ABSTRACT
The period after psychiatric hospitalization is an extraordinarily high‐risk period for suicidal thoughts and behaviours (STBs). Affective–cognitive constructs (ACCs) are salient risk ...factors for STBs, and intensive longitudinal metrics of these constructs may improve personalized risk detection and intervention. However, limited research has examined how within‐person daily levels and between‐person dynamic metrics of ACCs relate to STBs after hospital discharge. Adult psychiatric inpatients (N = 95) completed a 65‐day ecological momentary assessment protocol after discharge as part of a 6‐month follow‐up period. Using dynamic structural equation models, we examined both within‐person daily levels and between‐person dynamic metrics (intensity, variability and inertia) of positive and negative affect, rumination, distress intolerance and emotion dysregulation as risk factors for STBs. Within‐person lower daily levels of positive affect and higher daily levels of negative affect, rumination, distress intolerance and emotion dysregulation were risk factors for next‐day suicidal ideation (SI). Same‐day within‐person higher rumination and negative affect were also risk factors for same‐day SI. At the between‐person level, higher overall positive affect was protective against active SI and suicidal behaviour over the 6‐month follow‐up, while greater variability of rumination and distress intolerance increased risk for active SI, suicidal behaviour and suicide attempt. The present study provides the most comprehensive examination to date of intensive longitudinal metrics of ACCs as risk factors for STBs. Results support the continued use of intensive longitudinal methods to improve STB risk detection. Interventions focusing on rumination and distress intolerance may specifically help to prevent suicidal crises during critical transitions in care.
Ecological momentary assessment (EMA) is one research method increasingly employed to better understand the processes that underpin depression and related phenomena. In particular, EMA is well suited ...to the study of affect (e.g., positive and negative affect), affective responses to stress (e.g., emotion reactivity), and behaviors (e.g., activity level, sleep) that are associated with depression. Additionally, EMA can provide insights into self-harm behavior (i.e. suicide and non-suicidal self-injury), and other mood disorders (e.g. bipolar disorder) commonly associated with depressive episodes. Given the increasing availability and affordability of handheld computing devices such as smartphones, EMA is likely to play an increasingly important role in the study of depression and related phenomena in the future.
•Adolescents are at elevated suicide risk following psychiatric hospitalization.•Within-person increased misery and anger were associated with suicidal ideation.•Within-person happiness was ...protective for same-day suicidal ideation.•Within-person happiness was a risk factor for next-day suicidal ideation.•These dynamic risk factors represent modifiable, real-time treatment targets.
Suicide is a major public health problem among adolescents. Identifying factors that confer increased risk for suicidal ideation, particularly during the high-risk period following psychiatric hospitalization, is essential for preventing suicide in this population. Negative and positive affect are two such important modifiable risk factors. This study examined relationships between specific affective states and suicidal ideation, collected via daily diary, as continuous functions of time among discharged adolescents. Adolescents hospitalized for suicidal ideation and/or behavior responded to daily surveys for four weeks after discharge (N = 34; 952 observations). Time-varying effects models (TVEM) were used to predict same- and next-day suicidal ideation. Examining between-persons effects, adolescents reporting greater misery and less happiness compared to others had a significantly increased likelihood of same-day suicidal ideation; between-person anger was not significantly associated with suicidal ideation. Within-persons effects suggested that elevated same-day, but not previous-day, misery and anger were associated with suicidal ideation. Elevated within-person happiness was protective for same-day suicidal ideation, but was also associated with next-day suicidal ideation. These findings begin to clarify not only which, but when, specific affective processes influence suicidal ideation for discharged adolescents. These dynamic risk factors represent modifiable treatment targets relevant for real-time interventions.
The purpose of this manuscript is to provide an overview of, and rationale for, the increasing adoption of a wide range of cutting-edge technological methods in assessment and intervention which are ...relevant for treatment. First, we review traditional approaches to measuring and monitoring affect, behavior, and cognition in behavior and cognitive-behavioral therapy. Second, we describe evolving active and passive technology-enabled approaches to behavior assessment including emerging applications of digital phenotyping facilitated through fitness trackers, smartwatches, and social media. Third, we describe ways that these emerging technologies may be used for intervention, focusing on novel applications for the use of technology in intervention efforts. Importantly, though some of the methods and approaches we describe here warrant future testing, many aspects of technology can already be easily incorporated within an established treatment framework.
Objective: Despite the prevalence and impact of nonsuicidal self-injury (NSSI), there are few treatments developed to treat the behavior specifically, and little is known about moderators of ...treatment response. The Treatment for Self-Injurious Behaviors (T-SIB), a brief, behavioral intervention, was developed to treat NSSI in young adults; a previous pilot randomized controlled trial (RCT) comparing T-SIB with treatment as usual (TAU) provided support for the intervention. This study examined demographic, clinical, and NSSI-related predictors of treatment outcome in the pilot RCT for T-SIB. Method: Young adults (N = 33) were randomized to receive T-SIB or treatment as usual; all participants were included in intent-to-treat analyses. The primary outcome of NSSI behaviors was assessed at baseline, posttreatment (9 weeks), and 3-month follow up, and potential moderators were assessed at baseline. Results: Greater lifetime and last year NSSI frequency was associated with fewer NSSI behaviors at posttreatment and follow up among participants in T-SIB. Anxious symptoms also moderated treatment outcomes, but other demographic and clinical variables did not. Conclusion: Previous research has shown that T-SIB is more effective than TAU overall; the current study suggests that T-SIB may be effective for individuals with more frequent NSSI and those with elevated anxiety. A larger evaluation of T-SIB is supported.
