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A model of suicidal behavior in posttraumatic stress disorder (PTSD): The mediating role of defeat and entrapment.
Abstract
The aim of this study was to examine whether depression, hopelessness and perceptions of defeat and entrapment mediated the effects of posttraumatic stress disorder (PTSD) symptoms on suicidal behavior. Participants were 73 individuals (mean age=29.2, S.D.=10.9, 79.5% female) diagnosed with current or lifetime PTSD who reported at least one PTSD symptom in the past month. Participants completed a series of self-report measures assessing depression, hopelessness and perceptions of defeat and entrapment. The Clinician Administrated Posttraumatic Scale for DSM-IV was administered to assess the presence and severity of PTSD symptoms. The results of Structural Equation Modeling supported a model whereby perceptions of defeat and entrapment fully mediated the effects of PTSD symptom severity upon suicidal behavior. The finding that perceptions of defeat and entrapment mediate the relationship between PTSD symptom severity and suicidal behavior was replicated in a subgroup of participants (n=50) who met the full criteria for a current PTSD diagnosis. The results support a recent theoretical model of suicide (The Schematic Appraisal Model of Suicide) which argues that perceptions of defeat and entrapment have a key role in the development of suicidal behaviors. We discuss the clinical implications of the findings.
... Cross-sectional evidence has been obtained showing that defeat/entrapment is a robust predictor of suicidality across different research populations including students (), parasuicidal individuals (O'Connor, 2003; Rasmussen et al., 2010), and individuals with psychoses (). In PTSD, a cross-sectional study showed that defeat/entrapment was strongly linked with suicidality in PTSD (Panagioti, Gooding, Taylor, & Tarrier, 2013). However, the cross-sectional nature of the extant research precludes any inferences regarding the temporal order of defeat/entrapment and suicidal ideation. ...
... Consistent with our previous approach (Panagioti et al., 2012b;), defeat and entrapment in this study were treated as a single variable in the analyses. It should be noted that the present study is an extension of a recently published cross-sectional study (Panagioti et al., 2013). Although both studies are based on the same participants and baseline data, this study has two unique features: (a) it focuses on analyzing prospective data (obtained 13 to 15 months after baseline data) to provide the first test of the hypothesis that defeat/entrapment lead to changes in suicidal ideation over time; (b) it examines whether defeat/ entrapment mediated the effects of three well-known risk factors (PTSD severity, comorbid depressive symptoms, and hopelessness) on suicidal ideation using a prospective research design, whereas the previous study examined only the mediating effects of defeat/entrapment on the relationship between PTSD severity and suicidality using a cross-sectional design. ...
... Hence, suicidal ideation in PTSD might be primarily triggered by perceptions of defeat and entrapment. The latter explanation fits well with the findings of our previous crosssectional research that has shown that defeat/entrapment mediated the effects of PTSD severity on suicidality (Panagioti et al., 2013). On the basis of these findings, a fruitful direction for future research would be to examine whether perceived defeat/entrapment prospectively mediates the effects of PTSD severity and comorbid depression severity on suicidal ideation. ...
Objectives:
This study aimed to provide the first prospective test of the ability of defeat and entrapment to predict suicidal ideation in posttraumatic stress disorder (PTSD) after controlling for the effects of PTSD severity, comorbid depressive symptoms, and hopelessness on suicidal ideation.
Methods:
Participants were 52 individuals diagnosed with PTSD. Baseline and follow-up assessments were 13 to 15 months apart. Defeat and entrapment were conceptualized and analyzed as a unique construct (defeat/entrapment) in this study. Multiple regression analysis was applied to examine the predictive effects of defeat/entrapment on suicidal ideation.
Results:
Defeat/entrapment scores predicted changes in the levels of suicidal ideation at follow-up while controlling for baseline suicidal ideation, PTSD severity, comorbid depressive symptoms, and hopelessness.
Conclusions:
These outcomes provide support to contemporary models of suicidality that suggest that defeat/entrapment is a strong predictor of suicidality in PTSD.
... Die Defeat Scale wurde, wie auch die Entrapment Scale, ursprünglich von Gilbert und Allan [1] entwickelt. In klinischen wie studentischen Stichproben sowie Gruppen von Gefängnisinsassen zeigte die Defeat Scale gute interne Konsistenzwerte (Cronbach's α > 0,85) und gute konvergente Validität im Sinne von positiven Zusammenhängen mit Depressivität und Hoff-nungslosigkeit [1,[11][12][13][14]. Darüber hinaus wurde die Defeat Scale in Studien zur Entwicklung suizidalen Erlebens und Verhaltens eingesetzt. ...
... Um den Mittelwert berechnen zu können, müssen die Items 2, 4 und 9 invertiert werden [23]. In Studien zur englischen Version zeigte sich eine hohe interne Konsistenz von α > 0,85 [1,[11][12][13]. nicht zu können [23]. ...
... The two scales consist of 16 items each using a five-point Likert scale. The DS showed good internal consistency and good convergent and criterion validity in terms of positive relations with depression, hopelessness and suicidality in students, patients, and male prison inmate samples [1,6,[17][18][19][20][21][22]. The ES showed comparable psychometric characteristics in terms of internal consistency and convergent and criterion validity [1,23]. ...
... Previous studies found high internal consistency (a = .86, [1,17,18,21]). The German version used in this study [34] has been translated according to the guidelines of the ISPOR Task Force for Translation and Cultural Adaption and shows good internal consistency (Cronbach's α = 0.95) [35]. ...
Background
Defeat and entrapment have been shown to be of central relevance to the development of different disorders. However, it remains unclear whether they represent two distinct constructs or one overall latent variable. One reason for the unclarity is that traditional factor analytic techniques have trouble estimating the right number of clusters in highly correlated data. In this study, we applied a novel approach based on network analysis that can deal with correlated data to establish whether defeat and entrapment are best thought of as one or multiple constructs. Methods
Explanatory graph analysis was used to estimate the number of dimensions within the 32 items that make up the defeat and entrapment scales in two samples: an online community sample of 480 participants, and a clinical sample of 147 inpatients admitted to a psychiatric hospital after a suicidal attempt or severe suicidal crisis. Confirmatory Factor analysis (CFA) was used to test whether the proposed structure fits the data. ResultsIn both samples, bootstrapped exploratory graph analysis suggested that the defeat and entrapment items belonged to different dimensions. Within the entrapment items, two separate dimensions were detected, labelled internal and external entrapment. Defeat appeared to be multifaceted only in the online sample. When comparing the CFA outcomes of the one, two, three and four factor models, the one factor model was preferred. Conclusions
Defeat and entrapment can be viewed as distinct, yet, highly associated constructs. Thus, although replication is needed, results are in line with theories differentiating between these two constructs.
... Three studies not included in the meta-analysis are also worthy of comment. The first two explored the role of entrapment in post-traumatic disorder [27,28] and the third focused on adolescents [29]. Panagioti et al. found that entrapment was significantly higher among trauma victims with PTSD compared to those without [28] and that defeat and entrapment fully mediated the relationship between PTSD symptom severity and suicidal behavior [27]. ...
... The first two explored the role of entrapment in post-traumatic disorder [27,28] and the third focused on adolescents [29]. Panagioti et al. found that entrapment was significantly higher among trauma victims with PTSD compared to those without [28] and that defeat and entrapment fully mediated the relationship between PTSD symptom severity and suicidal behavior [27]. Despite being consistent with the IMV Relationship between entrapment and suicidal behavior O'Connor and Portzky 13 model, these findings need to be replicated prospectively. ...
Suicide and suicidal behavior are major public health concerns. As a result, a number of psychological models have been developed to better understand the emergence of suicidal ideation and suicide attempts. One such model is the integrated motivational-volitional model, a tri-partite model of suicidal behavior, which posits that entrapment is central to the final common pathway to suicide. In this review we summarize the extant research evidence for the relationship between entrapment and suicidal ideation and behavior. Although there is robust evidence for the relationship between entrapment and suicidal ideation and behavior, there are gaps in our knowledge. We discuss the clinical implications and suggest key directions for future research.
... Die Defeat Scale wurde, wie auch die Entrapment Scale, ursprünglich von Gilbert und Allan [1] entwickelt. In klinischen wie studentischen Stichproben sowie Gruppen von Gefängnisinsassen zeigte die Defeat Scale gute interne Konsistenzwerte (Cronbach's α > 0,85) und gute konvergente Validität im Sinne von positiven Zusammenhängen mit Depressivität und Hoffnungslosigkeit [1,[11][12][13][14]. Darüber hinaus wurde die Defeat Scale in Studien zur Entwicklung suizidalen Erlebens und Verhaltens eingesetzt. ...
... Um den Mittelwert berechnen zu können, müssen die Items 2, 4 und 9 invertiert werden [23]. In Studien für die englische Version zeigte sich eine hohe interne Konsistenz von α > 0,85 [1,[11][12][13]. ...
Introduction:
Defeat and entrapment are transdiagnostic constructs that play an important role in the development of depression, anxiety, suicidality and trauma-associated mental disorders. The present study aimed at presenting and validating a first German version of the Defeat-Scale (DS-d).
