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Auditory verbal hallucinations increase the risk for suicide attempts in adolescents with suicidal ideation

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  • Initiative for Clinical Epidemiological Research
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... Research is needed to uncover the risk factors that are specifically tied to SA to prevent deaths by suicide. There is some evidence that PLEs may increase the risk of SA among those who endorse SI Fujita et al., 2015;Hielscher et al., 2019;Kelleher et al., 2012). In contrast, other studies have not found increased odds of attempts due to PLEs among individuals with SI (Bromet et al., 2017). ...
... Delusional-like experiences and, particularly, hallucinatory experiences were found to be significantly associated with higher levels of SAs among individuals who endorsed SI or SP in the past year, consistent with our hypotheses as well as previous literature Fujita et al., 2015;Kelleher et al., 2012). Results emphasize that hallucinatory experiences may be an especially relevant predictor of severe suicide outcomes among college students who report SI or SP. ...
... increased odds of SA among individuals who endorsed SI and/or SP, confirming evidence from previous workFujita et al., 2015;Kelleher et al., 2012). Findings also provided evidence for a dose-response relation, with the odds of endorsing a SA increasing sevenfold due to an endorsement of three or greater PLEs. ...
Article
The suicide rate among college students is particularly high, with evidence that psychosis‐like experiences (PLEs) put these individuals at greater risk. The current study explored whether there are differential relations between four subtypes of PLEs and three suicide outcomes. We analysed a large sample of college students from the Fall semester cohort of the 2020 Healthy Minds Study (HMS) (weighted N = 36727). PLEs and suicide outcomes were assessed using binary variables from the World Health Organization Composite International Diagnostic Interview. Findings revealed that reporting any of the subtypes of PLEs was associated with greater odds of suicidal ideation (SI), a suicide plan (SP) and a suicide attempt (SA) (signficant a ORs ranging from 1.30 to 3.30). For college students who endorsed SI or a SP in the past year, experiencing delusional mood (aOR [95% CI] = 1.30 [1.02–1.65]), suspiciousness (aOR [95% CI] = 1.31 [1.00–1.71]) and hallucinatory experiences (aOR [95% CI] = 2.76 [2.05–3.71]) in their lifetime increased their odds of reporting a SA in the past year. There was also evidence of a dose‐dependent relation between the number of PLEs endorsed and all three suicide outcomes. Certain subtypes of PLEs including delusional mood, suspiciousness and hallucinatory experiences may contribute to an elevated risk of suicide outcomes in college students. Moreover, the odds of reporting suicide outcomes were greater for individuals who endorsed a greater number of PLEs. It may be helpful to assess for indicated subtypes when determining suicide risk among college students and to be particularly mindful of those who report three or more PLEs.
... Presently, limited knowledge is available regarding the association between suicidal behaviors and auditory and visual hallucinations among adolescents due to the paucity of studies on both auditory and visual hallucinations simultaneously. Previous studies have indicated a strong association between auditory hallucinations and suicide attempts (Fujita et al., 2015;Maijer et al., 2019). The only study that simultaneously examined both auditory and visual hallucinations reported that suicidal ideation was not significantly associated with the former but was significantly clinically associated with the latter in adolescent outpatients (Grano et al., 2015), suggesting that auditory and visual hallucinations may be associated differently with suicidal ideation. ...
... Those who answered 'yes' were designated as having experienced the corresponding hallucination. Although previous studies used a 3-point scale, dichotomous questions were used herein for simplicity so that very young patients need not hesitate to answer (Fujita et al., 2015;Laurens et al., 2012). ...
... The current study revealed new and potentially important information regarding suicidal behaviors among adolescent patients with hallucinations using a larger sample compared with our previous study (Fujita et al., 2015). To the best of our knowledge, this is the first study to investigate the main and interaction effects of auditory and visual hallucinations with regard to suicide planning and suicide attempt among adolescent patients. ...
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Background: Suicide remains one of the leading causes of death among adolescents. Although recent studies have suggested a strong association between auditory hallucinations and suicidal behaviors, little is known regarding the association between suicidal behaviors and visual hallucinations, which are also common among adolescent psychiatric patients. Method: A cross-sectional study of all first-time patients aged 10-15 years was conducted at three child and adolescent psychiatric outpatient facilities in Kanagawa Prefecture, Japan, from April 2015 to March 2018. Self-reported questionnaires were administered to evaluate auditory and visual hallucinations, suicide planning, and suicide attempts within the two weeks prior to the first visit. Our logistic regression model included three covariates (sex, age, and presence of major depressive episode) for adjustments. Among the 1285 respondents, 37 who had moderate or severe intellectual disability were excluded, leaving 1248 for analysis. Results: Among the 1069 patients who completed questionnaire items on hallucinations, 230 (21.5%) experienced auditory or visual hallucinations. After controlling for all confounders, visual hallucinations, but not auditory hallucinations, were significantly associated with increased odds of suicide planning (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.5-4.1). In contrast, auditory hallucinations, but not visual hallucinations, were significantly associated with increased odds of suicide attempts (OR 2.8, 95% CI 1.3-6.1). No interaction effects were observed between suicidal behaviors and auditory or visual hallucinations. Conclusions: Clinicians should consider the prevalence of both auditory and visual hallucinations among young adolescent patients, with emphasis on auditory hallucinations, given their association with suicide attempts.
... [19][20][21] In comparison to mixed findings in adult samples, the relationship between psychotic symptoms and suicide-related outcomes among children and adolescents is more consistently supported. [22][23][24][25][26][27][28] Children and adolescents with psychotic symptoms have high rates of suicide attempts, ranging from 12% to 38%. 22,29 Research suggests suicidal ideation, suicide attempts, and death by suicide are more common in early-onset than adult-onset psychotic disorders, as well as being more common earlier in the illness, regardless of age of onset. ...
... A study specifically investigating auditory verbal hallucinations and their relationship to suicidal behaviors in Japanese school-aged children found that auditory verbal hallucinations were significantly related to increased odds of positive suicide attempt history in those with suicidal ideation. 24 Another study found associations between visual hallucinations and subsequent suicide attempts, both retrospectively reported, in early adolescence (age [10][11][12][13][14]. 33 Experiencing a greater number of psychotic symptoms has also been associated with suicidal ideation and self-injurious behaviors in psychotic adolescents. 27 Despite the evidence of a relationship between individual psychotic symptoms and suicide-related outcomes among children and adolescents with psychotic disorders broadly, this area is still relatively underexamined in children and adolescents with bipolar disorder specifically. ...
... Study results are consistent with past findings indicating there is an association between psychotic symptoms and suicidal ideation in youth. [22][23][24][25][26][27][28] As in past research on adults with mood disorders, delusions of guilt were significantly and independently related to suicidal ideation. [18][19][20] Our results, however, somewhat contrasted with previous findings [18][19][20][21]24,33 in that we did not find significant relationships between auditory hallucinations, visual hallucinations, or persecutory delusions and suicidal ideation, once we accounted for overall level of functioning. ...
Article
Objectives The purpose of this study was to explore associations between specific types of hallucinations and delusions and suicidal ideation in a sample of children and adolescents with bipolar I disorder. Methods Participants (N =379) were children and adolescents aged 6‐15 years (M = 10.2, SD = 2.7) with DSM‐IV diagnoses of bipolar I disorder, mixed or manic phase. The study sample was 53.8% female and primarily White (73.6% White, 17.9% Black, and 8.5% Other). Presence and nature of psychotic symptoms, suicidal ideation, and functioning level were assessed through clinician‐administered measures. A series of logistic regressions was performed to assess the contribution of each sub‐type of psychotic symptom to the presence of suicidal ideation above and beyond age, sex, socio‐economic status, age at bipolar disorder onset, and global level of functioning. Results Hallucinations overall, delusions of guilt, and number of different psychotic symptom types were uniquely associated with increased odds of suicidal ideation after accounting for covariates. Other forms of delusions (e.g. grandiose) and specific types of hallucinations (e.g., auditory) were not significantly uniquely associated with the presence of suicidal ideation. Conclusions Findings of this study suggest the presence of hallucinations as a whole, delusions of guilt specifically, and having multiple concurrent types of psychotic symptoms are associated with the presence of suicidal ideation in children and adolescents with bipolar I disorder. Psychotic symptom sub‐types, as opposed to psychosis as a whole, are an under‐examined, potentially important, area for consideration regarding suicidal ideation in pediatric bipolar I disorder. This article is protected by copyright. All rights reserved.
... Accumulating evidence, from both general population and clinical samples, demonstrates a strong relationship between hallucinations in children and adolescents and comorbid suicidality with an increased risk of suicide attempts. 29,30 Moreover, hallucinations predict incident suicidal behavior in the short term (at 3-month 31 and 12-month 31,32 follow-up), in the medium term (when followed from childhood into adolescence 25,33 ) and in the longer term (when followed from childhood and adolescence into adulthood 24,34,35 ). The relationship between hallucinations and suicidal behavior cannot be simply explained by co-occurring psychopathology. ...
... However, these measurements commonly assess the presence of hallucinations in the auditory domain only, using just a single item (eg "Have you ever heard voices or sounds that no one else can hear"). 19,29 Merely assessing the presence of hallucinations may be useful, but does not incorporate specific characteristics and qualities of hallucinations. For the purpose of this review, the focus will be on outlining (new) instruments specifically designed to assess the phenomenology of hallucinations in youth. ...
Article
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Hallucinations in children and adolescents are now known to occur on a continuum from healthy to psychopathology-related phenomena. Although hallucinations in young populations are mostly transient, they can cause substantial distress. Despite hallucinations being widely investigated, research so far has had limited implications for clinical practice. The present article has 3 main aims: (1) to review research findings since 2014 (when the last major review of the area was published); (2) to present assessment tools validated to measure hallucinations in children and adolescents; and (3) to discuss therapeutic strategies and clinical issues. We conclude by presenting a tailored care model for clinicians and outline future challenges for research.
... Investigaciones recientes, orientadas a intentar esclarecer las relaciones directas que existen entre las distintas dimensiones de las EPS con la IS, han logrado aportar al objetivo de demostrar la existencia de relaciones diferenciales entre las distintas dimensiones de EPS en población adolescente (Capra, Kavanagh, Hides y Scott, 2015;DeVylder y Hilimire, 2015;Fujita et al., 2015;Granö et al., 2015;Jang et al., 2014;Kelleher et al., 2012c;Kelleher, Cederlöf y Lichtenstein, 2014;Nishida et al., 2010;Taylor et al., 2010), es decir, distintas dimensiones de las EPS se relacionan diferencialmente con la IS. Capra et al. (2015) y Taylor et al. (2010 coinciden en reportar que las anomalías perceptuales y la ideación persecutoria se relacionan con la IS y el intento suicida. ...
... Capra et al. (2015) y Taylor et al. (2010 coinciden en reportar que las anomalías perceptuales y la ideación persecutoria se relacionan con la IS y el intento suicida. DeVylder y Hilimire (2015) y Fujita et al. (2015) reportaron que las alucinaciones auditivas se relacionan de manera significativa con la IS y la planificación. Granö et al (2015) encontraron asociaciones entre las anomalías perceptuales y la IS. ...
Thesis
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EN: Psychotic-like experiences (PLEs) are common in the general population, particularly during adolescence, a stage of development in which the prevalence of suicide has increased considerably over the last few decades. The present study sought to determine the relationship between the presence of PLEs and suicidal ideation (SI) in adolescents from different institutional contexts and to detect the differences between them. The study was carried out through correlational analysis, linear regression and comparison of Z scores. The sample consisted of 1635 individuals between the ages of 11 and 22 (M=16.04; SD=1.46) from educational institutions (CIa) (93%) and SENAME (CIb) (7%). The results showed that, at a general level, the PLE's presents a significant relationship with SI, being the dimensions of persecutory ideation (PI) and of perceptual anomalies (PA) the most important, while the negative symptoms (NS) the one with less impact. Comparing both institutional contexts, PIs and PAs maintained their relevance in CIa. However, PAs showed greater importance in CIb, where other PLEs lost significance. In general, PLEs proved to be a significant predictors for SI, so their early detection may be of great importance for the prevention of suicide risk since it adds to the list of risk factors relevant for their appearance, and therefore requires a comprehensive analysis that contributes to their understanding and allows evidence of their scope in the chilean population.
... Especially the combination of the two seems problematic in this young population. Suicidal risk has been associated with PE (10) in general populations (11,12) and clinical samples (13,14), particularly when PE are persistent (15,16). However, the underlying mechanisms explaining the links between PE and SI remain uncertain (17,18). ...
... According to Granö et al. (32), visual distortions could explain SI in adolescents; even when depressive symptoms (and other psychotic symptoms) were controlled for. Fujita et al. (14) reported that auditory verbal hallucinations, but not depressive symptoms, increased the risk for suicidal attempts in adolescents with suicidal ideation. Gill et al. (5) found that the associations between negative symptoms and SI persisted when controlled for depressive symptoms in a high-risk sample of adolescents and young-adults, and Nishida et al. (33) observed that the association between PE and suicidal feelings and behaviors remains significant when controlled for anxiety and DS and use of substances in a general sample of adolescents. ...
