Browsing by Subject "Suicide"
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Item Borderline Personality Features and Treatment Outcomes in an Adolescent Intensive Outpatient Treatment Population(2016-08-25) Rial, Katherine Vera; Foxwell, Aleksandra; Kennard, Beth D.; Moore, Patricia SinclairBorderline Personality Disorder (BPD) is a common psychiatric disorder associated with severe functional impairment, high rates of suicide, comorbid mental disorders, frequent utilization of mental health treatment, and therefore, high cost to society in both adults and adolescents. Although treatments have been developed to treat BPD in adults, little is known about the effectiveness of treatments in adolescents, in particular in an intensive outpatient setting. The current study examined differences in clinical characteristics among adolescents with and without borderline features who participated in an intensive outpatient program (IOP) for suicidal behaviors. In addition, this study examined whether borderline features predicted treatment outcomes at discharge. Fifty-eight participants, ages 13-17 (14.98±1.15), were categorized into adolescents with BPD features and those without. Assessments include the Concise Health Risk Tracking form (CHRT; self-report), Columbia Suicide Severity Rating Scale (C-SSRS; clinician-rated), Quick Inventory of Depressive Symptomatology- Adolescent version (QIDS-A; self-report), and the 11-item Borderline Personality Features scale for Children (BPFSC-11; self-report). Statistical analyses include chi-square and ANOVA for demographic and clinical characteristics. Spearman's correlations and a hierarchical linear regression were used to examine treatment outcomes. Results indicate that adolescents with BPD features presented to treatment with more severe depression and suicide risk than adolescents without BPD features. Following IOP treatment, adolescents with BPD features continued to endorse more severe depressive symptoms than those without BPD features. However, there was no statistical difference between groups in regards to suicidality. The presence of BPD features did not predict depression severity at discharge, but the relationship appeared to be trending.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 Conflicts of interest in clinical research: lessons from the Minnesota Markingson case(2015-09-08) Brown, E. Sherwood; Reisch, Joan S.; Sadler, John Z.; Wright, J. GregoryThe nationally-publicized Markingson case from the University of Minnesota involved a tragic suicide in the context of a university-based, industry-sponsored clinical trial. A panel of UT Southwestern faculty and staff consider the lessons emerging from the Markingson case, identify areas of risk and opportunities for prevention, and map the multiple layers of policy and practice that could prevent such events in the future.Item A Cry for Tomorrow(1985-04-06) Cason, VickiItem Emotion Dysregulation and the Interpersonal Theory of Suicide in Adolescents(2017-07-28) Eaddy, Michael E.; Stewart, Sunita M.; Kennard, Beth D.; Hughes, Jennifer L.; Schuster, Lisa; Emslie, Graham; Diederich, AndrewThe lack of progress in suicide prevention has been attributed to fractured investigations of disparate risk factors and inadequate theoretical frameworks. Adolescents are different from adults in ways that are likely to influence suicide ideation and acts. The Interpersonal Theory of Suicide (IPTS) is a promising theory that proposes three "final common pathways", perceived burdensomeness, thwarted belongingness, and acquired capability, as the most proximal risk factors to suicidal ideation and attempts. There is a growing body of literature that demonstrates that many known risk factors for suicidality are associated with these three IPTS variables, and that the IPTS variables account for the relationship between these known risk factors and suicidality. The current pair of studies was guided by two areas of interest in the current literature. First, emotional dysregulation has been consistently linked to suicide attempts, and appears to have a complex relationship with IPTS constructs in adults, but has been under-investigated in clinical adolescents when it may have particular relevance to suicidality. Second, little is known about the IPTS variables in relation to response to treatment, and whether individual characteristics interact with IPTS variables to promote or hinder changes in suicidality. This work is an examination of the relationship between emotion dysregulation and suicidality within the IPTS framework in a clinical sample of adolescents. The questions it will address are a) whether emotion dysregulation accounts for variance in suicidality independently of IPTS variables, and b) whether emotion dysregulation influences response to treatment for suicide ideation, and if so, whether this influence occurs in the context of the IPTS framework. This work will be structured as follows: An initial introductory context relevant to both studies will be provided. The measures used are the same in both studies and will be described next. These shared components will be followed by the study-specific components: abstract, introduction, aims of the study, study-specific methods, results and discussion. There is significant overlap in the references for each study and these will be condensed at the end.Item Examining the Feasibility and Acceptability of a Phone Application for Safety Planning in Youth with Suicidality(2020-08-01T05:00:00.000Z) Wolfe, Kristin Linette; Kennard, Beth D.; Brent, David; Emslie, Graham; Foxwell, Aleksandra; King, Jessica D.; Nakonezny, PaulSuicide is the second-leading cause of death in adolescents. Despite the documented efficacy of the safety plan, research has suggested that youth do not always refer to their plans when experiencing suicidal ideation. Accessibility is often cited as a primary concern. Addressing this concern in youth may mean turning to technological means, such as phone applications, to improve access and utilization. To date, there are relatively few suicide specific apps available, and even fewer that have been empirically