Material and methods:
Through a web-based survey, N=480 participants were recruited (74% female; MAge=28.5, SDAge=11.1, Range: 18-80 years); 14.2% reported to currently suffer from a mental disorder, 8.5% reported at least one lifetime suicide attempt. All participants filled in the DS-d, the Entrapment Scale, the Rasch-based Depression Screening, the Depressive Symptoms Inventory - Suicidality Subscale, the Suicidal Behavior Questionnaire-Revised, the Childhood Trauma Screener, and the questionnaire Generalized Anxiety Disorders 2. Factorial validity was investigated through a unidimensional confirmatory factor analysis (CFA). Moreover, internal consistency, convergent validity (correlations with the other measured constructs) and criterion validity (suicidality) were examined.
Results:
One residual correlation between 2 items that are inversely coded had to be allowed to reach a satisfying fit to the unidimensional model (RMSEA=0.077, TLI=0.94, NFI=0.93, CFI=0.95; item loadings>0.56). The DS-d-sumscore correlated highly with depression (r=0.87), Entrapment (r=0.83) and suicidality (r=0.70), and moderately with the other constructs. Participants with suicidal thoughts or behavior in the past showed higher DS-d-scores than participants without suicidality.
Discussion:
The unidimensional structure of the English version could be confirmed in the DS-d - after allowing for a residual correlation between two inversely coded items. Correlations with the other measured constructs give support for the validity of the DS-d. Criterion validity of the instrument is supported by its relations to suicidality. It remains open whether defeat and entrapment are 2 distinct constructs. In the current study - in accordance with the literature - both showed a very high intercorrelation.
Conclusion:
This study reports on the validation of a German version of the Defeat-Scale (DS-d) for the first time that shows good psychometric characteristics in terms of internal consistency and validity.
... Fourth, all of the existing studies which examined the association of PTSD with suicidality in adolescents were a-theoretical and, therefore, theoretically driven studies are sorely needed for clear hypothesis testing, a coherent integration of findings, and a determination of the next research steps. Our research team's work, which drew on two contemporary theoretical models of suicide (Schematic Appraisals Model of suicide and Cry of Pain) [28,30] suggested that psycho-cognitive appraisals of defeat and entrapment, hopelessness and low levels of social support are strong indicators of suicidality in adults with PTSD [13,23,[82][83][84]. Despite this, to date no effort has been made to replicate these findings in adolescents with PTSD. ...
... Fifth, we were unable to examine the influence of psychological factors that may account for the association between PTSD and suicidality, such as diagnosis of depression, type of trauma [90], prolonged trauma or multiple traumas [91], the influence of subjective negative appraisals (i.e. defeat and entrapment), hopelessness [12,13,83] and severity of particular PTSD symptoms [92,93], because none of the studies analyzed provided such information. ...
Purpose:
There is growing evidence in the literature that a diagnosis of Posttraumatic Stress Disorder (PTSD) is an important contributory factor to suicidality in adolescents. However, there is no existing review of the literature examining the relationship between PTSD and suicidality in adolescents. This study aims to provide the first systematic review and meta-analysis of the association between PTSD and suicidality in adolescents.
Methods:
Five bibliographic databases (Medline, EMBASE, PsycINFO, Web of Science and PILOT) were screened for suitable articles. Twenty-eight studies (which provided 28 independent samples) were included in the review. The overall meta-analyses of the association between PTSD and suicidality were followed by subgroup and meta-regression analyses.
Results:
A highly significant positive association was found between PTSD and suicidality (d = 0.701, 95% CI 0.555-0.848). The subgroup and meta-regression analyses showed that the association between PTSD and suicidality persisted whilst adjusting for various sources of between-study heterogeneity, such as, different levels of severity of suicidality, target groups, and methodological quality of the studies.
Conclusions:
Suicidality in adolescents with PTSD is a major problem which requires further research effort. The implications of these results are discussed.
... Second, the CARMS CBSPp intervention has been developed from evidence based on working with people with a range of severe mental health problems, such as those given diagnoses of schizophrenia, PTSD, the bipolar disorders and depression [32,62,63,107,[111][112][113][114][115]120]. This means that the intervention has a mechanistic, scientific basis which examines both transdiagnostic and the specificities of mental health problems, for example hallucinations and delusions, in the pathways to suicidal thoughts and behaviours [9]. ...
Background: Suicide is a leading cause of death globally. Suicide deaths are elevated in those experiencing severe mental health problems, including schizophrenia. Psychological talking therapies are a potentially effective means of alleviating suicidal thoughts, plans, and attempts. However, talking therapies need to i) focus on suicidal experiences directly and explicitly, and ii) be based on testable psychological mechanisms. The Cognitive AppRoaches to coMbatting Suicidality (CARMS) project is a Randomised Controlled Trial (RCT) which aims to investigate both the efficacy and the underlying mechanisms of a psychological talking therapy for people who have been recently suicidal and have non-affective psychosis.
Methods: The CARMS trial is a two-armed single-blind RCT comparing a psychological talking therapy (Cognitive Behavioural Suicide Prevention for psychosis [CBSPp]) plus Treatment As Usual (TAU) with TAU alone. There are primary and secondary suicidality outcome variables, plus mechanistic, clinical, and health economic outcomes measured over time. The primary outcome is a measure of suicidal ideation at 6months after baseline. The target sample size is 250, with approximately 125 randomised to each arm of the trial, and an assumption of up to 25% attrition. Hence, the overall recruitment target is up to 333. An intention to treat analysis will be used with primary stratification based on National Health Service (NHS) recruitment site and antidepressant prescription medication. Recruitment will be from NHS mental health services in the North West of England, UK. Participants must be 18 or over; be under the care of mental health services; have mental health problems which meet ICD-10 non-affective psychosis criteria; and have experienced self-reported suicidal thoughts, plans, and/or attempts in the 3 months prior to recruitment. Nested qualitative work will investigate the pathways to suicidality, experiences of the therapy, and identify potential implementation challenges beyond a trial setting as perceived by numerous stake-holders.
Discussion: This trial has important implications for countering suicidal experiences for people with psychosis. It will provide definitive evidence about the efficacy of the CBSPp therapy; the psychological mechanisms which lead to suicidal experiences; and provide an understanding of what is required to implement the intervention into services should it be
efficacious.
Trial registration: ClinicalTrials.gov (NCT03114917), 14th April 2017. ISRCTN (reference ISRCTN17776666 https://doi.org/10.1186/ISRCTN17776666); 5th June 2017). Registration was recorded prior to participant recruitment commencing.
... Elevated defeat, entrapment and suicidal behaviour have also been found in individuals with trauma and a diag- nosis of post-traumatic stress disorder (PTSD), relative to those with trauma but no PTSD diagnosis [71]. Furthermore, defeat and entrapment mediate the relationship between PTSD symptoms and suicidal behaviour [72]. The centrality of entrapment within the suicidal process was also evident in a study of 200 adult psychiatric patients who had been hos- pitalized following a suicide attempt or suicidal ideation. ...
Suicide is a major public health concern accounting for 800 000 deaths globally each year. Although there have been many advances in understanding suicide risk in recent decades, our ability to predict suicide is no better now than it was 50 years ago. There are many potential explanations for this lack of progress, but the absence, until recently, of comprehensive theoretical models that predict the emergence of suicidal ideation distinct from the transition between suicidal ideation and suicide attempts/suicide is key to this lack of progress. The current article presents the integrated motivational–volitional (IMV) model of suicidal behaviour, one such theoretical model. We propose that defeat and entrapment drive the emergence of suicidal ideation and that a group of factors, entitled volitional moderators (VMs), govern the transition from suicidal ideation to suicidal behaviour. According to the IMV model, VMs include access to the means of suicide, exposure to suicidal behaviour, capability for suicide (fearlessness about death and increased physical pain tolerance), planning, impulsivity, mental imagery and past suicidal behaviour. In this article, we describe the theoretical origins of the IMV model, the key premises underpinning the model, empirical tests of the model and future research directions.
This article is part of the theme issue ‘Evolutionary thanatology: impacts of the dead on the living in humans and other animals'.
... Elevated defeat, entrapment and suicidal behaviour have also been found in individuals with trauma and a diagnosis of post-traumatic stress disorder (PTSD), relative to those with trauma but no PTSD diagnosis [71]. Furthermore, defeat and entrapment mediate the relationship between PTSD symptoms and suicidal behaviour [72]. The centrality of entrapment within the suicidal process was also evident in a study of 200 adult psychiatric patients who had been hospitalised following a suicide attempt or suicidal ideation. ...
Suicide is a major public health concern accounting for 800,000 deaths globally each year. Although there have been many advances in understanding suicide risk in recent decades, our ability to predict suicide is no better now than it was 50 years ago. There are many potential explanations for this lack of progress but the absence, until recently, of comprehensive theoretical models that predicted the emergence of suicidal ideation distinct from the transition between suicidal ideation and suicide attempts/suicide is key to this lack of progress. The current article presents the integrated motivational–volitional (IMV) model of suicidal behaviour, one such theoretical model. We propose that defeat and entrapment drive the emergence of suicidal ideation and that a group of factors, entitled volitional moderators, govern the transition from suicidal ideation to suicidal behaviour. According to the IMV model, volitional moderators include access to the means of suicide, exposure to suicidal behaviour, capability for suicide (fearlessness about death and increased physical pain tolerance), planning, impulsivity, mental imagery and past suicidal behaviour. In this article, we describe the theoretical origins of the IMV model, the key premises underpinning the model, empirical tests of the model and future research directions.
