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Impulsivity and Suicidality in Adolescent Inpatients

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Abstract

Suicide is the second leading cause of death among adolescents, and impulsivity has emerged as a promising marker of risk. The present study tested whether distinct domains of impulsivity are differentially associated with suicide ideation, plans, and attempts. Adolescents (n = 381; boys = 106, girls = 275) aged 13-19 years (M = 15.62, SD = 1.41) were recruited from an acute, residential treatment program. Within 48 hours of admission to the hospital, participants were administered structured clinical interviews assessing mental health disorders and suicidality. Following these interviews, participants completed self-report questionnaires assessing symptom severity and impulsivity. Consistent with past research, an exploratory factor analysis of our 90-item impulsivity instrument resulted in a three-factor solution: Pervasive Influence of Feelings, Feelings Trigger Action, and Lack of Follow-Through. Concurrent analysis of these factors confirmed hypotheses of unique associations with suicide ideation and attempts in the past month. Specifically, whereas Pervasive Influence of Feelings (i.e., tendency for emotions to shape thoughts about the self and the future) is uniquely associated with greater suicidal ideation, Feelings Trigger Action (i.e., impulsive behavioral reactivity to emotions) is uniquely associated with the occurrence of suicide attempts, even after controlling for current psychiatric diagnoses and symptoms. Exploratory gender analyses revealed that these effects were significant in female but not male adolescents. These findings provide new insight about how specific domains of impulsivity differentially increase risk for suicide ideation and attempts. Implications for early identification and prevention of youth suicide are discussed.

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... Um elemento desencadeador do comportamento suicida é a ideação suicida 2,6 , que geralmente é o marco inicial do processo de suicídio e pode ser entendida como conjunto de pensamentos de não existir mais, extrair a própria vida e desejar morrer 7 . Constitui um fenômeno multifatorial, que envolve uma rede de fatores biológicos, psicológicos, sociais, demográficos, econômicos, pessoais, familiares e comportamentais 1,[8][9][10][11] . ...
... O sentimento de raiva e hostilidade e não pensar de forma otimista se mantiveram relacionados ao desfecho, respectivamente, no nível médio e universitário. Pesquisas destacam aspectos como amizades 8,9,17,39,51 , coesão e ligações familiares positivas 2,8,9,17,33,35,52 , resiliência psicológica 10,33 , suporte social 16 e resistência ao estresse psicossocial 2,10,53 , boas conexões afetivas, com a integração a um grupo ou comunidade 11,17 , como dimensões que influenciam adequadamente na saúde mental de adolescentes e jovens adultos 43 . As relações sociais autopercebidas estão vinculadas a comportamentos de saúde em geral e mental no grupo analisado. ...
... O sentimento de raiva e hostilidade e não pensar de forma otimista se mantiveram relacionados ao desfecho, respectivamente, no nível médio e universitário. Pesquisas destacam aspectos como amizades 8,9,17,39,51 , coesão e ligações familiares positivas 2,8,9,17,33,35,52 , resiliência psicológica 10,33 , suporte social 16 e resistência ao estresse psicossocial 2,10,53 , boas conexões afetivas, com a integração a um grupo ou comunidade 11,17 , como dimensões que influenciam adequadamente na saúde mental de adolescentes e jovens adultos 43 . As relações sociais autopercebidas estão vinculadas a comportamentos de saúde em geral e mental no grupo analisado. ...
Article
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RESUMO Objetivo Estimar a prevalência e analisar os fatores associados à ideação suicida em estudantes de ensino médio e superior. Métodos Estudo epidemiológico, transversal, analítico, realizado em Montes Claros, MG, Brasil. Para a coleta de dados, aplicou-se um questionário contendo questões relativas às características sociodemográficas, escolares, ocupacionais e de estilo de vida, e às condições socioafetivas e psíquicas. Investigou-se a ideação suicida por meio de um item do Inventário de Depressão de Beck. Na análise de dados, efetuou-se estatística descritiva das variáveis e a Regressão Logística hierarquizada para avaliar os fatores associados à ideação suicida. Resultados Constatou-se prevalência de ideação suicida de 11,6% entre estudantes do ensino médio e de 9,8% no ensino superior. No ensino médio, os fatores associados foram: sexo feminino (RO: 2,14; IC 95%: 1,39-3,27), uso de drogas (RO: 3,25; IC 95%: 1,40-7,52), consumo de álcool (RO: 2,50; IC 95%: 1,54-4,04), sentimento de raiva e hostilidade (RO: 1,73; IC 95%: 1,05-2,87) e síndrome de burnout (RO: 2,27; IC 95%: 1,31-3,95). No ensino superior, identificaram-se os fatores: ausência de companheiro (RO: 2,19; IC 95%: 1,68-4,14), turno de estudo noturno (RO: 0,51; IC 95%: 0,36-0,72), consumo de tabaco (RO: 1,74; IC 95%: 1,05-2,91), ausência de pensamento otimista (RO: 2,66; IC 95%: 1,75-4,03), adicção em internet (RO: 1,64; IC 95%: 1,08-2,50) e alto hábito de checagem corporal (RO: 1,69; IC 95%: 1,15-2,50). Sono prejudicado (RO: 1,62; IC 95%: 1,02-2,59; RO: 1,62; IC 95%: 1,05-2,51), interação dialogada prejudicada (RO: 3,04; IC 95%: 1,93-4,82; RO: 2,66; IC 95%: 1,81-3,92), sentimento de desapontamento e tensão (RO: 4,80; IC 95%: 2,97-7,77; RO: 4,02; IC 95%: 2,69-6,02) foram fatores associados nos dois grupos, respectivamente. Conclusão Houve importante prevalência de ideação suicida, associada a fatores sociodemográficos, do estilo de vida, socioafetivos e psíquicos.
... Emotionrelated impulsivity has also been linked to specific facets of suicidality, including suicidal ideation, to endorsing greater likelihood of dying in a future suicide attempt (Miller et al., 2003), and to suicide attempts (Anestis et al., 2012;Johnson et al., 2017;Klonsky & May, 2010). Some work links emotion-related impulsivity to increased risk of suicide attempts when controlling for suicidal ideation (Auerbach et al., 2017), but other work has not confirmed this pattern (Klonsky & May, 2010). In longitudinal work, emotion-related impulsivity has predicted risk of suicide attempts, faster time to suicide attempts among those at risk, and the onset of NSSI (Kasen et al., 2011;Riley et al., 2015;Yen et al., 2009). ...
... Lack of Follow-Through (LFT) includes items with no reference to emotion, including items from the Lack of Perseverance (Whiteside & Lynam, 2001), the Brief Self-Control Scale (scored in reverse, Tangney et al., 2004), the Laziness subscale (Jackson et al., 2010), and novel distractibility items. Scores reflect averages of the parcels within each subscale, with a possible range from 1 to 5. Previous research has shown that both forms of emotion-related impulsivity are more robustly related to suicidality and NSSI indices than are non-emotion-related impulsivity; Pervasive Influence of Feelings is particularly correlated with suicidal ideation, and Feelings Trigger Action is particularly correlated with suicide attempts and NSSI (Auerbach et al., 2017). ...
... Consistent with this idea, findings of a recent meta-analysis suggest that impulsivity is correlated to suicidal behavior in the past month, but not to such behavior across the life course (Liu et al., 2017). In one study, emotion-related impulsivity was related to past month suicide attempts, controlling for ideation (Auerbach et al., 2017). Other studies, though, frequently show little distinction between ideators and attemptors on many psychological variables (Klonsky et al., 2016), including rumination (Crane et al., 2007). ...
Article
Introduction: Rumination and emotion-related impulsivity predict suicidal ideation, suicide attempts, and nonsuicidal self-injury (NSSI). Because rumination and emotion-related impulsivity, though, are highly correlated, we consider their unique vs. conjoint influence on suicidal ideation and self-harm. Method: Across two samples of adults (N's = 171 and 191), we examined how rumination and emotion-related impulsivity relate to suicidal ideation, suicide attempts, and NSSI. We assess the more general process of repetitive negative thinking and the more specific process of suicide-related rumination. Participants completed the Three-Factor Impulsivity Index and the self-report Columbia-Suicide Severity Rating Scale. Those in sample 1 completed the Perseverative Thinking Questionnaire and the Deliberate Self-Harm Inventory, and those in Sample 2 completed the Suicide Rumination Scale. Results: Emotion-related impulsivity and both forms of rumination showed robust bivariate correlations with suicidal ideation, suicide attempts, and NSSI. Neither rumination or impulsivity related to suicide attempts controlling for ideation or to NSSI. In multivariable analyses, emotion-related impulsivity but not general rumination was tied to suicidal ideation. In contrast, suicide-related rumination was more directly tied to suicidal ideation than was impulsivity. Conclusions: Findings provide support for a more nuanced approach to the forms of impulsivity and rumination related to suicidal ideation.
... Suicidality. Suicidality, which is defined as suicidal ideation, preparation for attempting suicide, and attempted or completed suicide, is a significant public health problem and it causes significant expenses on psychiatric and other health care services (Allen et al., 2013: Auerbach, Stewart, & Johnson, 2017Choo et al., 2019). A suicide attempt is defined as a self-inflicted, possible harmful behavior(s) which aims to die, and it is separated from selfharm, since it purposed not to die (Choo et al., 2019). ...
... Ninety-five percent of people who die by suicide, suffer from major mental disorders, in other words, mental disorders increase the risk of attempt suicide (Auerbach, Stewart, & Johnson, 2017;Van Orden et al., 2010). As a result of many research studies, risk factors of suicidal behaviors are hopelessness, depression, schizophrenia, anorexia nervosa and substance use (Anestis et al. 2012;Anestis et al., 2011;Kuehn et al., 2020;Van Orden et al., 2010). ...
... In adolescence, suicide is the second major cause of death (Auerbach, Stewart, & Johnson, 2017). The frequency of suicide rises with adolescence (Lee et al., 2012). ...
Thesis
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Comorbid axis I disorders are highly common for suicidal borderline personality disorder (BPD) patients especially substance use disorder and anxiety disorders. Since interpersonal dysfunction is one of the core symptoms in BPD, the purpose of the current study is to examine perceived criticism and anxiety disorders and also substance abuse disorders (SUD) for women with borderline personality disorder (BPD) who attempt suicide at least once in their lifetime. In the current study, it was suggested that the perceived criticism from others and being upset by criticism differ between suicidal women with BPD with comorbidity of anxiety disorders and SUD (separately) and suicidal women with BPD without anxiety disorders and without SUD (separately). The participants in this study included ninety nine women who have already been diagnosed with borderline personality disorder and also have had at least two episodes of deliberate self-harm in other words suicide attempts and/or non-suicidal self-injury (NSSI) in the last five years, and at least one episode in the 8-week period before joining the research study and at least one suicide attempt in the previous year. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) and Social History Interview (SHI) were conducted to determine the comorbid axis I disorders and level of perceived criticism. As a result of the independent sample t-tests, perceived criticism and becoming/being upset by criticism is significantly different between suicidal women with BPD patients who also have alcohol abuse and those without alcohol abuse. Limitations, implications, and directions for future research are discussed.
... Lack of Follow Through covers impulsive responding without regard to emotion, including being distracted easily and failing to complete tasks. Both emotion-related factors have been validated as related to early trauma, a polymorphism of the serotonin transporter gene, and to internalizing disorders, externalizing disorders, suicidality, and aggression (Auerbach et al., 2017;Carver et al., 2011;Johnson et al., 2017). ...
... In the original validation study, factors showed small to moderate correlations, r Factor 1 and 2 = 0.36; r Factors 1 and 3 = 0.34 and r Factors 2 and 3 = 0.16 (Carver et al., 2011). The factor-analytically derived subscales were validated across multiple indices of psychopathology, aggression, and suicidality (Auerbach et al., 2017;Johnson et al., 2013;Johnson et al., 2017). ...