Article
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Associations between psychotic experiences and suicidal ideation are not yet fully understood, and the potential role of depressive symptoms in this relationship remains unclear. The current study examined relationships between depressive symptoms (DS), psychotic experiences (PE) and suicidal ideation (SI) using two complementary approaches on cross-sectional data from a community sample of adolescents aged 13–19 years ( N = 1,591). First, we investigated the association between the three domains using mediation analysis, showing that depressive symptoms partly mediate the relationship between psychotic experiences and suicidal ideation. Second, we looked at associations between the three domains at item level using network analysis. Specific associations between symptoms of the three domains were found, indicating depressive symptoms of sadness, avolition, pessimism, and self-criticalness/worthlessness as the most central symptoms in the network. Suicidal ideation was associated with the depressive symptoms pessimism and worthlessness, to social anxiety, and to perceptual anomalies. Our results show that the mediating effect of depressive symptoms between psychotic experiences and suicidal ideation may be due to associations between specific aspects of SI, depressive symptoms and psychotic experiences. These findings can contribute to the planning of health services and programs aimed at the timely detection of psychopathology and suicidal risk in young people.
... The prevalence rate for imperative hallucinations of 56% is in line with the findings that the presence of AVH in the context of BPD was associated with an increase in the incidence of suicidal plans and attempts, as well as with the number of hospitalizations. The same applies for suicidality in patients with AVH in schizophrenia spectrum disorders (59,60). Comorbidity (e.g., with mood disorders and substance use disorders) has sometimes been held responsible for the occurrence of AVH in patients with BPD (3). ...
Article
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Background: Auditory verbal hallucinations (AVH) are experienced more frequently by patients with borderline personality disorder (BPD) than previously assumed. However, consensus is lacking on how to treat them. Objective: To provide a systematic review of studies reporting on AVH in patients with BPD, with a focus on the efficacy of treatment of psychotic symptoms. Methods: For this review a systematic search was made in the PubMed and Ovid databases, and mean weighted prevalence rates, adjusted for sample size, were computed. Results: The search yielded 36 studies describing a total of 1,263 patients. Auditory hallucinations (including AVH) were reported in 27% of hospitalized BPD patients; AVH were reported in 25% of all patients and in 24% of outpatients. Of the hallucinating patients, 78% experienced AVH at least once per day, for a duration of several days to many years. On the whole, patients with BPD regarded their voices as malevolent and omnipotent in nature. Compared to patients with schizophrenia, the phenomenological characteristics of AVH were similar and the ensuing distress was equal or even higher, whereas scores for other positive symptoms were lower. The presence of AVH in BPD was associated with an increase of suicide plans and attempts, and more frequent hospitalization. Moreover, AVH in the context of BPD were associated with higher prevalence rates for post-traumatic stress disorder and emotional abuse. The efficacy of antipsychotics was investigated in 21 studies. Based on these studies, we conclude that both typical and atypical antipsychotics tend to have positive effects on AVH experienced in the context of BPD. The efficacy of cognitive-behavioral therapy and non-invasive brain stimulation has not yet been systematically assessed. Conclusions: These findings indicate that AVH experienced in the context of BPD are in need of proper diagnosis and treatment, and that antipsychotics tend to be beneficial in treating these (and other psychotic) symptoms.There is an urgent need for studies assessing the efficacy of cognitive-behavioral therapy and non-invasive brain stimulation in this underdiagnosed and undertreated group.
... According to Jang et al. (2014), perceptual disturbances and ideas of reference could be interpreted as warning signs for suicide-related behaviors in general adolescent populations, and visual distortions could explain suicidal ideation in help-seeking adolescents when other psychotic risk symptoms and demographic variables are controlled for (Granö et al., 2015). Finally, auditory hallucinations are associated with both higher rates of suicide attempt (Kelleher et al., 2013) and suicidal ideation (Kelleher et al., 2014), which was also observed in adolescent patients with suicidal ideation (Fujita et al., 2015) and suicidal attempts (Kelleher et al., 2012). ...
Article
Background: Suicide is one of the leading causes of death in young individuals. Timely and adequate identification of individuals with suicidal ideation could prevent from suicidal behavior. Psychotic experiences (PE) have been shown to increase levels of suicidal ideation (SI) in the general population. Therefore, detailed investigation of the relationship of PE and SI is relevant. However, the exact nature of the relationship between these two phenomena remains unclear. Understanding psychopathology as a complex network of interacting symptoms could be helpful to elucidate specific associations existing between PE and SI. Method: A specific type of network analysis, the Ising model, was used to examine connections between dichotomized questions on psychotic experiences and suicidal ideation in a cross-sectional study with 1685 adolescents from the general population aged 13-18 years. Results: SI was mostly connected to the PE domains perceptual anomalies (PA) and bizarre experiences (BE), which have higher strength values in the network. Central nodes within these domains, as indexed by higher centrality measures (strength and betweenness) were: auditory experiences (PA1: hearing voices when you are alone), persecutory ideation (BE1: feelings of being persecuted; BE2: conspiracy against you), and social anxiety (SANX) (SANX1: I cannot get close to people). Conclusions: Suicidal ideation is differentially connected to specific psychotic experiences. Auditory PE, persecutory ideation, and social anxiety symptoms could play a central role in the interconnectedness of the two constructs.
... Adults with AVH have less years of education than 'healthy' individuals and they show lower employment rates (5). Also, AVH are associated with medication noncompliance (6) and increased odds of suicide attempt in young people (7). ...
... 4 Also, AVHs are associated with medication non-compliance 5 and increased odds of suicide attempt. 6 AVHs are a common symptom in psychosis. A review shows prevalence rates of 40%-80% in schizophrenia. ...
Article
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Introduction Auditory verbal hallucinations (AVH) are prevalent experiences that can induce distress and impede social functioning. While most voice hearers benefit from antipsychotic medication or cognitive–behavioural therapy, additional effective interventions are needed to reduce the burden of experiencing AVH. ‘Temstem’ is an easily accessible and useable smartphone application that was developed by designers in close cooperation with voice hearers and experts. By using language games, Temstem aims to reduce distress and improve social functioning. Methods This is a single-blind multicentre randomised controlled trial with two arms: ‘Temstem+AVH monitoring’ versus ‘AVH monitoring’ (total n=100). Participants are adult patients who suffer daily from AVH and will be recruited in outpatient units. Primary assessment in daily life is made by the Experience Sampling Method (ESM) and daily monitoring with the PsyMate app. During an ESM period of 6 days, participants assess their mental state (including AVH and context) several times a day by filling in short questionnaires. There are three 6-day ESM periods: at baseline (week 0–1), post-treatment (weeks 5–6) and follow-up (weeks 9–10). In addition, during the entire 10-week study period, all participants monitor their AVH two times a day with a short assessment via the PsyMate app. Participants in the Temstem+AVH monitoring condition are provided with the Temstem app from week 1 to 6. Other assessments made at baseline, post-treatment and follow-up are based on questionnaires and a clinical interview. Ethics and dissemination The results from this study will provide an evaluation of the effectiveness of Temstem, a non-invasive and easily accessible app for voice hearers, and insight into the determinants of optimal use. Results will be disseminated unreservedly, irrespective of the magnitude or direction of the effects. This study protocol was approved by the Medical Ethics Committee of the VU University Medical Centre (METC number: 2015.435/NL53684.029.15). Trial registration number ISRCTN75717636; Pre-results.
... In einer ersten, niederländischen Studie war das Vorliegen von AVH gemessen mit dem PSYRATS mit einer signifikant höheren Inzidenz von Suizidplänen und Versuchen sowie mehr Krankenhausaufenthalten verbunden [33], wohingegen die Schwere der BPS und Anzahl komorbider Diagnosen keine Vorhersagekraft dafür hatten. Auch bei Schizophrenie gibt es erste Hinweise, dass in dieser Population Halluzinationen mit Suizidgedanken, -plänen und -versuchen assoziiert sind [34,35] Inwieweit Wahnerleben auf dieses hohe Ausmaß an Suizidalität Einfluss hat, wurde dabei bislang nicht untersucht, auch insgesamt lag der Schwerpunkt der Studien zu fraglich psychotischen Symptomen bei BPS auf der Untersuchung von WV. ...
Article
Zusammenfassung Hintergrund Eine Subgruppe von Patientinnen mit Borderline Persönlichkeitsstörung (BPS) berichtet von fraglich psychotischen Symptomen. Die Angaben zur Häufigkeit variieren beträchtlich (bis zu 50% Betroffene). Untersuchungen in Deutschland stehen bislang aus. Weiterhin sind die genaue Phänomenologie dieser Symptome und die Auswirkungen auf Suizidalität und Inanspruchnahme stationärer psychiatrischer Behandlung bisher unklar. Ziel der Arbeit Es erfolgte die Untersuchung der Prävalenzen und Phänomenologie der fraglich psychotischen Symptome. Assoziationen zwischen letzteren und Suizidalität sowie Inanspruchnahme stationärer psychiatrischer Behandlung wurden unter Berücksichtigung weiterer Einflussfaktoren überprüft. Methodik Fraglich psychotische Symptome wurden bei 95 BPS-Patientinnen mit dem Strukturierten Klinischen Interview-I erhoben. Zur Überprüfung der Assoziationen zwischen diesen Symptomen und Suizidalität sowie Inanspruchnahme stationärer psychiatrischer Behandlung wurden Korrelations- und Regressionsanalysen berechnet. PTBS-Symptomatik, Ausprägung der BPS und Depressivität wurden berücksichtigt. Ergebnisse 36% der Pat. berichteten von vielgestaltigen und langanhaltenden Wahrnehmungsveränderungen (WV) und 21% von ebensolchen Wahnvorstellungen. Die Anzahl der Suizidversuche war mit Wahnerleben, WV und Schwere der PTBS-Symptomatik, Ausprägung der BPS und Depressivität assoziiert. 25,8% der Varianz zur Vorhersage der Anzahl der Suizidversuche wurde durch Wahnerleben und PTBS-Symptomschwere erklärt. Für das Alter bei Ersthospitalisation zeigten sich weniger und für die Anzahl der Hospitalisationen keine Assoziationen. Diskussion Fraglich psychotische Symptome sollten nicht trivialisiert werden, was möglicherweise durch die Nutzung von Begrifflichkeiten wie Pseudohalluzinationen oder vorübergehende paranoide Vorstellungen geschieht und können insbesondere mit Suizidalität assoziiert sein, wodurch das klinische Bild erschwert wird.
... Consistent with studies investigating AVH (e.g. De Loore et al., 2011;Fujita et al., 2015), all adolescents were asked about the presence of AVH in the past five years: 'In the past five years, have you heard one or more voices that only you and no one else could hear?'. Those scoring positive on AVH in this period were interviewed with the Auditory Vocal Hallucination Rating Scale (AVHRS; Jenner and van de Willige, 2002; Bartels-Velthuis et al., 2012a), a structured interview to assess the characteristics and severity of AVH, in terms of frequency, duration, loudness, negative content, distress, anxiety, control, and interference with thinking and daily life. ...
Article
The current exploratory study examined the associations between auditory vocal hallucinations (AVH) and delusions and religiosity in young adolescents. 337 children from a population-based case-control study with and without AVH, were assessed after five years at age 12 and 13, on the presence and appraisal of AVH, delusions and religiosity. AVH status (persistent, remittent, incident or control) was examined in relationship to religiosity. Results demonstrated a non-linear association between AVH and religiosity. Moderately religious adolescents were more likely to report AVH than non-religious adolescents (O.R.= 2.6). Prospectively, moderately religious adolescents were more likely to have recently developed AVH than non-religious adolescents (O.R.= 3.6) and strongly religious adolescents (O.R.= 7.9). Of the adolescents reporting voices in this sample (16.3%), more than half reported positive voices. Religious beliefs were often described as supportive, useful or neutral (82%), regardless of the level of religiosity, for both adolescents with and without AVH. Co-occurrence of AVH and delusions, and severity of AVH were not related to religiosity. The present findings suggest there may be a non-linear association between religiosity and hearing voices in young adolescents. A speculative explanation may be that religious practices were adopted in response to AVH as a method of coping.