... According to these models, entrapment, defined as a felt urgency to escape from an unbearable situation from which there is no perceived escape [16], could be a core psychological mechanism in causal pathways to suicide. In agreement with this hypothesis, a strong positive association was found between perceptions of entrapment and suicidality in a range of subacute outpatient populations [17][18][19][20][21][22][23]. O'Connor's group also demonstrated that entrapment added incremental predictive validity for suicidal behaviors over depression, hopelessness, SI, and the frequency of previous suicide attempts [24]. ...
Background:
Prior research has validated the construct of a suicide crisis syndrome (SCS), a specific psychological state that precedes and may precipitate suicidal behavior. The feeling of entrapment is a central concept of the SCS as well as of several other recent models of suicide. However, its exact relationship with suicidality is not fully understood. In efforts to clarify the exact role of entrapment in the suicidal process, we have examined if entrapment mediates the relationship of other components of the SCS, including ruminative flooding, panic-dissociation, fear of dying and emotional pain, with suicidal ideation (SI) in recently hospitalized psychiatric inpatients.
Methods:
The Suicide Crisis Inventory (SCI) and Beck Scale for Suicidal Ideation (BSS) were administered to 200 high-risk adult psychiatric inpatients hospitalized following SI or suicide attempt, assessing SCS and SI levels at admission, respectively. The possible mediation effects of entrapment on the relationship between the other components of the SCS and SI at admission were evaluated.
Results:
Entrapment significantly and fully mediated the relationship of ruminative flooding, panic-dissociation, and fear of dying with SI, with no direct relationships between these variables and SI reaching statistical significance. Further, no reverse mediation relationships between these variables and SI were found, indicating that the mediation effects of entrapment were unidirectional. While entrapment did mediate the association between emotional pain and SI, the direct relationship between emotional pain and SI was also significant. Moreover, in reverse mediational analysis, emotional pain was a partial mediator of the relationship between entrapment and SI.
Conclusion:
Entrapment and emotional pain may have a more direct association with SI than the other components of the SCS, including ruminative flooding, panic-dissociation, and fear of dying, the effects of which are mediated by the former. This suggests entrapment and emotional pain may represent key symptomatic targets for intervention in acutely suicidal individuals. Further research is needed to determine the relationship of these constructs to suicidal behavior.
... Third, both PTSD and depression may play independent roles in the emergence of underlying suicide-related processual component such as feelings of hopelessness, emptiness and entrapment. Our results highlight that despite the overlap between PTSD numbing symptoms and MDD symptoms (Elhai et al., 2008(Elhai et al., , 2011, they have an additive role with regard to the different suicidal behaviours which is consistent with the underlying processual component hypothesis (Panagioti et al., 2013). These transdiagnostic processes are also implied in the association between AUD/SUD and suicidal behaviours. ...
Objective:
The current study examined whether trauma characteristics such as the type and number of traumatic events were associated with three suicidal behaviours (i.e. ideation, plan and attempt) after adjusting for sociodemographic factors, post-traumatic symptoms and history of psychiatric disorders.
Method:
Data came from the 2007 Australian National Survey of Mental Health and Wellbeing ( N = 8841). Respondents were asked about exposure to 28 traumatic events that occurred during their lifetime. Suicidal behaviours were measured using three statements about whether the person ever seriously thought about or planned or attempted suicide.
Results:
Sexual violence and exposure to multiple traumatic events were particularly associated with suicidal behaviours. The presence of the emotional numbing symptom cluster and co-occurrence of three psychiatric disorders (major depressive disorder, alcohol use disorder and substance use disorder) also increased the odds of suicidal behaviours. Analysis of age of onset revealed that the mean age of traumatic exposure was earlier than the age at which suicidal behaviours emerged.
Conclusions:
The current study is the first to demonstrate that sexual violence and exposure to multiple traumatic events are associated with suicidal behaviours in a representative sample of Australian adults. The results underline the potential benefits of thorough assessment of trauma history, post-traumatic symptoms and history of psychiatric disorders and their additive contribution in suicide risk among trauma victims. These findings can be used by clinicians and researchers for early intervention programmes.
... In accord with the theoretical assumption, a number of studies have found a strong positive association between perceptions of entrapment and suicide ideation/behaviour in a range of different populations such as students , prisoners (Slade, Edelmann, Worrall, & Bray, 2012), parasuicidal individuals (Rasmussen et al., 2010) and patients suffering from psychoses (Taylor, Gooding, Wood, Johnson, Pratt & Tarrier, 2010) and posttraumatic stress disorder (PTSD; Panagioti, Gooding, Taylor & Tarrier, 2012. Some of these studies have also shown that perceptions of entrapment mediate the effects of PTSD symptom severity (Panagioti et al., 2013) as well as positive psychotic symptoms and perceptions of defeat (Rasmussen et al., 2010) upon suicide ideation and suicidal behaviour. In a four-year prospective study, entrapment and frequency of past suicide attempts were the only significant predictors of subsequent suicide attempts in a sample of seventy suicidal patientseven after controlling for suicide ideation, hopelessness and depression (O'Connor, Smyth, Ferguson, Ryan, & Williams, 2013). ...
Rumination has been shown to be positively associated with suicide ideation. Yet, only few studies have attempted to explain potential mediators of this association. Perceptions of entrapment are a core component of recent psychological models of suicidality and might mediate the relationship between rumination and suicide ideation. Possible mediator effects were investigated in an online sample (n = 142) and a clinical sample (n = 226) of adults receiving outpatient psychotherapy. Results demonstrated that perceptions of entrapment fully mediated the association between ruminative thinking and suicide ideation. However, the reverse relationship, where the association between entrapment and suicide ideation is mediated by ruminative thinking, was not supported. These findings suggest that the relationship between rumination and suicide ideation is explained by perceptions of entrapment. Theoretical and clinical implications are discussed. Copyright © 2015 John Wiley & Sons, Ltd.
Key practitioner message:
Ruminative thinking and perceptions of entrapment are associated with suicidal ideation and suicidal behavior. Perceptions of entrapment fully mediate the association between ruminative thinking and suicide ideation. Clinically, it could be useful to incorporate perceptions of entrapment into the psychosocial risk assessment of persons contemplating suicide.
... The second possibility is the mediating role of depression in the association between PTSD and suicidality. The third possible interpretation corresponds to the role of both PTSD and depression in the aggravation of suicide related factors such as feelings of entrapment, defeat and hopelessness (Panagioti, Gooding, Taylor, & Tarrier, 2013). Concerning the relation between the recent suicide attempt and panic attack symptom, our results are in line with studies showing that the hyperarousal symptom cluster of PTSD is associated with suicidality. ...
The present study focuses on variables moderating the incidence of recent suicide attempt in a large community sample (n = 39,617) of French citizens with various levels of trauma. Five trauma levels were established based on Post-Traumatic Stress Disorder items of the MINI. Twenty-three symptoms were examined as potential moderating variables with a fan-shaped pattern. Seven symptoms regarding desire for death, self-harm intention, suicidal ideation, lifetime suicide attempt, depressed mood, loss of interest, and panic attack exhibited the fan-shaped pattern. The absence of these moderating symptoms decreases the incidence of suicide attempt and their presence leads to a gradual increase.
... Additionally, individuals involved in peacekeeping may have also been less likely to expect the experience of trauma compared to individuals who were in active military combat. Research also suggests that factors such as feelings of hopelessness , defeat, and entrapment may mediate the relationship between PTSD and the development of suicidality (Maria, Gooding, Taylor, & Tarrier, 2012; Panagioti, Gooding, & Tarrier, 2012; Panagioti, Gooding, Taylor, & Tarrier, 2013; Taylor, Gooding, Wood, & Tarrier, 2011 ). Traumas such as peacekeeping/relief work in a war zone or being kidnapped/held hostage/prisoner of war may have been more highly associated with hopelessness, defeat, or entrapment possibly stemming from a perceived lack of control over war conditions, compared to other traumas of a similar nature that were associated with lower rates of suicide ideation or attempt. ...
Posttraumatic stress disorder (PTSD) is associated with suicidal ideation and suicide attempt; however, research has largely focused on specific samples and a limited range of traumas. We examined suicidal ideation and suicide attempt relating to 27 traumas within a nationally representative U.S. sample of individuals with PTSD. Data were from the National Epidemiologic Survey of Alcohol and Related Conditions (N = 34,653). Participants were assessed for lifetime PTSD and trauma history, suicidal ideation, and suicide attempt. We calculated the proportion of individuals reporting suicidal ideation or suicide attempt for each trauma and for the number of unique traumas experienced. Most traumas were associated with greater suicidal ideation and suicide attempt in individuals with PTSD compared to individuals with no lifetime trauma or with lifetime trauma but no PTSD. Childhood maltreatment, assaultive violence, and peacekeeping traumas had the highest rates of suicidal ideation (49.1% to 51.9%) and suicide attempt (22.8% to 36.9%). There was substantial variation in rates of suicidal ideation and suicide attempt for war and terrorism-related traumas. Multiple traumas increased suicidality, such that each additional trauma was associated with an increase of 20.1% in rate of suicidal ideation and 38.9% in rate of suicide attempts. Rates of suicidal ideation and suicide attempts varied markedly by trauma type and number of traumas, and these factors may be important in assessing and managing suicidality in individuals with PTSD.