What is the public health significance of this article?
Moderators of treatment effectiveness for the Treatment of Self-Injurious Behaviors (T-SIB), a novel intervention for nonsuicidal self-injury, were investigated in a preliminary study to guide future research and to investigate who might benefit most from the intervention. Although the study was limited by its small sample, findings support the use of T-SIB in individuals with a range of clinical and nonsuicidal self-injury (NSSI) severity; T-SIB may be particularly effective for individuals with more frequent NSSI.
Posttraumatic stress disorder (PTSD) is a well-known risk factor for suicidal thoughts and behaviors (STBs). However, there is a scarcity of longitudinal studies exploring underlying pathways. This ...study sought to examine the mechanistic role of emotion dysregulation in the relations between PTSD and STBs following discharge from psychiatric inpatient treatment, a particularly high-risk period for suicide. Participants were 362 trauma-exposed psychiatric inpatients (45% female, 77% white, Mage = 40.37). PTSD was assessed via a clinical interview (Columbia Suicide Severity Rating Scale) during hospitalization, emotion dysregulation was assessed via self-report 3-weeks post-discharge, and STBs were assessed via a clinical interview 6-months post-discharge. St'1ructural equation modeling showed that emotion dysregulation significantly mediated the relation between PTSD and suicidal thoughts (β = 0.10, SE = 0.04, p = .01, 95%CI 0.04, 0.39) but not suicide attempts (β = 0.04, SE = 0.04, p = .29, 95%CI -0.03, 0.12) post-discharge. Findings highlight a potential clinical utility of targeting emotion dysregulation among individuals with PTSD to prevent suicidal thoughts following discharge from psychiatric inpatient treatment.
•PTSD increases risk for suicide, though mechanisms are poorly understood.•We examined suicide risk in the six months after inpatient psychiatric discharge.•Emotion dysregulation explained the link between PTSD and suicidal thoughts.
Media coverage of non-suicidal self-injury (NSSI) ranges from providing helpful education to displaying graphic images. We offer the first research-informed, consensus-based guidelines for the ...responsible reporting and depicting of NSSI in the media, while also advising on ideas for dissemination and collaboration between media professionals and healthcare experts.
•An investigation of suicidal ideation and suicide attempt based on speech-based parameters.•Reveals statistically significant differences between the healthy control and inpatients exhibiting ...suicidal behavior with regards to voice quality and speech disfluency attributes.•Demonstrates that voice quality and disfluency information can be applied as a compact feature set for machine learning techniques which can produce suicidal behavior classification with a relatively high degree (i.e. up to 80% classification accuracy).
Individuals that have incurred trauma due to a suicide attempt often acquire residual health complications, such as cognitive, mood, and speech-language disorders. Due to limited access to suicidal speech audio corpora, behavioral differences in patients with a history of suicidal ideation and/or behavior have not been thoroughly examined using subjective voice quality and manual disfluency measures. In this study, we examine the Butler-Brown Read Speech (BBRS) database that includes 20 healthy controls with no history of suicidal ideation or behavior (HC group) and 226 psychiatric inpatients with recent suicidal ideation (SI group) or a recent suicide attempt (SA group). During read aloud sentence tasks, SI and SA groups reveal poorer average subjective voice quality composite ratings when compared with individuals in the HC group. In particular, the SI and SA groups exhibit average ‘grade’ and ‘roughness’ voice quality scores four to six times higher than those of the HC group. We demonstrate that manually annotated voice quality measures, converted into a low-dimensional feature vector, help to identify individuals with recent suicidal ideation and behavior from a healthy population, generating an automatic classification accuracy of up to 73%. Furthermore, our novel investigation of manual speech disfluencies (e.g., manually detected hesitations, word/phrase repeats, malapropisms, speech errors, non-self-correction) shows that inpatients in the SI and SA groups produce on average approximately twice as many hesitations and four times as many speech errors when compared with individuals in the HC group. We demonstrate automatic classification of inpatients with a suicide history from individuals with no suicide history with up to 80% accuracy using manually annotated speech disfluency features. Knowledge regarding voice quality and speech disfluency behaviors in individuals with a suicide history presented herein will lead to a better understanding of this complex phenomenon and thus contribute to the future development of new automatic speech-based suicide-risk identification systems.
Despite significant advances in psychiatric and psychological treatment over the last 30 years, suicide deaths have increased. Unfortunately, neuroscience insights have yielded few translational ...interventions that specifically target suicidal thoughts and behaviors. In our view, this is attributable to two factors. The first factor is our limited integration of neurocircuitry models with contemporary suicide theory. The second challenge is inherent to the variable nature of suicide risk over time. Few interventional neuroscience studies evaluate how temporal fluctuations in risk affect treatment, despite evidence that temporality is a key component distinguishing suicide phenotypes. To wit, individual variability in risk trajectories may provide different treatment targets to engage as a patient moves between suicidal ideation and attempt. Here, we first review contemporary ideation-to-action theories of suicide from a neurobiological perspective, focusing on valence and executive function circuits and the key role of state-induced (e.g., within stressful contexts) functional modulation on longitudinal risk trajectories. We then describe neural correlates of suicide reduction following various interventions, ranging from circuit specific (i.e., transcranial magnetic stimulation) to broader pharmacological (i.e., ketamine, lithium) to psychological (i.e., brief cognitive therapy). We then introduce novel strategies for tracking risk in naturalistic settings and real time using ecological momentary interventions. We provide a critical integration of the literature focusing on the intersection between targets and temporality, and we conclude by proposing novel research designs integrating real-time and biologically based interventions to generate novel strategies for future suicide reduction research.
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