... Psychotic experiences were not prospectively predictive of suicidal ideation in our fully adjusted models, in contrast to one previous population-level study of Swedish adolescents (although that study did not adjust for depression, hopelessness, alcohol use, or lifetime suicidal ideation or behavior; Kelleher et al., 2014), but in agreement with a United Kingdom population-based adolescent cohort in which psychotic experiences added little predictive power for detecting future suicidal behavior beyond that offered by depression ( Sullivan et al., 2015). Epidemiological studies have suggested that psychotic experiences may be a stronger predictor of suicide attempts than suicidal ideation ( DeVylder et al., 2015b), and may be particularly relevant for differentiating between individuals with suicidal ideation and those who have made suicide attempts ( Fujita et al., 2015) suggesting that their predictive value should be further tested in larger samples over longer time periods that provide appropriate statistical power to analyze suicide attempts at followup. Further, these epidemiological associations may be driven by shared risk factors, which are potentially better (albeit more distal) predictors of ongoing suicidal thoughts and behavior ( DeVylder et al., 2015c). ...
Article
This prospective cohort study investigated longitudinal predictors of suicidal ideation among college students. A non-clinical cohort of college students (N = 171) completed baseline and 3-month follow-up surveys. Depressive symptoms, worst-point suicidal ideation, and suicide attempt history significantly predicted follow-up suicidal ideation severity after adjusting covariates. Similarly, depressive symptoms and worst-point suicidal ideation (but not attempt history) were significant predictors of follow-up suicidal ideation intensity in an adjusted model. The results suggest that current depressive symptoms and lifetime worst-point suicidal ideation are independently valuable constructs that may provide relatively short-term predictive information when screening for suicidal ideation among college students.
... However, only perceptual abnormalities and attenuated hallucinations were significantly associated with suicidality. This specific association is in accordance with studies on psychoticlike experiences (29,77) and on patients with psychosis (93). However, no significant mediation effect of any attenuated psychotic symptom between childhood adversities as well as trauma and suicidality was found in this study. ...
Article
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Suicidality is highly prevalent in patients at clinical high risk (CHR) for psychosis. Childhood adversities and trauma are generally predictive of suicidality. However, the differential effects of adversity/trauma-domains and CHR-criteria, i.e., ultra-high risk and basic symptom criteria, on suicidality remain unclear. Furthermore, the underlying mechanisms and, thus, worthwhile targets for suicide-prevention are still poorly understood. Therefore, structural equation modeling was used to test theory-driven models in 73 CHR-patients. Mediators were psychological variables, i.e., beliefs about one’s own competencies as well as the controllability of events and coping styles. In addition, symptomatic variables (depressiveness, basic symptoms, attenuated psychotic symptoms) were hypothesized to mediate the effect of psychological mediators on suicidality as the final outcome variable. Results showed two independent pathways. In the first pathway, emotional and sexual but not physical adversity/trauma was associated with suicidality, which was mediated by dysfunctional competence/control beliefs, a lack of positive coping-strategies and depressiveness. In the second pathway, cognitive basic symptoms but not attenuated psychotic symptoms mediated the relationship between trauma/adversity and suicidality. CHR-patients are, thus, particularly prone to suicidality if adversity/trauma is followed by the development of depressiveness. Regarding the second pathway, this is the first study showing that adversity/trauma led to suicidality through an increased risk for psychosis as indicated by cognitive basic symptoms. As insight is generally associated with suicidality, this may explain why self-experienced basic symptoms increase the risk for it. Consequently, these mediators should be monitored regularly and targeted by integrated interventions as early as possible to enhance resilience against suicidality.
... Concerning psychotic risk symptoms, Granö et al. [53] found that visual distortions explained suicidal ideation when other psychotic risk symptoms and demographic variables were controlled in a sample of help-seeking adolescents. Additionally, Fujita et al. [54] observed that auditory verbal hallucinations increase the risk for suicide attempts in a clinical sample of adolescents with suicidal ideation. The knowledge about the nature of this relation in non-clinical samples is scarce and contradictory [55]. ...
... Concerning psychotic risk symptoms, Granö et al. [53] found that visual distortions explained suicidal ideation when other psychotic risk symptoms and demographic variables were controlled in a sample of help-seeking adolescents. Additionally, Fujita et al. [54] observed that auditory verbal hallucinations increase the risk for suicide attempts in a clinical sample of adolescents with suicidal ideation. The knowledge about the nature of this relation in non-clinical samples is scarce and contradictory [55]. ...
Article
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he usage of rigorous analyses based on contemporary methods to enhance psychometric properties of screening questionnaires aimed to address psychotic-like experiences (PLE) is currently being encouraged. The Brief Self-Report Questionnaire for Screening Putative Pre-psychotic States (BQSPS) is a recently created tool addressing PLE beyond attenuated positive symptoms (APS). Its psychometric properties as a screening tool for first step assessment seems to be adequate, but further research is needed to evaluate certain validity aspects, particularly its dimensionality, internal structure, and psychometric properties in different populations. We assessed the reliability, construct validity, and criterion validity of BQSPS in two samples: 727 adolescents aged 13 - 18 years, and 245 young adults aged 18 - 33 years. We used exploratory structural equation modeling (ESEM), confirmatory factor analysis (CFA), and Structural Equation Modeling (SEM). The original four-factor structure was not replicated. The best fit in adolescents was obtained by a structure of three-correlated factors: social anxiety (SA), negative symptoms (NS), and positive symptoms (PS). This structure was confirmed in young adult subjects. The three-factor model reached a predictive capability with suicidality as external criterion. PLE are represented by a three-factor structure, which is highly stable between adolescent and young-adult samples. Although the BQSPS seems to be a valid tool for screening PLE, its psychometric properties should be improved to obtain a more accurate measurement.
... In examining data from three longitudinal European databases, Honings et al. [25] found that among individuals with mental disorders, psychotic experiences increased the odds of a suicide attempt by 8.9, whereas psychotic experiences were only minimally related to suicide ideation. Similarly, Fujita et al. [26] found that auditory verbal hallucinations, but not depression, increased the odds of a suicide attempt by 3.4 among adolescents with suicidal ideation. ...
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Purpose of review This article summarizes findings from recent studies (published since 2015) examining differences between suicide attempters and suicide ideators. Recent findings Converging evidence suggests that the capability to attempt suicide (e.g., acquired capability, painful and provocative experiences, high tolerance for pain and distress) is higher in suicide attempters than suicide ideators. Other psychosocial and biological differences have also been identified but require replication. Summary Recent literature reviews find that traditional risk factors for suicide – such as depression, hopelessness, most psychiatric disorders, and even impulsivity – robustly predict suicide ideation but poorly predict suicide attempts among ideators. To address this knowledge gap, studies are increasingly employing an ideation-to-action framework. This framework views the development of suicide ideation and the progression from ideation to potentially lethal attempts as distinct processes with distinct explanations and predictors. Converging evidence suggests that factors associated with diminished fear of pain, injury, and death can increase one’s capability to attempt suicide and facilitate the progression from suicidal thoughts to suicidal acts. Recent studies have also identified other variables that may differentiate attempters from ideators, but these require replication. Theories of suicide positioned within the ideation-to-action framework provide testable and promising hypotheses about the progression from ideation to attempts. These include the Interpersonal Theory, Integrated Motivational-Volitional Model, and Three-Step Theory.
... Individuals with AVH are more likely to develop post-psychotic depression, feelings of loss, humiliation, and entrapment. The presence of AVH has also been associated with a higher risk for suicide (6). Treatment with antipsychotic medication can usually reduce the severity and frequency of AVH (7), but the high prevalence of relapse and recurrence of psychosis (estimated at 81.9% within 5 years) (8,9) and the ubiquity of medication side effects necessitate the development of new approaches for treatment of AVH. ...
Article
Functional MRI studies have identified a distributed set of brain activations to be associated with auditory verbal hallucinations (AVH). However, very little is known about how activated brain regions may be linked together into AVH-generating networks. Fifteen volunteers with schizophrenia or schizoaffective disorder pressed buttons to indicate onset and offset of AVH during fMRI scanning. When a general linear model was used to compare blood oxygenation level dependence signals during periods in which subjects indicated that they were versus were not experiencing AVH (“AVH-on” versus “AVH-off”), it revealed AVH-related activity in bilateral inferior frontal and superior temporal regions; the right middle temporal gyrus; and the left insula, supramarginal gyrus, inferior parietal lobule, and extranuclear white matter. In an effort to identify AVH-related networks, the raw data were also processed using independent component analyses (ICAs). Four ICA components were spatially consistent with an a priori network framework based upon published meta-analyses of imaging correlates of AVH. Of these four components, only a network involving bilateral auditory cortices and posterior receptive language areas was significantly and positively correlated to the pattern of AVH-on versus AVH-off. The ICA also identified two additional networks (occipital–temporal and medial prefrontal), not fully matching the meta-analysis framework, but nevertheless containing nodes reported as active in some studies of AVH. Both networks showed significant AVH-related profiles, but both were most active during AVH-off periods. Overall, the data suggest that AVH generation requires specific and selective activation of auditory cortical and posterior language regions, perhaps coupled to a release of indirect influence by occipital and medial frontal structures.
... Difficulty inhibiting poor responses (e.g., Go/No-Go Test) Westheide et al., 2008 Behavior Decreased activation for disadvantageous choices in the lateral orbitofrontal and occipital cortices (e.g., Iowa Gambling Task) Jollant et al., 2010 Circuits Perception "Processes that perform computations on sensory data to construct and transform representations of the external environment, acquire information from, and make predictions about, the external world, and guide action." Auditory verbal hallucinations Fujita et al., 2015;Harkavy-Friedman et al., 2003;Nordentoft et al., 2002Self-report Visual acuity Rim, Lee, Sung, Chung, & Kim, 2015Behavior Chronic pain Calati, Bakhiyi, Artero, Ilgen, & Courtet, 2015Hooley, Franklin, & Nock, 2014 Self-report Higher pain tolerance (e.g., cold pressor task) Ribeiro et al., 2014 Behavior (continued) Language "System of shared symbolic representations of the world, the self and abstract concepts that supports thought and communication." Speech production patterns, acoustic effects (such as monotonous and repetitive phrasing), and voice quality Cummins et al., 2015; S. E. Silverman & Silverman, 2006 Behavior Social Processes: "mediate responses to interpersonal settings of various types, including perception and interpretation of others' actions" ...
Article
Suicide is a leading cause of death worldwide. Prior research has focused primarily on sociodemographic and psychiatric risk factors with little improvement in the prediction or prevention of suicidal behavior over time. The Research Domain Criteria (RDoC) may be an especially useful framework for advancing research in this area. This article provides a brief and broad overview of research on suicidal behavior relating to each of the RDoC domains—highlighting the RDoC construct(s) where research has focused, the construct(s) where research is lacking, and suggestions for future research directions. We also discuss major challenges for suicide research within the RDoC framework, including the intersection of RDoC domains, interaction of domains with the environment, incorporation of developmental stage, integration of distal and proximal processes, and inclusion of suicide-specific constructs. We conclude by underscoring important considerations for future research aimed at using the RDoC framework to study suicidal behavior and other forms of psychopathology.
... The relationship between psychosis and suicidal outcomes have received greater attention in the literature with studies indicating that hallucinations and delusions relate to increased risk for ideation, attempt, and completion (Bornheimer, 2019;Bornheimer and Jaccard, 2017;Connell et al., 2016;Fisher et al., 2013;Sharifi et al., 2015;Kelleher et al., 2014;Bromet et al., 2017;Kjelby et al., 2015;Fjalko et al., 2006;Fujita et al., 2015;Saha et al., 2011). While much of the research to date focuses on clinical samples, a recent systematic review and meta-analysis by Yates and colleagues (2018) synthesized these relationships across 10 studies that used nationally representative samples. ...
Article
Suicide is a leading cause of preventable death in the United States and worldwide, with symptoms of depression and psychosis relating to increases in risk for ideation, attempt, and completion. This study examined moderating effects of depression in the relationships between three categories of psychotic symptoms (experiencing only hallucinations, only delusions, and both hallucinations and delusions) and suicidal ideation. Data (n=12,195) were obtained from the cross-sectional Collaborative Psychiatric Epidemiology Surveys data which include large general population-based samples of households in the United States. Data were examined using Structural Equation Modeling (SEM) in Mplus 8. Approximately 19% of the sample met criteria for major depression and 13% reported having the experience of suicidal ideation. Only 16% of the sample reported having a diagnosis of schizophrenia and/or a psychotic disorder. Depression functioned as a moderator and among those who experienced depression, increases in all psychotic symptom categories significantly related to increased likelihood of experiencing suicidal ideation. Among those who were not depressed, increases in two psychotic symptom categories (only hallucinations and both hallucinations and delusions) were significantly related to greater likelihood of experiencing suicidal ideation. Findings emphasize the high-risk for ideation among individuals who experience hallucinations or delusions, with the cumulative effect of experiencing both hallucinations and delusions being most harmful in relation to the likelihood of experiencing suicidal ideation; particularly so among those who were depressed. Assessment of risk factors for suicidal ideation is imperative given its relationship to the potential of suicide attempt and/or completion.
... [1] AVH is a disabling and even fatal symptom of schizophrenia, as it can cause extreme suffering that leads to self-harm and suicidal behavior. [1,2] Hence, there is an urgent need to understand the mechanisms of AVHs as well as the pathological features and treatment strategies of AVHs in schizophrenia patients. [3] The International Consortium on Hallucination Research investigated AVHs from multiple perspectives in 2013. ...