Copyright © 2015 Wiley Periodicals, Inc., A Wiley Company.
... Suicidality is a serious public health problem, and approximately one million suicides and ten million suicide attempts occur worldwide each year (Hawton and van Heeringen, 2009;Mann, 2003;World Health Organization, 2014;Zhang et al., 2014). An extensive body of research suggests that suicidal behavior results from the complex interaction of numerous cumulative factors (Dieserud et al., 2001;O'Connor and Sheehy, 2001;Owen et al., 2015;Panagioti et al., 2013;Taylor et al., 2010;Wasserman et al., 2007). Therefore, a biopsychosocial conceptualization of suicidal behavior is utilized in many clinical settings (Hoffman, 2000;King and Merchant, 2008;O'Connor and Nock, 2014). ...
... Both, the negative appraisal system and the suicide schema are viewed as dynamic processes which constantly interact and strengthen each other (Johnson et al., 2008;Pratt et al., 2010;Taylor et al., 2011). Suicidal thoughts and acts are thought to emerge as a means of escape from the experience of severe feelings of defeat and entrapment caused by the constant maladaptive interaction of the appraisal system and suicide schema (Taylor et al., 2010a(Taylor et al., , 2010bPanagioti et al., 2013). For example, the appraisal of common stressors, such as, negative social interactions, psychiatric symptoms, and personal characteristics in terms of defeat and entrapment activate and strengthen suicide schema which in turn generates more rigid and difficult to overcome negative appraisals (Johnson et al., 2008). ...
... Another noteworthy observation is that none of studies included in this review was guided by a coherent theoretical model of suicide. The work of our research group has focused on examining the applications of two contemporary theories of suicide, namely Cry of Pain Model and Schematic Appraisals Model of Suicide, in a range of clinical groups (Johnson, Gooding, & Tarrier, 2008;Panagioti et al., 2012a;Panagioti, Gooding, Taylor, & Tarrier, 2013;Panagioti, Gooding, & Tarrier, 2015;Taylor, Gooding, Wood, & Tarrier, 2011).As a result of this theorydriven approach, negative appraisals of defeat and entrapment have repeatedly found to be the main drivers of suicidality among individuals with PTSD, psychoses and para-suicidal individuals (Panagioti et al., 2012a;Taylor et al., 2011). The consistency of the findings across different research groups suggests that these processes could actually be generic and trans-diagnostic (Conceicao Costa et al., 2012) and therefore applicable to OCD. ...
... Moreover, Cluster C (Avoidance) was related to SA in this sample of veterans. Consistent with previous literature, avoidance symptoms have been associated with suicide behaviors in a community sample (Panagioti et al., 2013); nonetheless, these findings have not been previously reported in a veteran population. Avoidance , especially in DSM–5, is a hallmark of PTSD and must be present in some form for the diagnosis to be given. ...
A connection between suicidality and posttraumatic stress disorder (PTSD) has been consistently demonstrated; however, the underlying relationship between suicidality and PTSD remains unclear. The aim of this study was to examine patterns of DSM-5 PTSD symptom endorsement that differentiated veteran participants with and without a history of suicide behaviors. We enrolled 95 veterans, 32 of whom reported no suicide ideation (SI) or suicide attempts (SA). The 63 remaining participants reported a history of SI, with 28 of the 63 also reporting a historical SA. Participants completed a standardized diagnostic interview (Structured Clinical Interview for DSM-IV-TR; First, Spitzer, Gibbon, & Williams, 2002), structured interview of suicidal behaviors (Columbia-Suicide Severity Rating Scale; Posner et al., 2011), and selected clinical measures. Veterans who reported SI and/or SA were more likely to meet criteria for PTSD on DSM-5 than were veterans who reported neither SI nor SA. Participants who reported SA were more likely to meet criteria for clusters C and D. Finally, at the symptom level, those who reported SI were more likely to report experiencing feelings of alienation. Those who reported a SA were more likely to report avoidance of thoughts and feelings, inability to recall an important aspect of their trauma, persistent negative beliefs, diminished interest, and feelings of alienation. These findings suggest that targeting specific symptoms of PTSD may aid in treatment of suicidal thoughts and behaviors associated with PTSD. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
... Some models suggest that certain PTSD symptoms directly increase suicide risk; for example, more severe re-experiencing and numbing symptoms, including physiological reactivity to trauma cues, inability to recall parts of the trauma, and a sense of a foreshortened future are directly associated with suicide attempts [92]. Other models highlight the role of various cognitive-affective processes as direct or indirect mediators between PTSD and suicidality, including perceptions of defeat and entrapment (e.g., [93]), negative self-appraisals (e.g., [94]), hopelessness (e.g., [91]), and guilt and shame (e.g., [95]). In addition, some models propose that the link between PTSD and suicidal behavior is partially explained and/or compounded by other comorbid problems such as functional impairment [96], depression [97], sleep disturbance [98], and alcohol dependence [99]. ...
Prolonged exposure (PE) is an effective psychological treatment for patients who suffer from PTSD. The majority of PTSD patients have comorbid psychiatric disorders, and some clinicians are hesitant to use PE with comorbid patients because they believe that comorbid conditions may worsen during PE. In this article, we reviewed the evidence for this question: what are the effects of PE on comorbid symptoms and associated symptomatic features? We reviewed findings from 18 randomized controlled trials of PE that assessed the most common comorbid conditions (major depression, anxiety disorders, substance use disorders, personality disorders, and psychotic disorders) and additional symptomatic features (suicidality, dissociation, negative cognitions, negative emotions, and general health and work/social functioning). Although systematic research is not available for all comorbid populations, the existing research indicates that comorbid disorders and additional symptomatic features either decline along with the PTSD symptoms or do not change as a result of PE. Therefore, among the populations that have been studied to date, there is no empirical basis for excluding PTSD patients from PE due to fear of increases in comorbid conditions or additional symptomatic features. Limitations of the existing research and recommendations for future research are also discussed.
... Suicide accounts for 1.5% of all mortality, making it the 14th leading cause of death worldwide (O' Connor and Nock, 2014). An extensive body of research suggests that suicidal behaviour occurs as the result of a complex interaction between numerous cumulative factors (e.g., Dieserud et al., 2001;O'Connor and Sheehy, 2001;Panagioti et al., 2013;Taylor et al., 2010;Wasserman et al., 2007). Therefore, a biopsychosocial conceptualisation of suicidal behaviour is utilised within many clinical settings (e.g., Hoffman, 2000;King & Merchant, 2008;O'Connor and Nock, 2014;O'Connor and Sheehy, 2000). ...
... The perception of defeat and entrapment in the Schematic Appraisal Model of Suicide (Johnson, Gooding, & Tarrier, 2008) has been shown to be a key psychological mechanism leading to suicidal behavior (Johnson et al., 2008). The association between defeat and entrapment and suicidal behavior was also shown by Panagioti, Gooding, Taylor, and Tarrier (2012) and Panagioti, Gooding, Taylor, and Tarrier (2013) to be strongly positive even after controlling for comorbid depression. The pathway in which re-experiencing and avoidance symptoms may lead to suicide attempts can be explained by examining this association in individuals diagnosed with PTSD. ...
Introduction. Generalization of biological, social, and psychological predictors of self-destructive behavior is one of the main tasks for world health care at the present time. For this reason, the development of an integrative model of self-destructive behavior, taking into account the diversity of biopsychosocial factors, as well as their representation in the virtual environment, will be highly relevant. The integrative model can be used to create automated systems for analyzing socio-cultural risk factors of self-destructive behavior, as well as helping specialists to create prevention, maintenance and correction programs. The purpose of the study is to describe and generalize the factors of the real and virtual environment that mediate the risk of developing self-destructive behavior and to create a hierarchical generalized model of self-destructive behavior based on the synthesis of biopsychosocial and cyberpsychological paradigms. Materials and methods. For a holistic analysis of the basic concepts and the creation of a general model of selfdestructive behavior, we used a combined approach that includes content analysis to describe the factors mediating self-destructive behavior, the method of expert assessments for the selection of significant factors, mathematical and statistical analysis for processing the data obtained (methods of descriptive statistics, cluster analysis (Ward method)). The results of the study. As a result of cluster analysis , the following components of the self-destructive behavior model were identified: 1) "Peculiarities of self-attitude" (23.2%) (the dynamic component, depending on the specific situation, is highly significant for face-to-face diagnosis; 2) "Endogenous factors of self-destructive behavior" (20.2%) (violations of the emotional-volitional sphere); 3) "Exogenous factors of self-destructive behavior" (21.4%) (negative factors of upbringing); 4) "Negative factors of the socio-cultural environment" (17.3%) (traumatic micro- and macrofactors that can provoke the occurrence of self-destructive symptoms); 5) "Individual characteristics developed in the process of personality formation" (14.2%) (individual predictors of self-destruction); 6) "Factors of isolation from the social environment" (3.6%) (a number of personal predictors that prevent open active interaction with others and getting help). Conclusion. A number of new data describing the structure of the generalized model of self-destructive behavior and the main directions of risk analysis have been obtained. The leading factors of the micro- and macro-socio-cultural environment are identified, representing a wide range of markers available for study through the analysis of virtual communication. The possibility of combining a biopsychosocial model and the capabilities of a cyberpsychological approach to create a dynamic digital monitoring model that allows for a general risk assessment for large samples to minimize the resources of individual diagnostics is shown.