Article
A growing body of research has focused on the differentiation of emotion-related versus non-emotion-related impulsivity, assessed by the Three-Factor Impulsivity (TFI) index. The goal of this study is to develop a German TFI index, and to validate the emotion-related impulsivity subscales against indices of substance abuse, physical or psychological disorder, physical exercise, BMI, and hours of sleep. 395 native-German speakers completed the German TFI index and questions on validity indicators online. Factor analyses supported the threefactor structure, including Pervasive Influence of Feelings, Lack of Follow Through, and Feelings Trigger Action. Correlations between factors were higher than in the original work. Both emotion-related impulsivity subscales correlated significantly with psychological disorder, engagement in and minutes of physical exercise per week. When included in multivariate regression models, the three factors explained 3.1%, and 29.2% of variance in amount of exercise per week and psychological disorder, respectively. In sum, findings indicated that the German TFI index has a robust three-factor structure that showed expected links to validity indicators, and novel effects in relation to physical exercise.
... and has been conceptualized to include an umbrella of maladaptive behaviors such as an inability to wait, difficulty in withholding responses, and insensitivity to delayed or negative consequences [15]. Problematic associations have been documented between conceptualizations of impulsivity and a wide range of externalizing issues, including risky sexual behaviors [16], substance misuse and dependence [17], suicide attempts and nonsuicidal self-injury [18], and symptomology associated with Attention-Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder (CD) diagnoses [7]. There has been limited evidence of the relationship between impulsivity and more internalizing forms of psychopathology. ...
... Depression has been broadly associated with increases in several forms of impulsivity. Trait impulsivity, conceptualized as a relatively stable personality characteristic, has been shown to predict children's future depressive symptoms [23] and major depression in adolescent and adult psychiatric populations (i.e., [18,24]). However, the precise nature and direction of this relationship are unclear. ...
Article
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Purpose of Review The goal of the current review was to examine recent (within the past 5 years) evidence of impulsivity, broadly defined to include both (a) self-report and (b) behavioral measures including measures of decision-making, inhibition, and inattention, as a feature of Major Depressive Disorder in terms of (a) differences between MDD groups compared to controls and (b) associations between impulsivity and self-reported depressive symptomatology. Recent Findings Of the 3304 studies screened, 21 met the inclusion criteria. Findings support higher levels of impulsivity in individuals with MDD compared to controls and an association between various facets of impulsivity and MDD. Summary There is consistent evidence for impulsivity as a transdisease process influencing MDD. This evidence may be dependent on the facet of impulsivity being measured.
... These authors stated that these results are because people with suicidal behavior present more difficulties in establishing and maintaining cohesive and extended social networks. The third most mentioned category in terms of self-characterization and as an influencing factor of this behavior was impulsiveness, corroborating the results previously obtained (Auerbach et al., 2018;Brent et al., 1994;Bridge et al., 2006;Evans et al., 2004). However, Simon et al. (2001) and Auerbach et al. (2018) contradict the association of impulsiveness with suicidal behavior. ...
... The third most mentioned category in terms of self-characterization and as an influencing factor of this behavior was impulsiveness, corroborating the results previously obtained (Auerbach et al., 2018;Brent et al., 1994;Bridge et al., 2006;Evans et al., 2004). However, Simon et al. (2001) and Auerbach et al. (2018) contradict the association of impulsiveness with suicidal behavior. ...
Article
Introduction A better understanding of the meanings that adolescents associate with suicide, contributes to the development of psychotherapeutic intervention programs to be implemented by nurse specialists in mental health and psychiatric nursing. Therefore, adolescents need to characterize their adopted suicidal behaviors and identify the personal characteristics that contribute to this same behavior. Methodology A descriptive, exploratory, and qualitative study was conducted with 33 adolescents with suicidal behavior, hospitalized in a child psychiatry unit. Data were collected through a structured interview, and data treatment used the content analysis technique. Results Suicidal behaviors are characterized according to causality, meaning, and intent. Causality is mostly related to psychological factors (sadness, desperation, mental suffering, internal pain, emptiness, and rejection). As to the meaning, suicidal behavior is understood as an escape but also as a personal choice, sometimes regarded as rational. In what concerns intent, the intent to die is the most frequently reported. The most-reported personal characteristics which contributed to the suicidal behavior are feelings of exclusion, rejection, and humiliation, and also introversion. Conclusions The results point to the need to reflect on the perceptions of adolescents with suicidal behavior. The current intervention strategies should be adjusted especially through the identification of the signs associated with mental distress in adolescents and the training of gatekeepers, contributing to productive and congruent suicide prevention in this vulnerable group.
... Childhood emotion dysregulation was not associated with suicide ideation or ideation severity in this FEP population, in contrast to past findings that affect reactivity is associated with ideation in Clinical High Risk populations (Palmier-Claus, Taylor, Gooding, Dunn, & Lewis, 2012). This was also contrary to the finding that poor control over emotional reactions was associated with suicide ideation but not behavior in adolescent inpatients (Auerbach, Stewart, & Johnson, 2017). It seems possible current emotion dysregulation impacts suicide ideation, rather than the presence of emotion dysregulation in childhood. ...
... Note: WURS = Wender Utah Rating Scale (Millner et al., 2018). In addition, impulsivity in relation to suicide behavior may be better accounted for by emotional reactivity, rather than acting impulsively in general, as suggested by Auerbach et al. (2017). These findings should be considered within the context of methodological limitations. ...
Article
Historically, research on suicide behavior has not included those experiencing first episode psychosis (FEP), hindering prevention efforts for this population. Emotion dysregulation and impulsivity represent two mechanisms that contribute to suicide, but these have not been examined in FEP. We hypothesize that the combination of trait impulsivity and childhood emotion dysregulation are associated with suicide behavior (SB) and ideation (SI) in those experiencing FEP. Participants were recruited from an Early Psychosis Program (N=80, ages 12-32, 65% male). Clinician ratings of symptoms and history of SI and SB were obtained at baseline. Participants also completed self-report measures of childhood emotion dysregulation and trait impulsivity. Regression analyses examined whether childhood emotion dysregulation and trait impulsivity individually or in combination were associated with SI and SB, and the severity of SI and SB. Childhood emotion dysregulation was significantly associated with a history of SB and its severity, but not SI. Attention impulsivity was associated with the severity of SI. However, other impulsivity types, and interactions were not associated with a history of SI or SB. This suggests childhood emotion dysregulation is a potential target for prevention of SB in FEP, while trait impulsivity may be less important in this effort.
... Suicidality-Suicidal behavior spanning suicidal ideation, plans, and attempts (Auerbach et al., 2017) effects of early life factors on personality development (Figueredo et al., 2005), risky adolescent behavior (Ellis et al., 2012;Simpson et al., 2012), and psychopathology (Del Giudice, 2014;Hurst & Kavanagh, 2017). This growing body of work calls for an explicit integration of evolutionary theories of suicidality with insights from life history theory. ...
... Rather than view this process purely as dysregulation, however, we propose that under certain life history conditions modulation to present orientation is part of an evolved adaptive response, which occurs irrespective of the potential for self-harm and threats to well-being (Frankenhuis & de Weerth, 2013). While the link between impulsivity (or specific constructs of impulsivity) and suicidality has been debated (Auerbach et al., 2017;Millner et al., 2020), the psychological literature has fair support for a connection between dysregulated executive function (i.e., more present orientation/future discounting) and suicidality. In more supportive environments (with less stress and more predictability), cognitive development is characterized by executive functioning, which is more goal-directed, planned, and deliberative (Cohen, 2017). ...
Article
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Suicidality is an important contributor to disease burden worldwide. We examine the developmental and environmental correlates of reported suicidal ideation at age 15 and develop a new evolutionary model of suicidality based on life history trade-offs and hypothesized accompanying modulations of cognition. Data were derived from the National Longitudinal Survey of Children and Youth (Statistics Canada) which collected information on children’s social, emotional, and behavioral development in eight cycles between 1994 and 2009. We take a model selection approach to understand thoughts of suicide at age 15 ( N ≈ 1,700). The most highly ranked models include social support, early life psychosocial stressors, prenatal stress, and mortality cues. Those reporting consistent early life stress had 2.66 greater odds of reporting thoughts of suicide at age 15 than those who reported no childhood stress. Social support of the primary caregiver, neighborhood cohesion, nonkin social support of the adolescent, and the number of social support sources are all associated with suicidal thoughts, where greater neighborhood cohesion and social support sources are associated with a reduction in experiencing suicidal thoughts. Mother’s prenatal smoking throughout pregnancy is associated with a 1.5 greater odds of suicidal thoughts for adolescents compared to children whose mother’s reported not smoking during pregnancy. We discuss these findings in light of evolutionary models of suicidality. This study identifies both positive and negative associations on suicidal thoughts at age 15 and considers these in light of adaptive response models of human development. Findings are relevant for mental health policy.
... Others have found that young students with a previous history of suicide attempts in the family exhibit higher suicide risk and depression levels but also are more exposed to psychosocial stress A previous work (n= 4 772) found that students with a history of at least one suicide attempt when compared to students with suicide ideation were more prone to report they had been This study has also reported that both previous suicide attempts and impulsiveness are mediators between anxiety, depression and hopelessness when predicting suicide risk. Others have found that impulsiveness is a risk factor of suicide attempts among young adolescents Additional studies have identified impulsivity as a risk factor facilitating the transition from ideation to suicide attempts (Auerbach et al., 2017). Impulsivity responses have also been found to increase with the number of suicide attempts in youth (Kasen et al., 2011). ...
Article
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Suicidal behavior in youth is a multi-causal phenomenon and a global public health problem. Studies to identify risk factors have increased in recent decades, however, studies rarely examine the combined and mediating effect of multiple psychosocial and clinical factors in predicting suicidal risk in college students. This study aims to analyze the psychosocial risk factors and clinical predictors associated directly and indirectly with suicide risk in Colombian university students. 786 students between the ages of 16 and 30 (M=22.34 years; SD=4.7) from the Luis Amigó Catholic University (Colombia) participated. 72% were women and 28% men. An ad hoc socio-demographic card was used with information about the history of attempted suicide (SAS), mental disorder (HMI) and family suicide attempts (SAF). Plutchik's Suicide Risk Scale (SR), Hopelessness Scale (BHS), Beck's Anxiety Scale (BAI) and Depression Scale (BDI) and Barratt's Impulsivity Scale (BIS) were used. It was found that 22% of the college students were at risk of suicide and 9.7% had attempted suicide in the past year. Significant (p<0.01) and positive correlations were found between SR, SAS, HMI, SAF, BHS, BAI, BDI and BIS. Binary regression analysis showed that depression (OR=1.2) anxiety (OR=1), impulsivity (OR=1.1), suicide attempts (OR=70), mental disorder and family suicide attempts (OR=2.0; OR=3.8) explained between 45% and 68% of the suicide risk variance. The structural equation model showed that impulsivity and suicide attempt are mediating variables for suicide risk. The totality of independent variables explained 65% of suicidal risk. These findings will help to orient the design of clinical strategies for the detection, prevention and intervention of suicidal risk in university contexts.
... Among SAs, this enhanced attendance to and arousal from negative information may explain, in part, why certain suicidal youth transition from ideation to action. Namely, attendance to negative emotional information may elicit more impulsive behaviors that lead to suicide attempts, which is consistent with previous research focusing on the role of negative urgency-or feelings triggering action-in relation to adolescent suicidal behaviors (90). Our cross-sectional design is ill suited to directly address this important empirical issue; however, future longitudinal research may clarify whether P2 amplitudes to negative information directly facilitate the transition to suicide attempts and death among high-risk youth. ...