Article
Background: Few studies have reported brain function differences in drug-naïve first-episode schizophrenia patients who had auditory verbal hallucinations (AVH) with insight vs. those without insight. This study aimed to investigate brain function differences between drug-naïve first-episode AVH-schizophrenia patients with and without insight. Methods: Forty first-episode drug-naïve AVH-schizophrenia patients with or without insight and 40 healthy controls between December 2016 and December 2018 from Jining Medical University affiliated Second Hospital were recruited in this study. The auditory hallucinations rating scale (AHRS) was used to assess AVH severity, while the insight and treatment attitudes questionnaire was used to distinguish insight. The global functional connectivity density (gFCD) between different groups was compared using a voxel-wise one-way analysis of covariance. The relationship between gFCD and AHRS total scores were analyzed using voxel-wise multiple regression. Results: Finally, 13 first-episode drug-naïve AVH-schizophrenia patients with insight, 15 AVH-schizophrenia patients without insight, and 20 healthy controls were included for analysis. Except for global assessment of functioning scores, there were no significant differences in sociodemographic information between the AVH-schizophrenia and healthy groups (P > 0.05). Compared to the healthy controls, AVH-schizophrenia patients with insight demonstrated a decreased gFCD in the supra-marginal gyrus within the primary auditory cortex, while those without insight demonstrated an increased gFCD in the inferior frontal gyrus and superior temporal gyrus and decreased gFCD in the supplemental motor area. Compared to the AVH-schizophrenia patients with insight, those without insight demonstrated an increased gFCD in the supra-marginal gyrus and posterior superior temporal lobule and a decreased gFCD in the frontal lobe. No significant correlation between gFCD and AVH severity (AHRS total score: r = 0.23, P = 0.590; and frequency: r = 0.42, P = 0.820) was found in both AVH-schizophrenia groups. Conclusions: The gFCD-aberrant brain regions in the AVH-schizophrenia patients without insight were wider compared to those with insight, although the AHRS scores were not significantly different. The AVH-schizophrenia patients without insight had wide functional impairment in the frontal lobule, which may underlie the lack of insight and the abnormal hyperactivity in the inferior frontal gurus and temporal lobe related to the AVH symptoms.
... Childhood experiences of voice hearing do not necessarily lead to mental health difficulties in adulthood (Edelsohn, 2006;Linscott & van Os, 2013;Poulton et al., 2000), although hearing voices in youth has been connected to later experiences of depression and anxiety (Kelleher & Cannon, 2011). Young people who experience even transient voice hearing tend to report reduced quality of life at later follow-ups compared with their peers (Calkins et al., 2017) and a higher rate of suicidal ideation (Fujita et al., 2015). There are likely to be a wide range of multisystemic factors connecting mental health difficulties and voice hearing, such as internalizing stigma, threats to selfperception, adverse childhood experiences (Varese et al., 2012), the appraisal of hallucinations (Fannon et al., 2009;Peters et al., 2017), and societal adversity (Veling, Counotte, Pot-Kolder, van Os, & van der Gaag, 2016). ...
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Despite the prevalence of voice hearing in childhood and adolescence, little qualitative research has been undertaken with young people directly to advance phenomenological and etiological insights into their experiences and interpretations. Consequently, the researchers sought demographic, contextual and qualitative data from 74 young people from eleven countries, aged 13‐18 years (28%=M; 61%=F; 21%=TGNB), who self‐identified as hearing voices. A Foucauldian‐informed Narrative Analysis yielded four analytic chapters, offering novel perspectives into individual, relational, systemic and cultural interpretative narratives surrounding multisensory and multi‐self voice hearing. Overall, young people reported heterogenous experiences of voice hearing and associated sensory experiences and most participants reported voice hearing beginning between ages eight and eleven. Further, the emotions felt by the child, as well as reactions displayed by people around the child in relation to the voices, influenced voice‐related distress and the nature of the voices in a triadic relationship. A continuum of multisensory features of voice content, nature and relational significance is tentatively proposed to capture the breadth and depth of voice hearing for adolescents to offer a possible framework for future study and intervention design. Specifically, participants described voice‐related distress could be exacerbated by observed anxiety or internalized stigma about voice hearing, social isolation, and attribution to illness. These findings suggest we may need to reconsider how the experience of hearing voices in childhood influences their relationships and how relationships influence the voice hearing experience. Further, young people seem to have a broad understanding of what the term ‘hearing voices’ means, which could inform how researchers and practitioners work with this group of young people. Finally, participants described benefitting from multisensory coping strategies, such as imagery and meditation, which could offer important considerations for tailoring therapeutic interventions for adolescent voice‐hearers.
... Furthermore, while depression often mediates the relationship between established risk factors and suicide, recent studies have found that associations between psychotic symptoms and suicidal thoughts and behaviors remain stable even when controlling for depression, hopelessness, substance use, mania, anxiety, and other known risk factors. 14,32,34,63,64 ...
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Background: Psychotic disorders, as well as psychotic symptoms, are associated with a greater lifetime risk of suicidal behavior (SB). It is not known, however, whether psychotic symptoms are independent predictors for short-term SB. Methods: Data were collected from 201 psychiatric inpatients at Mount Sinai Beth Israel Hospital. Self-reported psychotic symptoms were assessed using the Brief Symptom Inventory (BSI). Postdischarge SB defined as an aborted, interrupted, or actual suicide attempt was assessed using the Columbia-Suicide Severity Rating Scale (C-SSRS), during the 4 to 8 weeks following discharge from an inpatient psychiatric unit (n=127, 63% retention). Logistic regressions were performed to assess the relationships between psychotic symptoms and SB, controlling for primary psychiatric disorders. Results: Self-reported psychotic symptoms were associated with subsequent postdischarge SB. There was no significant difference between the SB versus no SB groups on the basis of primary psychiatric disorder. Self-reported psychotic symptoms remained an independent and significant predictor of postdischarge SB when the analysis controlled for primary psychiatric disorder. Conclusions: These results suggest that psychotic symptoms are a dimensional predictor of near-term postdischarge SB and are a necessary component of suicide risk assessment during inpatient hospitalization, independent of psychiatric diagnosis.
... 6,[9][10][11][12][13][14] The relationship between psychosis and suicide-related experiences has been extensively investigated and studies highlight psychosis as a putative amplifier of suicidal thoughts and behaviors. [15][16][17][18][19][20][21][22][23][24][25][26][27] Furthermore, individuals with psychosis are vulnerable to distress due to psychosis. 28 Previous research has indicated that suicidal experiences may be a consequence of the psychological distress caused by delusions and hallucinations. ...
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Suicide deaths in people with non-affective psychosis represent a major health care concern. Previous research has shown that psychosis and the associated distress increase suicidal experiences, whereas psychological resilience weakens the impact of suicide precursors, such as defeat, entrapment, and hopelessness on suicidal experiences. The moderating roles of psychosis, distress, and psychological resilience in the relationships between defeat, entrapment, hopelessness, and suicidal thoughts and behaviors have not been tested longitudinally. This 3-month longitudinal study used moderated mediation analysis to investigate: (1) the impact of defeat/entrapment and hopelessness on suicidal thoughts and behaviors and (2) the moderating effects of psychosis, distress, and psychological resilience in the relationships between defeat/entrapment, hopeless-ness, and suicidal thoughts and behaviors. Individuals with non-affective psychosis-related diagnosis (including schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, or psychotic disorders not otherwise specified) and lifetime experiences of suicidal thoughts, plans, and/or acts were recruited from the NorthWest of England, UK. Of the 100 participants at base-line, 90 took part in the follow-up assessment. At baseline, most of the participants had experienced one or more lifetime suicide attempts. Suicidal thoughts and behaviors scores were significantly lower at follow-up, compared with baseline. Over time, defeat/entrapment predicted suicidal thoughts and behaviors when the severity of psy-chosis and the associated distress were moderate and high, and resilience was lowest. The impact of defeat/entrap-ment, psychosis, distress due to psychosis, and resilience needs to be incorporated into interventions aiming to reduce suicidal experiences. These findings impact psychosis and resilience-focused suicide prevention interventions for people with non-affective psychosis.
... A cross-sectional study of adolescents referred for psychiatric care (aged 10-15 years) reported the presence of auditory hallucinations increased the odds for suicide attempts (OR = 3.4; 95%CI = 2.0-5.7) among those with suicidal ideation, but depression did not (25). Two population representative cross-sectional studies (26,27) confined to adult populations (18-95 years) showed contrasting results. ...
Article
Objective: Psychotic experiences, including auditory hallucinatory experiences (HEs), are strongly associated with both suicidal thoughts and behaviour. This study examined their role in the ideation-to-attempt transition in adolescents, including their direct and indirect effect via potential mediators. Method: Participants were from an Australian prospective longitudinal cohort of 1669 adolescents (12–17 years); of which a subsample endorsing baseline suicidal ideation (n = 216) was the focus of most analyses. Suicidal thoughts and behaviours were measured using the Self-Harm Behaviour Questionnaire. The Diagnostic Interview Schedule for Children was used to assess auditory HEs. Potential mediators of interest were psychological distress and Interpersonal Theory of Suicide (IPTS) constructs. Results: Among adolescents reporting suicidal ideation at baseline (n = 216), 6.5% had attempted suicide during follow-up. The size of auditory HEs’ univariate effect suggests a possible strong relationship with increased risk of incident suicide attempts (OR = 2.40; 95%CI = 0.76–7.56); however, there was inadequate statistical power to produce a precise estimate.When HEs were accompanied by distress there was a nine-fold increased risk of acting on suicidal thoughts. Distress was independently associated with risk of attempt transition (OR = 4.09), whereas IPTS constructs were poor explanatory variables in most models. Conclusion: Adolescents with psychological distress and auditory HEs are at high risk of incident suicide attempts. Further investigations on the role of negative/distressing content of hallucinations in the ideation-to-attempt transition are warranted.
... AHs may also occur in the general population, with a reported prevalence of 10%-15% (Alderson-Day et al., 2016;Daalman, Diederen, Hoekema, Lutterveld, & Sommer, 2016;Diederen, Daalman, et al., 2012;Diederen, van Lutterveld, & Sommer, 2012;Garrison et al., 2017;Sommer et al., 2010). AHs are associated with a high incidence of self-harm, aggression, and increased suicide risk in individuals that experience them, especially during adolescence and early adulthood (Brennan, Mednick, & Hodgkin, 2000;Fujita et al., 2015;Harris & Barraclough, 1997;Hodelet, 2001;Slotema et al., 2017). Nevertheless, the neural mechanisms of AHs have not been fully elucidated. ...
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Background: We explored common and distinct pathological features of different subtypes of auditory hallucinations (AHs) to elucidate the underlying pathological mechanisms. Methods: We recruited 39 individuals with constant commanding and commenting auditory verbal hallucinations (CCCAVHs), 49 with own thought auditory verbal hallucinations (OTAVHs), 46 with nonverbal AHs (NVAHs), 32 with replay AVHs (RAVHs), and 50 healthy controls. Functional connectivity density mapping was used to investigate global functional connectivity density (gFCD) alterations in these AH groups relative to the control group. Results: We observed common brain functional alterations among four subtypes of AHs, such as increased gFCD in the bilateral superior temporal gyrus and mesial frontal lobe, and decreased gFCD in the bilateral medial prefrontal cortex. Increased gFCD was detected in the bilateral insula in CCCAVH individuals, bilateral thalamus in OTAVH individuals, bilateral precuneus in NVAH individuals, and bilateral hippocampus in RAVH individuals. The common and distinct gFCD alterations among four AH subtypes were located in main components of the frontoparietal, default mode, salience, central executive, and memory networks. Different AH subtypes exhibited specific aberrant patterns. Conclusions: Our findings suggest that aberrant functional activity and metabolism in the abovementioned networks play key roles in the occurrence of AHs. Our findings provide evidence for distinct gFCD alterations in specific AH subtypes.
... Insulting "voices" can lead to self-harm, suicidal attempts, suicide, and extreme violence in patients with schizophrenia (Dugré et al., 2018). Therefore, there is an urgent need to understand the underlying neural mechanisms to identify therapeutic targets for the effective treatment of AVHs (Fujita et al., 2015;Hugdahl, 2015). ...