Introduction. The relevance of the problem stems from the importance of studying the psychological determinants of people’s attitudes to hazards. A number of factors among them that can act as safety resources are of special importance. These factors include psychological capital and resilience. The purpose of the study was to identify the relationship between psychological capital, resilience and people’s attitudes to hazards, as exemplified by students. Materials and methods. The following was used as diagnostic tools: original questionnaires aimed to assess sensitivity to threats and substantiate the choice of response methods in hazardous situations, the Russian author-modified version of F. Lutans, K. Joseph and B. Avolio questionnaire towards identifying psychological capital, a brief version of the resilience questionnaire adapted by M.V. Alfimova and V.E. Golimbet. The study encompassed 340 students from a number of higher educational establishments of Moscow, Ivanovo, Cherepovets (Russian Federation); women – 268 (78.82%), men – 72 (21.18%), average age 19.8 years old (SD=1.88). Results. It was found that sensitivity to threats and the choice of adequate response methods are positively correlated with psychological capital (r=0.38, p≤0.01 and r=0.43, p≤0.01) and resilience (r=0.31, p≤0.01 and r=0.33, p≤0.01). Conversely, exaggeration of hazards proved to be negatively correlated to psychological capital (r=-0.29, p≤0.01) and resilience (r=-0.21, p≤0.01); meanwhile downplaying (ignoring) threats was negatively correlated with hope (r=-0.25, p≤0.01), activity involvement (r=-0.16, p≤0.01) and positively correlated with risk acceptance (r=0.12, p≤0.05). Conclusion. The obtained results can be used in organising safety activities and in working with students towards development of adequate style of handling hazards.
Antecedentes:
El Modelo Integrado Motivacional-Volitivo contempla la ideación suicida como una reacción psicológica a una situación que se percibe como una derrota junto a la percepción de estar atrapado/a y sin posible escape ni rescate.
Objetivo:
El presente estudio tiene como objetivo adaptar al contexto español y analizar las propiedades psicométricas de dos escalas, una para medir derrota y otra para medir atrapamiento.
Método:
Doscientas treinta y cuatro personas de 18-35 años (58,6% mujeres) completaron un cuestionario online.
Resultados:
El análisis de la estructura interna mostró una solución bifactorial para la escala de derrota y una solución unifactorial para la escala de atrapamiento, ambas con adecuados índices de ajuste. Además, mostraron buena fiabilidad de las puntuaciones de los test y evidencias favorables de validez.
Conclusiones:
Disponer de ambas escalas adaptadas contribuye a mejorar la evaluación del riesgo suicida, así como a orientar la intervención y realizar aportaciones en el campo de la suicidología.
Introduction:
Suicidality is prevalent worldwide, particularly in people who access mental health services. The quality of therapeutic alliance between people with mental health difficulties and staff has been associated with suicidality but only in community settings. Defeat and entrapment are correlated with suicidality and may mediate any relationship between alliance and suicidality. Therefore this exploratory study explored these relationships in people admitted to mental health wards.
Aim:
To explore defeat, entrapment, suicidality and alliance between nurses and people admitted to mental health wards.
Method:
Fifty inpatient nurse-patient dyads completed questionnaires regarding demographics, defeat, entrapment, suicidality and alliance with their named nurse. Nurses completed questionnaires on demographics, alliance with their patient and the patients' suicidality.
Results:
Defeat, entrapment and suicidality were correlated. A correlation between nurse-rated bond and external entrapment was found but no other correlations between alliance, defeat, entrapment and suicidality were statistically significant.
Discussion and clinical implications:
Ward-based nurses should consider the relationship between defeat, entrapment and suicidality when developing interventions to improve suicidality. Although there was no evidence of a relationship between total alliance and suicidality, developing closer bonds with patients may reduce patients' feelings of being trapped by their environment. This article is protected by copyright. All rights reserved.
The present study examines variables affecting the incidence of recent suicide attempt in a large sample of participants who experienced various levels of traumatic morbidity. The sample was drawn from a French nationally representative, general population survey (N= 39,617). In the same line with previous research on the data provided by the survey, five levels of traumatic morbidity were used on the basis of answers to the post-traumatic stress disorder items from the French version of Mini International Neuropsychiatric Interview. Twenty four items, representing Axis I psychopathological symptoms and suicidality indexes, were tested to identify intervening variables moderating the suicide attempt incidence in any given traumatic morbidity level. Seven items yielded a systematic effect: four suicidality items, two major depression items and one panic disorder item. The main findings consist of (i) the suppressing effect of the absence of these symptoms, and (ii) the gradual increasing effect of their presence. These results underline the importance of comorbid symptoms in the association between trauma and suicidality.
In this article, we attempt to distinguish between the properties of moderator and mediator variables at a number of levels. First, we seek to make theorists and researchers aware of the importance of not using the terms moderator and mediator interchangeably by carefully elaborating, both conceptually and strategically, the many ways in which moderators and mediators differ. We then go beyond this largely pedagogical function and delineate the conceptual and strategic implications of making use of such distinctions with regard to a wide range of phenomena, including control and stress, attitudes, and personality traits. We also provide a specific compendium of analytic procedures appropriate for making the most effective use of the moderator and mediator distinction, both separately and in terms of a broader causal system that includes both moderators and mediators. (46 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Previous research has shown that exposure to traumatic events, especially sexual trauma during childhood, is associated with an increased risk of attempted suicide. However, no information is available as to whether the increased risk of attempted suicide is related primarily to posttraumatic stress disorder (PTSD) following traumatic experiences or applies also to persons who experienced trauma but did not develop PTSD.
We examine the association between exposure to traumatic events with and without resulting PTSD and the risk of a subsequent suicide attempt in a community sample of urban young adults.
A cohort study followed young adults who had participated in a randomized trial of all first-grade students entering 19 public schools.
Baltimore, Maryland, an urban setting.
A total of 1698 young adults (mean age, 21; 47% male; 71% African American) who represented 75% of the original cohort of 2311 persons.
Relative risk of a subsequent suicide attempt associated with PTSD and with exposure to assaultive and non-assaultive traumas (no PTSD), as estimated using discrete time survival analysis.
Posttraumatic stress disorder was associated with increased risk of a subsequent suicide attempt. The PTSD-suicide attempt association was robust, even after adjustment for a prior major depressive episode, alcohol abuse or dependence, and drug abuse or dependence (adjusted relative risk, 2.7; 95% confidence interval, 1.3-5.5; P < .01). In contrast, exposure to traumatic events without PTSD was not associated with an increased risk of attempted suicide.
Posttraumatic stress disorder is an independent predictor of attempted suicide. Exposure to traumatic events without PTSD is not associated with a later suicide attempt.
SYNOPSIS
Post-traumatic stress disorder (PTSD) was studied in the Piedmont region of North Carolina. Among 2985 subjects, the lifetime and six month prevalence figures for PTSD were 1·30 and 0·44 % respectively. In comparison to non-PTSD subjects, those with PTSD had significantly greater job instability, family history of psychiatric illness, parental poverty, child abuse, and separation or divorce of parents prior to age 10. PTSD was associated with greater psychiatric co-morbidity and attempted suicide, increased frequency of bronchial asthma, hypertension, peptic ulcer and with impaired social support. Differences were noted between chronic and acute PTSD on a number of measures, with chronic PTSD being accompanied by more frequent social phobia, reduced social support and greater avoidance symptoms.
Administered a scale designed to quantify hopelessness to 294 hospitalized suicide attempters, 23 general medical outpatients, 62 additional hospitalized suicide attempters, and 59 depressed psychiatric patients. The scale had a Kuder-Richardson-20 internal consistency coefficient of .93 and correlated well with the Stuart Future Test (SFT) and the pessimism item of the Beck Depression Inventory (BDI; .60 and .63, respectively). The scale was also sensitive to changes in the patient's state of depression over time, as evidenced by a correlation of .49 with change scores on the SFT and .49 with the change scores on the BDI. Findings also indicate that depressed patients have an unrealistically negative attitude toward the future and that seriousness of suicidal intent is more highly correlated with negative expectancies than with depression. A principal-components factor analysis revealed 3 factors which tapped affective, motivational, and cognitive aspects of hopelessness. (16 ref)
The social rank theory of psychopathology suggests that with the evolution of social hierarchies various psychobiological mechanisms became attuned to the success or failure in conflict situations. Specifically, subordinates and those who have lost status are at greater risk of pathology than winners and those of higher status. In this theory concepts of defeat and entrapment are seen to be of special relevance to the study of depression. We outline the role of defeat and entrapment within the social rank theory of depression.
New self-report measures of entrapment and defeat were developed and used to test predictions of the social rank theory of depression. Both a sample of students and depressed patients were assessed with these new scales and other social rank measures (e.g. social comparison and submissive behaviour).
The entrapment and defeat measures were found to have good psychometric properties and significantly correlated with depression. They were also strongly associated with other rank variables. Defeat maintained a strong association with depression even after controlling for hopelessness (r = 0.62), whereas the relationship between hopelessness and depression was substantially reduced when controlling for defeat. Entrapment and defeat added substantially to the explained variance of depression after controlling for the other social rank variables.