Article
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Background: Adolescent suicide is a major public health concern, and presently, there is a limited understanding of the neurophysiological correlates of suicidal behaviors. Cognitive models of suicide indicate that negative views of the self are related to suicidal thoughts and behaviors, and the current study investigated whether behavioral and neural correlates of self-referential processing differentiate suicide ideators and recent attempters. Methods: Depressed adolescents reporting current suicidal ideation and no lifetime suicide attempts (SI=30) and past year suicide attempts (SA=26) completed a self-referential encoding task (SRET) while high density electroencephalogram data were recorded. Behavioral analyses focused on negative processing bias (i.e., tendency to attribute negative information as being self-relevant) and drift rate (i.e., slope of reaction time and response type that corresponds to how quickly information is accumulated to make decision about whether words are self-referent). Neurophysiological markers probing components reflecting early semantic monitoring (P2), engagement (early LPP), and effortful encoding (late LPP) also were tested. Results: SI and SA adolescents reported comparable symptom severity, suicide ideation, and mental disorders. Although there were no behavioral differences, relative to SI, SA exhibited greater P2 amplitudes for negative versus positive words, which may reflect enhanced attention and arousal to negative stimuli. There were no group differences for the early or late LPP. Conclusions: Enhanced sensory arousal to negative stimuli—that is, attentional orienting to semantic, emotional, and self-relevant features—differentiates adolescent suicide attempters from ideators and thus, may signal risk for suicidal behavior.
... In this context, emotion-related impulsivity-the tendency to react impulsively during experiences of heighted affective states [20]-may contribute to adolescent risk for STBs. Indeed, both peer-related stressors [21,22] and emotion-related impulsivity [23] have been shown separately to predict STBs in adolescents. ...
Article
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Suicide is the second leading cause of death among adolescents. While clinicians and researchers have begun to recognize the importance of considering multidimensional factors in understanding risk for suicidal thoughts and behaviors (STBs) during this developmental period, the role of puberty has been largely ignored. In this review, we contend that the hormonal events that occur during puberty have significant effects on the organization and development of brain systems implicated in the regulation of social stressors, including amygdala, hippocampus, striatum, medial prefrontal cortex, orbitofrontal cortex, and anterior cingulate cortex. Guided by previous experimental work in adults, we also propose that the influence of pubertal hormones and social stressors on neural systems related to risk for STBs is especially critical to consider in adolescents with a neurobiological sensitivity to hormonal changes. Furthermore, facets of the pubertal transition, such as pubertal timing, warrant deeper investigation and may help us gain a more comprehensive understanding of sex differences in the neurobiological and psychosocial mechanisms underlying adolescent STBs. Ultimately, advancing our understanding of the pubertal processes that contribute to suicide risk will improve early detection and facilitate the development of more effective, sex-specific, psychiatric interventions for adolescents.
... Finally, in addition to the two mediators tested here, other factors may be important in the pathway from IGD to suicidal ideation. For example, impulsivity is a characteristic trait of adolescence and is strongly associated with addictive disorders (e.g., IGD) and other risky behaviors (e.g., suicidal ideation) (51). As adolescence is characterized by internal psychological change and external interpersonal adaption, future studies should examine other psychological factors that may be associated with suicidal ideation. ...
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Background: High prevalence and strong relationships among suicidal ideation, Internet gaming disorder (IGD), insomnia, and depression have been reported for adolescents worldwide, but the mechanism underlying these psychological problems remains unclear. This cross-sectional study explored the mediating effect of insomnia and depression on the association between IGD and suicidal ideation. Methods: Participants were 1,066 adolescents (median age= 13.0 years) with Internet games exposure in the previous 12 months from junior high schools in Shanghai, China. Questionnaire measures of suicidal ideation, IGD, insomnia, depressive symptoms, and background characteristics were obtained. Path analysis was conducted to test the multiple mediating roles of insomnia and depression. Results: Suicidal ideation, IGD, insomnia, and depression prevalence was 27.2%, 13.6%, 9.2%, and 17.0%, respectively. A serial multiple mediation model was generated. The mediation effect of insomnia and depression on the pathway from IGD to suicidal ideation was 45.5% (direct effect: standardized estimate [Std. estimate] = 0.186; total indirect effect: Std. estimate = 0.155). The association between IGD and depression was partially mediated by insomnia (direct effect: Std. estimate = 0.211; indirect effect: Std. estimate = 0.135). The proposed model fit the data well. Conclusions: Insomnia and depression may serially mediate the association between IGD and suicidal ideation. IGD was positively associated with insomnia, then with depression, which in turn positively contributed to suicidal ideation. We suggest greater monitoring of Internet use and prevention of insomnia and depression to mitigate the risk of suicidal ideation among Chinese adolescents.
... Among SAs, this enhanced attendance to and arousal from negative information may explain, in part, why certain suicidal youth transition from ideation to action. Namely, attendance to negative emotional information may elicit more impulsive behaviors that lead to suicide attempts, which is consistent with previous research focusing on the role of negative urgency-or feelings triggering action-in relation to adolescent suicidal behaviors (90). Our cross-sectional design is ill suited to directly address this important empirical issue; however, future longitudinal research may clarify whether P2 amplitudes to negative information directly facilitate the transition to suicide attempts and death among high-risk youth. ...
Article
Background Identifying mechanisms of major depressive disorder (MDD) that continue into remission is critical, as this may contribute subsequent depressive episodes. Biobehavioral markers related to depressogenic self-referential processing biases have been identified in depressed adults. Thus, we investigated whether these risk factors persisted during remission as well as contributed to the occurrence of stress and depressive symptoms over time. Method At baseline, adults with remitted depression (n=33) and healthy controls (n=33) were administered diagnostic and stress interviews as well as self-report symptom measures. Additionally, participants completed the Self-Referential Encoding Task while EEG data were acquired. Stress interviews and self-report symptom measures were re-administered at the 6-month follow-up assessment. Results Drift diffusion modeling showed that compared to healthy individuals, adults with remitted depression exhibited a slower drift rate to negative stimuli, indicating a slower tendency to reject negative stimuli as self-relevant. At the 6-month follow-up assessment, a slower drift rate to negative stimuli predicted greater interpersonal stress severity among remitted depressed but not healthy individuals while controlling for both baseline depression symptoms and interpersonal stress severity. Highlighting the specificity of this effect, results were non-significant when predicting non-interpersonal stress. For self-relevant positive words endorsed, remitted depressed adults exhibited smaller left than right hemisphere late LPP amplitudes; healthy controls did not show hemispheric differences. Conclusion Self-referential processing deficits persist into remission. In line with the stress generation framework, these biases predicted the occurrence of interpersonal stress, which may provide insight about a potential pathway for the re-emergence of depressive symptoms.
... The element of impulsivity in these impulsive acts of suicide was understudied in Malaysia, compared to other risk factors such as gender, depression and other psychopathological and demographic profiles. To our knowledge, the research concerning impulsivity trait in suicide behavior in Malaysia, especially in adolescents, is limited, although the role of impulsivity as a risk factor of suicide was recognized in other countries (Auerbach et al., 2017;Lockwood et al., 2017). Therefore, our objectives of this study are to identify the relationship between impulsivity, depression and suicide ideation and to examine moderation properties of impulsivity in depression and suicide ideation relationships. ...
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Introduction: The increasing prevalence of suicidal behavior among adolescents in Malaysia recorded for the past decades needs further attention and investigation. Past research has suggested that impulsivity serves as a predictor and risk factor for suicidal ideation. The role of impulsivity as a moderator in the relationship between depression and suicidal ideation among late adolescents in Malaysia were understudied. Objectives: This study aims to identify the relationship between impulsivity, depression and suicide ideation and examine the moderation properties of impulsivity in depression and suicide ideation relationships among late adolescents in Malaysia. Methods: A cross-sectional survey was conducted involving 577 respondents recruited among university students who were currently pursuing their study in public universities located in Wilayah Persekutuan Kuala Lumpur and Selangor. The Short Version UPPS-P Impulsive Behaviour Scale (SUPPS-P), Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) and Revised Suicide Ideation Scale (R-SIS) was utilized to obtain the data regarding impulsivity personality trait, depression and suicide ideation respectively. Results and Discussion: Results show that impulsivity correlated positively and significantly with depression and suicide ideation. Impulsivity was also found to moderate the relationship between depression and suicidal ideations. Furthermore, the suicidal individual with high intention to die exhibit impulsivity traits equally to individuals with self-inflicted injury and has no intention to die. Conclusion: In summary, impulsivity personality trait shall be treated as a profound risk factor when combined with depressive symptoms in elevating the probability of suicide among late adolescents. Therefore, impulsivity trait screening should be practiced during the initial clinical interview, especially among high-risk groups.
... The current report included data from adolescent patients (N ¼ 970) admitted to an inpatient treatment program. In our prior research with subsamples of this larger dataset, we demonstrated that, relative to ideators, attempters reported increased interpersonal stress exposure , greater peer victimization (Stewart, Valeri, Esposito, & Auerbach, 2018), increased anhedonia severity and associated reward learning impairments (Auerbach, Millner, Stewart, & Esposito, 2015), increased impulsivity (i.e., negative urgency [Auerbach, Stewart, & Johnson, 2017]) and risky behavior engagement Stewart et al., 2018), and diminished attentional control . Building on this research, we aimed to clarify the lifetime and 12-month prevalence of STBs, and then, test sociodemographic and clinical correlates of STBs that may contribute to the transition from ideation to action among these high-risk adolescents. ...
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Background Given low base rates of suicidal thoughts and behaviors (STBs) in national samples of adolescents, clarifying the sociodemographic and clinical correlates among psychiatric inpatients may afford insights into potential risk factors that predict STBs onset. Method Adolescents (N = 970; ages 12–19 years) admitted for acute, psychiatric inpatient care completed baseline clinical interviews and self-report measures assessing demographics and early life adversity. Lifetime and 12-month STBs prevalence were obtained, allowing for the estimate of STBs persistence (i.e., rates of those with both current and past STBs) and transition rates (i.e., proportion of ideators that transition to plans or attempts). Univariate and multivariate logistic regression tested sociodemographic and clinical correlates of STBs. Results Age-of-onset for STBs occurred in early adolescence. Most patients reported suicide ideation with nearly half of patients making a plan and one-third a suicide attempt. Although relatively modest, the strongest correlates of lifetime attempts were depressive disorders, physical abuse, and non-suicidal self-injury. Knowing a peer that had attempted suicide also increased the likelihood of a suicide attempt, especially among attempters who transitioned from ideation to planned attempts. Conclusion STBs are highly prevalent among adolescents admitted for acute psychiatric inpatient treatment. The modest effects suggest that correlates, particularly those related to suicide attempts, are widely distributed. As a history of physical abuse and knowing a peer with a suicide attempt history are related to transitioning from ideation to action, these may be critical factors to target in the deployment of future suicide prevention and treatment programs. • HIGHLIGHTS • One-third of adolescent inpatients report a lifetime history of suicide attempts. • Approximately 65% of adolescent inpatients with a lifetime plan attempt suicide. • Knowing peers who attempt suicide may facilitate the transition from ideation to action.
... Inpatient admission is often triggered by an acute psychiatric crisis, with a need to stabilize symptoms. These may include suicidality, violent behavior and significant impairment in daily functioning [26][27][28][29][30]. Only a minority of children and adolescents with mental healthcare needs are treated in hospitals, but inpatient treatment accounts for a significant share of the resources allocated to CAP [21,31,32]. ...
