Abstract The current study tests whether perceptions of defeat and entrapment are the psychological mechanisms underlying the link between positive psychotic symptoms and suicidal ideation in ...schizophrenia. A sample of 78 patients with schizophrenia spectrum disorders completed self-report measures and a clinical interview. Of this sample, 21.8% reported a single past suicide attempt and 50% reported multiple past attempts. It was found that perceptions of defeat and entrapment, conceptualised as a single variable, accounted for a large proportion (31%) of the variance in suicidal ideation and behaviour. Defeat and entrapment also mediated the relationship between positive symptom severity and suicidal ideation. This result held whilst controlling for levels of hopelessness and depression. Secondary analyses suggested that suspiciousness in particular was linked to suicidal ideation. The results support a socio-cognitive model (The Schematic Appraisals Model of Suicide: SAMS) of suicide in psychosis.
Suicide is a global problem and suicidal behavior is common in acute psychiatric wards. Inpatient suicides regularly occur with 10.4/100,000 such deaths recorded in the UK in 2016. Inpatient suicides ...are potentially the most avoidable of all suicides as inpatients have 24-h staff contact. Current inpatient treatment prioritizes maintenance of physical safety by observation, medication and general supportive measures, however efficacious and effective specific treatments are lacking. Psychological treatments have a growing evidence base for suicide prevention yet provision of inpatient therapy is uncommon. The present qualitative study aimed to understand the patient acceptability issues by investigating suicidal inpatients views and expectations of a novel suicide-focussed cognitive behavioural psychological therapy which was nested alongside a pilot clinical trial of the intervention.
Thematic analysis of semi-structured individual qualitative interviews with twenty suicidal psychiatric inpatients to investigate their views and expectations about ward-based suicide-focused psychological treatment.
Two main themes were identified. The first, 'A therapy that works', revealed inpatients' views of the necessary components for effective ward-based suicide-focused psychological therapy. The second, 'Concerns about in-patient suicide-focused therapy', depicted their fears about engaging in this treatment. Results suggested that suicide-focused psychological therapy was cautiously welcomed by inpatients' whose narratives expressed their needs, priorities and concerns. Further data analysis enabled formation of a user-informed model of suicide-focussed psychological therapy which offers guidance for researchers and clinicians.
We conclude that hospitalization of suicidal individuals offers a critical opportunity to intervene with effective treatment to preserve life and that suicide-focussed psychological therapy is likely to be well received by suicidal inpatients warranting further testing with a sufficiently powered definitive trial. It is important that provision of ward-based psychological therapy for suicidal inpatients addresses the considerable context-specific challenges inherent in this setting.
ISRCTN 17890126 , Registry: UK Clinical Trials Gateway, Date of registration: 22/04/15, Date of enrolment of first participant to the trial: 20/05/14 (retrospectively registered).
Suicidal thoughts and behaviors are highly prevalent in prisoners. Nevertheless, there have been scant attempts to understand suicidality in prisoners from a psychological perspective. The goals of ...this study were to characterize a prison sample at high risk of suicide in terms of hopelessness, defeat, and entrapment, and to determine which of these variables predicted suicidality. A cross-sectional questionnaire design was used. Measures of hopelessness, defeat, entrapment, and suicide probability were administered to male prison inmates in the United Kingdom. Defeat and hopelessness, especially the affective component of hopelessness, predicted the probability of suicide in this sample, but entrapment was not a significant predictor. Suicide risk assessment procedures in prisons tend to be sparse. Such procedures would benefit from using measures of hopelessness and defeat. Future work should aim to understand how the impact of these psychological constructs on suicidality in prisoners can be attenuated.
Suicidal thoughts, acts, plans and deaths are considerably more prevalent in people with non-affective psychosis, including schizophrenia, compared to the general population. Social isolation and ...interpersonal difficulties have been implicated in pathways which underpin suicidal experiences in people with severe mental health problems. However, the interactions between psychotic experiences, such as hallucinations and paranoia, suicidal experiences, and the presence, and indeed, absence of interpersonal relationships is poorly understood and insufficiently explored. The current study sought to contribute to this understanding.
An inductive thematic analysis was conducted on transcripts of 22, individual, semi-structured interviews with adult participants who had both non-affective psychosis and recent suicidal experiences. A purposive sampling strategy was used. Trustworthiness of the analysis was assured with researcher triangulation.