tested. In response to this gap in the literature, BRITE was developed as a means of utilizing technology for safety planning. This study examined the feasibility and acceptability of BRITE as a stand-alone intervention in a group of 40 youth who had been recently hospitalized for suicidality. This was measured utilizing the Post-Study System Usability Questionnaire (Lucas & Spitler, 1999; Davis, 1989), an exit interview containing both qualitative and quantitative questions, and data gathered on app usage from the BRITE clinician portal. Additional exploratory analyses around efficacy of the app were conducted utilizing the Concise Health Risk Scale- Self-Report (Trivedi et al. 2011). Results from this study indicated good feasibility and acceptability of the BRITE app. The majority of participants approached for the study gave consent and were retained in the study at four-week follow-up. Most participants (85.7%) utilized the app at least once, and many (66.7%) of these participants went on to engage with app-recommended activities. Analysis showed that there was a significant improvement in pre- and post-app usage ratings of distress. Surveyed participants, on average, rated the app as helpful, accessible and useful and reported that the platform was effective for safety planning. Qualitative analyses supported the quantitative findings, and participants reported overall satisfaction with the app as a whole and its specific components. Despite feasibility and acceptability of the app, exploratory analyses did not reveal any difference in the suicide propensity or suicide risk scores between groups. These findings suggest that BRITE compares favorably to other suicide prevention apps on the market, and adds to the literature suggesting the use of technology in suicide prevention for adolescents.Item Identifying Trauma Factors That Predict Suicide Specific Helplessness in Female Veterans with Chronic PTSD Resulting from Military Sexual Trauma(2009-09-04) Bass, Christina Marie; Surís, AlinaRESEARCH OBJECTIVE: This study attempts to understand the contribution of post-traumatic stress disorder (PTSD), resulting from Military Sexual Trauma (MST), and depressive symptoms to suicide specific hopelessness. It also examines specifically which of the PTSD symptom clusters is associated with this type of hopelessness along with the interaction of PTSD symptoms and suicide-specific hopelessness as it might relate to suicidal ideation. METHODS: A sample of 86 female veterans receiving mental or physical healthcare at a Southwestern Veteran Administration (VA) Healthcare System participated in the study. Participants were interviewed using the Clinician Administered PTSD Scale (CAPS); were assessed for depressive symptoms with the Beck Depression Inventory (BDI-II) and suicide-specific hopelessness with the Suicide Cognitions Scale (SCS). RESULTS: A linear regression indicated that trauma symptoms, as measured by the CAPS, accounted for a significant percentage of the variance in suicide-specific hopelessness (R2 = 18.2, p = 0.002). Contrary to expectations, when examined independently and along with the other symptom clusters, regression analysis revealed that the avoidant symptom cluster was not significantly associated with suicide-specific hopelessness (R2 = 9.5, p = .08 and t = - .66, p = 0.51). As expected, depressive symptoms as measured by the BDI-II, accounted for a significant portion of the variance of suicide-specific hopelessness (R2 = 48.8, p < 0.001). However, trauma symptoms did not contribute more than depressive symptoms (t = 0.54, p = 0.59 and t = 6.95, p = 0.001respectively). Lastly, a significant interaction between suicide-specific hopelessness and trauma symptoms was found to be associated with a positive endorsement of suicidal ideation (t = -4.193, p = 0.001). CONCLUSION: Female veterans with chronic PTSD resulting from Military Sexual Trauma (MST) are at risk for experiencing suicidal thoughts and behaviors.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 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 The Role of Impulsive Aggression in a Cohort of Suicide Attempters(2006-06-21) Hodges, Gayle Elizabeth; Claassen, Cynthia A.Research Objective: This study attempts to understand the role of impulsive aggression in a group of suicide attempters. The study hypothesized that a greater proportion of suicide attempters would meet criteria as impulsive aggressive than would be found among suicide ideators and unintentionally injured controls. The study further hypothesized that levels of impulsive aggression among all study participants would remain stable across time. Methods: Three groups of patients (n = 291) were recruited, with suicide attempters as the experimental group and suicide ideators and traumatic injury patients as control groups. Subjects were evaluated for the presence of impulsivity and aggression during initial treatment for suicidality or unintentional injury and again three months later. Two hundred one of the initial recruits also completed a follow-up assessment. Using a definition of impulsive aggression previously developed by Skodol (2002), study patients identified as "impulsive aggressive" needed to meet three criteria: the presence of significant impulsivity a measured by the Barratt Impulsivity Scale (Barratt, 1994), and significant aggression, measured using two subscales (irritability and assaultiveness) from the Buss-Durkee Hostility Inventory (Buss&Durkee, 1956). Chi-square analyses, one-way ANOVAs, and interclass correlation coefficients were utilized to compare groups, with post hoc tests used as warranted. Covariates that are known to impact impulsivity and aggression (i.e., age, race, gender, depression, borderline personality disorder, and alcohol use/abuse) were controlled. Results: Before controlling for clinical differences between groups (e.g., levels of depression, alcohol use/abuse), chi-square analysis revealed significant differences in the number of impulsive aggressive individuals by group. A post hoc analysis suggested that the percentage of impulsive aggressive individuals was significantly higher