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Implicit affective responses to suicide‐related stimuli: Differences as a function of suicide attempt history and concurrent substance use
Abstract
Introduction
Individuals who are depressed, have suicide attempts, and a substance use disorder (SUD) may have different patterns of suicidal thoughts and behaviors and respond differently to cues associated with suicide and death.
Method
Implicit affective reactions to visual cues suggestive of suicide and death (as well as to pleasant, unpleasant, and neutral cues), were compared among three groups of hospitalized adults: (a) depressed patients without the histories of suicidal behavior (depression only), (b) depressed patients with suicide attempts, but no current substance abuse disorder (SA), and (c) depressed patients with both suicide attempts and substance use disorder (SA + SUD).
Results
The SA group demonstrated higher positive evaluations of visual cues associated with suicide and death when compared to the SA + SUD group. The SA + SUD group demonstrated the lowest positive evaluation of suicide‐related stimuli as well as less positive evaluation of visual cues of generally unpleasant stimuli.
Conclusion
Differences observed between SA and SA + SUD participants underscore differences in responses to cues related to suicide, which may reflect differences in mechanisms of risk.
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Purpose
Research suggests that performance on the Death-Implicit Association Test (D-IAT) converges with explicit indicators of suicide risk (e.g., suicidal ideation, suicidal behaviors). However, the utility of the D-IAT in acute care settings has been questioned given limited studies and inconsistent findings. Additionally, it remains unclear whether the D-IAT incrementally improves the assessment of suicide risk beyond explicit measures.
Method
The present study evaluated the validity of the D-IAT in a large sample of psychiatric inpatients who attempted suicide within the past two years (N = 203; M age = 32.93 [SD = 12.61]; 50.7% female; 63.5% White; 22.7% Hispanic/Latino). The D-IAT was scored three ways: (1) conventional D scoring where positive scores indicate stronger implicit associations with death, (2) dichotomized D scores where participants were categorized based on positive or negative D score, and (3) DD scoring, which is a novel procedure that differentiates self-identification with death (Me-DD) from a lack of identification with life (Not Me-DD).
Results
D and Not Me-DD were weakly associated with suicide cognitions, hopelessness, suicidal ideation, and wishes to live/die and there were corresponding mean differences based on dichotomized D scores. D and Not Me-DD were also weakly correlated with number of lifetime suicide attempts. Me-DD evidenced fewer significant associations than Not Me-DD suggesting that a lack of association with life may be the central component of D scores.
Conclusions
Findings suggest that the D-IAT may not be a useful standalone measure of suicide risk in high-risk populations.
Introduction:
Suicide is a leading cause of death, and decades of research have identified a range of risk factors, including demographics, past self-injury and suicide attempts, and explicit suicide cognitions. More recently, implicit self-harm and suicide cognitions have been proposed as risk factors for the prospective prediction of suicidal behavior. However, most studies have examined these implicit and explicit risk factors in isolation, and little is known about their combined effects and interactions in the prediction of concurrent suicidal ideation.
Methods:
In an online community sample of 6855 participants, we used different machine learning techniques to evaluate the utility of measuring implicit self-harm and suicide cognitions to predict concurrent desire to self-harm or die.
Results:
Desire to self-harm was best predicted using gradient boosting, achieving 83% accuracy. However, the most important predictors were mood, explicit associations, and past suicidal thoughts and behaviors; implicit measures provided little to no gain in predictive accuracy.
Conclusion:
Considering our focus on the concurrent prediction of explicit suicidal ideation, we discuss the need for future studies to assess the utility of implicit suicide cognitions in the prospective prediction of suicidal behavior using machine learning approaches.
Prominent theories suggest that self-injurious thoughts and behaviours are negatively reinforced by decreased negative affect. The present meta-analysis quantifies effects from intensive longitudinal studies measuring negative affect and self-injurious thoughts and behaviours. We obtained data from 38 of the 79 studies (48%, 22 unique datasets) involving N = 1,644 participants (80% female, 75% white). Individual-participant data meta-analyses revealed changes in affect pre/post self-injurious thoughts and behaviours. In antecedent models, results supported increased negative affect before nonsuicidal self-injurious behaviour (k = 14, 95% CI 0.09 to 0.31) and suicidal thoughts (k = 14, 95% CI 0.03 to 0.19). For consequence models, negative affect was reduced following nonsuicidal self-injurious thoughts (k = 6, 95% CI −0.79 to −0.44), nonsuicidal self-injurious behaviours (k = 14, 95% CI −0.73 to −0.19) and suicidal thoughts (k = 13, 95% CI −0.79 to −0.23). Findings, which were not moderated by sampling strategies or sample composition, support the affect regulation function of self-injurious thoughts and behaviours.
Background
Distress tolerance (DT) has received increased attention in recent years due its purported role in dysregulated behaviours and their clinical manifestations, such as problematic substance use (PSU), disordered eating behaviours (e.g., binge-eating and purging; DEB), and borderline personality disorder (BPD) symptomatology. Despite the proposed transdiagnostic utility of DT across PSU, DEB, and BPD, there has yet to be a systematic and comprehensive examination characterising and comparing its association with this class of impulsive-type psychopathology.
Methods
A systematic search was conducted across five electronic databases using search terms designed to capture extant literature on the association between DT and PSU, DEB, or BPD. A series of meta-analyses were undertaken on correlation coefficients from 81 studies to examine the association between DT and each psychopathology domain, as well as impulsive-type psychopathology overall. Moderator analyses were conducted to examine whether these relationships were moderated by DT measurement type, sample type, age, and gender.
Results
DT shared significant, negative, medium correlations with PSU (r = –.18,), DEB (r = –.20), and BPD (r = –.27). The magnitude of these associations was not significantly different across the three psychopathology domains, supporting transdiagnostic conceptualisation. DT measurement type, age, and sample type moderated several of these indicated relationships.
Limitations
The majority of studies were conducted in adult samples from Western countries, limiting understanding of these relationships across development and different cultures.
Conclusions
The present findings support the putative transdiagnostic role of DT across PSU, DEB, and BPD, which may ultimately inform novel, cross-cutting interventions.
Many individuals report drinking alcohol to cope or relieve negative affective states, but existing evidence is inconsistent regarding whether individuals experience negatively reinforcing effects after drinking to cope (DTC). We used ecological momentary assessment to examine the effects of DTC during daily-life drinking episodes in a sample of current drinkers (N=110; 52 individuals with borderline personality disorder and 58 community individuals). Multilevel models were used to test whether momentary and episode-level endorsement of DTC-depression and DTC-anxiety motives would be related to increased subjective drinking-contingent relief and decreased depression and anxiety during drinking episodes. Momentary DTC-anxiety predicted greater subsequent drinking-contingent relief, and greater episode-level DTC-anxiety and DTC-depression predicted greater drinking-contingent relief during the episode. However, we did not find decreased depression and anxiety following endorsement of DTC-depression and DTC-anxiety. Instead, we found that greater episode-level DTC-depression was associated with increased depression. Thus, findings suggest that individuals’ negative affective states may not improve during DTC despite endorsing drinking-contingent relief. This discrepancy warrants further attention because subjective relief likely reinforces DTC, whereas awareness of one’s change (or lack of change) in affect may provide valuable counterevidence for whether alcohol use is an effective coping strategy.