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Inpatient treatment is an important part of child and adolescent psychiatric (CAP) care. This nationwide study explores the changes in length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnoses of CAP inpatients in Finland in 2000, 2011 and 2018. We obtained comprehensive questionnaire data on each study year from 93 to 95% of all CAP wards in Finland. We split the 1276 inpatients into two age groups in each study year: under 13 and 13–18. The median length of stay in inpatient treatment decreased from 82.0 days in 2000 to 20.5 days in 2018 ( p < 0.001) and recurrent hospitalization increased from 38 to 46%. General functioning, which was evaluated by the Children’s Global Assessment Scale, deteriorated by an average of six points between 2000 and 2018. Violent threats decreased from 21.5 to 16.6% and violent acts decreased from 26.9 to 20.3%. Suicidal threats decreased from 42.6 to 23.3% in those aged under 13 and remained stable among those aged 13–18. In the 13–18 group, there was an increase in the diagnoses of ADHD, from 5.0 to 16.9% and depression, from 25.1 to 41.7%. However, psychosis decreased from 23.2 to 12.6% in the older age group. In the whole cohort, anxiety disorders increased from 7.6 to 15.6%. The overall picture does not show that CAP inpatients have become more disturbed. While the general functioning of CAP inpatients deteriorated somewhat over the 2000–2018 study period, symptoms of suicidality and violence remained stable or decreased. There was also a continuous increase in short-term treatment.
... Parameters displayed are standardized estimates of the direct effect on each pathway. ***p < 0.001 associated with addictive disorders (e.g., IGD) and other risky behaviors (e.g., suicidal ideation) [51]. As adolescence is characterized by internal psychological change and external interpersonal adaption, future studies should examine other psychological factors that may be associated with suicidal ideation. ...
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Background: High prevalence and strong relationships among suicidal ideation, Internet gaming disorder (IGD), insomnia, and depression have been reported for adolescents worldwide, but the mechanism underlying these psychological problems remains unclear. This cross-sectional study explored the mediating effect of insomnia and depression on the association between IGD and suicidal ideation. Methods: Participants were 1066 adolescents (median age = 13.0 years) with Internet games exposure in the previous 12 months from junior high schools in Shanghai, China. Questionnaire measures of suicidal ideation, IGD, insomnia, depressive symptoms, and background characteristics were obtained. Path analysis was conducted to test the multiple mediating roles of insomnia and depression. Results: Suicidal ideation, IGD, insomnia, and depression prevalence was 27.2, 13.6, 9.2, and 17.0%, respectively. A serial multiple mediation model was generated. The mediation effect of insomnia and depression on the pathway from IGD to suicidal ideation was 45.5% (direct effect: standardized estimate [Std. estimate] = 0.186; total indirect effect: Std. estimate = 0.155). The association between IGD and depression was partially mediated by insomnia (direct effect: Std. estimate = 0.211; indirect effect: Std. estimate = 0.135). The proposed model fit the data well. Conclusions: Insomnia and depression may serially mediate the association between IGD and suicidal ideation. IGD was positively associated with insomnia, then with depression, which in turn positively contributed to suicidal ideation. We suggest greater monitoring of Internet use and prevention of insomnia and depression to mitigate the risk of suicidal ideation among Chinese adolescents.
... Additionally, the psychopathological component was found as a factor related to suicide, showing the risk that people with mental disorders have; especially depressive disorders, anxiety disorders, psychotic disorders, personality disorders, and Attention Deficit Hyperactivity Disorder (ADHD) (86,87,92,94). In the same way, several authors agree on how the cognitive component is important in this problem since it is recognized in the studies that it is more likely that the suicidal act is carried out when there is the presence of ideas related to death, as well as when there is a history of suffering from mental illnesses (19,87). ...
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The phenomenon of suicide is a worldwide problem that has been increasing in the last decade with greater prevalence in the adolescent and young population, generating impact in different contexts such as family, social, economic, and educational, among others. That is why this systematic review focuses on identifying psychosocial factors associated with suicidal behavior in adolescents and young people, in publications published worldwide. This will allow us to recognize within these studies the coincidence of different aspects, within which the following psychosocial factors are highlighted: family, exposure to various forms of violence, risk behaviors, psychopathology, and negative emotional states. The bibliographic review carried out confirms the multifactorial dynamics of suicide attempts and completed suicides. Suicide, besides being a complex phenomenon to approach, has equally complex predictability. However, it is still possible to develop strategies to warn or prevent the behavior in a timely manner. Thus, the findings invite us to have a holistic view of the phenomenon and to aim from different angles to counteract the risk factors that predispose us to such behavior. RESUMEN El fenómeno del suicidio es un problema mundial que ha ido en aumento en la última década con mayor prevalencia en la población adolescente y joven, generando impacto en diferentes contextos como el familiar, social, económico, educativo, entre otros. Es por ello que esta revisión sistemática se centra en identificar los factores psicosociales asociados a la conducta suicida en adolescentes y jóvenes, Psychosocial risk factors associated with suicide in youth and adolescents: A systematic review Factores de riesgo psicosocial asociados al suicidio en jóvenes y adolescentes: una revisión sistemática Vol. 130, Supl 3, julio 2022 S596 en publicaciones publicadas a nivel mundial. Esto nos permitirá reconocer dentro de estos estudios la coincidencia de diferentes aspectos, dentro de los cuales se destacan los siguientes factores psicosociales: familia, exposición a diversas formas de violencia, conductas de riesgo, psicopatología y estados emocionales negativos. La revisión bibliográfica realizada confirma la dinámica multifactorial de los intentos de suicidio y los suicidios consumados. El suicidio, además de ser un fenómeno complejo de abordar, tiene una predictibilidad igualmente compleja. Sin embargo, aún es posible desarrollar estrategias para advertir o prevenir la conducta de manera oportuna. Así, los hallazgos nos invitan a tener una visión holística del fenómeno, para apuntar desde diferentes ángulos a contrarrestar los factores de riesgo que predisponen a dicha conducta. Palabras clave: Factores de riesgo psicosocial, suicidio, ideación suicida, intento de suicidio, jóvenes, adolescentes.
... Impulsivity is a noteworthy personality trait that is associated with SI and has an important effect on SI (Klonsky and May, 2010). A number of studies have illustrated that the risk of suicidal ideation increases with the level of impulsivity (Auerbach et al., 2016;Wang et al., 2019). Thus, to take effective measures to protect susceptible individuals from emerging SI, it is essential to clarify the underlying mechanism by which impulsivity influences SI. ...
Article
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Suicidal ideation is one of the strongest predictors of suicide. A large number of studies have illustrated the important effect of impulsivity on suicidal ideation, and behavioral inhibitory control (BIC) is a specific manifestation of impulsivity. The goal of the present study is to evaluate the difference in BIC in response to happy and angry emotions between individuals with or without suicidal ideation to reveal the underlying mechanism of the effect of impulsivity on suicidal ideation when accounting for the effect of emotion. Combining the ERP technique and the two-choice oddball paradigm, a total of 70 college students were recruited to participate in this study. The Beck Scale for Suicidal Ideation–Chinese Version was used to identify whether the participants had suicidal ideation. There were 30 participants in the risky-suicidal ideation (SI) group and 19 participants in the non-suicidal ideation (NSI) group. The results showed that the reaction time of the SI group was longer than that of the NSI group for happy emotions. At the electrophysiological level, the P3 amplitude of the NSI group was larger than that of the SI group regardless of the electrode sites and valence, and the P3 component elicited by angry faces was larger than those elicited by happy faces in the SI group. These findings suggest that individuals without suicidal ideation have better BIC, and the SI group has more difficulty controlling their responses to happy emotions than their responses to angry emotions.
... Specifically, parents, health care providers, and school staff should be open to supporting adolescents' existing spiritual thoughts and beliefs given its role in improved self-control and well-being, and promote its protective role as a coping strategy to protect against mental health problems. For many decades, literature has shed light on the positive effects of self-control on mental health outcomes (e.g., Auerbach et al., 2017;Duckworth et al., 2019;Moffitt et al., 2011;Rawn & Vohs, 2006;Oquendo & Mann, 2000). When working with youth for whom a wide variety of at-risk behaviors are a concern, spirituality should be allowed more space to work as a protective factor against these risky behaviors (Donahue & Benson, 1995). ...
Article
Empirical knowledge on what specific aspects of mental health are associated with spirituality is limited, and explanations for the mechanisms underlying this association is scarce. Furthermore, there is limited research on this association among individuals from non-Christian religious backgrounds and non-Western countries. The current study examined relations between spirituality and aspects of mental health in 1,544 adolescents from diverse religious backgrounds in two Eastern countries, India and the United Arab Emirates (UAE). Additionally, we examined mediating and moderating factors. Adolescents (58% female) ages 11–15 years completed a questionnaire on aspects of their mental health, spirituality, and self-control abilities. Results showed that spirituality had a significant positive association with life satisfaction and a significant negative association with internalizing problems, but a non-significant relation with externalizing problems, controlling for age, gender, and socioeconomic status. Self-control completely mediated the association between spirituality and life satisfaction, and this mediational relation was only present for adolescents from the UAE. Results support prior research suggesting positive associations between spirituality and adaptive mental health outcomes and extend these findings to adolescents from diverse religious backgrounds in non-Western countries. These findings have important clinical and policy implications for supporting the role of spirituality in an adolescent’s life.
... An estimated 40% to 80% of adolescents who attempt suicide meet diagnostic criteria for depression at the time of the attempt, whereas as many as 90% of those who die by suicide have depression (Cash & Bridge, 2009). However, suicide can also be an impulsive act in response to overwhelming emotions or other internal or external stressors (Auerbach et al., 2017). Both of these etiologies for suicidal attempts or ideation were represented in our sample. ...
Article
The purpose of this retrospective case series was to describe adolescent psychiatric emergencies precipitated by the 2020 coronavirus (SARS-CoV-2; COVID-19) pandemic. This study used a sample of adolescents admitted to a safety net psychiatric hospital in Los Angeles, California between March and May 2020. Medical records and involuntary psychiatric holds were reviewed to determine if the events precipitating the psychiatric crisis were related to the pandemic (eligible N = 14). COVID-19-precipitated admissions were 24% of total admissions from March 15 to May 31, 2020; however, total admissions during this time period were reduced from the same time period in prior years. Most hospitalizations were precipitated by shelter-in-place stressors for adolescents with a psychiatric history, but for 28.6% of the sample, this was their first mental health encounter. The COVID-19 pandemic and corresponding shelter-in-place orders may precipitate psychiatric emergencies among adolescents with and without existing mental health disorders. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
... Suicide risk assessments have been used to predict suicidal ideation in at-risk adolescents placed in residential programs (Larzelere et al., 1996). Common predictors of suicide can include history of past attempts, current suicidal ideation and depression (Brent et al., 1993;Brown et al., 2012;Esposito & Clum, 2002;Galaif et al., 2007;Garrison et al., 1991), recent attempt by a friend (Lewinsohn et al., 1994), hopelessness about the future (Klonsky et al., 2016;Mehlum et al., 2019;Nock & Kazdin, 2002;Wolfe et al., 2019), substance use (Duppong Hurley et al., 2014;Galaif et al., 2007;Gonzalez et al., 2009;Hallfors et al., 2004;King et al., 2001), impulsivity (Auerbach et al., 2017;Gonzalez & Neander, 2018;Klonsky et al., 2016), and identification with death (Glenn et al., 2017). In 54% of cases, people who died from suicide did not have a known mental health condition (Centers for Disease Control and Prevention [CDC], 2018). ...