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Background Auditory verbal hallucinations (AVHs) and depressive symptoms are highly prevalent in schizophrenia, and recent progress has been made in understanding the reciprocal deterioration of both symptoms through structural and functional brain imaging studies. To date, there is limited literature on this topic. In this review, we synthesized the recent literature on the neuroimaging features of schizophrenia patients with concurrent AVHs and depressive symptoms. Methods A literature search was conducted with the major databases using the keywords, mainly including schizophrenia, AVHs, depression, neuropsychiatric disorders, brain imaging, and magnetic resonance imaging. Results The existing studies have shown that AVHs and depressive symptoms reciprocally deteriorate in patients with schizophrenia, which has challenged the conventional treatment of the disease. Interestingly, repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) therapies have emerged as two efficacious brain stimulation treatments that can normalize the brain regions associated with the symptoms, as shown through functional and structural brain imaging studies. In light of these important findings, there is an urgent need to conduct in‐depth neuronal mechanistic studies to identify targets for stimulation therapy. Conclusions These new findings may elucidate the pathological mechanisms underlying schizophrenia with concurrent AVHs and depressive symptoms. Furthermore, this review has important clinical implications for developing novel therapeutic strategies to alleviate the reciprocal deterioration AVHs and depressive symptoms of schizophrenia patients.
... Furthermore, it is plausible that hallucinations and psychotic experiences may lead individuals with SUD to attempt suicide. A cross-sectional study, for example, demonstrated that auditory verbal hallucinations increased the odds of suicide attempt in adolescents with suicidal ideation regardless of gender [62,63]. ...
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Background Suicide is a severe health problem, with high rates in individuals with addiction. Considering the lack of studies exploring suicide predictors in this population, we aimed to investigate factors associated with attempted suicide in inpatients diagnosed with cocaine use disorder using two analytical approaches. Methods This is a cross-sectional study using a secondary database with 247 men and 442 women hospitalized for cocaine use disorder. Clinical assessment included the Addiction Severity Index, the Childhood Trauma Questionnaire, and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, totalling 58 variables. Descriptive Poisson regression and predictive Random Forest algorithm were used complementarily to estimate prevalence ratios and to build prediction models, respectively. All analyses were stratified by gender. Results The prevalence of attempted suicide was 34% for men and 50% for women. In both genders, depression (PRM = 1.56, PRW = 1.27) and hallucinations (PRM = 1.80, PRW = 1.39) were factors associated with attempted suicide. Other specific factors were found for men and women, such as childhood trauma, aggression, and drug use severity. The men's predictive model had prediction statistics of AUC = 0.68, Acc. = 0.66, Sens. = 0.82, Spec. = 0.50, PPV = 0.47 and NPV = 0.84. This model identified several variables as important predictors, mainly related to drug use severity. The women's model had higher predictive power (AUC = 0.73 and all other statistics were equal to 0.71) and was parsimonious. Conclusions Our findings indicate that attempted suicide is associated with depression, hallucinations and childhood trauma in both genders. Also, it suggests that severity of drug use may be a moderator between predictors and suicide among men, while psychiatric issues shown to be more important for women.
... 95%CI=2.0-5.7) among those with suicidal ideation, but depression did not [297]. Two population representative crosssectional studies [25,101] [25] reported PEs did not make an additional contribution to suicide attempts among those with suicidal ideation. ...
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The article dwells on the influence of auditory pseudohallucinations on suicidal ideation of the patients with schizophrenia. The auditory pseudohallucinations are the most common and clinically significant symptoms of schizophrenia. According to researchers’ reports, the auditory pseudohallucinations are among the main factors leading to suicide in schizophrenia. The impact of the auditory pseudohallucinations was investigated on the level of suicidal ideation and the frequency of suicide attempts in patients hospitalized with schizophrenia in the present research. Seventy nine inpatient schizophrenic patients were involved in the study with diagnosis matching ICD10 criteria. The patients were subjected to clinical examination as well as were assessed by the following questionnaires: The Positive and the Negative Symptoms Scale (PANSS), the Calgary Depression at Schizophrenia Scale (CDSS) and the Montgomery-Asberg Depression Rate Scale (MADRS). The origin of hallucinations: imperative, threatening, accusing, commenting, antagonistic etc., was clarified based on clinical interview. The highest correlation (correlation coefficient – 0.36) with the severity of suicidal ideation and tendencies, assessed with the scale CDSS, has item 3 (hallucinations) of positive symptoms subscale of PANSS. Also statistically significant correlation with the severity of hallucinations was found during the assessment of the same symptoms with MADRS scale (correlation coefficient – 0.29). In addition to hallucinations, a relatively weak, but significant correlation can be traced between suicidal ideas and intensity of delusions. The 8th point of CDSS scale and 10th point of MADRS scale, as items that describe suicidal behavior, are the only ones that correlate with the third item (hallucinations) on the scale of PANSS. Mutual reliability in the assessment of suicidal ideation and actions with the help of two different questionnaires is confirmed by very high coefficient of correlation between points of suicide assessment in both. The levels of suicidal ideation were significantly higher (about 6 times) in patients with imperative hallucinations compared to those who experienced other types of auditory hallucinations. Majority of the patients who attempted suicide had imperative hallucinations despite the total number of patients who had imperative hallucinations, which was less than a half of all selection. Practically all patients who attempted suicide had imperative hallucinations and didn’t share it with anyone. Therefore, auditory pseudohallucinations, from all positive symptoms observed in schizophrenia, have the greatest impact on the level of suicidal thoughts and actions. Hallucinations’ character has the most important effect on suicidal ideation.
Article
Objective To assess rates and lethality of suicidal behavior in studies of children and adolescents diagnosed with major depressive disorder (MDD) or bipolar disorder (BD). Methods This PROSPERO-registered protocol (CRD-42019159676) systematically reviewed reports on suicidal behavior among juveniles (age ≤ 18 years), and pooled data on risk (% of subjects) and rates (%/year), followed by random-effects meta-analysis and multivariable linear regression modeling. Results Included were 41 reports (1995–2020) from 15 countries involving 104,801 juveniles (102,519 diagnosed with MDD, 2282 with BD), at risk for 0.80–12.5 years. Meta-analytically pooled suicide attempter-rates averaged 7.44%/year [95%CI: 5.63–9.25] with BD and 6.27%/year [5.13–7.41] with MDD. Meta-analysis of 5 studies with both diagnostic groups found significantly greater attempt risk with BD vs. MDD (OR = 1.59 [1.24–2.05], p < 0.0001). In 6 studies, suicide rate with juvenile mood disorders averaged 125 [56.9–236]/100,000/year, similar to adult rates, >30-times greater than in the general juvenile population, and higher among older adolescents. The ratio of attempts/suicides (A/S) was 52.6 among mood-disordered juveniles, indicating greater lethality than among juveniles in the general population (A/S ≥ 250), but somewhat less than in the estimated adult general population (A/S ca. 30). Conclusions Rates of suicide attempts in juveniles with a major mood disorder averaged 6580/100,000/year, were greater in BD versus MDD observed under the same conditions, and greater with shorter periods of observation. Lethality (fatalities per suicide attempt) was greater in juveniles diagnosed with major affective disorders than in the juvenile general population, but less than in adults.
Article
Résumé Objectifs Les hallucinations acoustico-verbales (HAV) représentent une prévalence de 12 % en population pédiatrique générale et sont considérées comme un phénomène développemental transitoire et bénin. La persistance des HAV représenterait un mauvais pronostic d’évolution vers un trouble psychotique. L’altération des marqueurs de cognition sociale et émotionnels sont décrits comme prodromiques de cette évolution. L’objectif de cette étude était d’évaluer ces marqueurs chez l’enfant et l’adolescent présentant des HAV. Méthodes Cette étude multicentrique prospective et longitudinale incluait des sujets de 8 à 16 ans issus d’une population pédiatrique clinique. Les patients étaient répartis en deux groupes avec et sans HAV et étaient appariés selon le sexe, l’âge et les diagnostics psychiatriques associés (MINI-Kid). Un diagnostic de trouble du spectre de la schizophrénie (K-SADS-PL) était un critère de non-inclusion. La NEPSY II évaluait la cognition sociale. Le marqueur émotionnel était évalué avec l’Échelle des Émotions Différentielles et BAVQ-R, catégorisant les émotions réactionnelles aux HAV. Résultats Il n’a pas été retrouvé de lien significatif entre les marqueurs de cognition sociale et émotionnels et la présence des HAV à l’inclusion. À 6 mois, 50 % des sujets HAV+ présentaient des HAV persistantes et 18 % évoluaient vers un trouble du spectre de la schizophrénie. La persistance des HAV était significativement corrélée à la présence de tristesse, peur, d’hostilité envers soi et de colère et inversement corrélée à la joie. Conclusion Les HAV en population pédiatrique ne sont pas liées au marqueur de cognition sociale mais les émotions négatives apparaissent comme marqueur de persistance des HAV. ClinicalTrials.gov Identifier NCT02567500.
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Voice hearing has been conceptualized as an interrelational framework, where the interaction between voice and voice hearer is reciprocal and resembles “real-life interpersonal interactions.” Although gender influences social functioning in “real-life situations,” little is known about respective effects of gender in the voice hearing experience. One hundred seventeen participants with a schizophrenia spectrum disorder took part in a semi-structured interview about the phenomenology of their voices and completed standardized self-rating questionnaires on their beliefs about their most dominant male and female voices and the power differentials in their respective voice-voice hearer interactions. Additionally, the voice hearers’ individual masculine/feminine traits were recorded. Men heard significantly more male than female dominant voices, while the gender ratio of dominant voices was balanced in women. Although basic phenomenological characteristics of voices were similar in both genders, women showed greater amounts of distress caused by the voices and reported a persistence of voices for longer time periods. Command hallucinations that encouraged participants to harm others were predominantly male. Regarding voice appraisals, high levels of traits associated with masculinity (=instrumentality/agency) correlated with favorable voice appraisals and balanced power perceptions between voice and voice hearer. These positive effects seem to be more pronounced in women. The gender of both voice and voice hearer shapes the voice hearing experience in manifold ways. Due to possible favorable effects on clinical outcomes, therapeutic concepts that strengthen instrumental/agentic traits could be a feasible target for psychotherapeutic interventions in voice hearing, especially in women.
Article
Background: In patients with borderline personality disorder (BPD), about 22-50% experience auditory verbal hallucinations (AVH). However, the impact of these hallucinations on suicidal ideation, suicide attempts, crisis-service interventions, and hospital admissions is unknown. Methods: In a cross-sectional design, data were collected with the Psychotic Symptom Rating Scales (PSYRATS) and the MINI International Neuropsychiatric Interview Plus, as well as from the medical records of a convenience sample of outpatients fulfilling the DSM-IV criteria for BPD. Results: Of the 89 included patients, 27 experienced AVH. In the latter group, the presence of AVH was associated with a significantly higher incidence of suicidal plans and attempts in the month prior to study participation, more hospitalisations, and a shorter interval until hospitalisation. All subscales of the PSYRATS correlated positively with suicide plans, while the phenomenological and emotional subscales also correlated positively with suicide attempts. Moreover, higher scores on the emotional subscale were associated with more hospital admissions. Conclusions: AVH experienced by patients with BPD might constitute a risk factor for suicide plans and attempts, and hospitalisation. This finding emphasises that this population requires adequate clinical attention, as well as effective treatment for AVH.
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【Abstract】 The traditional suicide approach treats suicide behavior as a unitary construct, having conflated the question of why people feel suicidal with the question of why people act on suicidal thoughts without differentiating the predictors of ideation with the predictors of the progression from ideation to attempts. The ideation-to-action framework views the devel• opment of suicide ideation and the progression from ideation to attempts as distinct processes with distinct explanations and predictors. The Three-Step Theory (3ST) is one of the representative theories based on the framework. In this review, the proposed background, the theoretical content and future prospects of the 3ST will be systematically introduced. The aim is to acquire a better understanding of the 3ST and promote the development of psychological theory based on the ideation-to-action framework.
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This article aims to analyze the factors associated with suicidal ideation in the COVID-19 pandemic. A cross-sectional homebased survey, with three-stage cluster sampling, was conducted with 4,203 adults from ten municipalities in the Mato Grosso, Brazil. The data collection was carried households to assessment of sociodemographic characteristics, substance use and behavior in the pandemic. The Level 1 Symptom Cross Scale was used to identify suicidal ideation and aspects of mental health (somatic symptoms, sleep disturbances, dissociation, depression, anger, mania, anxiety, thoughts, substance use and memory). Chemiluminescence was used to detect IgG anti-SARS-CoV-2 antibodies. The prevalence of suicidal ideation was 19.2%, and the associated with increased consumption of alcohol (RP=1.16), smoking (RP=1.30), COVID-19 symptoms (RP=1.03), having one’s life affected (RP=1.04), mental illness (RP=1.09) somatic symptoms (RP=1.15), sleep disturbance (RP=1.30), dissociation (RP=1.24), depression (RP=1.24), anger (RP=1.11), anxiety (RP=1.26), substance use (RP=1.19), drug prescription use (RP=1.18) and memory (RP=1.87). Highlights the high prevalence of suicidal ideation related to COVID-19 symptoms, changes in behavior post-pandemic and mental health factors
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The recent increase in the number of patients accessing healthcare services with a diagnosis of borderline personality disorder continues to put unprecedented pressure on healthcare professionals. It is likely that considerable national health service resources will have to be allocated to these patients in the future.