Assessment of implicit self-associations with death, measured by a death Implicit Association Test (IAT), has shown promise for the prediction of suicide risk. The present study examined whether the performance on the death IAT is associated with lifetime, recent, or future suicide attempt status as well as self-report measures of suicide risk factors (e.g., perceived burdensomeness, thwarted belongingness) in two inpatient samples with low versus high severity of suicidality. Furthermore, we investigated whether explicit suicidal ideation and implicit associations with death predict recent and future suicide attempt status. Seventy-one depressed inpatients with recent/lifetime suicidal ideation (first sample) as well as 226 inpatients with a recent suicide attempt or a severe suicidal crisis (second sample) were interviewed on lifetime suicidal ideation and behavior, completed self-report measures (i.e., suicidal ideation, thwarted belongingness, perceived burdensomeness), and conducted the death IAT. The second sample was also interviewed and completed self-report measures longitudinally, 6, 9, and 12 months later. The IAT was conducted twice in this sample, at the beginning of the assessment (T₀) as well as 12 months later (T₃). Implicit associations with death neither differ between lifetime suicide ideators, single attempters, and multiple attempters, nor between recent and future nonattempters and attempters. IAT scores were unrelated to other suicide risk factors. Neither the IAT scores nor the interaction of IAT scores and explicitly stated suicidal ideation was predictive of recent or future suicide attempts. The present study points to a limited utility of the death IAT for the prediction of suicide risk. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Short versions of the Beck Hopelessness Scale have all been created according the Classical Test Theory, but the use and the application of this theory has been repeatedly criticized. In the current study, the Item Response Theory approach was employed to refine and shorten the BHS in order to build a reasonably coherent unidimensional scale whose items/symptoms can be treated as ordinal indicators of the theoretical concept of hopelessness, scaled along a single continuum. In a sample of 492 psychiatrically hospitalized, adult patients (51.2% females), predominantly with a diagnosis of Bipolar Disorder type II, the BHS was submitted to Mokken Scale Analysis. A final set of the nine best-fitting items satisfied the assumptions of local independency, monotonicity, and invariance of the item ordering. Using the ROC curve method, the IRT-based 9-item BHS showed good discriminant validity in categorizing psychiatric inpatients with high/medium suicidal risk and patients with and without suicide attempts. With high sensitivity (>.90), this newly developed scale could be used as a valid screening tool for suicidal risk assessment in psychiatric inpatients.
Suicidal behavior (SB) can be impulsive or methodical; violent or not; follow a stressor or no obvious precipitant. This study tested whether childhood trauma, affective lability, and aggressive and impulsive traits predicted greater SI variability. We also assessed whether affective lability, aggressive or impulsive traits explain childhood trauma’s effects on SI variability and whether those with highly variable SI respond to stressful events with increases in SI. Finally, we assessed variable SI’s trajectory over 2 years. Depressed participants (n = 51) had ecological momentary assessments (EMA) over 7 days at baseline, 3, 6, 12, 18, and 24 months. SI variability was assessed using the square Root of the Mean Square of Successive Deviations. Mixed Effects Models were fit as appropriate. Childhood trauma was associated with subsequent aggression. Physical abuse predicted both aggression and affective lability as well as SI variability, but not impulsivity. In two-predictor models, physical abuse’s effect on SI variability was no longer significant, when controlling for the effect of higher aggression and impulsivity. Those with high SI variability exhibited greater increases in SI after stressors compared with those with less variability. We did not find that SI variability changed over time, suggesting it might be trait-like, at least over 2 years. Variable SI predisposes to marked SI increases after stressful events and may be a trait increasing risk for impulsive SB, at least over 2 years.
Objective: Distress tolerance (DT), the ability to withstand aversive internal states, represents an important risk factor for substance use relapse and a potential treatment target. Neurobiological research in substance using populations suggests that continued substance use could erode DT, whereas abstinence could bolster it. The current study characterized trajectories of behavioral and self-reported indices of DT and examined the prospective effect of substance use on DT trajectories among those seeking treatment for substance use. Method: Individuals (N = 263, Mage = 42.68, SD = 11.8, 70.7% male, 94.7% African American) in residential substance use treatment completed subjective (Distress Tolerance Scale) and behavioral (Mirror Tracing Persistence Task–computerized version) DT measures, as well as report of daily substance use (timeline follow-back) over 5 assessment time-points from pretreatment to 12 months posttreatment. Latent curve modeling estimated DT trajectories and their associations with substance use behavior, including abstinence duration (days until first use) and substance use frequency (percentage of substance use days between assessments). Results: Self-reported and behavioral DT indicators both exhibited positive, nonlinear change over time (standardized slope parameter estimates: Distress Tolerance Scale β = 0.61, p < .01; Mirror Tracing Persistence Task β = 0.34, p < .01). Abstinence duration was associated with greater improvement in behavioral (β = .20, p = .03) DT specifically. Frequency of use was statistically significantly associated with attenuated behavioral DT at 6-month (β = −.12, p = .03) and 12-month follow-ups (β = −.08, p = .045). Conclusions: DT appears to improve appreciably posttreatment, and return to substance use may shape the degree of this improvement. Collectively, these findings support the conceptualization of DT as a malleable treatment target and emphasize the benefit of abstinence on improvement in DT.
Cross-sectional and retrospective studies indicate that a primary motive for suicidal behavior among United States soldiers is the desire to alleviate or reduce emotional distress. This is also the aim of psychological services designed to prevent suicidal behavior. The prospective association of emotion relief (and other) motives with future suicidal behavior has yet to be examined, however. In a high-risk sample of 97 active duty soldiers presenting for an emergency behavioral health appointment, suicide motives were examined and compared between those with and without a history of suicide attempts. Results indicated that soldiers with a history of suicide attempts reported significantly more emotion relief (i.e., reducing or avoiding negative emotional states) and feeling generation (i.e., creating positive emotional states) motives. Feeling generation motives were positively correlated with severity of suicide ideation, hopelessness, depression, and posttraumatic stress, especially among those with a prior suicide attempt. Among soldiers with no previous suicide attempts, emotion relief motives were associated with significantly increased risk for suicide attempt during the 6-month follow-up assessment. Among soldiers with a prior attempt, emotion relief motives were not associated with later suicide attempts. Results provide preliminary evidence suggesting the desire to reduce or avoid negative emotional states may facilitate the emergence of a first suicide attempt among treatment-seeking Soldiers.