Defeat and entrapment appear to be promising variables for the study of depression. These variables may also help to develop linkages between human and animal models of psychopathology.
Most earlier studies of hopelessness as a risk factor for suicidal behavior were based on either clinical or restricted samples. Using a longitudinal study design with a community sample of more than 3,000 participants, we aimed to examine if hopelessness was a long-term predictor of suicidal behaviors.
Using longitudinal data from the Baltimore Epidemiologic Catchment Area (ECA) Program, we assessed the association of hopelessness at baseline and incident suicidal behaviors in the 13-year follow-up period, adjusting for the presence of depression and substance use disorders. Suicide behaviors studied included completed suicide, self-reported attempted suicide, and suicide ideation.
Hopelessness was predictive of all three types of suicidal behaviors in the follow-up period, even after adjustment. Persons who expressed hopelessness in 1981 were 11.2 times as likely to have completed suicide over the 13-year follow-up interval (95% confidence interval [1.8, 69.1]). The association between suicidality and hopelessness was stronger and more stable than the association of suicidality with the presence of depression and substance use disorders.
Hopelessness was an independent risk factor for completed suicide, suicide attempts, and suicidal ideation. Intervention strategies that lower hopelessness may be effective for suicide prevention.
The purpose of the study was to determine if patients with a history of major depressive episode and comorbid posttraumatic stress disorder (PTSD) have a higher risk for suicide attempt and differ in other measures of suicidal behavior, compared to patients with major depressive episode but no PTSD. In addition, to explore how PTSD comorbidity might increase risk for suicidal behavior in major depressive episode, the authors investigated the relationship between PTSD, cluster B personality disorder, childhood sexual or physical abuse, and aggression/impulsivity.
The subjects were 230 patients with a lifetime history of major depressive episode; 59 also had lifetime comorbid PTSD. The demographic and clinical characteristics of subjects with and without PTSD were compared. Multivariate analysis was used to examine the relationship between suicidal behavior and lifetime history of PTSD, with adjustment for clinical factors known to be associated with suicidal behavior.
Patients with a lifetime history of PTSD were significantly more likely to have made a suicide attempt. The groups did not differ with respect to suicidal ideation or intent, number of attempts made, or maximum lethality of attempts. The PTSD group had higher objective depression, impulsivity, and hostility scores; had a higher rate of comorbid cluster B personality disorder; and were more likely to report a childhood history of abuse. However, cluster B personality disorder was the only independent variable related to lifetime suicide attempts in a multiple regression model.
PTSD is frequently comorbid with major depressive episode, and their co-occurrence enhances the risk for suicidal behavior. A higher rate of comorbid cluster B personality disorder appears to be a salient factor contributing to greater risk for suicidal acts in patients with a history of major depressive episode who also have PTSD, compared to those with major depressive episode alone.
Chapter 5 explains the basis of the theory of entrapment, which is a state that results from a person perceiving that they are defeated and/or humiliated, feeling that they must escape, and sensing that their present situation will continue indefinitely. Suicidal acts are viewed as a means of an individual escaping from this positionin detail, including how deficiencies in problem solving, related to abnormalities of autobiographical memory, may contribute to a person feeling entrapped, and how a tendency to experience hopelessness may add to this. It also considers how differential activation—that is the tendency for patterns of moods, thoughts and bodily sensations all to be activated by changes in a single modality—may explain why some people rapidly and repeatedly experience thoughts of suicidal behaviour. This model is a basis for proposing how mindfulness-based cognitive therapy, already shown to be effective in preventing relapse of mood disorders, might have a significant role to play in the prevention of repetition of suicidal acts.
Through Monte Carlo simulation, small sample methods for evaluating overall data-model fit in structural equation modeling were explored. Type I error behavior and power were examined using maximum likelihood (ML), Satorra-Bentler scaled and adjusted (SB; Satorra & Bentler, 1988, 1994), residual-based (Browne, 1984), and asymptotically distribution free (ADF; Browne, 1982, 1984) test statistics. To accommodate small sample sizes the ML and SB statistics were adjusted using a k-factor correction (Bartlett, 1950); the residual-based and ADF statistics were corrected using modified χ 2 and F statistics (Yuan & Bentler, 1998, 1999). Design characteristics include model type and complexity, ratio of sample size to number of estimated parameters, and distributional form. The k-factor-corrected SB scaled test statistic was especially stable at small sample sizes with both normal and nonnormal data. Methodologists are encouraged to investigate its behavior under a wider variety of models and distributional forms.
Thanks to the theoretical and analytical frameworks developed by Preacher, Rucker and Hayes (2007) and further advanced by Hayes (2013), studies of moderated mediation effects (conditional indirect effects) are booming in recent years. Yet, to date the most popular analytical method for testing moderated mediation is the regression approach (including MODMED and PROCESS), which is based on observed variables that assume no measurement errors. It is well-known that measurement errors attenuate the estimated regression coefficients, but the problem is more serious when both the predictor and moderator in a moderated mediation model are measured with errors. Hence, we extend the analytical frameworks developed by Preacher et al. (2007) and Hayes (2013) to a latent variable model approach. We developed two SPSS macros to circumvent some of the limitations of Mplus in generating the bias-corrected bootstrap confidence interval for the regression coefficient of the interaction term of two latent variables. Results in the numerical example show that the latent variable model approach produces estimated effects that are close to the true values despite that the standard errors and the confidence intervals are larger due to the incorporation of measurement errors in the estimation. On the other hand, the observed variable regression approach underestimates the effects and produces inaccurate confidence intervals for some estimates, including the estimated moderated mediation effect, where the confidence interval does not include the true value. It may also result in inflated Type I error which makes interpretation of results difficult.
The psychometric properties of the Beck Hopelessness Scale (BHS) were examined among 544 university students. Internal consistency of scores was satisfactory (Cronbach’s alpha = .88). A principal-axis factor analysis with oblique rotation suggested four factors that were largely uninterpretable. Removal of items and further analysis suggested a two-factor structure of questionable interpretability. Convergent validity was demonstrated by high correlations with the Hope Scale and the Life Orientation Test (LOT). A correlation of .57 between the BHS and perceived stress reduced to .24 when trait negative affect was controlled for, indicating a degree of discriminant utility. It is concluded that for normal populations, measures such as the LOT and Hope Scale are more appropriate.
Previous research has suggested that parasuicides are impaired in their ability to generate positive future experiences. This study aimed to look at the relationship between future experiences, cognitive vulnerability and hopelessness in parasuicides and matched hospital controls. Parasuicides (N5 20) and matched hospital controls ( N5 20) were assessed the day following an episode of deliberate self-harm on measures of hopelessness, depression, anxiety, cognitive vulnerability and future directed thinking. The parasuicides differed from hospital controls on measures of depression, hopelessness and negative cognitive style in the predicted direction. Future positive thinking, depression and negative cognitive style explained 70.5% of the hopelessness variance. Future positive thinking was not correlated with either depression or negative cognitive style, whereas negative cognitive style was correlated with depression and hopelessness. Future directed thinking contributes to hopelessness independently of depression and does not seem to be associated with cognitive
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The cry of pain hypothesis (Pollock &Williams, 2001; Williams, 2001) is a psychological model of suicidal behavior that extends existing theories of escape (Baumeister, 1990) and arrested flight (Gilbert & Allan, 1998). The model conceptualizes suicidal behavior as the response (the cry) to a situation that has three components: defeat, no escape and no rescue. In this study, the model was tested empirically in a case control study, by comparing suicidal patients and matched hospital controls on measures of affect, stress and post-traumatic stress. The logistic regression analyses yielded evidence to support the model. The implications for future research are described.
Atest of significance for analysis into principal components is described and illustrated. Lawley's maximum likelihood method is discussed. Equivalent analyses of correlation structure, direct derivation of the
X2 approximation, closeness of the
X2 approximation, and the effect of eliminating the larger roots are examined on a theoretical basis. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Research has shown an increased frequency of suicidal behaviors in those with PTSD, but few studies have investigated the factors that underlie the emergence of suicidal behavior in PTSD. Two theories of suicide, the Cry of Pain and the Schematic Appraisal Model of Suicide, propose that feelings of hopelessness, defeat, and entrapment are core components of suicidality. This study aimed to examine the association between suicidal behavior and hopelessness, defeat, and entrapment in trauma victims with and without a PTSD diagnosis. The results demonstrated that hopelessness, defeat, and entrapment were significantly positively associated with suicidal behavior in those with PTSD. Hopelessness and defeat were also significantly positively associated with suicidal behavior in trauma victims without PTSD. In those with PTSD, the relationship between suicidal behavior and hopelessness and entrapment remained significant after controlling for comorbid depression. The findings provide support for the contemporary theories of suicidality and have important clinical implications.
Because of the importance of mediation studies, researchers have been continuously searching for the best statistical test for mediation effect. The approaches that have been most commonly employed include those that use zero-order and partial correlation, hierarchical regression models, and structural equation modeling (SEM). This study extends MacKinnon and colleagues (MacKinnon, Lockwood, Hoffmann, West, & Sheets, 2002; MacKinnon, Lockwood, & Williams, 2004, MacKinnon, Warsi, & Dwyer, 1995) works by conducting a simulation that examines the distribution of mediation and suppression effects of latent variables with SEM, and the properties of confidence intervals developed from eight different methods. Results show that SEM provides unbiased estimates of mediation and suppression effects, and that the bias-corrected bootstrap confidence intervals perform best in testing for mediation and suppression effects. Steps to implement the recommended procedures with Amos are presented.