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Significant research questions persist regarding the short- and long-term outcomes of Latina adolescents who attempt suicide. To address these limitations, we utilize an ecodevelopmental framework to identify potential factors that shape differential outcomes following a suicide attempt. Through an exploratory, longitudinal, qualitative research design, we investigate two research questions: How do trajectories of well-being vary among Latina teens after a suicide attempt? What risk and protective factors might contribute to different trajectories? We conducted qualitative interviews with 17 Latina participants living in predominantly low-income households in New York City. Interviews took place within the six-months following their suicide attempts, and again, 12 months later. Analysis revealed three distinct trajectories after a suicide attempt: resilience, tenuous growth, and chronic stress. Our findings elucidate potential factors that contribute to resilience following a suicide attempt and underscore the importance of prevention and intervention programs that foster adolescents’ connectivity across ecodevelopmental contexts.
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Psychotic experiences may be part of normal development or indicate a wide range of mental disorders. This article shows how a systematic, domain-based, phenomenological approach to assessing psychotic symptoms in youth facilitates the gathering of the nuanced clinical information necessary to understand a child's specific experience. Mapping this information onto a narrative timeline, while understanding the evolution and developmental context of psychotic experiences, is essential in making an accurate diagnostic formulation and appropriate treatment plan for youth presenting with psychotic experiences.
Thesis
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Background: The structure of psychopathology determines how we identify people who need support services and how we can best help them. Currently, we identify those with psychopathological issues via assessments based on diagnostic manuals, such as the International Statistical Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM). However, there is a growing literature that has raised serious concerns about these two manuals. Some have suggested that such diagnostic manuals have misguided decades of mental health studies and may have contributed to dissatisfaction among service seekers and users relating to ineffective treatments and negative experiences with service providers. This doctoral dissertation explores possible alternative approaches to our understanding of the structure of psychopathology. It considers how these approaches could contribute to future classification, diagnostic and service delivery systems. Method: We used one dataset for all four studies. It was mined from https://www.livejournal.com/ and consisted of narratives about lived experiences from people diagnosed with mental disorders. The data were analysed using Jaccard’s Coefficient to find similarity between diagnostic categories (study 1), K-Means Clustering to group symptoms into diagnostic categories (in study 2), Network Analysis to find the relationships between the co-occurring symptoms and Eigenvector Centrality to estimate which among them are co-occurring with most other symptoms (study 3), and standard correlation to find the strength of such associations (in study 4). Findings: We proposed an alternative approach for estimating the reliability of the existing system (study 1) to study the extent of diagnostic overlap (heterogeneity) because the present studies evaluating the reliability had their limitations. Study 1 (chapter 4) contributes to the literature by being the first study to exploit patient narrative data, using innovative text-mining methods in this context, to assess the diagnostic heterogeneity of the DSM categories. It provides unique evidence to reinforce existing studies of diagnostic heterogeneity using alternative approaches such as Jaccard’s coefficients. Once verified that the diagnostic heterogeneity of human-led traditional diagnostic categories is too large for practical usage, we searched for the reasons. Many studies have attributed the problem to the committee members who created the manuals. Among the several raised questions, the committee members reported a financial conflict of interests with the industry and relied more on consensus than data. So, eliminating the human component of decision making, we should be able to find homogeneous groups of disorders. Therefore, we attempted to create categories of mental illnesses using Artificial Intelligence (study 2) from patients’ reported symptoms. Study 2 (chapter 5) contributes to the literature by being the first study in this context to demonstrate how to cluster the patients using artificial intelligence based on the similarities in their reported symptoms or experiences from their illness narratives. It provides evidence to contrast the conventional idea of conceptualising “mental illnesses as categories” using unsupervised machine learning algorithms and the silhouette score elbow method. For example, in study 2, when the machine-driven approach also produced mental disorder categories with high heterogeneity, we inferred that while there might have been human biases with the traditional diagnostic manuals, the more important point is that the categorical approach is not the way forward. The findings from study 2 support the literature and state the same. The literature has proposed several alternatives, such as the dimensional and network approaches. But related to this notion of diagnosing and studying humans (and their conditions) as categories, such as depression, consisting of individual entities (e.g., symptoms), there is another serious problem with the mental health research culture - that has found its way into these new alternatives as well. This problem is related to using total scores of survey items as objects of inquiry (e.g., total depression score). This approach assumes that all the items in the questionnaire (e.g., low mood, lack of interest) contributes in equal proportions to the construct (e.g., depression), but the empirical evidence suggests otherwise. The newer dimensional approaches such as the HiTOP relies on such sum scores. Likewise, some network studies are also using such sum scores. Therefore, in doing so, such alternatives risk carrying forward some of the weaknesses of its categorical predecessors. As an alternative, we proposed the use of individual symptoms as an object of inquiry. It’s a relatively novel approach, and we hoped to advance the literature. Therefore, we created a network of psychopathological symptoms based on patients’ reports (study 3). Study 3 (chapter 6) contributes to the literature by being the first study to demonstrate how to create network graphs from pure narrative data from patients in this context and presented a new approach for exploratory analysis by finding inter-relations in their reported symptoms or experiences from patients’ illness narratives. It demonstrates a relatively novel approach to focus on individual symptoms for the object of inquiry instead of categories of mental disorders or sum-scores of scales or questionnaires. The study discovered relationships based on co-occurrences of the reported symptoms. Still, it did not communicate the strength (“numeric” degree) of such association. While finding the association has merit for preliminary exploration, for this approach of using individual symptoms as an object of inquiry to be useful for clinical and research purposes, we argue that it must provide the information related to the strength of association. So, in the final study, we attempted to find the correlations of auditory hallucination and, in doing so, demonstrated how to find correlation coefficients between pairs of symptoms from a qualitative (text-based narrative) dataset. Furthermore, the correlations were valuable to the advancement of the theoretical literature of auditory hallucination. Study 4 (chapter 7) contributes to the literature by being the first study to demonstrate how to do correlation analysis on qualitative data in this context. It suggests a new direction of conducting exploratory research using rich qualitative datasets and standard statistical methods without the limitations of a conventional survey dataset. Conclusion: The doctoral thesis found that the traditional categorical approach does not accurately reflect the complexity of people’s experiences. There might be human biases and conflict of interest, which might have influenced the creation of the diagnostic manuals. Still, even when artificial intelligence attempted to find similar patterns within the patients’ experiences, it could not indicate that psychopathological experiences cannot be categorised into homogenous groups. So, we argue that the future of mental health literature should divorce itself from using DSM and ICD categories of mental disorders as the object of investigations and as the framework for conceptualising mental illnesses. Instead, we argue that the focus should be on alternative conceptualisations of psychopathology, such as the network model of psychopathology, which focuses on the individual symptoms and the inter-relationships between them. Our preliminary network model explores the specific relationships between symptoms found that were frequently occurring but relatively less studied in the literature - opening up newer lines of investigation for future studies to build upon. Furthermore, using auditory hallucination as an object of investigation, we found the variables with the highest correlation coefficients and attempted to advance the psychosis literature. One major merit and contribution of the doctoral thesis is to demonstrate how we can do all that was mentioned above using rich qualitative data. Unlike survey data, the current data did not pose any restrictions in terms of the number or type of variables being reported. The respondents reported everything that had to report. Additionally, the thesis demonstrated how a large volume of qualitative data could be obtained and then analysed using statistical and machine learning-based approaches with minimum effort and time using advanced technologies such as Natural Language Processing, Artificial Intelligence, and Web-Scraping technologies. This thesis's second major merit and contribution are to demonstrate how to use novel data analytic procedures such as Jaccard’s Coefficient, K-Means Clustering and Network Graphs, and conventional statistics such as correlation coefficients on such qualitative datasets. No manual analysis, such as thematic analysis of the qualitative data, was done. This thesis's third merit and contribution were in terms of advancing the literature by evaluating diagnostic heterogeneity between categories of mental disorders using a novel approach (study 1); finding out symptoms that exclusive to each cluster of mental disorders (study 2); estimating the tendency of specific symptoms to co-occur with other symptoms (study 3), and finding out the symptoms associated with auditory hallucination (study 4). Future mental health studies will benefit from this contribution and are expected to produce deeper insight into mental conditions and treatment of mental ill-health.
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It is time for policy-makers, funders, researchers and clinicians to tackle high suicide rates, say André Aleman and Damiaan Denys.
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Importance: Suicidal behavior has increased since the onset of the global recession, a trend that may have long-term health and social implications. Objective: To test whether suicide attempts among young people signal increased risk for later poor health and social functioning above and beyond a preexisting psychiatric disorder. Design: We followed up a cohort of young people and assessed multiple aspects of their health and social functioning as they approached midlife. Outcomes among individuals who had self-reported a suicide attempt up through age 24 years (young suicide attempters) were compared with those who reported no attempt through age 24 years (nonattempters). Psychiatric history and social class were controlled for. Setting and participants: The population-representative Dunedin Multidisciplinary Health and Development Study, which involved 1037 birth cohort members comprising 91 young suicide attempters and 946 nonattempters, 95% of whom were followed up to age 38 years. Main outcomes and measures: Outcomes were selected to represent significant individual and societal costs: mental health, physical health, harm toward others, and need for support. Results: As adults approaching midlife, young suicide attempters were significantly more likely to have persistent mental health problems (eg, depression, substance dependence, and additional suicide attempts) compared with nonattempters. They were also more likely to have physical health problems (eg, metabolic syndrome and elevated inflammation). They engaged in more violence (eg, violent crime and intimate partner abuse) and needed more social support (eg, long-term welfare receipt and unemployment). Furthermore, they reported being lonelier and less satisfied with their lives. These associations remained after adjustment for youth psychiatric diagnoses and social class. Conclusions and relevance: Many young suicide attempters remain vulnerable to costly health and social problems into midlife. As rates of suicidal behavior rise with the continuing global recession, additional suicide prevention efforts and long-term monitoring and after-care services are needed.
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Recent community-based research has suggested that psychotic experiences act as markers of severity of psychopathology. There has, however, been a lack of clinic-based research. We wished to investigate, in a clinical sample of adolescents referred to a state-funded mental health service, the prevalence of (attenuated or frank) psychotic experiences and the relationship with (i) affective, anxiety and behavioural disorders, (ii) multimorbid psychopathology, (iii) global functioning, and (iv) suicidal behaviour. The investigation was a clinical case-clinical control study using semi-structured research diagnostic psychiatric assessments in 108 patients newly referred to state adolescent mental health services. Psychotic experiences were prevalent in a wide range of (non-psychotic) disorders but were strong markers of risk in particular for multimorbid psychopathology (Z = 3.44, p = 0.001). Young people with psychopathology who reported psychotic experiences demonstrated significantly poorer socio-occupational functioning than young people with psychopathology who did not report psychotic experiences, which was not explained by multimorbidity. Psychotic experiences were strong markers of risk for suicidal behaviour. Stratified analyses showed that there was a greatly increased odds of suicide attempts in patients with a major depressive disorder [odds ratio (OR) 8.89, 95% confidence interval (CI) 1.59-49.83], anxiety disorder (OR 15.4, 95% CI 1.85-127.94) or behavioural disorder (OR 3.13, 95% CI 1.11-8.79) who also had psychotic experiences compared with patients who did not report psychotic experiences. Psychotic experiences (attenuated or frank) are an important but under-recognized marker of risk for severe psychopathology, including multimorbidity, poor functioning and suicidal behaviour in young people who present to mental health services.