Molecular Psychiatry publishes work aimed at elucidating biological mechanisms underlying psychiatric disorders and their treatment
Background:
Suicide is a major public health concern, particularly among people who use illicit substances and/or non-prescribed medications.
Methods:
The present study prospectively assessed the incidence and predictors of suicidal ideation (SI) and suicide attempt (SA) among 868 substance-using patients over 12 months after receiving primary care within seven public primary care clinics.
Results:
Participants reported a high incidence of SI (25.9%) and SA (7.1%) over the year following primary care visits. Suicidality was elevated in patients who were female; lacked a high school diploma; were unemployed; reported depression, anxiety, hallucinations, concentration difficulty, or violent behavior; used nicotine or stimulants; used the emergency department or mental health services in the past 90 days; reported current quality-of-life impairment in mobility or usual activities; or reported recent SI or lifetime SA at baseline. In multiple regression analyses, only past 30-day SI, any lifetime SA, past 90-day violent behavior, and current impairment due to anxiety or depression at baseline uniquely predicted SI or SA beyond other variables.
Conclusions:
Results support the need for screening for suicidality among primary care patients who use illicit substances and identify key of these patients who are at particularly elevated risk for suicidality.
Introduction
Although suicidality is frequently the cause of stigma, it is conversely true that stigma may be the cause of suicidality. The present paper focuses on the complex relationships that exist between suicidal behavior and stigmatizing attitudes.
Methods
A narrative review of the topic will be presented on the basis of the relevant literature collected from an electronic search of PubMed, ISI Web of Knowledge, and Scopus databases, using stigma, public stigma, structural stigma, perceived stigma, self-stigma, suicide, attempted suicide, and suicidality as key words.
Results
A negative perception is frequently held of suicidal people, labeling them as weak and unable to cope with their problems, or selfish. Individuals who have attempted suicide are subject to similar processes of stigmatization and “social distancing”; insurance policies include an exclusion clause against death by suicide. Subjects with a direct personal experience of depression or suicide strongly endorse a feeling of self-stigma; those who have attempted suicide are often ashamed and embarrassed by their behavior and tend to hide the occurrence as much as possible. Similar processes are observed among family members of subjects who have committed suicide or made a suicide attempt, with a higher perceived stigma present in those bereaved by suicide. Perceived or internalized stigma produced by mental or physical disorders, or through belonging to a minority group, may represent a significant risk factor for suicide, being severely distressing, reducing self-esteem and acting as a barrier in help-seeking behaviors.
Conclusion
With the aim of preventing suicide, greater efforts should be made to combat the persisting stigmatizing attitudes displayed toward mental disorders and suicide itself. Indeed, the role of stigma as a risk factor for suicide should further motivate and spur more concerted efforts to combat public stigma and support those suffering from perceived or internalized stigma. Experts and scientific societies should form an alliance with the media in an effort to promote a marked change in the societal perception of mental health issues and suicide. As stigma may result in severe consequences, specialist care and psychological interventions should be provided to populations submitted to stigma.
Introduction: Substance use craving are a known predictor of relapse to substance use following treatment for a substance use disorder. Thus, research on factors that may be correlated with craving, and could then be targeted in substance use treatment, is needed. Both distress tolerance and experiential avoidance, similar but distinct constructs, are independently associated with substance use craving. However, no known research has examined these constructs as simultaneous predictors of substance use craving, which may have important implications for treatment. The current study examined this in a sample of men and women in residential substance use treatment (N = 117). Method: We utilized pre-existing data from a larger study where men and women were recruited for participation from a residential substance use treatment facility. The majority of the sample was male (n = 87; 74.3%) and White (92.2%). The mean age was 41.27 (SD = 10.68). Results: Better distress tolerance and lower experiential avoidance were negatively and significantly associated with alcohol and drug craving, but only experiential avoidance remained significantly and negatively associated with craving when both predictors were examined simultaneously. Discussion: Our findings provide preliminary support for the importance of decreasing experiential avoidance in substance use treatment, which may result in reduced substance use craving.
Background:
This meta-analysis addressed the association between substance use disorder (SUD) and suicide outcomes based on current evidence.
Methods:
We searched PubMed, Web of Science and Scopus until May 2015. We also searched the reference lists of included studies and Psycinfo website. We included observational (cohort, case-control, cross-sectional) studies addressing the association between SUD and suicide. Our outcomes of interest were suicide ideation, suicide attempt and suicide death. For each outcome, we calculated the odds ratio (OR) or risk ratio (RR) with 95% confidence intervals (CI) based on the random-effects model.
Results:
We identified a total of 12 413 references and included 43 studies with 870 967 participants. There was a significant association between SUD and suicidal ideation: OR 2.04 (95% CI: 1.59, 2.50; I(2) = 88.8%, 16 studies); suicide attempt OR 2.49 (95% CI: 2.00, 2.98; I(2) = 94.3%, 24 studies) and suicide death OR 1.49 (95% CI: 0.97, 2.00; I(2) = 82.7%, 7 studies).
Conclusions:
Based on current evidence, there is a strong association between SUD and suicide outcomes. However, evidence based on long-term prospective cohort studies is limited and needs further investigation. Moreover, further evidence is required to assess and compare the association between suicide outcomes and different types of illicit drugs, dose-response relationship and the way they are used.
Mental imagery, seeing with the mind’s eyes, can induce stronger positive as well as negative affect compared to verbal processing. Given this emotion-amplifying effect, it appears likely that mental images play an important role in affective disorders. According to the subcomponents model of depression, depressed mood is maintained by both negative imagery (which amplifies negative mood) and less efficient positive imagery processes. Empirical research on the link between mental imagery and affect in clinical depression, however, is still sparse. This study aimed at testing the role of mental imagery in depression, using a modified version of the affect misattribution procedure (AMP) and the self-assessment manikin (SAM) to assess implicit (AMP) and explicit (SAM) affect elicited by mental images, pictures, and verbal processing in clinically depressed participants (n = 32) compared to healthy controls (n = 32). In individuals with a depressive disorder, compared to healthy controls, negative mental images induced stronger negative affect in the explicit as well as implicit measure. Negative mental imagery did not, however, elicit greater increases in explicitly and implicitly assessed negative affect compared to other processing modalities (verbal processing, pictures) in the depressed group. Additionally, a positive imagery deficit in depression was observed in the explicit measure. Interestingly, the two groups did not differ in implicitly assessed affect after positive imagery, indicating that depressed individuals might benefit from positive imagery on an implicit or automatic level. Overall, our findings suggest that mental imagery also plays an important role in depression and confirm the potential of novel treatment approaches for depression, such as the promotion of positive imagery.