This article examines the adequacy of the “rules of thumb” conventional cutoff criteria and several new alternatives for various fit indexes used to evaluate model fit in practice. Using a 2‐index presentation strategy, which includes using the maximum likelihood (ML)‐based standardized root mean squared residual (SRMR) and supplementing it with either Tucker‐Lewis Index (TLI), Bollen's (1989) Fit Index (BL89), Relative Noncentrality Index (RNI), Comparative Fit Index (CFI), Gamma Hat, McDonald's Centrality Index (Mc), or root mean squared error of approximation (RMSEA), various combinations of cutoff values from selected ranges of cutoff criteria for the ML‐based SRMR and a given supplemental fit index were used to calculate rejection rates for various types of true‐population and misspecified models; that is, models with misspecified factor covariance(s) and models with misspecified factor loading(s). The results suggest that, for the ML method, a cutoff value close to .95 for TLI, BL89, CFI, RNI, and Gamma Hat; a cutoff value close to .90 for Mc; a cutoff value close to .08 for SRMR; and a cutoff value close to .06 for RMSEA are needed before we can conclude that there is a relatively good fit between the hypothesized model and the observed data. Furthermore, the 2‐index presentation strategy is required to reject reasonable proportions of various types of true‐population and misspecified models. Finally, using the proposed cutoff criteria, the ML‐based TLI, Mc, and RMSEA tend to overreject true‐population models at small sample size and thus are less preferable when sample size is small.
Several interviews are available for assessing PTSD. These interviews vary in merit when compared on stringent psychometric and utility standards. Of all the interviews, the Clinician-Administered PTSD Scale (CAPS-1) appears to satisfy these standards most uniformly. The CAPS-1 is a structured interview for assessing core and associated symptoms of PTSD. It assesses the frequency and intensity of each symptom using standard prompt questions and explicit, behaviorally-anchored rating scales. The CAPS-1 yields both continuous and dichotomous scores for current and lifetime PTSD symptoms. Intended for use by experienced clinicians, it also can be administered by appropriately trained paraprofessionals. Data from a large scale psychometric study of the CAPS-1 have provided impressive evidence of its reliability and validity as a PTSD interview.
Research studies focusing on the psychometric properties of the Beck Depression Inventory (BDI) with psychiatric and nonpsychiatric samples were reviewed for the years 1961 through June, 1986. A meta-analysis of the BDI's internal consistency estimates yielded a mean coefficient alpha of 0.86 for psychiatric patients and 0.81 for nonpsychiatric subjects. The concurrent validitus of the BDI with respect to clinical ratings and the Hamilton Psychiatric Rating Scale for Depression (HRSD) were also high. The mean correlations of the BDI samples with clinical ratings and the HRSD were 0. 72 and 0.73, respectively, for psychiatric patients. With nonpsychiatric subjects, the mean correlations of the BDI with clinical ratings and the HRSD were 0.60 and 0.74, respectively. Recent evidence indicates that the BDI discriminates subtypes of depression and differentiates depression from anxiety.
The concepts of defeat and entrapment have been employed in evolutionary accounts of clinical phenomena such as depression and suicide. Recently theorists have argued that both concepts may be best conceptualised as a single distinct factor. The current study is the first to empirically test this assertion. A sample of 305 students completed measures of defeat and entrapment. Their responses were then analysed via exploratory factor analysis. The results strongly suggest that a single factor underlies both defeat and entrapment. These findings have considerable implications for past studies and theoretical accounts that rely on the distinction between defeat and entrapment.
Three studies examined the diagnosis of posttraumatic stress disorder (PTSD) in agencies treating at risk youth. Studies 1 and 2 (1999) found that baseline PTSD diagnosis was rare in a residential and an outpatient agency (2.3% and 5.4%, respectively) whereas trauma-focused interviews identified PTSD in 47.7% and 44.6% of these clients. Subsequent training efforts increased awareness of PTSD and recognition of unique issues in assessing at risk youth. Study 3 (2009) reexamined PTSD diagnosis rates in these agencies 10 years later and found that the residential agency had an increased rate of PTSD diagnosis (10.8%), whereas PTSD diagnosis remained rare in the outpatient agency (4.0%). Suggestions are offered for increased accuracy in the diagnosis of PTSD and complex PTSD with at risk youth.
This study tested whether feelings of defeat and entrapment mediated the effects of negative appraisals upon suicidal ideation and behavior. A sample of 93 university students who reported some degree of suicidal ideation completed questionnaires of negative appraisals of social-support and problem-solving, defeat, entrapment, hopelessness and suicidality. The results supported a model whereby defeat and entrapment fully mediated the effect of appraisals of social support and problem-solving ability upon suicidality. Furthermore, controlling for hopelessness had no substantive impact upon this model. The findings support socio-cognitive models of suicidal behavior and highlight the key role of defeat and entrapment in suicide. The clinical implications of these findings are discussed.
Recent years have seen growing interest into concepts of resilience, but minimal research has explored resilience to suicide and none has investigated resilience to suicide amongst clinical groups. The current study aimed to examine whether a proposed resilience factor, positive self-appraisals of the ability to cope with emotions, difficult situations and the ability to gain social support, could buffer against the negative impact of hopelessness amongst individuals with psychosis-spectrum disorders when measured cross-sectionally. Seventy-seven participants with schizophrenia-spectrum disorders completed self-report measures of suicidal ideation, hopelessness and positive self-appraisals. Positive self-appraisals were found to moderate the association between hopelessness and suicidal ideation. For those reporting high levels of positive self-appraisals, increased levels of hopelessness were significantly less likely to lead to suicidality. These results provide cross-sectional evidence suggest that positive self-appraisals may buffer individuals with psychosis against the pernicious impact of a well known clinical risk factor, hopelessness. Accounting for positive self-appraisals may improve identification of individuals at high risk of suicidality, and may be an important area to target for suicide interventions.
The current study tests whether perceptions of defeat and entrapment are the psychological mechanisms underlying the link between positive psychotic symptoms and suicidal ideation in schizophrenia. A sample of 78 patients with schizophrenia spectrum disorders completed self-report measures and a clinical interview. Of this sample, 21.8% reported a single past suicide attempt and 50% reported multiple past attempts. It was found that perceptions of defeat and entrapment, conceptualised as a single variable, accounted for a large proportion (31%) of the variance in suicidal ideation and behaviour. Defeat and entrapment also mediated the relationship between positive symptom severity and suicidal ideation. This result held whilst controlling for levels of hopelessness and depression. Secondary analyses suggested that suspiciousness in particular was linked to suicidal ideation. The results support a socio-cognitive model (The Schematic Appraisals Model of Suicide: SAMS) of suicide in psychosis.
The current study examined the manner in which childhood sexual abuse (CSA) history relates to risk factors for suicidal behavior among recent suicide attempters (n = 166). Men who recently attempted suicide and endorsed a CSA history had higher scores on measures of hopelessness and suicide ideation than men without a CSA history. Men with a CSA history were also more likely to have made multiple suicide attempts and meet diagnostic criteria for posttraumatic stress disorder and borderline personality disorder. In contrast, there were fewer group differences as a function of CSA history among the female suicide attempters. Hopelessness was a significant mediator between CSA history and suicide ideation in both men and women.
There is a large literature investigating the underlying mechanisms, risk factors and demographics of suicidal thoughts and behaviors across a number of psychiatric disorders, such as, major depression, anxiety and schizophrenia. However, less research has focused on the relationship between Post-Traumatic Stress Disorder (PTSD) and suicide. There were two broad aims of this review. The first was to assess the extent to which PTSD is associated with suicide, and the second was to determine the effects of co-morbid disorders on this relationship. Overall, there was a clear relationship between PTSD and suicidal thoughts and behaviors irrespective of the type of trauma experienced. Very few studies directly examined whether depression was a mediating factor in the relationships reported. However, where this was investigated, the presence of co-morbid depression appeared to boost the effect of PTSD on suicidality. It was noteworthy that hardly any studies had investigated concepts thought to be key in other domains of research into suicidality, such as, feelings of entrapment, defeat and hopelessness.
Few studies have specifically tested the Cry of Pain model (CoP model; Williams, 2001). This model conceptualizes suicidal behaviour as a behavioural response to a stressful situation which has three components: defeat, no escape potential, and no rescue. In addition, the model specifies a mediating role for entrapment on the defeat-suicidal ideation relationship, and a moderating role for rescue factors on the entrapment-suicidal ideation relationship. This is the first study to investigate the utility of this psychological model in a sample of first-time and repeat self-harm (SH) patients.
One hundred and thirteen patients who had been admitted to hospital following an episode of SH (36 first-time, 67 repeat) and 37 hospital controls completed measures of defeat, entrapment/escape potential, rescue (social support and positive future thinking), as well as depression, anxiety, and suicidal ideation.
Analyses highlighted differences between the three participant groups on all of the CoP variables. Hierarchical regression analysis confirmed that total entrapment and internal entrapment mediated the relationship between defeat and suicidal ideation, whilst impaired ability to think positively about the future (but not social support) moderated the relationship between total and internal entrapment and suicidal ideation.