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Over the years, the prevalence of auditory verbal hallucinations (AVH) has been documented across the lifespan in varied contexts, and with a range of potential long-term outcomes. Initially the emphasis focused on whether AVHs conferred risk for psychosis. However, recent research has identified significant differences in the presentation and outcomes of AVH in patients compared to those in non-clinical populations. For this reason, it has been suggested that auditory hallucinations are an entity by themselves and not necessarily indicative of transition along the psychosis continuum. This review will examine the presentation of auditory hallucinations across the life span. The stages described include childhood, adolescence, adult non-clinical populations, hypnaogogic/hypnopompic experiences, high schizotypal traits, schizophrenia, substance induced AVH, AVH in epilepsy and AVH in the elderly. In children, need for care depends upon whether the child associates the voice with negative beliefs, appraisals and other symptoms of psychosis. This theme appears to carry right through to healthy voice hearers in adulthood, in which a negative impact of the voice usually only exists if the individual has negative experiences as a result of their voice(s). This includes features of the voices such as the negative content, frequency and emotional valence as well as anxiety and depression, independently or caused by voices presence. It seems possible that the mechanisms which maintain AVH in non-clinical populations are different from those which are behind AVH presentations in psychotic illness. For example; the existence of maladaptive coping strategies in patient populations is one significant difference between clinical and non-clinical groups which is associated with a need for care. Whether or not these mechanisms start out the same and have differential trajectories is not yet evidenced. Future research needs to focus on the comparison of underlying factors and mechan
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Importance: Up to 1 million persons die by suicide annually. However, a lack of risk markers makes suicide risk assessment one of the most difficult areas of clinical practice. Objective: To assess psychotic symptoms (attenuated or frank) as a clinical marker of risk for suicide attempt. Design, setting, and participants: Prospective cohort study of 1112 school-based adolescents (aged 13-16 years), assessed at baseline and at 3 and 12 months for self-reported psychopathology, psychotic symptoms, and suicide attempts. Main outcomes and measures: Suicide attempts at the 3- and 12-month follow-up and acute suicide attempts (defined as those occurring in the 2 weeks before an assessment). Results: Of the total sample, 7% reported psychotic symptoms at baseline. Of that subsample, 7% reported a suicide attempt by the 3-month follow-up compared with 1% of the rest of the sample (odds ratio [OR], 10.01; 95% CI, 2.24-45.49), and 20% reported a suicide attempt by the 12-month follow-up compared with 2.5% of the rest of the sample (OR, 11.27; 95% CI, 4.44-28.62). Among adolescents with baseline psychopathology who reported psychotic symptoms, 14% reported a suicide attempt by 3 months (OR, 17.91; 95% CI, 3.61-88.82) and 34% reported a suicide attempt by 12 months (OR, 32.67; 95% CI, 10.42-102.41). Adolescents with psychopathology who reported psychotic symptoms had a nearly 70-fold increased odds of acute suicide attempts (OR, 67.50; 95% CI, 11.41-399.21). Differences were not explained by nonpsychotic psychiatric symptom burden, multimorbidity, or substance use. In a causative model, the population-attributable fraction of suicide attempts would be 56% to 75% for psychotic symptoms. Conclusions and relevance: Adolescents with psychopathology who report psychotic symptoms are at clinical high risk for suicide attempts. More careful clinical assessment of psychotic symptoms (attenuated or frank) in mental health services and better understanding of their pathological significance are urgently needed.
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Self-harm and suicide are major public health problems in adolescents, with rates of self-harm being high in the teenage years and suicide being the second most common cause of death in young people worldwide. Important contributors to self-harm and suicide include genetic vulnerability and psychiatric, psychological, familial, social, and cultural factors. The effects of media and contagion are also important, with the internet having an important contemporary role. Prevention of self-harm and suicide needs both universal measures aimed at young people in general and targeted initiatives focused on high-risk groups. There is little evidence of effectiveness of either psychosocial or pharmacological treatment, with particular controversy surrounding the usefulness of antidepressants. Restriction of access to means for suicide is important. Major challenges include the development of greater understanding of the factors that contribute to self-harm and suicide in young people, especially mechanisms underlying contagion and the effect of new media. The identification of successful prevention initiatives aimed at young people and those at especially high risk, and the establishment of effective treatments for those who self-harm, are paramount needs.
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Suicidal youths are rarely identified in primary care settings. We describe here a care process that includes a computerized screen, colocated social workers, and a coordinated suicide-prevention team at a specialty mental health unit. Patients were 1547 youths aged 11 to 20 years seen in an urban primary care system during 2005 and 2006. We performed an observational study of services provided to youths who screened positive for suicidal ideation on a computerized behavioral health screen during visits to pediatric primary care clinics. Data included clinical records, provider notes, and patients' responses to the screen. A total of 209 (14%) youths reported suicidal thought in the previous month. Suicidal thought was more common among girls, younger youths, substance users, depressed youths, youths who carried weapons, and those who had been in fights; 87% reported at least 1 other serious behavioral health problem. Social workers were able to triage 205 (98%) youths. Triage occurred on the visit day for 193 youths (94%). Mental health evaluations were recommended for 152 (74%) of the triaged youths. Of the 109 subjects referred to a clinic with records accessible for review, 71 (65%) received a mental health service within 6 months. Pediatric primary care is a feasible setting in which to screen for suicidal youths and link them with mental health services. Youths who visit primary care clinics are willing to disclose suicidal ideation on a computerized screen. Youths who screen positive for suicide have many associated behavioral health needs. The use of information technology, colocated physician extenders, and a coordinated team on the mental health side can facilitate rapid, personal contact between the family and mental health service providers, and has the potential to overcome barriers to care for youths with suicidal ideation in the primary care setting.
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To examine the validity of the Patient Health Questionnaire 2 (PHQ-2), a 2-item depression-screening scale, among adolescents. After completing a brief depression screen, 499 youth (aged 13-17 years) who were enrolled in an integrated health care system were invited to participate in a full assessment, including a longer depression-screening scale (Patient Health Questionnaire 9-item depression screen) and a structured mental health interview (Diagnostic Interview Schedule for Children). Eighty-nine percent (n = 444) completed the assessment. Criterion validity and construct validity were tested by examining associations between the PHQ-2 and other measures of depression and functional impairment. A PHQ-2 score of > or =3 had a sensitivity of 74% and specificity of 75% for detecting youth who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for major depression on the Diagnostic Interview Schedule for Children and a sensitivity of 96% and specificity of 82% for detecting youth who met criteria for probable major depression on the Patient Health Questionnaire 9-item depression screen. On receiver operating characteristic analysis, the PHQ-2 had an area under the curve of 0.84 (95% confidence interval: 0.75-0.92), and a cut point of 3 was optimal for maximizing sensitivity without loss of specificity for detecting major depression. Youth with a PHQ-2 score of > or =3 had significantly higher functional-impairment scores and significantly higher scores for parent-reported internalizing problems than youth with scores of <3. The PHQ-2 has good sensitivity and specificity for detecting major depression. These properties, coupled with the brief nature of the instrument, make this tool promising as a first step for screening for adolescent depression in primary care.
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Childhood hallucinations of voices occur in a variety of contexts and have variable long-term outcomes. To study the course of experience of voices sequentially over a 3-year period in those with and those without a need for mental health care (patient status). In a group of 80 children of mean age 12.9 years (s.d. = 3.1), of which around 50% were not receiving mental health care, baseline measurement of voice characteristics, voice attributions, psychopathology, stressful life events, coping mechanisms and receipt of professional care were used to predict 3-year course and patient status. The rate of voice discontinuation over the 3-year period was 60%. Patient status was associated with more perceived influence on behaviour and feelings and more negative affective appraisals in relation to the voices. Predictors of persistence of voices were severity and frequency of the voices, associated anxiety/depression and lack of clear triggers in time and place. Need for care in the context of experience of voices is associated with appraisal of the voices in terms of intrusiveness and 'omnipotence'. Persistence of voices is related to voice appraisals, suggesting that experience of voices by children should be the target of specific interventions.
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Describes adolescents who attempt suicide and their risk for ongoing suicidal behavior. Fifty-eight adolescents (53 female) who attempted suicide received a baseline evaluation that was analyzed to identify factors that were associated with continued suicidal ideation and reattempt. At a 3-month follow-up assessment, 45% reported continued suicidal ideation and 12% reported a repeat attempt. Baseline measures of family functioning, feelings of hopelessness, and abilities to regulate affect were associated with suicidal ideation at follow-up but not as strongly as depressed mood. After controlling for depressive symptoms, the association between family functioning and continued suicidal behavior was no longer significant. Depressed mood at baseline was most strongly associated with both continued suicidal ideation and reattempt.
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Psychosis in pediatric mood disorder patients may be related to suicidal ideation. Bipolar (BP) adolescents are at high risk of completed suicide. We examined whether pediatric BP patients with psychosis have a higher prevalence of suicidality than non-psychotic BP patients. Based on previous findings in adult BP patients, we predicted that pediatric BP patients with psychotic symptoms would have higher prevalence of suicidality, higher occurrence of lifetime psychiatric hospitalizations and worse current Global Assessment of Functioning Scale (GAF) scores compared to non-psychotic BP patients. We studied 43 BP children and adolescents (mean age +/- S.D = 11.2 +/- 2.8 y, range = 8-17) who did (n = 17) or did not have (n = 26) a lifetime history of psychotic symptoms. Indicators of suicidality (thoughts of death and suicidal ideation, plans, and attempts), psychiatric diagnoses, psychotic symptoms, psychiatric hospitalizations and GAF scores were assessed with the K-SADS-PL interview. Small sample size, cross-sectional study and exclusion of substance abuse comorbidity. Pediatric BP patients with a lifetime history of psychotic symptoms compared to BP patients without psychosis were more likely to have thoughts of death (100% versus 69.2%, p = 0.01), suicidal ideation (94.1% versus 42.3%, p = 0.001) and suicidal plans (64.7% versus 15.4%, p = 0.002). Occurrence of psychiatric hospitalization was higher in psychotic BP patients compared to non-psychotic BP patients (82.4% versus 46.2%, p = 0.018). Psychotic symptoms in pediatric BP patients are associated with suicidal ideation and plans, and psychiatric hospitalizations. Psychotic symptoms are a risk factor for suicidality amongst pediatric BP patients.
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The purpose of this study was to examine whether suicidal ideation in a community population of adolescents represents normative adolescent angst or is predictive of psychopathology, suicidal and problem behaviors, and compromised functioning 15 years after onset. Participants were 346 largely Caucasian individuals who were part of a single-age cohort from a working class community and whose development had been traced prospectively from ages 5 to 30. Those with suicidal ideation at age 15 were compared to those without suicidal ideation at age 15 on measures of psychopathology, suicidal ideation and behavior, problem behaviors, and adult functioning at age 30. Gender differences were assessed across all domains. At age 30, there were marked differences between adolescents with suicidal ideation and adolescents without suicidal ideation of both genders in most domains examined. Subjects with suicidal ideation were twice as likely to have an axis I disorder, nearly 12 times more likely to have attempted suicide by age 30, and 15 times more likely to have expressed suicidal thoughts in the past 4 years. Subjects with suicidal ideation had more problem behaviors and poorer overall functioning as assessed by multiple informants. Their self-perceptions of coping ability, self-esteem, and interpersonal relations were also lower. Although subjects with suicidal ideation among both genders had higher levels of psychopathology, suicidal ideation and behavior, and problem behaviors at age 30, male subjects with suicidal ideation had lower salaries and socioeconomic status and were less likely to have achieved residential independence. Findings underscore the importance of considering suicidal ideation in adolescence as a marker of severe distress and a predictor of compromised functioning, indicating the need for early identification and continued intervention.
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Objective: The purpose of this study was to examine whether suicidal ideation in a community population of adolescents represents normative adolescent angst or is predictive of psychopathology, suicidal and problem behaviors, and compromised functioning 15 years after onset. Method: Participants were 346 largely Caucasian individuals who were part of a single-age cohort from a working class community and whose development had been traced prospectively from ages 5 to 30. Those with suicidal ideation at age 15 were compared to those without suicidal ideation at age 15 on measures of psychopathology, suicidal ideation and behavior, problem behaviors, and adult functioning at age 30. Gender differences were assessed across all domains. Results: At age 30, there were marked differences between adolescents with suicidal ideation and adolescents without suicidal ideation of both genders in most domains examined. Subjects with suicidal ideation were twice as likely to have an axis I disorder, nearly 12 times more likely to have attempted suicide by age 30, and 15 times more likely to have expressed suicidal thoughts in the past 4 years. Subjects with suicidal ideation had more problem behaviors and poorer overall functioning as assessed by multiple informants. Their self-perceptions of coping ability, self-esteem, and interpersonal relations were also lower. Although subjects with suicidal ideation among both genders had higher levels of psychopathology, suicidal ideation and behavior, and problem behaviors at age 30, male subjects with suicidal ideation had lower salaries and socioeconomic status and were less likely to have achieved residential independence. Conclusions: Findings underscore the importance of considering suicidal ideation in adolescence as a marker of severe distress and a predictor of compromised functioning, indicating the need for early identification and continued intervention.
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Background: Suicidal ideation is an important indicator for subsequent suicidal behaviour, yet only a proportion of ideators transit from thought to action. This has led to interest surrounding the factors that distinguish ideators who attempt from non-attempters. The study aimed to identify distinct classes of life event categories amongst a sample of ideators and assess the ability of the classes to predict the risk of a suicide attempt. Methods: A subsample of ideators was extracted based on responses to the suicidality section of the Adult Psychiatric Morbidity Survey (N=7403). Fifteen stressful life events (SLEs) were grouped into six broad categories. Results: Using Latent Class Analysis (LCA), three distinct classes emerged; class 1 had a high probability of encountering interpersonal conflict, class 2 reported a low probability of experiencing any of the SLE categories with the exception of minor life stressors, whereas class 3 had a high probability of endorsing multiple SLE categories. The Odds Ratio for attempted suicide were highest among members of Class 3. Limitations: The use of broad event categories as opposed to discrete life events may have led to an underestimation of the true exposure to SLEs. Conclusions: The findings suggest the experience of multiple types of SLEs may predict the risk of transitioning towards suicidal behaviour for those individuals who have contemplated suicide. In application, this re-emphasises the need for a routine appraisal of risk amongst this vulnerable group and an assessment of the variety of events which may signal the individuals who may be at immediate risk.