Behavioral economics combines basic concepts from economics and behavioral psychology to explain how people allocate their behavior among various activities over time. The current review paper provides an overview of how behavioral economic theory has been applied to substance use. A key component of a behavioral economic approach to substance abuse is the relationship between the reinforcement derived from substance use relative to the reinforcement derived from substance-free activities. Studies conducted in both the laboratory and the natural environment support the notion that increases in the availability or utilization of reinforcing substance-free activities are associated with decreased use of substances. Treatments designed to increase engagement in substance-free activities or that increase the reinforcing value of abstinence have also proven to be effective ways of addressing the abuse of a wide range of substances. Future studies focused on measurement issues and better understanding the functional relationship between substance us and alternative reinforcers across a range of contexts will likely increase our understanding of substance abuse and inform treatment efforts.
We identified and analyzed a total of 92 studies, representing 167,894 suicide decedents, to determine if there is evidence to support what appears to be a widely held cultural, clinical, and scholarly view that many people who die by suicide had been drinking at the time of death. It was determined that, based on weighted averages, approximately 27% of suicide decedents had above-zero blood alcohol concentrations (BACs) at the time of death. We emphasize that it was not 27% who were intoxicated at the time of death; rather, 27% had above-zero BACs and 73% had BACs of 0.00%. Among studies of suicide decedents, BACs differed as a function of race (higher in non-White individuals). We conclude that the role of alcohol use at the time of death may be less than some assume, and this interpretation can inform clinical practice and theories of suicide. Important unanswered questions are posed which will help refine research in this area going forward.
There is a pressing need to improve the ability to identify individuals at risk for nonsuicidal self-injury (NSSI; e.g., cutting or burning oneself); unfortunately, beyond prior NSSI, there are few powerful longitudinal predictors of NSSI. The present study addressed this limitation by investigating the ability of a novel factor-low aversion to self-cutting stimuli-to longitudinally predict NSSI in 49 individuals with a history of self-cutting. Results revealed that both low implicit and explicit aversion to self-cutting stimuli were significantly associated with future NSSI (rs = .32-.51), and that these associations were unique from several other theoretically important predictors, including prior NSSI, number of NSSI methods, implicit identification with self-cutting, self-prediction of future NSSI, emotion dysregulation, and therapy status. These findings are consistent with the notion that instinctive barriers (e.g., aversion to NSSI stimuli, pain) dissuade most people from engaging in NSSI, and that the erosion of these barriers may facilitate NSSI. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
The field of behavioral economics has made important inroads into the understanding of substance use disorders through the concept of reinforcer pathology. Reinforcer pathology refers to the joint effects of (a) the persistently high valuation of a reinforcer, broadly defined to include tangible commodities and experiences, and/or (b) the excessive preference for the immediate acquisition or consumption of a commodity despite long-term negative outcomes. From this perspective, reinforcer pathology results from the recursive interactions of endogenous person-level variables and exogenous environment-level factors. The current review describes the basic principles of behavioral economics that are central to reinforcer pathology, the processes that engender reinforcer pathology, and the approaches and procedures that can repair reinforcement pathologies. The overall goal of this review is to present a new understanding of substance use disorders as viewed by recent advances in behavioral economics.
Objective:
To review the psychometric properties of the Beck Depression Inventory-II (BDI-II) as a self-report measure of depression in a variety of settings and populations.
Methods:
Relevant studies of the BDI-II were retrieved through a search of electronic databases, a hand search, and contact with authors. Retained studies (k = 118) were allocated into three groups: non-clinical, psychiatric/institutionalized, and medical samples.
Results:
The internal consistency was described as around 0.9 and the retest reliability ranged from 0.73 to 0.96. The correlation between BDI-II and the Beck Depression Inventory (BDI-I) was high and substantial overlap with measures of depression and anxiety was reported. The criterion-based validity showed good sensitivity and specificity for detecting depression in comparison to the adopted gold standard. However, the cutoff score to screen for depression varied according to the type of sample. Factor analysis showed a robust dimension of general depression composed by two constructs: cognitive-affective and somatic-vegetative.
Conclusions:
The BDI-II is a relevant psychometric instrument, showing high reliability, capacity to discriminate between depressed and non-depressed subjects, and improved concurrent, content, and structural validity. Based on available psychometric evidence, the BDI-II can be viewed as a cost-effective questionnaire for measuring the severity of depression, with broad applicability for research and clinical practice worldwide.
Addictive behaviour has qualities that make it ideal for study using implicit techniques. Addictive behaviours are mediated in part by automatic responses to drug cues, and there is sometimes social pressure to distort self-reports. However, relationships between implicit attitudes and addictive behaviours have been inconsistent. Using a new implicit measure, the affect misattribution procedure (AMP), we found consistent evidence that drinking-related behaviours are systematically related to implicit attitudes. The procedure predicted a behavioural choice to drink beer and self-reported typical drinking tendencies, including hazardous drinking and alcohol-related problems. The AMP showed larger relationships with drinking behaviour than other implicit measures, and explained unique variance in drinking beyond those measures and beyond explicit measures. Though self-presentation distorted self-reports, it did not affect AMP scores. These studies highlight the importance of automatic affective responses in addictive behaviour and suggest a useful means for measuring those responses.
An extensive body of research has demonstrated that patients with a co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) diagnosis are at high risk for a wide range of negative clinical outcomes, including treatment noncompletion. However, no studies to date have explored the effect of a PTSD-SUD diagnosis on residential SUD treatment completion, as well as potential moderators of this effect. Consequently, the goal of this study was to examine the interactive effect of a PTSD diagnosis, distress tolerance (DT), and gender on residential SUD treatment retention. Participants were 214 substance-dependent patients consecutively admitted to a residential SUD treatment facility. Participants were administered diagnostic interviews, completed a laboratory-based measure of DT, and were followed throughout the course of treatment. Although no significant main effects were found, results did reveal a significant PTSD × gender × DT interaction. Post hoc analyses indicated that, among men, those with a current diagnosis of PTSD and low DT completed a significantly lower proportion of residential SUD treatment compared to all other groups. The implications of the study's findings for identifying ways to improve residential SUD treatment retention among patients with a PTSD-SUD diagnosis are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Research on suicide prevention and interventions requires a standard method for assessing both suicidal ideation and behavior to identify those at risk and to track treatment response. The Columbia-Suicide Severity Rating Scale (C-SSRS) was designed to quantify the severity of suicidal ideation and behavior. The authors examined the psychometric properties of the scale.