Article
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Youth in residential programs have high rates of Posttraumatic Stress Disorder (PTSD) and suicidality. Although trauma symptoms and suicidality can both be related to peer relationship problems, there is little research on how social skills training on peer relations could help these youth. This study examined if progress made on peer relations training and sex moderated the association between trauma symptoms at intake and suicide ideation incidents while in the program. The sample included archival data on youth placed in a large residential program in the Midwest (N = 1118) ages 12–19 years old (M = 15.97 years, SD = 1.15), of which 62.2% were boys. Results indicated both peer relations training (b = −0.07, SE = 0.02, p = 0.001) and sex (b = −0.04, SE = 0.02, p = 0.032) moderated the relationship between trauma symptoms at intake and suicide ideation incidents in care. The benefits of peer relations training for youth presenting with trauma symptoms and suicide ideations are discussed along with recommendations for further research. Full text access to view only version: https://rdcu.be/cETvQ
... 'I am easily distracted by stray thoughts'). The emotion-related impulsivity factors have been shown to relate to early adversity, as well as symptoms of depression, anxiety, mania, externalising disorders and suicidality (Auerbach et al., 2017;Johnson et al., 2013aJohnson et al., , 2013b. Lack of Follow Through enables tests of discriminant validity of emotion-related as compared to non-emotionrelated impulsivity, and has demonstrated diminished correlations with psychopathology and neurocognitive indices (Pearlstein et al., 2019). ...
Article
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The trait-based tendency to respond rashly to emotions is robustly tied to many forms of psychopathology and poor behavioural outcomes, including aggression and suicidality. Researchers have found associations between response inhibition and emotion-related impulsivity; however, effect sizes are often small. Because emotion-related impulsivity emerges in the context of heightened positive and negative emotions, arousal is a candidate trigger of impulsivity. The goals of the present study were to (1) replicate the association between emotion-related impulsivity and response inhibition, and (2) test whether emotion-related impulsivity is associated with arousal-induced decays in response inhibition performance. Participants ( N = 55) completed a self-report measure of emotion-related impulsivity, and then completed a computer-based response inhibition task (the antisaccade task, in which participants must make a rapid saccadic eye movement away from a cue rather than toward it) before and after a well-validated stress induction (the Trier Social Stress Test). Psychophysiological indices of arousal were measured throughout the session. Findings provide partial support for the association between emotion-related impulsivity and pre-stress response inhibition. Contrary to hypotheses, emotion-related impulsivity did not interact with arousal to predict post-stress response inhibition performance after controlling for pre-stress response inhibition performance. Future research is needed to consider clinical samples and to assess whether emotion-related impulsivity is related to deficits in other facets of cognitive control and decision-making.
... Impulsivity is widely believed to be a risk factor for suicide among individuals with major depressive disorder [1,2]. A study in both adults [3] and adolescent patients with major depressive disorder (MDD) found that those who attempted suicide showed higher impulsivity scores than those who did not attempt suicide [4]. The same tendency was observed in non-psychiatric individuals [5], and a prospective study also showed that impulsivity was one of the major predictors of suicide attempts [2]. ...
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Trait impulsivity is a known risk factor for suicidality, and the prefrontal cortex plays a key role in impulsivity and its regulation. However, the relationship between trait impulsivity, neural basis, and suicidality has been inconsistent. Therefore, this study aimed to explore the relationship between impulsivity and its structural correlates (prefrontal gray matter volume), suicidal ideation, and actual suicide attempts. A total of 87 individuals with major depressive disorder participated in study, and the gray matter volume of the prefrontal regions was extracted from T1 images based on region of interest masks. The variables for the mediation models were selected based on correlation analysis and tested for their ability to predict suicide attempts, with impulsivity and suicidal ideation as the mediation variables and gray matter volume as the independent variable. A significant correlation was observed between suicidal ideation and the left dorsolateral prefrontal cortex and right dorsomedial prefrontal cortex. The dual-mediation model revealed a significant indirect relationship between gray matter volume in both regions and suicide attempts mediated by motor impulsivity and suicidal ideation. The counterintuitive positive relationship between gray matter volume and suicidality was also discussed.
... Of note, impulsivity and its relation to behavioral reactivity to emotions has previously been found to be significantly associated with suicide attempts among youth with mental illness, even after controlling for mental illness factors. 12 This is of particular concern in the context of COVID-19, as adolescents may adopt risk-taking behaviors as a means of escaping extended psychosocial stressors related to the pandemic. ...
Article
The coronavirus disease 2019 pandemic has vastly disrupted the lives of youth. Stressors related to the pandemic and related lockdown measures have increased the prevalence of adolescent depression, suicidal ideation, and suicide attempts, with their mental and psychosocial development making them highly vulnerable to isolating restrictions. Research has demonstrated increased loneliness and decreased social support among adolescents during the pandemic. Increased social media usage has further affected depression among adolescents. Pandemic-related stressors such as fear of illness or life changes have negatively affected adolescent mental well-being. Health care use during the pandemic has involved disruption in primary care suicide screening, patterns of suicide-related presentations in emergency departments, and access to mental health services. Health care providers can support adolescent mental health through consistent screening, effectively coordinating referral for mental health evaluation, and providing family guidance on resiliency, pandemic-related mental health risks, and suicide prevention. [Pediatr Ann. 2022;51(4):e144-e149.].
... In turn, rumination and hopelessness are associated with depression (e.g., Miranda, Tsypes, Gallagher, & Rajappa, 2013). Of particular relevance to the current study, poor inhibitory control has also been linked to heightened risk for suicidality in adolescence (Auerbach, Stewart, & Johnson, 2017;Gvion & Apter, 2011;Venables et al., 2015), and thus may provide an important target for early childhood preventive interventions to reduce the risk of subsequent suicide-related behaviors. Further, inhibitory control develops in the context of early family relationships, with harsh, inconsistent, or abusive parenting associated with poorer inhibitory control across early childhood (e.g., Moilanen, Shaw, Dishion, Gardner, & Wilson, 2010;Pears, Fisher, Bruce, Kim, & Yoerger, 2010). ...
Article
This study employed integrative data analysis techniques to examine the long-term effects of the family check-up (FCU) on changes in youth suicide risk using three randomized prevention trials, including one trial initiated in early childhood and two initiated in early adolescence. Data were harmonized across studies using moderated nonlinear factor analysis, and intervention effects were tested using an autoregressive latent trajectory model examining changes in suicide risk across long-term follow-up. Across trials, significant long-term effects of the FCU on reductions in suicide risk were observed, although differences between intervention and control group trajectories declined over time. No moderation of intervention effects was observed by youth gender or race/ethnicity or across samples. While results offer further support for the benefits of the FCU for suicide risk reduction, they also suggest that such effects may wane over time, underscoring the need for continued development of the FCU to enhance longer-term durability of effects on suicide-related behaviors.
... Some empirical investigations have linked the inability to control one's behavior when experiencing extreme effects (impulse subscale of DERS) to a higher risk of suicide. A relationship between impulsivity/impulsive behavioral reaction to distress and suicide attempts has been established (68). In conclusion, the strategies, nonacceptance, and impulse dimensions of ED are supported by empirical evidence as significant characteristics associated with suicide ideation and attempts in teenagers (69). ...
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Background: There is a high prevalence of suicidal behavior among Nigerian youths. However, the connections between suicidal behavior and precipitating factors, such as gambling disorder and emotional dysregulation (ED) in this population, are not well researched. Objectives: The present study examined the associations between gambling disorder, ED, and suicidal behavior in Nigerian university undergraduate students. Methods: This study was carried out during October 2020 - April 2021 on 1338 undergraduates with a mean ± SD age of 19.84 ± 3.22 years selected using random and purposive sampling for the universities and participants respectively. Participants responded to the Attitudes Towards Gambling Scale, Difficulties in Emotion Regulation Scale, and Redeemer's University Suicidality Scale. Descriptive statistics (simple percentages) and inferential statistics (Pearson’s correlation and regression analysis) were used for data analysis. Results: The Pearson's correlation revealed that suicidal behaviour had significant positive correlations with the nonacceptance of emotional responses or distress (r = 0.22, P = 0), difficulties engaging in goal-directed behaviours (r = 0.21, P = 0), difficulties in impulse control (r = 0.27, P = 0), the lack of emotional awareness (r = 0.14, P = 0), limited access to emotional regulation strategies (r = 0.33, P = 0), the lack of emotional clarity (r = 0.32, P = 0), and difficulties in emotional regulation (r = 0.4, P = 0). Problematic gambling (PG) independently predicted suicidal behavior, while PG and ED dimensions jointly predicted suicidal behavior. The ED dimensions contributed 15% incrementally to the prediction of suicidal behavior and beyond the 2% variance accounted for PG in undergraduates. Conclusions: Our results showed positive links between PG, ED, and suicidal behavior among Nigerian undergraduates. It suggests that the combination of PG and ED increases the severity of suicidal behavior among students.
... 7-020-01607 -3) contains supplementary material, which is available to authorized users. others who self-harm, can translate into self-harming behaviour with or without suicidal intent in the younger population [1,8]. ...
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Existing interventions to reduce self-harm in adolescents admitted to psychiatric wards are usually focused on individual psychological treatments. However, the immediate ward environment in which treatment takes place is an important factor in the success of the treatment and can also influence the likelihood of self-harming behaviours. The aim of the current study was to evaluate changes made to a psychiatric ward environment on incidence of self-harm in adolescents. A quasi-experimental interrupted time series study was conducted on one child and adolescent psychiatric ward. An intervention was developed alongside staff and patients to address the high incidence of self-harm on weekday evenings on the ward. The intervention components involved adding a regular twilight shift (3–11 pm) for nursing staff and introducing a structured evening activity programme on the ward. A segmented regression analysis of an interrupted time series found that the rate of self-harm per 100 bed days was already declining at baseline and continued to decline post-intervention, but the rate of decline was not significant (p = 0.415). However, the proportion of patients self-harming was increasing at baseline and significantly reduced post-intervention (p = 0.001), and this reduction was significantly larger in the evenings (p = 0.004) compared to other times of day (p = 0.09). A tailored intervention targeting the psychiatric ward environment helped to reduce the proportion of adolescents self-harming on the ward. An interrupted time series analysis should be considered for future interventions making changes to health systems over time.
... Items are rated from 1 ("I strongly disagree") to 5 ("I strongly agree"), with higher scores reflecting higher impulsivity levels. The questionnaire covers eight different components of impulsivity shown in oblique factor analyses and confirmatory structural equation modeling to load onto three separate factors [9,57]: Pervasive Influence of Feelings, (lack of) Follow-Through, and Feelings Trigger Action; alphas = 0.837, 0.897, and 0.857, respectively. The first and the third factors are emotion-related. ...
Article
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The unique contribution of the serotonin transporter-linked polymorphic region (5-HTTLPR), intronic region 2 (STin2), and monoamine oxidase A (MAO-A) genes to individual differences in personality traits has been widely explored, and research has shown that certain forms of these polymorphisms relate to impulsivity and impulsivity-related disorders. Humans showing these traits are also described as having an asymmetrical prefrontal cortical activity when compared to others. In this explorative study, we examine the relationship between serotonergic neurotransmission polymorphisms, cortical activity features (prefrontal alpha asymmetry, individual alpha peak frequency [iAPF]), emotion-related and non-emotion-related impulsivity in humans. 5-HTTLPR, MAO-A, and STin2 polymorphisms were assessed in blood taken from 91 participants with high emotion-related impulsivity levels. Sixty-seven participants completed resting electroencephalography and a more comprehensive impulsivity index. In univariate analyses, iAPF correlated with both forms of emotion-related impulsivity. In multiple linear regression models, 5-HTTLPR polymorphism (model 1, adj. R ² = 15.2%) and iAPF were significant interacting predictors of emotion-related impulsivity, explaining a large share of the results’ variance (model 2, adj. R ² = 21.2%). Carriers of the low transcriptional activity 5-HTTPLR and MAO-A phenotypes obtained higher emotion-related impulsivity scores than others did. No significant results were detected for non-emotion-related impulsivity or for a form of emotion-related impulsivity involving cognitive/motivational reactivity to emotion. Our findings support an endophenotypic approach to impulsivity, showing that tri-allelic 5-HTTLPR polymorphism, iAPF, and their interaction are relevant predictors of one form of emotion-related impulsivity.
