Browsing by Subject "Suicidal Ideation"
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Item Cognition and Suicide: The Relationship Between Problem-Solving and Suicidal Behavior(2009-01-14) Roaten, Kimberly Dayle; Claassen, Cynthia A.Suicidal behavior impacts thousands of individuals worldwide each year and exacts an incalculable toll on the victims’ family members and loved ones. Past research has examined the role of demographic variables associated with suicidality yielding important information about individuals who engage in suicidal behavior. Despite the significance of these findings, limited data exists linking demographic factors and clinically useful risk assessment. More recently, researchers began examining the role of cognition and suicidal behavior in an effort to elucidate the underpinnings of the suicide mode. Early evidence suggests that study of the time period immediately surrounding the suicide attempt may yield important evidence for risk assessment. The current study examined cognitive variables during the time period immediately following a suicide attempt. Specifically, the primary goal of the study was to explore the relationship between depression, hopelessness, problem-solving skills and suicidality. The study sample included 76 patients presenting for treatment in the Parkland Health and Hospital System: 41 individuals who attempted suicide and required inpatient medical treatment, and 35 suicidal psychiatry emergency room patients. Problem-solving skills, levels of depression and hopelessness, and negative self-cognitions were assessed for each participant in a cross-sectional study design. Results indicated that suicide attempters and suicide ideators did not differ with regard to measures of depression or hopelessness. A relationship between depression and hopelessness and social problem-solving was found, but did not predict study group status. Resistance to premature closure, a measure of an individual’s ability to remain open to potential solutions for problems, was found to be significantly different between the two study groups. However, resistance to premature closure did not correlate with depression or hopelessness. In summary, evidence in support of problem-solving as a mediator between hopelessness/depression and suicide was not found. Preliminary evidence suggests that resistance to premature closure measures an aspect of problem-solving that effectively differentiates between suicide ideators and attempters.Item Consistency of Self-Reported Suicidal Intent Following a Suicide Attempt(2010-05-14) Rose, Lindsey Christine; Stewart, Sunita M.Suicide is a major problem in the U.S., but the empirical basis for assessment of suicidal risk is severely lacking. Critical to understanding the level of risk present after an act of self-harm is the degree to which the self-injuring patient intended to die via the act, which is called the degree of suicidal intent. In most studies, suicidal intent is identified at baseline as the self-reported intent of the self-injurer: however, clinicians commonly encounter cases where patients’ self-reported suicidal intent immediately after an injury episode is denied a few days later. This study tested the hypothesis that subjects would retrospectively report reduced levels of suicidal intent and fewer motives for their self-injury at follow-up (7 to 12 days after the attempt) than they did at baseline (within 48 hours after the attempt). Intent and motives were assessed using the Oxford Reasons for Parasuicide Interview and the Suicide Intent Scale (SIS). Statistical analyses found that subjects scored significantly higher on the SIS at baseline than they did at follow-up, confirming the hypothesis that retrospective self-reported suicidal intent would decrease with increasing time since the event. Although subjects reported fewer motives on average at follow-up than at baseline, the hypothesis that subjects would significantly decrease the number of reported motives at follow-up was not supported due to a lack of statistical significance. The findings of this study suggest that self-reports of suicidal intent are not consistent over time and are thus not necessarily reliable. Therefore, clinicians may do well to group suicide attempters and non-suicidal self-harmers together and treat them with similar precaution, as is done in Europe.Item Does the Experience of Peer Victimization in Adolescence Predict Future Suicidal Ideation? A Cross Cultural Investigation(2005-08-11) Gandhi, Puja R.; Stewart, Sunita M.Peer victimization has been linked to adolescent suicide in several countries. Community adolescents from Hong Kong (n= 1694) and the United States (n=481) provided information regarding their experience of victimization, depressive symptoms, and suicidal ideation at two surveys six months apart. This study would examine the predictive relationship between peer victimization and suicidal ideation and the role of depressive symptoms in mediating this relationship. The implications