The C-SSRS's validity relative to other measures of suicidal ideation and behavior and the internal consistency of its intensity of ideation subscale were analyzed in three multisite studies: a treatment study of adolescent suicide attempters (N=124); a medication efficacy trial with depressed adolescents (N=312); and a study of adults presenting to an emergency department for psychiatric reasons (N=237).
The C-SSRS demonstrated good convergent and divergent validity with other multi-informant suicidal ideation and behavior scales and had high sensitivity and specificity for suicidal behavior classifications compared with another behavior scale and an independent suicide evaluation board. Both the ideation and behavior subscales were sensitive to change over time. The intensity of ideation subscale demonstrated moderate to strong internal consistency. In the adolescent suicide attempters study, worst-point lifetime suicidal ideation on the C-SSRS predicted suicide attempts during the study, whereas the Scale for Suicide Ideation did not. Participants with the two highest levels of ideation severity (intent or intent with plan) at baseline had higher odds for attempting suicide during the study.
These findings suggest that the C-SSRS is suitable for assessment of suicidal ideation and behavior in clinical and research settings.
An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted on the Suicide Ideation Scale (SIS) with a large military clinical sample (total N = 3,072). The EFA identified a two-factor solution with the first factor (Resolved Plans/Preparation) accounting for 17.3% of the variance and the second (Suicidal Desire) accounting 15.1% of the variance. This 2-factor solution demonstrated a good fit to the data in the CFA. SIS construct validity and internal reliability data are also reported. The results of this study provide additional psychometric data for the SIS that support use of the measure in clinical work and research. Implications for theories related to suicide assessment and clinical practice are discussed.
To address gaps identified in earlier reviews, namely, the comparative influence of substance use on attempted suicide and completed suicide; the proximal role of substance use as a trigger of suicidal behaviour; the association between substances and suicidal behaviour; suicide and substance use disorders in youth; and the influence of combinations of risk factors, including psychiatric morbidity, on suicide.
The presence of an alcohol use disorder is confirmed as a distal risk factor for completed suicide, as well as attempted suicide. Alcohol use at the time of the suicide attempt is associated with low-risk methods. The use of other substances as a trigger of suicidal behaviour is highlighted in recent studies, but the circumstances leading to the suicidal act and the direct influence of substances in suicidal behaviour need to be explored further. Inhalant use and cocaine use are particularly associated with suicidal behaviour. Young people with multiple risk behaviours, such as substance use and risky sexual behaviours, are at high risk for suicidal behaviour. Psychiatric comorbidity with substance use escalates the risk for suicidal behaviour. Environmental interventions, such as reduction in the number of bars, may be helpful in reducing alcohol-related morbidity, including suicides.
Prevention strategies for reducing suicidal behaviour among substance users need to be prioritized at the individual and the national level through effective design, policy and implementation.
Alcohol use is often regarded as a means of coping with sadness and distress. The present research was conducted to explore the relation between negative mood and the reinforcing value of alcohol, while clarifying the role of coping motives.
Participants with a history of recent alcohol use (N=44; 72% female) attended a laboratory session and were randomly assigned to either a negative (n=22) or a neutral (n=22) mood condition. A manipulation check confirmed that participants in the negative mood condition, but not the neutral mood condition, displayed a significant increase in negative affect. The multiple choice procedure (MCP) was used to measure the reinforcing value of alcohol after the mood manipulation.
Regression models employing the MCP crossover point as the dependent variable and mood condition (neutral or negative) and drinking to cope as predictors indicated that a model with an interaction term accounted for the most variance.
These results suggest that the relation between mood and the reinforcing value of alcohol is moderated by drinking to cope, and help clarify the conditions under which drinking to cope may lead to negative outcomes.
Introduction
We investigated whether the Death/Suicide Implicit Association Test (D/S‐IAT) predicted suicidal ideation (SI) in psychiatric inpatients.
Methods
One hundred eighty veterans admitted for either SI or suicidal behavior (SB) (the primary sample) ( N = 90) or alcohol detoxification ( N = 90) completed the D/S‐IAT and scales measuring SI. Correlation and regression coefficients were measured between the D/S‐IAT (as a full‐scale or dichotomized score [ D > 0]) and self‐reported current or imminent SI (over the next 1–3 days).
Results
In the primary sample, the full‐scale D/S‐IAT was significantly correlated with the intensity of current SI ( r = 0.22, p = 0.04) and especially with wishes to be dead ( r = 0.35, p < 0.001). The intensity of imminent SI was significantly predicted by the full‐scale ( p = 0.02) and dichotomized D/S‐IAT score ( p = 0.05) in a multiple regression model. However, no significant associations were observed when both the D/S‐IAT score and current (present/absent) or imminent SI (occurred/did not occur) were dichotomous measures. In participants receiving alcohol detoxification, the D/S‐IAT significantly predicted only wishes to be dead ( r = 0.33, p < 0.001).
Conclusion
The full‐scale D/S‐IAT score predicted the current intensity of wishes to be dead in both inpatient samples, and current and imminent SI in participants admitted for SI/SB. The dichotomized D/S‐IAT score did not predict the simple occurrence of SI.
Objective:
The purpose of this study was to examine implicit affect toward suicide (i.e., how good/bad suicide is perceived). Some people might be more likely to think about/choose suicide because they perceive it as a good option (to gain relief) relative to available alternatives.
Method:
Implicit affect toward suicide among adults (N = 72) and adolescents (N = 174) with and without suicidal thoughts was examined using first-person (FP) perspective suicide pictures in the affect misattribution procedure (AMP).
Results:
Suicidal adults' implicit positive affect toward suicide was associated with STB variables, such as explicit valence (r = 0.34) and arousal (r = 0.44) ratings of suicide pictures, and implicit affect differentiated groups above and beyond explicit valence ratings. Contrary to our hypothesis, suicidal participants did not display higher implicit positive affect toward suicide than nonsuicidal participants. However, suicidal participants displayed consistent implicit affect toward different suicide pictures, whereas nonsuicidal participants evaluated some pictures as more pleasant than others (ORs = 1.92-2.27).
Conclusions:
Implicit affect toward suicide may relate to STB, but stimuli characteristics (e.g., color) likely influence the accuracy of assessment with the AMP and should be a focus of future research involving this and other implicit measures.