... Finally, in addition to the two mediators tested here, other factors may be important in the pathway from IGD to suicidal ideation. For example, impulsivity is a characteristic trait of adolescence and is strongly associated with addictive disorders (e.g., IGD) and other risky behaviors (e.g., suicidal ideation) (51). As adolescence is characterized by internal psychological change and external interpersonal adaption, future studies should examine other psychological factors that may be associated with suicidal ideation. ...
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Background: High prevalence and strong relationships among suicidal ideation, Internet gaming disorder (IGD), insomnia, and depression have been reported for adolescents worldwide, but the mechanism underlying these psychological problems remains unclear. This cross-sectional study explored the mediating effect of insomnia and depression on the association between IGD and suicidal ideation. Methods: Participants were 1,066 adolescents (median age= 13.0 years) with Internet games exposure in the previous 12 months from junior high schools in Shanghai, China. Questionnaire measures of suicidal ideation, IGD, insomnia, depressive symptoms, and background characteristics were obtained. Path analysis was conducted to test the multiple mediating roles of insomnia and depression. Results: Suicidal ideation, IGD, insomnia, and depression prevalence was 27.2%, 13.6%, 9.2%, and 17.0%, respectively. A serial multiple mediation model was generated. The mediation effect of insomnia and depression on the pathway from IGD to suicidal ideation was 45.5% (direct effect: standardized estimate [Std. estimate] = 0.186; total indirect effect: Std. estimate = 0.155). The association between IGD and depression was partially mediated by insomnia (direct effect: Std. estimate = 0.211; indirect effect: Std. estimate = 0.135). The proposed model fit the data well. Conclusions: Insomnia and depression may serially mediate the association between IGD and suicidal ideation. IGD was positively associated with insomnia, then with depression, which in turn positively contributed to suicidal ideation. We suggest greater monitoring of Internet use and prevention of insomnia and depression to mitigate the risk of suicidal ideation among Chinese adolescents.
... Importantly, ERP investigations can play a role in suicide prevention. Studies comparing patients with suicidal ideation and patients who attempted suicide found that the latter group was characterized by enhanced P200 amplitudes in response to the presentation of negative attempters, enhanced attendance to negative information may facilitate, at least in some cases, the transition from ideation to action [74]. ...
... In psychological models of suicide, impulsivity is often considered in the context of suicidal behaviors rather than suicidal thinking (Baumeister, 1990;Mann, Waternaux, Haas, & Malone, 1999;O'Connor & Kirtley, 2018); however, several studies have found a relationship specifically between suicidal ideation and impulsivity (e.g., Auerbach, Stewart, & Johnson, 2017;Conner, Britton, Sworts, & Joiner, 2007;Gonzalez & Neander, 2018). Perhaps unsurprisingly, there is a large body of literature linking impulsivity and a number of risky behaviors. ...
Article
Objective: Numerous studies have found support for the relationship between suicide and risky behavior. However, few studies have examined factors that may help explain the relationship between suicidal ideation (SI) and risky behavior. This preregistered study examined the relationship between SI and risky behavior and whether there is an indirect relationship through hopelessness, impulsivity, and low wish to live. These factors were selected due to their relationships with both SI and risky behavior. Methods: Participants recruited from Amazon Mechanical Turk completed measures of SI, risky behavior, hopelessness, impulsivity, and wish to live. Consistent with our preregistered methods, we analyzed data from 180 participants with valid data. Indirect effects were evaluated via bootstrapping with 5000 resamples of the a path x b path product. Results: Consistent with prior work, we found a significant positive association between SI and frequency of risky behavior (r = .49). We found significant indirect effects of SI on risky behavior through impulsivity and wish to live but not through hopelessness. Conclusion: SI and risky behavior are associated with each other through impulsivity and wish to live. Though future longitudinal research is needed to determine causality, this has important implications for models of suicidal thoughts and behaviors and their relationship with risky behavior. The potential of future orientation to explain the results is discussed.
... Respective data are missing for adolescents . Suicide attempts often occur impulsively and the intensity of suicidal thoughts fluctuates rapidly in adolescence (Auerbach et al., 2017;Czyz et al., 2019), making the prediction of suicide attempts even more difficult. The distinct pattern of instability in a range of intra-and interpersonal domains, commonly supplemented by issues with impulse control and different forms of suicidal or non-suicidal behavior, may lead to biased self-assessment and difficulties in anticipating one's own future behaviors in patients with BPD symptomatology. ...
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Background. Predicting suicide attempts is a challenging task for clinicians and researchers, particularly among high-risk individuals (i.e. adolescents with lifetime suicide attempts). In this study, we examined whether adolescents were able to predict their own risk of attempting suicide in the future and whether borderline personality disorder (BPD) or depressive symptoms impacted the predictive value of self-ratings. Methods. Structured clinical assessments were conducted at baseline and after 12 months in a high-risk sample of treatment-seeking adolescents (n = 134; 12-17y.; 90% female) with at least one lifetime suicide attempt. Results. During the follow-up period, n = 51 participants (38%) attempted suicide at least once. Self-rated risk was a significant predictor for the recurrence of a suicide attempt, whereas BPD and depression were not. While there was no significant interaction between self-rated risk and BPD, a negative interaction emerged between self-rated risk and depression in the prediction of a suicide attempt. Greater depression severity diminished the predictive value of self-ratings. Limitations. Depression severity was measured using a questionnaire, not a clinical interview. The findings may not be applicable to less burdened samples. Conclusions. Asking high-risk adolescents to rate their own risk of attempting suicide appears to be an easy to apply method in improving the prediction of future suicide attempts in the clinical context.
Article
Objective: Characterize relationships among substance misuse, depression, employment, and suicidal ideation (SI) following moderate to severe traumatic brain injury (TBI). Design: Prospective cohort study. Setting: Inpatient rehabilitation centers with telephone follow-up; level I/II trauma centers in the United States. Participants: Individuals with moderate to severe TBI with data in both the National Trauma Data Bank and the Traumatic Brain Injury Model Systems National Database, aged 18 to 59 years, with SI data at year 1 or year 2 postinjury (N = 1377). Main outcome measure: Primary outcome of SI, with secondary employment, substance misuse, and depression outcomes at years 1 and 2 postinjury. Results: Cross-lagged structural equation modeling analysis showed that year 1 unemployment and substance misuse were associated with a higher prevalence of year 1 depression. Depression was associated with concurrent SI at years 1 and 2. Older adults and women had a greater likelihood of year 1 depression. More severe overall injury (injury severity score) was associated with a greater likelihood of year 1 SI, and year 1 SI was associated with a greater likelihood of year 2 SI. Conclusions: Substance misuse, unemployment, depression, and greater extracranial injury burden independently contributed to year 1 SI; in turn, year 1 SI and year 2 depression contributed to year 2 SI. Older age and female sex were associated with year 1 depression. Understanding and mitigating these risk factors are crucial for effectively managing post-TBI SI to prevent postinjury suicide.
Article
(248 words) Introduction There is public concern about potential associations between adolescent social media/smartphone use and risk for suicide. However, no prior studies leverage qualitative methods to explore the experiences of adolescents currently at-risk for suicide. Methods This study examined social technology use from the perspectives of adolescents (n = 30; Mage = 16.1 years) currently hospitalized for a recent suicide attempt or severe ideation. We conducted in-depth interviews and coded transcripts using thematic analysis. We had three research questions: What (1) negative and (2) positive experiences do suicidal adolescents report related to their use of social media/smartphones? (3) How do adolescents describe their disconnection from these technologies use during inpatient hospitalization and views on a subsequent return to digital connectivity after discharge? Results and conclusions Results reveal both positive and negative social technology uses, with most participants reporting mixed (positive and negative) experiences. Negatives/risks included trouble regulating use, stress related to social media metrics, encounters with “triggering” content, hostility and meanness, self-denigrating comparisons, and burdensome friendship expectations. Positives/benefits included social connection, social support, affect-enhancing content, shared interests, and resources for mental health and coping. Overall, the documented risks and benefits of social technology use correspond with established (offline) risk and protective factors for suicidal thoughts and behaviors. Participants generally valued the break from social technologies during hospitalization, and also viewed them as integral to social re-entry and identified related concerns. Future studies should test well-being focused ‘digital hygiene’ interventions for maximizing potential benefits and minimizing potential harms of social technologies for at-risk adolescents.
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"THE MOST IMPORTANT THEORY OF SUICIDE IN THE CURRENT LITERATURE" [Review by Riadh Abed, FRCPsych, Former (Founding) Chair of the Evolutionary Psychiatry Special Interest Group at the Royal College of Psychiatrists (UK)]. --- "This is an important book setting out ground-breaking ideas about the roots of suicide. I have read Cas Soper’s new book as well as his previous book, both of which are based on his PhD thesis proposing a new evolutionary theory of suicide. In my view Cas’ ‘Pain and Brain’ theory of suicide is the best explanation for suicide in the current literature, evolutionary or otherwise. His new book is aimed at the general public and goes further in developing the consequences and implications of his theory that provides a theory to explain the origins of happiness, love and religion as well as functional mental disorders (this bit, some psychiatrists may find controversial). "The theory Cas presents is rigorously argued and he meticulously references research findings and other relevant literature. The book should be of interest to evolutionists from diverse fields including psychology and psychiatry, suicidologists, mental health professionals as well as anyone interested in understanding the human condition. It is unfortunate that the hardback of his first book was priced out of reach of many potential readers but this one should hopefully get the attention it deserves." (February 2021)
Article
Objective Disturbances in interpersonal functioning are prevalent in individuals with suicidality. Foundational for interpersonal functioning is theory of mind (ToM), a social-cognitive ability that allows individuals to understand the thoughts and feelings of others. Recent work has begun to investigate ToM performance in individuals with suicidality, though no review has quantitatively aggregated findings from these varied studies. The current study investigated the relations between ToM and suicidality with meta-analysis. Method: We identified and meta-analyzed 15 studies that presented data for 2,895 participants (617 of whom had reported at least one suicide attempt). Results: Results indicated a significant, negative relation between ToM and suicidality with a medium overall effect size (g = −.475). Moderator analyses revealed that this effect was consistent across age, sex, ToM content, and suicidal outcome. Conclusion: Deficits in ToM associated with suicidality hold promise for risk-identification, treatment, and prevention work. • HIGHLIGHTS • Theory of mind (ToM) abilities are critical for effective interpersonal functioning. • Meta-analytics results indicate that ToM deficits are associated with suicidality. • Identifying such suicidality-related ToM deficits may inform risk-identification, treatment, and prevention work.
Article
Objective: Suicide is the second leading cause of death in youth and is of public health importance. Characteristics and precipitating circumstances may differ by adolescent age groups. Understanding these differences may inform prevention efforts that are population-specific. Therefore, we sought to compare suicides between younger and older adolescents in Virginia from 2008 to 2017. Methods: We used data from the Virginia Violent Death Reporting System (VVDRS), part of the National Violent Death Reporting System (NVDRS). We included suicides of all adolescents aged 10–17 who were residents of Virginia from 2008 to 2017. Descriptive statistics and unadjusted logistic regression were used to compare characteristics and circumstances between younger (10–14) and older (15–17) adolescents. Results: Three hundred and 24 (324) adolescents died by suicide between 2008 and 2017 in Virginia, of which 20% were younger adolescents, and 80% were older adolescents. Suicides of younger adolescents increased significantly over the 10-year period. Younger adolescent suicides seemed to occur after a crisis, while suicides among older adolescents occurred due to intimate partner problems and substance use. Mental health issues were common in both. Conclusions: Suicides may be more impulsive among younger adolescents and warrants further attention, while strategies to cope with intimate partner problems and substance use may be important for older adolescents and should be considered when implementing services and interventions. • HIGHLIGHTS • Impulsivity may be an issue among younger adolescents. • Strategies for relationship and substance use issues may benefit older adolescents. • Targeted interventions may be necessary for younger and older adolescents.