of this study are discussed.Item Frequency, Versatility, and Duration of Nonsuicidal Self-Injury in Relation to Acquired Capability for Suicide among Adolescents(2015-08-31) Matney, Jacquelyn Deanna; Stewart, Sunita M.; Westers, Nicholas; Hughes, Jennifer L.Suicide is the 2nd leading cause of death among youth, and those who present to inpatient settings have been shown to have higher rates of suicidal behaviors (World Health Organization, 2012). Nonsuicidal self-injury (NSSI) is a leading risk factor for suicide. We propose that an increase in frequency, versatility, and/or duration of NSSI is associated with an increased risk for suicide attempt (SA) by means of the Acquired Capability for Suicide (ACS) proposed in Joiner's (2005) Interpersonal Psychological Theory of Suicide (IPTS) regardless of demographic or diagnostic factors. Preliminary results from this sample of inpatient adolescents (N = 150) were consistent with our proposed hypotheses. Yet, depressive symptoms appeared to interact with the association between these NSSI variables and ACS. These findings suggest that inpatient youth with greater NSSI versatility, frequency and duration, are at an increased risk for future SA by means of increased ACS. Consistent with the IPTS, the link between engagement in NSSI and history of SA appeared to be mediated by the ACS component. While limited by its cross-sectional design, the findings from this study have clinical implications regarding suicide risk assessment and prevention.Item Implementing an Interpersonal Theory of Suicide Treatment Approach to Improve Outcomes in Suicidal Youth(2019-07-12) Zullo, Lucas Peter Salvatore; Stewart, Sunita M.; Lee, Simon Craddock; Emslie, Graham; Hughes, Jennifer L.; Kennard, Beth D.Suicide is the second leading cause of death among adolescents in the United States, with rates that have continued to increase over the past several years. Theoretical models of suicide have arisen in order to provide an organizing framework to better understand this phenomenon. Among them, the Interpersonal Psychological Theory of Suicide (IPTS; Joiner, 2005) has gathered significant empirical support. This theory proposes two interpersonal constructs that serve as a final common pathway to understanding suicidal ideation: thwarted belongingness and perceived burdensomeness. There has been limited translation of core themes of this theory to clinical care and there are few theory informed interventions present in the field of suicide prevention overall. We aimed to address this gap in the literature by intentionally targeting cognitions related to perceived burdensomeness with a series of novel interventions by conducting two separate studies. In Study 1 we first gathered information about the manifestation of perceived burdensomeness among suicidal adolescents from teens, their parents, and clinicians working with this population through a series of qualitative interviews. Results from these interviews indicated a need for an enhanced model of perceived burdensomeness highlighting potential mechanisms of change that may be harnessed during therapeutic interventions. Possible clinical interventions operating through these pathways were then developed for examination. In Study 2, a clinical trial was conducted in an intensive outpatient program (IOP) administering evidence-based care for suicidal youth. Participants were 124 adolescents who completed measures on IPTS variables, depressive symptoms, and suicide risk at intake, discharge, and one-month follow-up. The control arm of the study consisted of the treatment provided by the unchanged IOP and the experimental arm added the study interventions to standard care. Results demonstrated that the intervention did not result in a significant difference in perceived burdensomeness or suicide risk between the control and experimental arms. However, there was a difference between groups on thwarted belongingness, with a greater drop in the experimental condition from intake to discharge. Furthermore, the study interventions indicated a small effect size on the majority of study variables. Feasibility and acceptability ratings from study clinicians were supplemented by qualitative exit interviews with parents and adolescents. Feedback gathered during this stage of the study provided support for several of the study interventions and endorsed them as worthwhile additions to the IOP. During exploratory analyses with a sample combining the experimental and control groups, results indicated that the pathway by which suicide risk changes from intake to discharge is through a change in perceived burdensomeness and depressive symptoms. From discharge to one-month follow-up, the pathway explaining a change in suicide risk includes both a change in thwarted belongingness and perceived burdensomeness with a change in depressive symptoms. This finding supports the notion of IPTS variables contributing unique variance to changes in suicide risk even when depressive symptoms are included in the