among suicide ideators than among traumatic injury patients However, when covarying for age, gender, race, borderline personality disorder, major depressive disorder, and alcohol abuse, no differences were found in the level of impulsivity, irritability, or assaultiveness between groups. There was good consistency in the proportions of individuals by group who maintained their baseline level of impulsivity, irritability, and assaultiveness at follow-up, suggesting that these characteristics function in many individuals as a trait, rather than a state. In an attempt to corroborate the validity of this study's operationalized definition of impulsive aggression, external items that assessed these tendencies were identified and analyses were performed to see if participants who endorsed impulsive aggressive behavior also endorsed these external variables. There was not a good match between groups of individuals who were classified as impulsive aggressive using the traditional BIS-11/BDHI criteria and selected external variables. Conclusions: Findings from this research study do not support an association between impulsive aggression and suicidal behaviors.Item The Role of Incarceration in Treatment-Seeking Veterans with PTSD: Evaluating Differences in Trauma Symptoms, Suicidality, and Substance Use(August 2021) Sligar, Kylie Blake; LePage, James; Jeon-Slaughter, Haekyung; Shivakumar, Geetha; Pai, Anushka; Smith, JuliaVeterans are an at-risk population with increased chances of exposure to trauma, mental health diagnoses, substance use, and suicidality. Individuals who have been incarcerated demonstrate similar increased risks. As such, when a Veteran also has a history of incarceration, these risks may be exacerbated. It is posited the rate of PTSD among Veterans is 11-20% (National Center of PTSD, 2019). Additionally, it is estimated over 120,000 Veterans are currently incarcerated, with as many as 67% having a mental illness or substance use disorder (Finlay et al., 2017; Bronson et al., 2015). This study aimed to examine how a history of incarceration may impact trauma symptoms in Veterans, and how this differs when compared to Veterans without an incarceration history. The data did not support overall differences between these two groups; however, exploratory analyses suggest potential areas of future directions. Exploratory analyses suggest potential differences in PTSD symptomology, specifically increased endorsement of Cluster C / avoidance among Veterans with PTSD, and increased risk taking among Veterans with PTSD and an incarceration history. Results also suggested higher rates of substance use treatment among Veterans with PTSD and an incarceration history. Lastly, analyses suggest higher endorsement of feeling "tense and keyed up" among Veterans with PTSD. No differences were found between groups in areas of PTSD severity, number of endorsed trauma events, suicidality, or adverse childhood events.Item Suicide Risk Assessment in Mental Health Settings(2017-05-25) Fuad, Mamuna Nasim; Roaten, Kimberly Dayle; North, Carol S.; Faith, Melissa A.Suicide is a significant public health issue in terms of both loss of life and the associated economic burden. The psychological factors associated with suicide and its related behavioral manifestations are not well understood despite decades of focused legislative initiatives and research. The approach to suicide prevention is multifaceted ranging from governmental policies, to public awareness, to clinical interventions for individuals at risk. It is understood that precise prediction and prevention of suicide may never be possible; however, it may be possible to develop an improved understanding of risk and protective factors to estimate the overall level of risk. This estimation of risk can then be directly linked to an individualized treatment plan in order to reduce suicidal behavior. This model is only possible through the use of a systematic approach consisting of the use of validated instruments and methods in combination with clinical judgment by a well-trained provider. The purpose of this document is to review the existing literature regarding suicide risk assessment in mental health settings and identify knowledge gaps and opportunities for improving both research initiatives and clinical practice. The document will conclude with a summary of recommendations for clinical care and future research directions.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 Warning Signs for Imminent Risk of Suicidal Behavior: A Preliminary Investigation(2009-09-04) Womack, Jennifer Nicole; Claassen, Cynthia A.; Casenave, Gerald W.; Elliott, AlanApproximately one million individuals worldwide died from suicide in 2000 and estimates suggest that ten to twenty times more individuals attempted suicide (World Health Organization, 2005). The statistics for suicide rates in the United States are just as alarming for "each year in the United States approximately 30,000 lives are lost to suicide (CDC, 1999); yet this disturbing loss of American lives is preventable" (DeMartino et al., 2003). As such, this preliminary study aims to provide an initial investigation into the reliability and validity of the AAS Suicide Warning Signs to identify individuals at imminent risk for suicidal behavior. Although the results indicate a statistically significant correlation between one's suicidal risk and one's endorsement of the Warning Signs, possible confounding variables (such as past-week depression level) might play a role in explaining part of this correlation. Additionally, because statistical analyses suggest that one's endorsement of the Suicide Warning Signs as well as one's past-week depression level both significantly predict group status, there appears to be an interaction between depression and endorsement of the Warning Signs. In conclusion, although it is suggested that risk status and Warning Signs are correlated, this study barely tips the iceberg when it comes to research involving the identification of imminent risk. More research is essential in order to develop a better understanding of possible markers of imminent suicidal risk.