Article
Objective: Non-suicidal self-injury (NSSI) is strongly associated with difficulties in emotion regulation, but its relationships with maladaptive cognitive processes are less clear. Method: The current study examined relationships between self-reported NSSI (presence, number of methods, frequency, recency, duration, functions) and negative cognitive processes (rumination, worry, self-criticism, perceived burdensomeness, thwarted belongingness) among 1,357 undergraduates. Cognition variables were submitted to exploratory factor analysis (EFA), and relationships were examined between the resulting factors and NSSI history (among the full sample) and NSSI severity and functions (among those with a history of NSSI). Results: The EFA derived two higher order cognitive factors: repetitive negative thinking (RNT) and negative self-perception (NSP). Both RNT and NSP were significantly higher among participants with than those without a history of NSSI. Among those with NSSI, NSP, but not RNT, was positively related to lifetime NSSI frequency and number of methods, as well as recency (presence in the past 12 months) and total duration (in years) of NSSI engagement. Moreover, RNT and NSP were positively associated with aggregate intrapersonal (but not interpersonal) functions of NSSI. The two cognitive factors demonstrated differential relationships with the individual intrapersonal NSSI functions. Conclusions: Higher order categories of cognitive risk factors may have unique relationships with functions and severity of NSSI, with possible implications for more targeted approaches to risk assessment and intervention.HighlightsNegative thinking and self-perception were higher in people who engage in NSSI.Negative self-perception was associated with greater NSSI severity.Negative thinking and self-perception had different relations to NSSI functions.
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The present study aimed to establish the associations between hopelessness, depression and impulsivity with respect to suicidal ideation and behavior, and to explore the role that impulsivity plays in the mechanism that operates between depression and hopelessness. Through an empirical observational study, with an analytical scope based on a cross-sectional design for a sample of 228 university students and using The Inventory of Suicide Orientation (ISO-30); Beck Depression Inventory (BDI); Beck Hopelessness Scale (BHS); and Barratt Impulsiveness Scale (BIS-11). The results indicated a significant positives correlations between BDI, BHS, BIS and ISO-30. Regression analysis showed that depression, impulsivity and hopelessness explain between 57% and 67% of the variance in the risk of suicidal ideation and behavior. Through the analysis of structural equation modeling, three models were established showing that impulsivity mediates the relationship between depressive symptomatology and suicidal ideation and behavior. This study has implications for mental health intervention and research, in that it emphasizes the importance of impulsivity traits as factors that act as triggers in the association between the presence of depressive symptoms and suicidal behavior.
Article
Suicide is the second leading cause of death for adolescents in the United States, yet remarkably little is known regarding risk factors for suicidal thoughts and behaviors (STBs), relatively few federal grants and scientific publications focus on STBs, and few evidence-based approaches to prevent or treat STBs are available. This “decade in review” article discusses five domains of recent empirical findings that span biological, environmental, and contextual systems and can guide future research in this high priority area: (1) the role of the central nervous system; (2) physiological risk factors, including the peripheral nervous system; (3) proximal acute stress responses; (4) novel behavioral and psychological risk factors; and (5) broader societal factors impacting diverse populations and several additional nascent areas worthy of further investigation.
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Introduction Emotion-related impulsivity, defined by poor constraint in the face of emotion, is related to internalizing symptoms, cross-sectionally and longitudinally. Internalizing symptoms, though, are profoundly tied to stress reactivity, and little is known about how emotion-related impulsivity relates to stress reactivity. Method Taking advantage of a sample that had completed measures of depression, anxiety, suicidal ideation, and two forms of emotion-related impulsivity before the pandemic, we asked participants to complete three weekly follow-up internalizing assessments early in the pandemic. Results Among the 150 participants, pre-pandemic emotion-related impulsivity scores predicted higher depression, anxiety, general distress, and suicidal ideation during the COVID-19 pandemic. Controlling for pre-pandemic scores, one form of emotion-related impulsivity (Feelings Trigger Action) predicted increased anxiety and general distress. We also examined how pre-pandemic emotion-related impulsivity was moderated by weekly COVID-related stress. One form of emotion-related impulsivity (Pervasive Influence of Feelings) predicted internalizing symptoms at low stress levels, and a different form (Feelings Trigger Action) predicted internalizing symptoms at higher stress levels. Limitations Limitations include the small sample size, the absence of repeat measures of impulsivity, the attrition of individuals with more internalizing symptoms, and the reliance on self-rated measures. Conclusions Forms of emotion-related impulsivity predict increases in anxiety and distress over time, but the interactions with stress levels appear to vary. Emotion-related impulsivity can be addressed with accessible intervention tools, suggesting promise for broader screening for those at risk for internalizing symptoms during periods of high stress.
Article
Objective: The objective of the study was to help pediatricians understand and respond to suicidal ideation (SI) in adolescents based on data from 2 widely used screening measures that assessed SI and other psychosocial vulnerabilities in a large, national sample. Methods: Adolescents (ages 11-17 years) completed the Patient Health Questionnaire Modified for Teenagers (PHQ-9M) using the Comprehensive Health and Decision Information System software before their well-child visits. Question 9 asks about past 2-week SI. Their parents filled out the Pediatric Symptom Checklist (PSC-17P), which screens for a broad range of psychosocial problems. Chi-square analyses and one-way analysis of variances assessed the relationship between SI and psychosocial problems. Results: Among 5411 adolescents, 266 (4.9%) reported SI at least several days in the past 2 weeks. Among adolescents with SI, 187 (70.3%) reported moderate to very severe depression on the PHQ-9M (≥10), 68.1% were at risk on at least 1 PSC-17P problem subscale, 59.7% on the PSC-17P internalizing scale, 42.9% on PSC-17P overall, 20.6% on PSC-17P externalizing, and 18.5% on PSC-17P attention. Within the subsample endorsing SI nearly all days, 35.7% had a former suicide attempt. Conclusion: The PHQ-9M identifies a clinically heterogeneous subset of approximately 5% of adolescents who report occasional to frequent SI. The PSC-17P corroborates their high degree of overall risk and offers additional information that can help pediatricians assess clinical severity and range of psychosocial problems. Given our limited knowledge of how to predict and prevent an individual adolescent's suicide, the focus of screening should be to identify and help the subset of patients with chronic psychosocial vulnerability of any type.
Article
Background: US suicide rates have risen steadily in the past decade, and suicide risk is especially high in the months after discharge from inpatient psychiatric treatment. However, suicide research has lagged in examining dynamic within-person processes that contribute to risk over time among individuals known to be at high risk of suicide. Almost no research has examined how affective, cognitive, and physiological processes change over minutes, hours, or days to confer risk of suicidal behavior in daily life. Objective: This protocol describes a longitudinal study designed to examine real-world changes in risk of suicide across multiple assessment domains. Specifically, the study involves following adults known to be at high risk of suicide after discharge from inpatient psychiatric care using self-report, interview, actigraphy, and behavioral methods to identify proximal contributors to suicidal thoughts and behaviors. First, we hypothesize that negative affective experiences, which are featured in most major suicide theories, will comprise a latent factor indicative of psychache (emotional pain), which will predict increases in suicidal thinking over time. Second, we hypothesize that poor inhibitory control in the context of negative affective stimuli, as well as emotion-related impulsivity, will predict the transition from suicidal thinking to suicidal behavior over time. Third, we hypothesize that short sleep duration will precede within-person increases in suicidal ideation as well as increased odds of suicidal behavior among those reporting suicidal thoughts. Methods: The desired sample size is 130 adults with past-week suicidal thoughts or behaviors who are receiving inpatient psychiatric treatment. Participants will complete a battery of measures while on the inpatient unit to assess negative affective experiences, emotion-related impulsivity, inhibitory control, typical sleep patterns, and relevant covariates. After discharge from inpatient care, participants will complete 4 weeks of signal-contingent ecological momentary assessment surveys, as well as mobile behavioral measures of inhibitory control, while wearing an actigraphy device that will gather objective data on sleep. Participants will complete interviews regarding suicidal thoughts and behaviors at 4 and 8 weeks after discharge. Results: The study was funded by the National Institutes of Health in November 2020. Recruitment began in April 2021. Data analysis will begin after completion of data collection. Conclusions: This study will elucidate how affective, cognitive, and physiological risk factors contribute (or do not contribute) to within-person fluctuations in suicide risk in daily life, with important implications for extant theories of suicide. Of import, the examined risk factors are all modifiable; thus, the results will inform identification of key targets for just-in-time, flexible, personalized, digital interventions that can be used to decrease emotional distress and prevent suicide among those at highest risk. International registered report identifier (irrid): DERR1-10.2196/38582.
Article
Objectives: Suicidal ideation is a pervasive and painful experience that varies considerably in its phenomenology. Here, we consider how one key risk variable might inform our understanding of variation in suicidal ideation: emotion-related impulsivity, the trait-like tendency towards unconstrained speech, behaviour, and cognition in the face of intense emotions. We hypothesized that emotion-related impulsivity would be tied to specific features, including severity, perceived lack of controllability, more rapidly fluctuating course, higher scores on a measure of acute suicidal affective disturbance, and more emotional and cognitive disturbance as antecedents. Methods: We recruited two samples of adults (Ns = 421, 221) through Amazon Mechanical Turk (MTurk), with oversampling of those with suicidal ideation. Both samples completed psychometrically sound self-report measures online to assess emotion- and non-emotion-related dimensions of impulsivity and characteristics of suicidal ideation. Results: One form of emotion-related impulsivity related to the severity, uncontrollability, dynamic course, and affective and cognitive precursors of ideation. Conclusions: Despite limitations of the cross-sectional design and self-report measures, the current findings highlight the importance of specificity in considering key dimensions of impulsivity and suicidal ideation.
Article
Background Emotion-related impulsivity (ERI) refers to chronically poor self-control during periods of strong emotion. ERI robustly predicts psychiatric disorders and related problems, yet its neuroanatomical correlates are largely unknown. We tested whether local brain morphometry in targeted brain regions that integrate emotion and control could explain ERI severity. Methods 122 adults (aged 18-55) with internalizing or externalizing psychopathology completed a structural MRI scan, the Three Factor Impulsivity Index (TFII), and the Structured Clinical Interview for the DSM-5. The TFII measured two types of ERI and a third type of impulsivity not linked to emotion. Cortical reconstruction yielded cortical thickness and local gyrification measurements. We evaluated whether morphometry in the orbitofrontal cortex, insula, amygdala, and nucleus accumbens was associated with ERI severity. Hypotheses and analyses were pre-registered. Results Lower cortical gyrification in the right lateral orbitofrontal cortex (OFC) was associated with high ERI severity in a full, pre-registered model. Separate examinations of local gyrification and cortical thickness also showed a positive association between gyrification in left lateral OFC and ERI. An integrated measure of hemispheric imbalance in lateral OFC gyrification (right < left) correlated with ERI severity. These findings were specific to ERI and did not appear with non-emotion-related impulsivity. Conclusions Local gyrification in the lateral OFC is associated with ERI severity. The current findings fit with theory of OFC function, strengthen the connections between the transdiagnostic literatures in psychiatry and neuroscience, and may guide future treatment development.