model. Results also support the trend in the literature emphasizing the proximal role of perceived burdensomeness to suicide risk and capitalizing on the need to better target this construct in a clinical setting. This study adds to the literature by being the first to utilize the construct of perceived burdensomeness in clinical interventions for suicidal youth and effectively translating theory to clinical application.Item The Interpersonal Theory of Suicide among Adolescents: Examining the Theory over the Course of Treatment(2016-07-29) King, Jessica Davidson; Stewart, Sunita M.; Emslie, Graham; Hughes, Jennifer L.; Kennard, Beth D.; Roaten, Kimberly DayleSuicide is a one of the leading causes of death among young adults and adolescents. Adolescence is the period where suicidal phenomena typically develop and may offer an important window for understanding suicidal behavior. There are many known risk factors for suicide, but it has been difficult to integrate findings in a meaningful way that increases overall understanding of various risk factors for suicide. The Interpersonal Psychological Theory of Suicide (IPTS; Joiner, 2005) offers an organizing framework for understanding risk factors. The IPTS posits that an individual has to have the desire for suicide, as indicated by perceived burdensomeness and thwarted belongingness as well as the acquired capability to do so. There are few multiwave studies that indicate how IPTS variables change over time and also few studies that control for or compare against well-established variables associated with suicidality, specifically depressive symptoms. We aimed to address these shortcomings by examining how the IPTS variables change with treatment, and simultaneously including a measure of depressive symptoms to investigate the dynamic nature of the model and its relationship with suicidal ideation relative to depressive symptoms. Participants were 56 adolescents engaged in an intensive outpatient treatment program, who completed measures of key IPTS constructs, depressive symptoms, and suicidal ideation at entrance and discharge. Results demonstrated that the interpersonal constructs of perceived burdensomeness and thwarted belongingness decreased significantly over the course of treatment while acquired capability remained stable. Change in interpersonal constructs and change in depressive symptoms were associated with change in suicidal ideation when tested in separate models. When change in depressive symptoms and change in interpersonal constructs were examined together, change in the interpersonal constructs contribution to prediction of variance in change in suicidal ideation persisted. This finding supports the unique contribution of IPTS variables to changes in suicidal ideation in a dynamic framework.Item Prediction by Insomnia to Treatment Outcomes in an Adolescent Suicide Management Program(2019-03-15) Lau, Jenny Wong; Emslie, Graham; Stewart, Sunita M.; Kennard, Beth D.BACKGROUND: Insomnia is the symptom most strongly associated with suicide-related thoughts and behaviors in adolescents and young adults with diverse diagnoses, even after adjusting for psychiatric conditions like depression (Goldstein, 2008). However, there is little empirical evidence that demonstrates prospectively that sleep problems are in fact a risk factor for suicide attempts (Franklin et al. 2017). OBJECTIVE: This study examines the previously unexplored relationship between insomnia and suicidal relapse in youth enrolled in an outpatient suicide prevention program. METHODS: Data were obtained from clinical records of adolescents ages 12-17 enrolled in the Suicide Prevention and Resilience at Children's Intensive Outpatient program (SPARC IOP) from January 1, 2014 through March 1, 2016 (n = 206). Patients completed measures of depressive symptoms, insomnia, and suicide risk at entry and exit. The association between insomnia, exit suicide risk, and 6-month attempts was tested with multiple regression analyses. RESULTS: Patients were mainly female (79.1%; n = 163) with a primary diagnosis of depression (89.8%; n = 185). Depression, suicide risk, and insomnia scores decreased overall. Entry insomnia was associated with exit suicide risk (CHRT) after controlling for entry risk, age, sex, time in the program, and number of previous attempts. Patients with insomnia did not show a different rate of treatment response (β = 0.257, p > .10). Entry insomnia was also associated with suicide attempts within 6 months after exiting the program when controlling for age, sex, and previous attempts. When entry and exit risk were added to the model, the association between entry insomnia and attempts within 6 months lost significance while the association between exit risk and attempts at 6 months became significant. Thus, patients with higher insomnia scores at entry had higher suicide risk scores at exit, which increased the likelihood of a suicide attempt 6 months after the program. CONCLUSION: These findings suggest that insomnia is a