There has been exponential growth in research on emotion regulation and substance use in the past decade. The current meta-analysis evaluated variability in the magnitude of the relation between aspects of emotion regulation and substance use. A search of PsycINFO, Embase, PubMed, CINAHL Plus, and PILOTS in December 2020 resulted in 6,642 initial studies, of which 95 met inclusion criteria (association between emotion regulation and substance use was reported, participants were > 18 years old, article was in English). A total of 445 effects were obtained (N = 156,025 participants; weighted Mage = 29.31; 59.5% female; 66.1% White; 76.6% non-clinical). Emotion regulation and substance use were significantly related (r = 0.19; p <.001; 95%CI [0.17, 0.20]). Emotion regulation abilities were generally more strongly related to substance use than emotion regulation strategies; this pattern was stronger for behavioral vs. cognitive abilities and extended to both negative and positive emotions. Relations were stronger for older and clinical samples; mixed effects were found for sex and no conclusive effects were found for race. Despite limitations of the existing literature (e.g., cross-sectional, self-reports), results indicated that the magnitude of the relation between emotion regulation and substance use varied considerably as a function of emotion regulation and substance use constructs and sample characteristics.
Substance use disorder (SUD) comorbidity in mood disorders increases suicide risk. Suicide attempters with active SUD appear to have distinct characteristics but little is known whether these characteristics persist during remission and if they are related to different aspects of suicidal behavior. In this study, suicide attempters with a DSM mood disorder and remitted SUD (AT+SUD) (N = 135) were compared to those without lifetime SUD (AT-SUD) (N = 219) in terms of demographic, clinical and suicidal behavioral characteristics. Factor analyses were conducted to generate subjective distress and impulsivity/aggression factors – previously identified by our group to predict suicide risk in mood disorders. Associations between these traits and SUD history and suicidal behavior characteristics were then tested. Compared with AT-SUD, AT+SUD were more likely to be male, less educated and to have a Cluster B personality disorder. AT+SUD individuals had greater impulsivity/aggression factor scores, but comparable subjective distress scores. AT+SUD made a greater number of suicide attempts, with higher lethality, despite comparable suicide intent and degree of planning with AT-SUD. Impulsivity/aggression was higher in multiple versus single attempters, but did not correlate with suicide attempt lethality. Among suicide attempters with mood disorders, a history of lifetime SUD was associated with more frequent and more lethal suicide attempts. Among other correlates of lifetime SUD in this sample, impulsive/aggressive traits may explain greater frequency of suicide attempts. The results underscore that persons with mood disorders and lifetime SUD are at particularly high risk of frequent and lethal suicide attempts where more intensive prevention efforts are warranted.
Individuals with suicidal ideation (SI), demonstrate an association between suicide-related information and the self that is automatic and outside conscious control (i.e., implicit). However, it is unclear whether this implicit bias is a state-like processes that will resolve with the reduction of SI or whether it is more trait-like and enduring. Given that implicit bias has been proposed as an indirect measurement of SI, understanding its dynamic nature is important. To investigate this, we recruited 79 (22 with a history of, but no current, SI; 57 with no lifetime history of SI) young adults who completed a structured interview assessing current and past SI. Participants also completed the Suicide Affect Misattribution Procedure assessing implicit association with suicide-relevant, negative but not suicide relevant, positive, and neutral stimuli. Participants with a history of SI demonstrated greater implicit bias for suicide compared to participants with no lifetime history, but did not significantly differ in their responses to negative, positive, or neutral stimuli. This indicates that suicide-relevant implicit bias may be a trait-like process that endures after resolution of SI. This has important implications for the conceptualization of cognitive bias in suicide and the use of these biases as implicit markers of SI.
Background and aims:
Patients with addictions have a great risk of suicidal ideation and attempts. Suicidal behaviour is a continuum that begins with ideation and may continue with planning, attempts and suicide completion. Investigating the specific risk characteristics for suicidal attempts in patients with addiction problems who present with suicidal ideation is crucial for developing prevention strategies. The main aims of this study were to determine the prevalence rate of suicide attempts among patients with lifetime suicidal ideation receiving treatment for addiction, and to explore the differential characteristics for suicide ideators with and without suicide attempts.
Methods:
A sample of 149 patients with suicidal ideation (110 male and 39 female) who sought treatment for addiction in a Spanish clinical centre was assessed.
Measurements:
Information concerning socio-demographic characteristics, addiction severity, and psychopathological symptoms was obtained.
Results:
In total, 39.6% of the patients had attempted suicide (95% Confidence Interval: 32.1%-47.6%). Although all patients with suicidal behaviours presented a high severity in their addiction, patients with both suicidal ideation and suicide attempts showed a more severe addiction profile and more maladjustment to everyday life than patients with only suicidal ideation. Specifically, three psychopathological variables were related to suicide attempts: worse psychiatric state, previous hospitalization for psychological problems, and history of delirium.
Conclusions:
According to the results, a systematic screening of suicidal risk in patients seeking treatment for addiction problems is recommended. Addiction treatment centres should develop treatment strategies to prevent suicidal ideators from attempting suicide, mainly in those cases with a worse lifetime psychiatric condition.
1 Background
To examine whether there are subtypes of suicidal thinking using real‐time digital monitoring, which allows for the measurement of such thoughts with greater temporal granularity than ever before possible.
2 Methods
We used smartphone‐based real‐time monitoring to assess suicidal thoughts four times per day in two samples: Adults who attempted suicide in the past year recruited from online forums (n = 51 participants with a total of 2,889 responses, surveyed over 28 days; ages ranged from 18 to 38 years) and psychiatric inpatients with recent suicidal ideation or attempts (n = 32 participants with a total of 640 responses, surveyed over the duration of inpatient treatment [mean stay = 8.79 days], ages ranged 23–68 years). Latent profile analyses were used to identify distinct phenotypes of suicidal thinking based on the frequency, intensity, and variability of such thoughts.
3 Results
Across both samples, five distinct phenotypes of suicidal thinking emerged that differed primarily on the intensity and variability of suicidal thoughts. Participants whose profile was characterized by more severe, persistent suicidal thoughts (i.e., higher mean and lower variability around the mean) were most likely to have made a recent suicide attempt.
4 Conclusions
Suicidal thinking has historically been studied as a homogeneous construct, but using newly available monitoring technology we discovered five profiles of suicidal thinking. Key questions for future research include how these phenotypes prospectively relate to future suicidal behaviors, and whether they represent remain stable or trait‐like over longer periods.
Background
Many studies have documented robust relationships between depression and hopelessness and subsequent suicidal thoughts and behaviours; however, much weaker and non-significant effects have also been reported. These inconsistencies raise questions about whether and to what degree these factors confer risk for suicidal thoughts and behaviours.
Aims
This study aimed to evaluate the magnitude and clinical utility of depression and hopelessness as risk factors for suicide ideation, attempts and death.
Method
We conducted a meta-analysis of published studies from 1971 to 31 December 2014 that included at least one longitudinal analysis predicting suicide ideation, attempt or death using any depression or hopelessness variable.
Results
Overall prediction was weaker than anticipated, with weighted mean odds ratios of 1.96 (1.81–2.13) for ideation, 1.63 (1.55–1.72) for attempt and 1.33 (1.18–1.49) for death. Adjusting for publication bias further reduced estimates. Effects generally persisted regardless of sample severity, sample age or follow-up length.