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Most individuals who consider suicide do not make suicide attempts. It is therefore critical to identify which suicide ideators are at greatest risk of acting on their thoughts. However, few seminal theories of suicide address which ideators go on to make attempts. In addition, perhaps surprisingly, most oft-cited risk factors for suicide-such as psychiatric disorders, depression, hopelessness, and even impulsivity-distinguish poorly between those who attempt suicide and those who only consider suicide. This special section of Suicide and Life-Threatening Behavior serves to highlight this knowledge gap and provide new data on differences (and similarities) between suicide attempters and suicide ideators.
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Suicide attempts are more common in adolescence than in any other time in life, despite the low prevalence of actual suicide deaths among adolescents. Studies of adolescent suicide risk tend to focus on factors such as psychiatric diagnosis—particularly depression—and history of previous suicide attempts in predicting risk of future suicidal behavior. However, given that a large number of adolescent suicides are first-time attempts, understanding the circumstances that precede suicide attempts—including the nature of suicidal ideation and of the cognitive and emotional responses that precede ideation—is a critical part of preventing a potentially lethal attempt. We review the psychological precipitants that may inform how suicidal thoughts are transferred into action and examine the risk conferred by having a history of previous suicide attempts and ideation.
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Command hallucinations are experienced by 33–74% of people who experience voices, with varying levels of compliance reported. Compliance with command hallucinations can result in acts of aggression, violence, suicide and self-harm; the typical response however is non-compliance or appeasement. Two factors associated with such dangerous behaviours are anger and impulsivity, however few studies have examined their relationship with compliance to command hallucinations. The current study aimed to examine the roles of anger and impulsivity on compliance with command hallucinations in people diagnosed with a psychotic disorder. The study was a cross-sectional design and included individuals who reported auditory hallucinations in the past month. Subjects completed a variety of self-report questionnaire measures. Thirty-two people experiencing command hallucinations, from both in-patient and community settings, were included. The tendency to appraise the voice as powerful, to be impulsive, to experience anger and to regulate anger were significantly associated with compliance with command hallucinations to do harm. Two factors emerged as significant independent predictors of compliance with command hallucinations; omnipotence and impulsivity. An interaction between omnipotence and compliance with commands, via a link with impulsivity, is considered and important clinical factors in the assessment of risk when working with clients experiencing command hallucinations are recommended. The data is highly suggestive and warrants further investigation with a larger sample.
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Auditory hallucination, or hearing voices, is generally associated with psychopathology. In psychiatry it is inter-preted as a symptom of an illness, with no connection to the individual's life history. Voice hallucinations in childhood occur in a variety of contexts and have variable long-term outcomes. Little is known about the course of the experience. In this study, 80 children and youngsters hearing voices were interviewed on four occasions over a period of three years about the content of the voices and their overall experience of voices, focusing on the determinants for a promising outcome in the pathways through care. The results indicate that the need for care in the context of the experience of voices is associated not only with high levels of problem behaviour and associated negative symptoms of psychosis, but also, independently, with an appraisal of the voices in terms of anxiety, depression, dissociation and frequency of occurrence. In 60 per cent of the participants the voices disappeared during the three-year research period. The relationship between the disappearance of voices and the course of mental health treatment is, however, ambiguous.
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After an epidemic rise in Australian young male suicide rates over the 1970s to 1990s, the period following the implementation of the original National Youth Suicide Prevention Strategy (NYSPS) in 1995 saw substantial declines in suicide in young men. To investigate whether areas with locally targeted suicide prevention activity implemented after 1995 experienced lower rates of young adult suicide, compared with areas without such activity. Localities with or without identified suicide prevention activity were compared during the period of the NYSPS implementation (1995-1998) and a period subsequent to implementation (1999-2002) to establish whether annual average suicide rates were lower and declined more quickly in areas with suicide prevention activity over the period 1995-2002. Male suicide rates were lower in areas with targeted suicide prevention activity (and higher levels of funding) compared with areas receiving no activity both during (RR = 0.89, 95% CI 0.80-0.99, P = 0.030) and after (RR = 0.86, 95% CI 0.77-0.96, P = 0.009) implementation, with rates declining faster in areas with targeted activity than in those without (13% v. 10% decline). However, these differences were reduced and were no longer statistically significant following adjustment for sociodemographic variables. There was no difference in female suicide rates between areas with or without targeted suicide prevention activity. There was little discernible impact on suicide rates in areas receiving locally targeted suicide prevention activities in the period following the NYSPS.
Article
To identify circumstances and characteristics of suicidal behavior among early (aged 10-14 years) and late (aged 15-18 years) adolescents from a cohort of youth who were prescribed antidepressant medication. In-depth reviews of all available medical records were performed for 250 randomly chosen confirmed episodes of suicidal behavior identified as part of a large retrospective cohort study of antidepressant users and suicidal behavior. Study data were obtained from Tennessee Medicaid records and death certificates from January 1, 1995, to December 31, 2006. Medical records and autopsy reports for cases identified from electronic data were adjudicated by 2 investigators blinded to exposure status and classified by using a validated scale. Of the 250 cases reviewed, 65.6% were female and 26.4% were aged 10 to 14 years. Medication ingestion was the most frequent method of suicidal behavior for both early and late adolescents; however, early adolescents were significantly more likely to use hanging as a method of suicide. Nearly one-half of the adolescents had previously attempted suicide. Early adolescents were significantly more likely to have a history of sexual abuse and significantly less likely to have a history of substance abuse. Early adolescents were also significantly more likely than older adolescents to have a history of a psychotic disorder and to report hallucinations before the suicide attempt. Suicidal behavior among early and late adolescents prescribed antidepressant medication differed in terms of methods used, previous psychiatric history, and proximal symptoms.
Article
Psychotic disorders are a significant risk factor for suicide, especially among young people. Psychotic-like experiences (PLEs) in the general population may share an etiological background with psychotic disorders. Therefore, the present study examined the association between PLEs and risk of suicide in a community sample of adolescents. Psychotic-like experiences, suicidal feelings, and self-harm behaviors were studied using a self-report questionnaire administered to 5073 Japanese adolescents. Depression and anxiety were evaluated using the 12-item General Health Questionnaire (GHQ). The presence of PLEs was significantly associated with suicidal feelings (OR = 3.1, 95% CI = 2.2-4.5) and deliberate self-harm behaviors (OR = 3.1, 95% CI = 2.0-4.8) after controlling for the effects of age, gender, GHQ-12 score, victimization, and substance use. Suicidal feelings and behaviors were more prevalent in subjects with a greater number of PLEs. Psychotic-like experiences may increase the risk of suicidal problems among adolescents.
Article
A nationally representative sample of Norwegian high school students (ages 14 to 19, N = 2,924) completed self-reports in school about non-suicidal self-injury (NSSI), suicide attempt (SA), and risk and protective factors. They were re-examined 5 years later. In all 2.2% reported NSSI with no SA during the follow-up period and 3.2% reported SA. Several risk and protective factors were common to NSSI and SA: previous SA, young age, debut of sexual intercourse before the age of 15, and non-heterosexual sexual interest. However, other risk and protective factors were unique to NSSI or SA: Previous NSSI increased the risk for future NSSI whereas satisfaction with social support protected against later NSSI. Suicidal ideation increased the risk for SA whereas attachment to parents protected against it. NSSI did not increase the risk of future SA. NSSI and SA may be thus conceived of as only partly overlapping phenomena, and not necessarily just representing different degrees of suicidality.
Article
To examine risk for suicide attempts among 180 consecutively referred adolescents during the first 5 years after discharge from an inpatient psychiatry unit. In a prospective naturalistic study, adolescents were assessed at psychiatric hospitalization and semiannually thereafter for up to 5 years with semistructured psychiatric diagnostic interviews and self-report questionnaires. Approximately 25% of the adolescents attempted suicide and no adolescents completed suicide within the first 5 years after discharge. The first 6 months to 1 year after discharge represented the period of highest risk. The number of prior attempts was the strongest predictor of posthospitalization attempts. Affective disorders by themselves did not predict later suicide attempts but were related to posthospitalization attempts when accompanied by a history of past suicide attempts. Independent of psychiatric diagnoses, severity of depressive symptoms and trait anxiety also predicted suicide attempts. Similar to the effect with affective disorders, depressive symptoms were most strongly related to posthospitalization suicidality among adolescents with a prior history of suicide attempts. Particularly among youths with prior suicidal behavior, clinicians should be alert to the above constellation of psychiatric predictors of posthospitalization suicidal behavior.
Article
A number of self-administered questionnaires are available for assessing depression severity, including the 9-item Patient Health Questionnaire depression module (PHQ-9). Because even briefer measures might be desirable for use in busy clinical settings or as part of comprehensive health questionnaires, we evaluated a 2-item version of the PHQ depression module, the PHQ-2. The PHQ-2 inquires about the frequency of depressed mood and anhedonia over the past 2 weeks, scoring each as 0 ("not at all") to 3 ("nearly every day"). The PHQ-2 was completed by 6000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-2 depression severity increased from 0 to 6, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and healthcare utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-2 score > or =3 had a sensitivity of 83% and a specificity of 92% for major depression. Likelihood ratio and receiver operator characteristic analysis identified a PHQ-2 score of 3 as the optimal cutpoint for screening purposes. Results were similar in the primary care and obstetrics-gynecology samples. The construct and criterion validity of the PHQ-2 make it an attractive measure for depression screening.
Article
Hallucinatory experiences in children are often thought to indicate serious psychopathology. However, they have also been reported in normally developing children and in association with temporary psychological reactions to acute stress. The aim of this study was to investigate the prevalence of hallucinatory experiences in a nonclinical population of children and to examine the relationship between the modality and content of hallucinations and psychopathology. Seven hundred sixty-one Japanese children, 11 to 12 years old, completed a battery of four measures: (1) a questionnaire about the type of hallucinatory experience, (2) the Children's Depression Inventory, (3) the State-Trait Anxiety Inventory for Children, and (4) the Adolescent Dissociative Experiences Scale. Approximately 21% of the subjects had experienced hallucinations. Subjects who had experienced hallucinations, in particular, hallucinations characterized by combined modalities, closely self-related auditory content, or concrete visual content, had more significant psychopathology than did those who had never experienced hallucinations. Therapeutic intervention should be considered for children who experience hallucinations in association with depression, anxiety, or dissociation.
Article
This review examines the descriptive epidemiology, and risk and protective factors for youth suicide and suicidal behavior. A model of youth suicidal behavior is articulated, whereby suicidal behavior ensues as a result of an interaction of socio-cultural, developmental, psychiatric, psychological, and familyenvironmental factors. On the basis of this review, clinical and public health approaches to the reduction in youth suicide and recommendations for further research will be discussed. © 2006 The Authors Journal compilation 2006 Association for Child and Adolescent Mental Health.
Article
Psychotic-like experiences (PLEs) are considered predictive of mental health problems later in life. However, little has been known about the mental health status and psychopathological distress in adolescents with PLEs in the general population. To investigate the associations between PLEs and mental health status or psychopathologies in a community sample of adolescents in a school-based cross-sectional fashion, PLEs were studied using a self-rating questionnaire in 5073 Japanese junior-high school students aged 12-15 years. Mental health status was evaluated using the 12-item General Health Questionnaire (GHQ-12). Psychopathologies, lifestyle, victimization, and interpersonal and help-seeking attitudes were also studied using a self-rating questionnaire. Fifteen percent of the students reported definitely having experienced at least one PLE. A dose-response relationship between the severity of PLEs and the prevalence of poor mental health status was observed. PLEs were also significantly associated with psychopathologies (strong anxiety in the classroom: OR = 1.4, 95% CI 1.2-1.6; suicidal ideation: OR = 2.1, 95% CI 1.8-2.4; self-harm behaviors: OR = 1.4, 95% CI 1.0-1.9; difficulty falling asleep due to hypersensitivity to environmental noise: OR = 1.7, 95% CI 1.4-2.0; difficulty concentrating due to hypersensitivity to environmental noise: OR = 1.5, 95% CI 1.3-1.8; physically assaulting others: OR = 1.3, 95% CI 1.0-1.5; bullying others, OR = 1.3, 95% CI 1.1-1.5; irritability when exchanging e-mails: OR = 1.3, 95% CI 1.0-1.6). Adolescents with PLEs in the community suffer from a wide range of psychopathological problems during crucial developmental periods [corrected]
Patterns of stressful life events: distinguishing suicide ideators from suicide attempters
  • D Mcfeeters
  • D Boyda
  • S O'niell
McFeeters, D., Boyda, D., O'Niell, S., 2014. Patterns of stressful life events: distinguishing suicide ideators from suicide attempters. J. Affect. Disord. 175, 192-198.