Participants relayed both positive and negative experiences of interpersonal relationships. A novel conceptual model is presented reflecting a highly complex interplay between a range of different suicidal experiences, psychosis, and aspects of interpersonal relationships. Three themes fed into this interplay, depicting dynamics between perceptions of i. not mattering and mattering, ii. becoming disconnected from other people, and iii. constraints versus freedom associated with sharing suicidal and psychotic experiences with others.
This study revealed a detailed insight into ways in which interpersonal relationships are perceived to interact with psychotic and suicidal experiences in ways that can be both beneficial and challenging. This is important from scientific and clinical perspectives for understanding the complex pathways involved in suicidal experiences.
ClinicalTrials.gov (NCT03114917), 14
April 2017. ISRCTN (reference ISRCTN17776666 .); 5
June 2017). Registration was recorded prior to participant recruitment commencing.
Suicide is a leading cause of premature death in people with a diagnosis of schizophrenia. Although exposure to stressors can play a part in the pathways to death by suicide, there is evidence that ...some people with a diagnosis of schizophrenia can be resilient to the impact of suicide triggers.
To investigate factors that contribute to psychological resilience to suicidal thoughts and behaviours from the perspectives of people with a diagnosis of schizophrenia.
A qualitative design was used, involving semi-structured, face-to-face interviews. Twenty individuals with non-affective psychosis or schizophrenia diagnoses who had experience of suicide thoughts and behaviours participated in the study. The interviews were audio-recorded, transcribed verbatim and examined using inductive thematic analysis.
Participants reported that psychological resilience to suicidal thoughts and behaviours involved ongoing effort. This ongoing effort encompassed: (a) understanding experiences (including reconciliation to mental health experiences and seeking reasons to live), (b) active behaviours (including talking to people and keeping occupied), and (c) relationship dynamics (including feeling supported by significant others and mental health professionals).
Psychological resilience was described as a dynamic process that developed over time through the experiences of psychosis and the concomitant suicidal experiences. Psychological resilience can be understood using a multicomponential, dynamic approach that integrates buffering, recovery and maintenance resilience models. In order to nurture psychological resilience, interventions should focus on supporting the understanding and management of psychosis symptoms and concomitant suicidal experiences.
None.
Introduction
This systematic review and meta‐analysis aimed to (i) examine the associations between experiential avoidance (EA), non‐suicidal self‐injury (NSSI), and suicide experiences, and (ii) ...identify sample‐ and methodological‐related variables affecting the strength of these associations.
Method
Medline, Embase, PsychINFO, Web of Science, and CINAHL were searched until April 2020. Random‐effect meta‐analyses were applied. The I2 statistic and the Egger's test assessed heterogeneity and publication bias. Meta‐regression analyses were used to evaluate the impact of moderator variables on the strength of these associations.
Results
Data from 19 independent studies based on n = 9900 participants were pooled. The analyses demonstrated a weak but significant association between EA and NSSI. None of the examined moderator variables influenced the strength of this relationship. There was an indication of publication bias, suggesting that this association may have been inflated. The associations between EA, and suicide ideation and behaviors were moderate to strong.
Discussion
The current study concluded that (i) the EA model for NSSI should be revised by incorporating new evidence implicating feelings of relief in NSSI, and (ii) future studies should examine interactive factors between EA and key psychological components in the pathways to suicide experiences because these findings have direct clinical implications.
Abstract Posttraumatic Stress Disorder (PTSD) has been strongly associated with suicidality. Despite the growing evidence suggesting that suicidality is heightened by the presence of an elaborated ...suicide schema, investigations of suicide schemas are sparse. Using novel methodologies, this study aimed to compare the suicide schema of PTSD individuals with and without suicidal ideation in the past year. Fifty-six participants with a diagnosis of PTSD (confirmed via the Clinician Administered PTSD Scale) completed questionnaires to assess suicidality, depressive severity and hopelessness. A series of direct and indirect cognitive tasks were used to assess suicide schemas. The pathfinder technique was employed to construct graphical representations of the groups׳ suicide schemas. The suicidal group reported significantly more severe PTSD symptoms, depressive symptoms, hopelessness and suicidality. The suicide schema of the suicidal group was significantly more extensive compared to the non-suicidal group even after taking into account in the analyses group differences in clinical measures. Moreover, the suicide schemas of the two groups were qualitatively distinct from each other. These findings provide support for contemporary theories of suicide which view suicide schemas as an important indicator of suicide risk. The investigation of schema constructs opens a new avenue of research for understanding suicide.