Conclusions
Several methodological constraints were prominent across studies; addressing these issues would likely be fruitful moving forward.
Declaration of interest
None.
Background:
Theoretical work and clinical observation suggest that many patients experience relief from negative affect after thinking about suicide, which may increase the likelihood of future suicidal thoughts. Accordingly, our objective was to examine whether the occurrence of suicidal thinking was followed by decreased negative affect and increased positive affect.
Methods:
Participants were 43 adults who attempted suicide at least once in the past year (78% female, 78% White, M age = 23.28 years, SD age = 4.38 years) who completed 28 days of smartphone-based real-time monitoring, where they were signaled four times/day to report on current affect and whether they were having suicidal thoughts. Participants could initiate a survey whenever they had a suicidal thought.
Results:
First, we examined changes in affect that occurred when suicidal thinking at the current time (T) but not at T + 1 (approximately 4-8 h later). Negative affect decreased and positive affect increased when participants went from a period when they were experiencing suicidal thoughts to a period where they were not. Second, to assess the time course of changes in affect, we examined changes in affect before and after participant-initiated reports of suicidal thinking. Positive affect increased and sadness decreased.
Limitations:
Given its preliminary nature, the study has some limitations including insufficient power to expand beyond a 4-8 h timespan.
Conclusions:
Findings provide preliminary evidence that suicidal thinking leads to shifts in affect. These shifts in affect may be reinforcing, helping to explain (in part) why suicidal thinking is so persistent for some patients.
Few risk factors for nonsuicidal self-injury (NSSI) have been identified. This study investigated diminished aversion toward self-injury (i.e., NSSI, suicide/death stimuli) and self-criticism as unique NSSI risk factors. After terminating a treatment study, 154 adults with a recent and frequent NSSI history completed self-report and computer-based measures of psychopathology, implicit and explicit self-criticism, and implicit aversion to NSSI and suicide/death. Participants were then contacted 4 weeks later to test factors predicting NSSI frequency over this follow-up period. Diminished aversion toward NSSI stimuli and self-criticism significantly predicted NSSI 4 weeks later. These effects were unique from other theoretically important predictors, such as past week NSSI frequency and total number of NSSI methods used. Findings provide support that erosion of barriers to NSSI (e.g., aversion to self-injurious stimuli, decreased self-worth) may facilitate continued engagement in these dangerous behaviors. Results shed light on potential treatment targets for NSSI.
The identification of indirect markers of suicide that do not rely on explicit self-report of suicide ideation is vital, as research indicates that a significant number of individuals who die by suicide do not discuss or explicitly deny thoughts of suicide with a provider in their last health care interaction. The current study tests whether a new measure of implicit association with suicide, a modified version of the Affect Misattribution Procedure (AMP), predicts suicide ideation in participants oversampled for the experience of suicide ideation. Results indicated that implicit associations with suicide-related images were positively correlated with levels of suicide ideation and predicted suicide ideation when entered as a simultaneous predictor with symptoms of depression, thwarted belongingness, and perceived burdensomeness. Implicit associations with positive and negative images were unrelated to thoughts of suicide. The modified version of the AMP may be a particularly useful indirect measure of suicide ideation that can be easily included in suicide risk assessment paradigms in clinical practice and research studies.
Introduction:
People who die by suicide have a higher risk of an alcohol-use disorder (AUD) at the time of death. The present study aims to compare 1) suicide cases with and without AUD, and 2) suicide and sudden-death controls with AUD.
Methods:
The psychological autopsy method was utilized to investigate suicide and sudden death in Australia (QLD and NSW). Initial information was gathered from coroners' offices. Potential informants were approached and semi-structured interviews were conducted. Univariate and multivariate logistic regression were applied.
Results:
People with AUD who died by suicide were significantly more likely to have another substance-use disorder, history of suicide attempt, recent serious arguments with spouse/partner and other family members, been unfaithful to partner/spouse, be victims of a crime, and were less likely to be from a non-English speaking background. They were also younger and had higher levels of aggression compared to non-AUD suicides. AUD suicides were more likely to have mood disorders, previous suicide attempt, expressing hopelessness, higher scores in aggression towards self, romantic relationship breakup, and serious arguments with other family members than AUD sudden deaths. Aggressive behavior, having another substance-use disorder, and history of serious arguments with family members remained significant in the final model comparing suicides with and without AUD.
Conclusion:
Our findings support that aggressive behavior, comorbidity with other psychiatric disorders as predisposing factors, and recent interpersonal conflicts such as breakup and family conflicts can trigger suicide in people with AUD. There is a need for proper diagnosis, risk assessment, and treatment in suicidal people with AUD.
This study reports dose–response estimates for the relative risk and population attributable risk (PAR) between acute alcohol use and serious suicide attempt. Data were analyzed on 272 suicide attempters arriving at 38 emergency departments within 6 hours of the event in 17 countries. Case-crossover analysis, pair-matching the number of standard drinks consumed within the 6 hours prior to the suicide attempt with that consumed during the same 6-hour period of the previous week, was performed using fractional polynomial analysis for dose–response. Every drink increased the risk of a suicide attempt by 30 percent; even one–two drinks was associated with a sizable increase in the risk of a serious suicide attempt, and a dose–response was found for the relationship between drinking 6 hours prior and the risk of a suicide attempt up to 20 drinks. Acute use of alcohol was responsible for 35 percent PAR of all suicide attempts. While very high levels of drinking were associated with larger relative risk s of suicide attempt, the control and reduction of smaller quantities of acute alcohol use also had an impact on population levels of suicide attempt, as showed here for the first time with our PAR estimates. Interventions to stop drinking or at least decrease levels of consumption could reduce the risk of suicide attempt. Screening people more at risk to suffer these acute effects of ethanol and offering interventions that work to these high-risk groups are a matter of urgent new research in the area.
Few studies have investigated suicide risk characteristics associated with interrupted suicide attempts (ISAs) and aborted suicide attempts (ASAs). The present study aimed to empirically examine whether assessing a history of ISAs and ASAs is valuable when quantifying risk for future suicidal behavior, given the relative lack of literature in this area to date. To inform this question, the current study examined differences in risk factors for future suicidal behavior among individuals who have carried out a suicide attempt, individuals who report having a history of only ISAs and/or ASAs, and non-attempter controls. Approximately 447 university students (M = 21.10 years; SD = 4.16; 77.6% female) completed measures of carried out suicide attempts, ISAs, ASAs, acquired capability for suicide, suicide likelihood, depressive symptoms, suicidal ideation, and non-suicidal self-injury. Results suggest that there exists a fairly large group of individuals who endorse ISAs and/or ASAs, but who do not endorse carried out suicide attempts, even in non-clinical samples. Furthermore, results suggest that there are few clinically meaningful differences between those with a history of carried out suicide attempts and ISAs/ASAs, suggesting that individuals with a history of these lesser studied suicidal behaviors are an important group to target for suicide risk intervention.