Article
Adolescent suicide is a preventable health problem; however, warning signs are often missed. In this study we developed a grounded theory to explore the process of how adolescent girl suicide attempters escape suicide in a sample of 12 young female adults ages 18-25. Using grounded theory methods of constant comparison, memo-writing, axial, and theoretical coding, searching for a sense of place emerged as the core process encompassing social process stages of: (1) existing in a toxic environment; (2) seeing suicide as the only way out; (3) seeing new ways to escape. Implications for nursing practice, education, and research are discussed.
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Objective: Presently, little is know about what factors predict adolescent psychiatric rehospitalization. Thus, the present study tested whether a battery of demographic and clinical characteristics predicted readmission within 6 months of discharge. Method: Participants were 165 adolescents (112 female) aged 13-19 (M = 15.61, SD = 1.48) admitted to an acute residential treatment program between November 25, 2013 and November 18, 2014. Patients met diagnostic criteria (DSM-IV-TR) for current Major Depressive Disorder and/or Dysthymia. At admission, participants completed a battery of clinical interviews and questionnaires assessing demographics, early life stress, comorbid diagnoses, psychiatric symptoms, suicidality, self-injury and risky behavior engagement. At discharge, psychiatric symptoms were reassessed. Readmission to the same residential service was monitored over a 6-month period following discharge. Results: Overall, 12.1% of adolescents were rehospitalized. We conducted a series of cox regression survival analyses to test demographic and clinical predictors of patients’ time to readmission. More frequent self-injurious behaviors in the month prior to hospitalization was significantly associated with a more rapid time to rehospitalization, b = .05, SE = .02, Wald(1) = 4.35, p = .037, OR = 1.05, CI95 = 1.003 - 1.10. Conclusions: It is critical to more effectively manage self-injury during the treatment of depressed adolescents, as this is the strongest predictor of later rehospitalization.
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Background: Suicide is the second leading cause of death among adolescents, and depressed youth are six times more likely to make suicide attempts as compared to non-depressed adolescents. The present study examined the unique and interactive effects of two well-established correlates of suicidality – childhood sexual abuse (CSA) and disinhibition – in predicting suicide attempts among depressed adolescents. Method: Participants were 163 adolescents (125 females) aged 13 to 18 (M = 15.60, SD = 1.27) diagnosed with Major Depressive Disorder (n = 95, 58.3%) and/or Dysthymia (n = 69, 42.3%) recruited from an acute residential treatment service. Participants completed interviews assessing psychopathology and suicidality, self-report measures of depressive symptoms and CSA, and a computerized disinhibition task. Results: Consistent with hypotheses, CSA moderated the association between disinhibition and adolescents’ report of their past year and lifetime suicide attempts. Specifically, higher disinhibition was associated with a greater likelihood of having made a suicide attempt among adolescents with a history of CSA, but not among those without. The same pattern of results held in analyses of suicide attempt frequency. Limitations: Primary findings were based on observational, cross-sectional data, and therefore, causal relationships cannot be inferred. The gender imbalance in the sample precluded stratifying our analyses by gender. CSA was ascertained by self-report; replication of the results with more objective measures is warranted. Conclusions: Our findings indicate that CSA and disinhibition may work together to predict elevated suicide risk, and these results have implications for early identification efforts in youth at high risk for suicide. Keywords: adolescence, impulsivity, depression, suicide, child sexual abuse
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The construct of impulsivity is implicated in a wide variety of psychopathology. However, the heterogeneous factors or subcomponents that differentially predict outcomes are still in the process of being parsed. The present review and meta-analysis focuses on the psychopathological correlates of the Negative Urgency, (lack of) Premeditation, (lack of) perseverance, Sensation Seeking, and Positive Urgency (UPPS/UPPS-P; Whiteside & Lynam, 2001). which provides a relatively new model of impulsivity that posits 5 potentially overlapping pathways to impulsive action. The present meta-analysis included 115 studies that used the UPPS, with a total of 40,432 participants. Findings suggested that the Negative Urgency pathway to impulsivity demonstrated the greatest correlational effect sizes across all forms of psychopathology, with the Positive Urgency pathway demonstrating a pattern of correlations similar to that of Negative Urgency. These findings raise questions regarding the conceptual and practical separability of these pathways. Lack of Premeditation and Lack of Perseverance also demonstrated similar correlational patterns, suggesting that further investigation of the distinctiveness of these pathways is warranted. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
Article
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The Self-Injurious Thoughts and Behaviors Interview (SITBI) was created to address limitations in existing suicide assessments and its validity was evaluated in the original publication. However, this work has not yet been extended to inpatient adolescents, a population in which suicide assessment is crucial. Moreover, information on the psychometric properties of the SITBI has not been provided by other groups beyond the developers of the SITBI. The aim of this study was to examine the concurrent validity of the suicide ideation, attempt, plan, and gesture modules of the SITBI with inpatient adolescents (N = 106, 64.8 % female, M age = 14.63), as an extension to previous validation efforts using this measure. Concurrent validity was examined with established interview-based and self-report measures of suicide ideation and suicide intent. The SITBI demonstrated adequate agreement with other measures, suggesting adequate validity for the suicide ideation, attempt, plan, and gesture modules in a sample of inpatient adolescents.
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Despite the widespread use of exploratory factor analysis in psychological research, researchers often make questionable decisions when conducting these analyses. This article reviews the major design and analytical decisions that must be made when conducting a factor analysis and notes that each of these decisions has important consequences for the obtained results. Recommendations that have been made in the methodological literature are discussed. Analyses of 3 existing empirical data sets are used to illustrate how questionable decisions in conducting factor analyses can yield problematic results. The article presents a survey of 2 prominent journals that suggests that researchers routinely conduct analyses using such questionable methods. The implications of these practices for psychological research are discussed, and the reasons for current practices are reviewed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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It is widely accepted that suicidal behavior often occurs with little planning. We propose, however, that suicidal behavior is rarely if ever impulsive-that it is too frightening and physically distressing to engage in without forethought-and that suicidal behavior in impulsive individuals is accounted for by painful and fearsome behaviors capable of enhancing their capacity for suicide. We conducted a meta-analysis of the association between trait impulsivity and suicidal behavior and a critical review of research considering the impulsiveness of specific suicide attempts. Meta-analytic results suggest the relationship between trait impulsivity and suicidal behavior is small. Furthermore, studies examining a mediating role of painful and provocative behaviors have uniformly supported our model. Results from our review suggest that researchers have been unable to adequately measure impulsivity of attempts and that measures sensitive to episodic planning must be developed to further our understanding of this phenomenon.
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Following an exploratory factor analysis, factor scores may be computed and used in subsequent analyses. Factor scores are composite variables which provide information about an individual's placement on the factor(s). This article discusses popular methods to create factor scores under two different classes: refined and non-refined. Strengths and considerations of the various methods, and for using factor scores in general, are discussed.
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Mental disorders are among the strongest predictors of suicide attempts. However, little is known regarding which disorders that are uniquely associated with suicidal behavior because of high levels of psychiatric comorbidity. We examined the unique associations between individual disorders and subsequent suicidal behavior (suicide ideation, plans and attempts) using data from the National Comorbidity Survey Replication, a nationally representative household survey of 9282 US adults. Results revealed that approximately 80% of suicide attempters in the United States have a temporally prior mental disorder. Anxiety, mood, impulse-control and substance use disorders all significantly predict subsequent suicide attempts in bivariate analyses (odds ratios (OR)=2.7–6.7); however, these associations decrease substantially in multivariate analyses controlling for comorbidity (OR=1.5–2.3) but remain statistically significant in most cases. Disaggregation of the observed effects reveals that depression predicts suicide ideation, but not suicide plans or attempts among those with ideation. Instead, disorders characterized by severe anxiety/agitation (for example, post-traumatic stress disorder) and poor impulse control (for example, conduct disorder, substance use disorders) predict which suicide ideators who go on to make a plan or attempt. These results advance understanding of the unique associations between mental disorders and different forms of suicidal behavior. Future research must further delineate the mechanisms through which people come to think about suicide and progress from suicidal thoughts to attempts.Keywords: epidemiology; mental disorders; comorbidity; suicide; suicidal ideation; suicide attempt
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The extent to which a specific negative life event (NLE) is a triggering factor for a suicide attempt is unknown. The current study used a case-crossover design, an innovative within-subjects design, to quantify the unique effects of recent NLEs on suicide attempts. In an adult sample of 110 recent suicide attempters, a timeline follow-back methodology was used to assess NLEs within the 48 hours prior to the suicide attempt. Results indicated that individuals were at increased odds of attempting suicide soon after experiencing a NLE and that this effect was driven by the presence of an interpersonal NLE, particularly those involving a romantic partner. Moreover, the relation between interpersonal NLEs and suicide attempts was moderated by current suicide planning. Interpersonal NLEs served as triggers for suicide attempts only among patients who were not currently planning their attempt. Findings suggest the importance of considering potential interpersonal NLEs when evaluating imminent risk for suicide attempts. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
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There are well-established links between impulsivity and alcohol use in humans and other model organisms; however, the etiological nature of these associations remains unclear. This is likely due, in part, to the heterogeneous nature of the construct of impulsivity. Many different measures of impulsivity have been employed in human studies, using both questionnaire and laboratory-based tasks. Animal studies also use multiple tasks to assess the construct of impulsivity. In both human and animal studies, different measures of impulsivity often show little correlation and are differentially related to outcome, suggesting that the impulsivity construct may actually consist of a number of more homogeneous (and potentially more meaningful) subfacets. Here, we provide an overview of the different measures of impulsivity used across human and animal studies, evidence that the construct of impulsivity may be better studied in the context of more meaningful subfacets, and recommendations for how research in this direction may provide for better consilience between human and animal studies of the connection between impulsivity and alcohol use.
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Impulsivity as a behavioral construct encompasses a wide range of what are often considered maladaptive behaviors. Impulsivity has been assessed using a variety of measures, including both self-report personality questionnaires and behavioral tasks, and each of these measures has been further subdivided into separate components which are thought to represent different underlying processes. However, few studies have employed both personality measures and behavioral tasks, and so the relations among these measures are not well understood. In one analysis we examined correlations between three widely used personality measures (i.e., BIS-11, I7, and MPQ) and four laboratory-task measures of impulsive behavior (behavioral inhibition (2), delay discounting, and risk taking) in 70 healthy adult volunteers. The correlations among the various self-report measures were high, but self-reports were not correlated with behavioral-task measures. In a second analysis we performed a principal-components analysis using data from the four behavioral tasks for 99 participants. Two components emerged, labeled “impulsive disinhibition” (Stop Task and Go/No-Go task) and “impulsive decision-making” (Delay-Discounting task and Balloon Analog Risk Task). Taken collectively, these analyses support other recent findings indicating that self-report and behavioral tasks probably measure different constructs, and suggest that even among the behavioral measures, different tasks measure different, perhaps unrelated, components of impulsive behavior.
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The present project utilized the Five Factor Model of personality (FFM; McCrae & Costa, 1990) to clarify the multi-faceted nature of impulsivity. The NEO-PI-R and a number of commonly used impulsivity measures were administered to over 400 young adults. Exploratory factor analyses identified four distinct personality facets associated with impulsive-like behavior which were labeled urgency, (lack of) premeditation, (lack of) perseverance, and sensation seeking. Each of these traits was marked by a different facet of the FFM. Following the initial factor identification, scales to measure each of the personality facets were created and combined to form the UPPS Impulsive Behavior scale. Implications for the understanding of impulsive behavior and the FFM are discussed, as are future applications of the UPPS impulsive behavior scale.
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