distal variable in the pathway to risk for suicide attempts after discharge. Entry insomnia is associated with exit risk, which has a more proximal relationship with 6-month attempts. Direct management of insomnia symptoms could reduce suicide risk at program exit, which could then reduce the probability of a suicide attempt in the 6 months following discharge. These studies could ultimately lead to new therapeutic approaches for reducing suicide attempts by treating insomnia symptoms.Item Suicidal Ideation in Youth with Depression(2010-11-02) Hughes, Jennifer Lynn; Kennard, Beth D.Suicide is the third leading cause of death in youth ages10 to 24 (Centers for Disease Control, 2007). Frequent thoughts of suicide are a strong predictor of suicide attempt (Kienhorst, de Wilde, Van den Bout, Diekstra, & Wolters, 1990), and most suicide attempters report a history of suicidal ideation (Lewinsohn, Rohde, & Seeley, 1996). Although suicidal ideation does not always intensify into suicidal behavior, a better understanding of suicidal ideation may lead to a greater understanding of suicidal behavior (Reuter, Holm, McGeorge, & Conger, 2008). It has been suggested that suicidality can be conceptualized as a spectrum, ranging from passive thoughts of death to death by suicide (Bridge, Goldstein, & Brent, 2006). Mood disorders, including MDD, are the most common in suicide attempters and those who die by suicide (Bridge et al., 2006; Kelly, Cornelius, & Lynch, 2002; Weissman et al., 1999), and hopelessness has consistently been implicated as being related to attempted suicide and death by suicide (Goldston et al., 2001; Lewinsohn, Rohde, & Seeley, 1994; Shaffer et al., 1996). As up to 85% of adolescents with major depressive disorder (MDD) or dysthymia report experiencing suicidal ideation (Kovacs, Goldston, & Gatsonis, 1993), the co-occurrence of depression and suicidal ideation is high. Therefore, it is important that interventions for depressed youth include strategies to manage suicidal ideation and behavior. In addition, it is important for clinicians to have an awareness of how higher levels of suicidal ideation might affect treatment in depressed youth. Thus, a better understanding of the course of suicidal ideation and behavior during early treatment and a better understanding of how depression treatment affect suicidality have important public health implications.Item Suicide Cognitions Among Veterans: A Construct for Assessment and Intervention(2019-07-09) Wiblin, Jessica Leigh; LePage, James; Surís, Alina; Hughes, Jennifer L.; Morris, E. Ellen; Richardson, ColleenMilitary veterans represent a population that is more likely to be exposed to traumatic events and therefore diagnosed with posttraumatic stress disorder (PTSD) compared to civilian men and women. Military sexual trauma (MST) is a traumatic event endorsed by approximately 28% of women veterans and 1.5% of male veterans. Not only are survivors of MST more likely to be diagnosed with PTSD than survivors of other traumas, they are also at risk for significant psychosocial consequences and comorbid psychiatric diagnoses. Of particular significance, veterans with MST-related PTSD report increased suicidal ideation and report higher incidences of suicidal self-directed violence (SDV). The Veterans Health Administration (VHA) has placed emphasis on both screening for MST and suicide prevention efforts. As a result, providers within the VHA have a greater opportunity to provide clinical care to a vulnerable population. However, research is mixed regarding whether veteran survivors of MST are more or less likely to utilize health care services within the VHA. Women veterans who have experienced MST in particular have been found to be less likely to utilize VHA health care services. This dissertation sought to increase understanding of suicide cognitions as a construct for assessment as well as potential treatment-seeking barriers and consists of two studies, each a secondary analysis of an RCT examining the efficacy of CPT in treating MST-related PTSD. The aim of the first study was to evaluate the psychometric properties of the SCS and identify the optimal factor structure. A four-factor structure was identified and the SCS was psychometrically valid in this sample. The purpose of the second study was to investigate whether suicide cognitions predict greater or lesser medical and mental health care utilization among female veterans with MST-related PTSD. Both logistic regression analyses and hierarchical multiple linear regression analyses were conducted to identify whether SCs predict medical (inpatient and outpatient) and mental health (inpatient and outpatient) care utilization. Decreased physical health concerns and unbearability predicted inpatient medical care utilization. These studies provide additional support for how SCs can be utilized to improve assessment of suicide risk, as well as inform clinical approaches.Item Suicide Research: Addressing the Motivational Differences in