•Differences and similarities between people with and without childhood abuse were examined.•Abused participants reported more severe anxiety, depression and suicide acts.•Abused participants had ...lower perceptions of social support.•The negative link between social support and suicide acts was stronger in abused participants.•Social support moderated the link between depression and suicide acts equally in both groups.
No studies have examined the differences and similarities between individuals with and without experiences of childhood sexual and/or physical abuse in relation to anxiety and depression severity, perceived social support, and suicide experiences. Furthermore, whether the strength of these associations differs between these two groups, and whether the buffering role of perceived social support is equally effective, remain unknown. This study, which was based on 842 British participants, aimed to address these gaps. There were three key findings: i) abused individuals reported significantly more severe depression, anxiety, and suicide experiences, and lower social support, ii) the associations between depression, anxiety, and suicide experiences did not differ between these groups, whereas the association between social support and suicide experiences was more pronounced in abused individuals, and iii) perceived social support acted as a moderator of the association between depression and suicide experiences in both groups. These findings are important because they suggest that for the individuals with childhood trauma perceptions of being less supported by their significant others may lead to suicide acts. Furthermore, perceptions of being socially supported appeared to weaken the association between depression and suicide experiences equally in individuals with and without childhood trauma.
Objective
Theory and clinical literature suggest that pride may play an important role in the maintenance of restrictive eating disorders. A grounded theory study explored experiences of, and ...reflections on, pride among women with a current or past diagnosis of anorexia nervosa.
Design
This is a qualitative study using grounded theory.
Method
Semistructured interviews were conducted with 21 women recruited from an eating disorder unit in England, and from a UK self‐help organization. Grounded theory from a constructivist lens was used. Analysis involved coding, constant comparison, and memo‐writing.
Results
Pride evolves over the course of anorexia nervosa. Two overarching conceptual categories were identified: ‘pride becoming intertwined with anorexia’ and ‘pride during the journey towards recovery’. These categories encompassed different forms of pride: ‘alluring pride’, ‘toxic pride’, ‘pathological pride’, ‘anorexia pride’, ‘shameful pride’, ‘recovery pride’, and ‘resilient pride’. Initially, pride contributed to self‐enhancement and buffered negative emotions. As the condition progressed, pride became a challenge to health and interfered with motivation to change. During recovery, perceptions of pride altered as a healthy approach to living ensued.
Conclusions
The evolving nature of pride plays a central role in development, maintenance, and treatment of anorexia nervosa. Understanding of pride and its role in psychotherapeutic work with this client group may increase motivation to change and promote recovery. Future work should investigate whether tackling pride in eating disorders increases treatment efficacy and reduces the risk of relapsing.
Practitioners points
Pride associated with anorexia appeared to evolve in nature.
During early stages of the eating disorder, it stopped people from seeking help. Later on, it prevented them from seeing pride in healthy domains of life (outside anorexia). Over time, pride in anorexia became an overwhelming emotion that interfered with motivation to change.
It is important for practitioners to assess and discuss pride in anorexia and its evolving nature during treatment.
Understanding of pride and its role in psychotherapeutic work with this client group may increase motivation to change and promote recovery.
Background
A considerable body of literature has shown a strong association between posttraumatic stress disorder (PTSD) and suicidal behavior but only a limited number of studies have investigated ...the putative psychological mechanisms underlying suicidal behavior in PTSD. Based on a recent theoretical model of suicide, the Schematic Appraisals Model, the current study aimed to examine whether perceptions of defeat and entrapment mediated the effects of three types of negative self‐appraisals (emotion coping, problem solving, and social support) on suicidal behavior among individuals experiencing PTSD symptoms in the past month.
Methods
The sample comprised 56 individuals who had been previously exposed to a traumatic event and reported at least one PTSD symptom in the past month (confirmed through the Posttraumatic Diagnostic Scale). The mediational analyses were conducted using a nonparametric, bootstrapping method.
Results
The results showed that defeat and entrapment fully mediated the effect of all three types of self‐appraisals on suicidal behavior. When controlling for PTSD symptom severity, defeat and entrapment continued to mediate fully the effect of two types of self‐appraisals, namely the perceived ability to control negative emotions (emotion coping) and the perceived ability to cope with difficult situations/problems (problem solving) on suicidal behavior.
Conclusions
The current findings provide support for the Schematic Appraisals Model of Suicide and suggest that both specific types of negative self‐appraisals and general perceptions of defeat and entrapment are strongly related to suicidal behavior in those with PTSD. The findings have important clinical implications.
PDF