Objectives
Increasing rates of suicide in the military indicate current assessment approaches are not yielding accurate determinations of risk. Concern that endorsement of suicidal ideation may result in obstacles to career advancement may be resulting in nondisclosure.Method
To test this, we recruited a sample of US National Guard personnel (n = 789; 81.7% male; 63.2% white) and administered two measures of current thoughts of suicide. One measure was integrated into our risk assessment protocol and soldiers were thus aware that answers could result in referral to on site military mental health professionals. The other measure was not integrated into the risk assessment protocol and soldiers were thus aware that results would not be reported to on site military mental health professionals.ResultsAs hypothesized, a higher proportion of individuals reported current thoughts of suicide on the measure not integrated into the risk protocol (9.4%) than on the measure that was (6.0%). Also as hypothesized, a higher proportion of those willing to endorse current thoughts of suicide on the measure not integrated into the risk protocol denied current thoughts of suicide on the one that was (61.5%) than vice versa (39.0%). Limitations include cross-sectional self-report data and a lack of counter-balancing of measures.Conclusions
The results indicate that increasing the confidentiality of risk assessments within the National Guard increases the likelihood of reporting of current thoughts of suicide.
The current study is based on the hypothesis that alcohol-involved suicide attempts are characterized by lower premeditation and intent, but only when the use of alcohol is not motivated by the desire to facilitate the attempt. Test of this idea was conducted by comparing proximal suicide premeditation and intent of suicide attempts among three groups: individuals who (a) drank to facilitate the attempt (e.g., to "numb fears" about attempting), (b) drank for nonfacilitative motives, and (c) did not use alcohol before the attempt.
Participants included 324 (62% female) recent suicide attempters presenting to a Level 1 trauma hospital. The Timeline Followback Interview for Suicide Attempts and a novel Suicide Facilitative Drinking Motives Scale were used to assess facilitative motives for drinking and characteristics of the attempt.
One third of participants drank before the attempt, and most (73%) who used alcohol did not do so to facilitate the attempt. As hypothesized, attempts carried out by this group had shorter proximal suicide premeditation and lower suicide intent compared with the other study groups; in contrast, individuals who drank to facilitate the attempt were similar to non-alcohol users on these indices.
Alcohol-involved suicide attempts are heterogeneous. Motives for drinking are a key source of heterogeneity insofar as fundamental characteristics of attempts (proximal premeditation, intent) differ as a function of drinking motivation. Clinical implications include that individuals making suicide attempts with facilitative motives for drinking cannot be assumed to be at lowered risk upon a drop in blood alcohol level.
BACKGROUND: Self-reported reasons for suicide attempts were examined in a sample of active duty soldiers who had attempted suicide using a functional approach that classifies suicidal behaviors into four primary functions of reinforcement: automatic negative (AN-R; to reduce aversive internal experiences), automatic positive (AP-R; to generate desired internal experiences), social negative (SN-R; to avoid aversive contextual demands), and social positive (SP-R; to generate desired environmental contexts). Based on previous theory and research, the authors hypothesized that soldiers would attempt suicide primarily to reduce aversive internal experiences (i.e., AN-R). METHODS: 72 soldiers (66 male, 6 female; 65.3% Caucasian, 9.7% African-American, 2.8% Asian, 2.8% Pacific Islander, 4.2% Native American, and 9.7% "other"; age M=27.34, SD=6.50) were interviewed using the Suicide Attempt Self Injury Interview to assess suicidal intent, method, lethality, and reasons for attempting suicide. RESULTS: Soldiers endorsed attempting suicide for both automatic and social reasons, with multiple functions being endorsed in 95% of attempts. AN-R was endorsed in 100% of suicide attempts, and was primary to other functions. Suicidal intent was weakly correlated with AN-R, AP-R, and SN-R functions (rs<.22), and medical lethality was very weakly correlated with only the SP-R function (r=.18). LIMITATIONS: Small sample size and retrospective self-report methodology. CONCLUSIONS: Soldiers attempt suicide primarily to alleviate emotional distress. Reasons for attempting suicide do not correlate strongly with suicidal intent or medical lethality.
Anxiety sensitivity, distress tolerance, and discomfort intolerance have been identified as important factors related to alcohol use motives and alcohol-related problems. Yet, these variables are highly correlated and little work has delineated whether these psychological vulnerability factors are differentially related to alcohol use motives and problems. To fill this gap in the existing literature, the present study evaluated whether anxiety sensitivity, distress tolerance, and discomfort intolerance were differentially related to high-risk alcohol use motives (i.e., coping and conformity motives) and alcohol use problems among 224 young adult, current drinkers (52.3% women; M(age)=21.18, SD=7.08). Results indicated that distress tolerance, but not anxiety sensitivity or discomfort intolerance, was significantly related to coping motives for alcohol use. Additionally, anxiety sensitivity, but not distress tolerance or discomfort intolerance, was significantly related to conformity motives for drinking. For both sets of analyses, the observed significant effects were evident above and beyond the variance accounted for by alcohol consumption level, smoking rate, negative affectivity, and non-criterion alcohol use motives. Additionally, discomfort intolerance and anxiety sensitivity each predicted alcohol use problems; effects were not attributable to negative affectivity, cigarettes smoked per day, or shared variance with distress tolerance. Findings are discussed in relation to the role of emotional sensitivity and intolerance in terms of the motivational bases for alcohol use and alcohol use problems among young adult drinkers.
Although affective and substance use disorders frequently co-occur, the role of affective dysregulation in addiction is often overlooked. This paper reviews the role of affective dysregulation in the initiation and maintenance of substance use disorders (SUDs), presenting evidence for a relationship between SUD and three biologically-based dimensions of affective temperament and behaviour: negative affect (NA), positive affect (PA), and effortful control (EC). High NA, low EC, and both high and low PA were each found to play a role in conferring risk and maintaining substance use behaviours, although the strength of their influence differed depending on stage of illness (i.e., early onset use through to addiction). Given these findings, we argue that future research should explicitly consider how changes within affective systems may underlie the development of SUDs. A better understanding of the role of affective dysregulation in addiction will aid in clarifying how risk is conferred, as well as how addictive behaviours are maintained, thereby informing the development of preventative strategies and novel treatments. Future studies should continue to examine the role of high NA in SUDs, and further examine the respective roles of high PA, low PA, and low EC, as well as identifying the affective characteristics that predispose high-risk individuals to later substance use problems.