The findings provide further empirical support for the CoP Model. The findings are discussed in relation to theory and practice and we recommend that the findings are replicated within a prospective design.
In a study that used 149 university undergraduates and a 3-week test-retest interval, the stability of the Hopelessness Scale was examined. Scale scores and item responses demonstrated high test-retest reliabilities. Additional analyses indicated significant sex differences on the Hopelessness Scale. It was concluded that the Hopelessness Scale's stability fulfills a prerequisite for it to be a predictor of long-term suicidal risk.
In this psychometric study, a scale to measure hope in chronically ill patients was developed and evaluated. Four hundred fifty participants with a variety of chronic diagnoses completed two forms of the Multidimensional Hope Scale (MHS) (state and trait) and the Beck Hopelessness Scale (BHS). High levels of internal consistency (alpha = .95) and test-retest reliability (r = .82, p < .001) were estimated for the state form. Good concurrent validity was also indicated with a significant negative correlation between the MHS and the BHS (r = -.45, p < .001). Factor analysis using principal axis factoring and oblimin rotation identified six factors: Resource to Others, Civic Interest, Spirituality, Health, Social Support, and Self-Actualization. The psychometric data suggest a promising tool for measuring hopefulness in physically ill individuals.
The goal of the present study was to examine whether posttraumatic stress disorder (PTSD) is underrecognized in routine clinical practice. One thousand patients were evaluated at the Rhode Island Hospital Department of Psychiatry outpatient practice. The first 500 patients completed a psychiatric diagnostic screening questionnaire that included a PTSD subscale. The next 500 individuals were interviewed with the Structured Clinical Interview for DSM-IV (SCID). In the first 500 patients, 36 (7.2%) patients were diagnosed by their clinicians with PTSD and an additional 18.6% of the sample screened positive on the questionnaire but were not diagnosed with PTSD. The patients who were diagnosed with PTSD and the patients who screened positive but were not given the diagnosis were significantly younger, had lower GAF scores, and less frequently graduated from college than the non-PTSD group. The frequency of suicidal thoughts was identical in the two PTSD groups and twice as high as the frequency in the non-PTSD group. Scores on 9 of the other 12 psychopathology dimensions assessed by the screening questionnaire were significantly higher in the two PTSD groups than the non-PTSD group. In the 500 patients interviewed with the SCID the prevalence of PTSD was two times higher than in the 500 patients diagnosed with an unstructured clinical interview (14.4% vs. 7.2%). The difference in prevalence rates of PTSD between the SCID and clinical samples was significant when considering PTSD as an additional diagnosis; there was no difference in prevalence rates when restricting the analysis to principal diagnoses. The results of this study suggest that PTSD is frequently overlooked in routine clinical practice when symptoms of PTSD are not the presenting complaint.
Reliance on the categorical model of psychiatric disorders has led to neglected study of posttraumatic sequelae that fall short of full criteria for posttraumatic stress disorder (PTSD). Substantial disability and suicidal risk is associated with subthreshold PTSD, but this association has not been well studied. In addition, no studies have examined the role of comorbidity in explaining disability and impairment in subthreshold PTSD.
On National Anxiety Disorders Screening Day 1997, 2,608 out of 9,358 individuals screened for affective and anxiety disorders at 1,521 sites across the United States reported at least one PTSD symptom of at least 1 month's duration. Impairment, comorbid anxiety disorders, major depressive disorder, and rates of suicidality were determined and compared for individuals with no, one, two, three, or four (full PTSD) symptoms on a screening questionnaire. Regression analyses examined the relative contribution of subthreshold PTSD and comorbid disorders to impairment and suicidal ideation.
Impairment, number of comorbid disorders, rates of comorbid major depressive disorder, and current suicidal ideation increased linearly and significantly with each increasing number of subthreshold PTSD symptoms. Individuals with subthreshold PTSD were at greater risk for suicidal ideation even after the authors controlled for the presence of comorbid major depressive disorder.
Higher numbers of subthreshold PTSD symptoms were associated with greater impairment, comorbidity, and suicidal ideation. Disability and impairment found in previous studies of subthreshold PTSD symptoms may be related in part to the presence of comorbid disorders. However, the presence of subthreshold PTSD symptoms significantly raised the risk for suicidal ideation even after the authors controlled for major depressive disorder. Given the broad public health implications of these findings, more efforts are needed to identify subthreshold PTSD symptoms in clinical populations, epidemiologic surveys, and treatment studies.
Past suicidal behaviors including ideation and attempts have been identified as significant risk factors for subsequent suicidal behavior. However, inadequate attention has been given to the development or validation of measures of past suicidal behavior. The present study examined the reliability and validity of a brief self-report measure of past suicidal behavior, the Suicidal Behaviors Questionnaire-Revised (SBQ-R). Participants included psychiatric inpatient adolescents, high school students, psychiatric inpatient adults, and undergraduates. Logistic regression analyses provided empirical support for the usefulness of the SBQ-R as a risk measure of suicide to differentiate between suicide-risk and nonsuicidal study participants. Receiver operating characteristic (ROC) analyses indicated that the most useful cutoff scores on the SBQ-R were 7 for nonsuicidal samples, and 8 for clinical samples. Both the single SBQ-R Item 1 and SBQ-R total scores are recommended for use in clinical and nonclinical settings.
There appears to be a strong connection between suicidality and the experience of trauma. The study investigated suicidality in chronic civilian post-traumatic stress disorder (PTSD).
Ninety-four participants suffering from chronic PTSD were assessed for suicidal ideation, plans and attempts since the index trauma as part of a comprehensive assessment. The prevalence of these was assessed and characteristics of those reporting suicide-related thoughts and behaviour were investigated through logistic and multinominal regression analyses.
Over half of the sample (56.4%) reported some aspect of suicidality with 38.3% reporting ideation, 8.5% reporting suicide plans and 9.6% having made suicide attempts since the trauma. Of the nine participants who reported suicide attempts, six had made more than one attempt. The proportions of participants who reported suicidality in this sample were significantly greater than reported within the general population, when comparisons were made with an epidemiological study. Logistic regression analysis indicated that a unit increase in life impairment (OR = 3.1) and depression (OR = 1.14) scores were independently and significantly associated with suicidality. Multinominal regression indicated that life impairment (OR = 2.71) and depression (OR = 1.13) scores were associated with the presence of suicidal ideation compared to no ideation, and life impairment (OR = 5.75), depression (OR = 1.2) scores and receiving psychotropic medication (OR = 10.6) were associated with the presence of plans and attempts compared to no suicidal behaviour.
Suicide risk is elevated in those suffering from chronic PTSD and is associated with impaired functioning in combination with depression.
Researchers often conduct mediation analysis in order to indirectly assess the effect of a proposed cause on some outcome through a proposed mediator. The utility of mediation analysis stems from its ability to go beyond the merely descriptive to a more functional understanding of the relationships among variables. A necessary component of mediation is a statistically and practically significant indirect effect. Although mediation hypotheses are frequently explored in psychological research, formal significance tests of indirect effects are rarely conducted. After a brief overview of mediation, we argue the importance of directly testing the significance of indirect effects and provide SPSS and SAS macros that facilitate estimation of the indirect effect with a normal theory approach and a bootstrap approach to obtaining confidence intervals, as well as the traditional approach advocated by Baron and Kenny (1986). We hope that this discussion and the macros will enhance the frequency of formal mediation tests in the psychology literature. Electronic copies of these macros may be downloaded from the Psychonomic Society's Web archive at www.psychonomic.org/archive/.
The objective of this paper was to evaluate the Cry of Pain model of suicide behaviour as applied to psychosis and to derive theoretically driven guidelines for prevention. Suicide risk in psychotic patients is a serious but poorly understood clinical and social problem. There is a dearth of psychological models to explain suicidal behaviour and to guide effective preventative clinical interventions. Understanding suicidal behaviour in psychosis may be facilitated by utilizing models from depression. The 'Cry of Pain' model of suicide is founded on an evolutionary approach to understanding suicidal behaviour in depression.
The model was critically evaluated and relevant literature reviewed.
Although strengths of the model were identified, lack of clarity regarding the concepts of defeat, entrapment, and lack of rescue appeared to limit its theoretical and clinical utility. We suggest a modification to this model which replaces concepts of defeat, entrapment, and lack of rescue with a four-stage appraisal process in conjunction with information-processing biases and suicidal schema.
Methods of testing this model are suggested and guidelines for a clinical intervention (Cognitive Behavioural Suicide Prevention for Psychosis; CBSPp) are outlined.
Suicide behavior is a serious clinical problem worldwide, and understanding ways of reducing it is a priority. A systematic review and meta-analysis were carried out to investigate whether Cognitive-behavioral therapies (CBTs) would reduce suicide behavior. From 123 potential articles, 28 studies met the entry criteria. Overall, there was a highly significant effect for CBT in reducing suicide behavior. Subgroup analysis indicates a significant treatment effect for adult samples (but not adolescent), for individual treatments (but not group), and for CBT when compared to minimal treatment or treatment as usual (but not when compared to another active treatment). There was evidence for treatment effects, albeit reduced, over the medium term. Although these results appear optimistic in advocating the use of CBT in ameliorating suicidal thoughts, plans, and behaviors, evidence of a publication bias tempers such optimism.
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