology and to attempt suicide, suggesting that risk may be "transmitted" from parents to children. We examined this phenomenon during the transition from childhood to adolescence, when risk for SA increases dramatically. A cohort of 418 children were examined at average age 9.4 (range 7-14) years at enrollment (Time 1, childhood) and approximately 5 years later, prior to reaching age 18 (Time 2, adolescence). One or both biological parents, oversampled for AUD, were also interviewed. Structural equation models (SEM) examined father-child, mother-child, and either/both parent-child associations. The primary outcome was SA over follow-up among offspring, assessed at Time 2. As hypothesized, parental antisocial personality disorder predicted conduct disorder symptoms in offspring both during childhood and adolescence (parent-child model, father-child model) and maternal AUD predicted conduct disorder symptoms during childhood (mother-child model). However, we did not find evidence to support transmission of depression from parents to offspring either during childhood or adolescence, and parent psychopathology did not show statistically significant associations with SA during adolescence. In conclusion, we conducted a rare study of parent-to-child "transmission" of risk for SA that used a prospective research design, included diagnostic interviews with both parents and offspring, and examined the transition from childhood to adolescence, and the first such study in children of parents with AUD. Results provided mixed support for hypothesized parent-child associations.
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Affiliation(s)
- Kenneth R Conner
- a University of Rochester Medical Center , Rochester , New York , USA
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Pisani AR, Wyman PA, Petrova M, Schmeelk-Cone K, Goldston DB, Xia Y, Gould MS. Emotion regulation difficulties, youth-adult relationships, and suicide attempts among high school students in underserved communities. J Youth Adolesc 2013; 42:807-20. [PMID: 23666604 PMCID: PMC3654393 DOI: 10.1007/s10964-012-9884-2] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [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] [Received: 08/28/2012] [Accepted: 11/30/2012] [Indexed: 10/27/2022]
Abstract
To develop and refine interventions to prevent youth suicide, knowledge is needed about specific processes that reduce risk at a population level. Using a cross-sectional design, the present study tested hypotheses regarding associations between self-reported suicide attempts, emotion regulation difficulties, and positive youth-adult relationships among 7,978 high-school students (48.6% male, 49.9% female) in 30 high schools from predominantly rural, low-income communities. 683 students (8.6%) reported a past-year suicide attempt. Emotion regulation difficulties and a lack of trusted adults at home and school were associated with increased risk for making a past-year suicide attempt, above and beyond the effects of depressive symptoms and demographic factors. The association between emotion regulation difficulties and suicide attempts was modestly lower among students who perceived themselves as having higher levels of trusted adults in the family, consistent with a protective effect. Having a trusted adult in the community (outside of school and family) was associated with fewer suicide attempts in models that controlled only for demographic covariates, but not when taking symptoms of depression into account. These findings point to adolescent emotion regulation and relationships with trusted adults as complementary targets for suicide prevention that merit further intervention studies. Reaching these targets in a broad population of adolescents will require new delivery systems and "option rich" (OR) intervention designs.
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Affiliation(s)
- Anthony R Pisani
- Department of Psychiatry, University of Rochester, Rochester, NY 14642, USA.
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Pisani AR, Schmeelk-Cone K, Gunzler D, Petrova M, Goldston DB, Tu X, Wyman PA. Associations between suicidal high school students' help-seeking and their attitudes and perceptions of social environment. J Youth Adolesc 2012; 41:1312-24. [PMID: 22562217 PMCID: PMC3534737 DOI: 10.1007/s10964-012-9766-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [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] [Received: 01/26/2012] [Accepted: 04/07/2012] [Indexed: 10/28/2022]
Abstract
Suicide is a leading cause of death among adolescents, many of whom fail to disclose suicide concerns to adults who might help. This study examined patterns and predictors of help-seeking behavior among adolescents who seriously considered suicide in the past year. 2,737 students (50.9 % female, 46.9 % male; racial distribution 79.5 % Caucasian, 11.9 % Hispanic/Latino, and 3.6 % Black/African-American) from 12 high schools in rural/underserviced communities were surveyed to assess serious suicide ideation (SI) in the past year, disclosure of SI to adults and peers, attempts to get help, attitudes about help-seeking, perceptions of school engagement, and coping support. Help-seeking was defined as both disclosing SI to an adult and perceiving oneself as seeking help. The relationship between adolescents' help-seeking disclosure and (1) help-seeking attitudes and (2) perceptions of social resources was examined among suicidal help-seeking youth, suicidal non-help-seeking youth, and non-suicidal youth. Of the 381 (14 %) students reporting SI, only 23 % told an adult, 29 % sought adult help, and 15 % did both. Suicidal help-seekers were similar to non-suicidal peers on all measures of help-seeking attitudes and social environment perceptions. Positive attitudes about help-seeking from adults at school, perceptions that adults would respond to suicide concerns, willingness to overcome peer secrecy requests, and greater coping support and engagement with the school were associated with students' increased disclosure of SI and help-seeking. This study supports prevention strategies that change student norms, attitudes and social environments to promote help-seeking among adolescents with SI. Promising intervention targets include increasing students' perceptions of the availability and capability of adults to help them, and strengthening students' understanding of how existing resources can help them cope.
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Affiliation(s)
- Anthony R Pisani
- Department of Psychiatry, University of Rochester, Rochester, NY 14623, USA.
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Abstract
Substance use disorders and suicidal thoughts and behaviors commonly co-occur in adolescent and adult psychiatric populations and are often functionally interrelated. Although the evidence base for treatment of this population is sparse, integrated cognitive behavioral treatment (CBT) protocols, or those that rely heavily on CBT techniques, hold promise. In this paper, we provide an overview of the evidence-based literature for interventions that target suicidal behavior and substance use disorders with adults and adolescents. We then discuss the manner in which these behaviors may be functionally interrelated and offer a conceptual framework (S-O-R-C) to guide case conceptualization and treatment planning for clients with co-occurring suicidality and substance use disorders. Next, we provide a case example of a client with suicidal behavior and an alcohol use disorder and demonstrate how to apply an integrated CBT treatment protocol to this case. This case example is followed by a more general discussion about the potential advantages of integrated CBT protocols for suicidality and substance use disorders, guidelines for prioritizing treatment targets and skill selection for each individual client, and other important treatment considerations. We conclude with recommendations for future research in this area.
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