Self-Injury(2011-02-01) Edwards, Robin Kathleen; Stewart, Sunita M.Suicide research does not consistently differentiate between self-injuring patients who wanted to die from their injury and those who wanted to live, when defining a “suicidal act” (Silverman, Berman, Sanddal, O'Carroll P, & Joiner, 2007a). This lack of standard categorization creates significant barriers to the generalizability of findings (Silverman, et al., 2007a). In addition, the need to distinguish between various groups of self-injurers stems from the concern that patients who injure themselves without the intent to die have different reasons for the self-injurious behavior than patients who intended to die via the act (Cholbi, 2007). Thus, each group may require differing medical treatment (Freedenthal, 2007). To begin to characterize the impact of these definitional discrepancies, the current study uses a research protocol with scales for assessing intent, lethality, and motive in a U.S. population to determine motivational differences between samples of self-mutilating patients, patients attempting suicide, and those who were ambivalent about dying. The study replicated methods used during the World Health Organization Region of Europe (WHO/EURO) Multicentre Study on Suicidal Behavior as applied in the Oxford, England cohort (Hawton, Fagg, Simkin, Bale, & Bond, 1997; Hjelmeland, et al., 2002). Deliberate self-injury patients admitted to Parkland Hospital were interviewed to determine their specific motives and the level of suicidal intent present during the self-injurious behaviors. This investigation identifies an important difference between suicidal patients and self-mutilating patients in terms of their motives for self-injurious behavior. While suicidal and nonsuicidal self-injurers demonstrated no significant difference in number of motives endorsed, the nature of motives endorsed by suicidal and non-suicidal patients differed significantly. On average, those who wanted to die from the injury endorsed intrapersonal motives while those who wanted to live endorsed interpersonal motives for their self-injury.Item Suicide Risk Assessment in the Emergency Department Setting(2015-08-31) Danko, Mary McCormick; Roaten, Kimberly Dayle; North, Carol S.; Westers, NicholasSuicide is a prominent problem that has far-reaching effects. In 2013, 41,149 suicides were reported in the United States, a rate of 13.0 per 100,000. Suicide was the tenth leading cause of death for Americans with someone in the country committing suicide every 12.8 minutes. The World Health Organization estimates that by the year 2020 roughly 1.53 million people will commit suicide annually, and 10-20 times more will attempt suicide. This translates to one death due to suicide every 20 seconds and one suicide attempt every 1-2 seconds (World Health Organization, 1999, 2006). Given these trends, it is becoming even more important to develop and utilize screening and assessment measures to assist in identifying individuals who are at risk for suicide in order to implement appropriate treatment. Emergency departments (ED) are responsible for providing medical and surgical care to patients in need of immediate treatment upon arriving at hospitals. As such, EDs are a primary point of access for individuals immediately following a suicide attempt. Previous studies have investigated the prevalence of suicidal ideation in patients presenting to the ED for non-psychiatric reasons and found that increased suicide-related risk for nearly all of the patients was undetected during routine care. Given these findings, it is highly important that ED providers understand how to perform a proper suicide risk assessment to evaluate for intensity and severity of risk and develop an appropriate care plan.Item Tests of the Interpersonal Psychological Theory of Suicide among Adolescents(2015-07-17) Horton, Sarah Elizabeth; Stewart, Sunita M.; Glasier, Paul; Kennard, Beth D.; Roaten, Kimberly Dayle; Westers, NicholasSelf-injurious behaviors tend to first manifest during adolescence, marking this developmental period as an important context for suicide research. The lack of theory-driven research in this area has made it difficult to integrate scattered findings in a way that increases understanding of suicidal behaviors. The Interpersonal Psychological Theory of Suicide (IPTS; Joiner, 2005) aims to remedy this issue by offering an organizing framework that has many conceptual and practical merits. Although this theory has a growing base of evidence among adults, it has yet to be tested in adolescents using direct measures of its central constructs. The current study offers preliminary examinations of 1) psychometric properties of scales to assess key constructs in the IPTS: perceived burdensomeness and thwarted belongingness assessed by the Interpersonal Needs Questionnaire (INQ), and acquired capability for suicide measured by the Acquired Capability for Suicide Scale-Fearlessness About Death (ACSS-FAD) and 2) hypotheses guided by the IPTS in an adolescent clinical sample. Participants were 147 adolescents on an inpatient psychiatric unit, who completed measures of key IPTS constructs, depression severity, hopelessness, severity of suicidal symptoms, and various constructs relevant to convergent and discriminant validity. Factor analyses and evidence for construct validity of the 15-item INQ and 7-item ACSS-FAD provided preliminary support for utilization of these scales in this population (Study 1). Study 2 findings were largely consistent with hypotheses derived from the IPTS: perceived burdensomeness, and at a marginal level, thwarted belongingness, were independently associated with current suicidal ideation. The thwarted belongingness by perceived burdensomeness interaction distinguished between adolescents with passive and active suicidal ideation. Acquired capability for suicide was associated with recent suicidal intent. IPTS constructs and their interactions were associated with suicidal symptom severity. This study offers strong, albeit preliminary, support of the IPTS in a clinical adolescent sample. Assessment of IPTS constructs may be useful in determining persistent risk for suicide attempts. Prospective tests of the theory, and extensions to intervention and prevention should be considered in future IPTS research.Item Validation of a Scale Measuring Perceived Burdensomeness and Thwarted Belongingness in Adolescents(August 2021) Frazee, Laura Alexandra; King, Jessica D.; Stewart, Sunita M.; Scott, Kristin M.; LePage, James; Lee, Simon CraddockDeath by suicide is of growing concern for youth ages 14 to 24. In 2019, it was the second leading cause of death for this age group (CDC, 2019). To better understand why suicide rates have been on the rise over the last decade, various theoretical models were created. One of those theories, The Interpersonal Psychological Theory of Suicide (IPTS), was created by Thomas Joiner and has received significant empirical support across the world (Chu et al., 2017; Joiner, 2005). This theory includes two constructs, perceived burdensomeness and thwarted belongingness, to facilitate the understanding of the origin of suicidal ideation. Perceived burdensomeness is a construct reflecting the perception one's mere existence is a burden on others, and one's life is worthless. Thwarted belongingness describes the perception that one lacks reciprocally loving or caring relationships. These two constructs are hypothesized to be the final pathways by which suicidal ideation occurs. The most widely used assessment tool to measure perceived burdensomeness and thwarted belongingness is the Interpersonal Needs Questionnaire (INQ), which was initially designed for adults. This study addresses the measurement of these constructs by creating and validating a new scale specifically for the adolescent population using concrete scenarios and developmentally appropriate language. The scenario-based items were designed to reflect various contexts during which adolescents likely experience perceived burdensomeness and thwarted belongingness via qualitative interviews and review of the literature. A factor analysis of the new scale resulted in two subscales reflecting perceived burdensomeness, including worthlessness, and thwarted belongingness. The scale also demonstrated strong reliability and validity when compared to the INQ. It also was moderately correlated with concurrent measures of depression and suicidal ideation, and weakly correlated with fearlessness about death reflecting adequate convergent and discriminant validity. In both the new scale, and the INQ, perceived burdensomeness and thwarted belongingness were highly correlated. This suggests these cognitive-affective states might arise together, particularly in real-life situations and in clinical samples. In examination of the IPTS model, the interaction of perceived burdensomeness and thwarted belongingness, when measured both by the new scale and the INQ, did not contribute any significant variance to concurrent suicidal ideation when controlling for depressive symptoms. In this sample, depression was the only significant contributor in the model. This contradicts the IPTS and suggests an important area of consideration in future investigations of the model. The scale addressed gaps in the literature regarding measurement of perceived burdensomeness and thwarted belongingness across varying relational contexts (i.e., family versus friends) in a developmentally appropriate way. Exploratory analyses using the scale also provided evidence supporting a difference in the extent to which perceived burdensomeness and thwarted belongingness are elicited across domains and roles for clinically depressed adolescents. This has the opportunity to provide clinically relevant information when trying to target these cognitive-affective states in treatment. Future research can use this scale to continue testing the relationship between the IPTS variables across contexts and suicidal ideation in both clinical and community samples.