Suicide prevention efforts often depend on the willingness or ability of people to disclose current suicidal behavior. The aim of this study is to identify characteristics that are associated with ...non-disclosure of suicidal ideation. Data from the Dutch cross-sectional survey Health Monitor 2016 were used, resulting in 14,322 respondents (age 19+). Multiple logistic regression analyses were conducted to assess the strength of the associations between demographics and health-related characteristics as independent variables, and non-disclosure of suicidal ideation as the dependent variable. The mean age of the respondents was 60 years (SD 16.7) and 45% were male. Of these adults, 5% (
= 719) reported suicidal ideation in the past year, nearly half of which (48%) did not disclose suicidal ideation. Non-disclosure was significantly associated with social loneliness (OR = 1.29). Inverse significant associations were found for age (35⁻49 years, OR = 0.53), poor health status (OR = 0.63), frequent suicidal ideation (OR = 0.48), and severe psychological distress (OR = 0.63). The accuracy of this model was fair (AUC = 0.73). To conclude, non-disclosure is a substantial problem in adults experiencing suicidal ideation. Adults who do not disclose suicidal ideation are more likely to have few social contacts, while they are less likely to experience poor (mental) health and frequent suicidal thoughts.
Aim: Depressive symptoms have a high prevalence in dialysis patients and are associated with adverse clinical outcomes. Unraveling specific dimensions of depressive symptoms may help to improve ...screening and treatment. We aimed to identify the best fitting factorial structure for the Beck Depression Inventory-II (BDI-II) in dialysis patients and assess the relation of these structure dimensions with Quality of Life (QoL), hospitalization and mortality. Methods: This prospective study included chronic dialysis patients from 10 dialysis centers between 2012 and 2017. Dimensions of depressive symptoms within the BDI-II were analyzed using confirmatory factor analysis. The associations between symptom dimensions and quality of life, hospitalization rate and mortality were investigated using linear, poisson and cox proportional hazard regression models respectively. Multivariate regression models included demographic, social and clinical variables. Results: In total, 687 dialysis patients were included. The factor model that included a general and a somatic factor provided the best fitting structure of the BDI-II. The factor loadings for the cognitive dimensions were low. Both the somatic and cognitive dimension showed a significant association with Quality of Life scores. However, only the somatic dimension was associated with the hospitalization rate and all-cause mortality. Conclusion: The somatic dimension of the BDI-II showed a significant association with adverse clinical outcomes, which was even higher compared to the general score of the BDI-II. These findings indicate that the somatic dimension of depressive symptoms needs specific attention in further research, when unraveling the association of depression scores with adverse clinical outcomes in dialysis patients.
Psychological interventions that are efficacious as treatments for depression could indirectly affect suicide-related outcomes. We examined suicidal thoughts and behaviours as eligibility criteria, ...outcomes, and adverse events across trials of psychotherapy for depression.
We used a publicly available meta-analytic database developed through systematic searches (updated as of May 1, 2023) to identify randomised controlled trials in which a psychological intervention for depression was compared with an inactive or non-specific control condition in adults with depression and in which any suicide-related outcomes were reported. We also identified studies in which suicide risk was an exclusion criterion. We excluded inpatient studies and trials of unguided digital interventions or collaborative care that included a psychological component. Pairs of reviewers worked independently to select studies and extract data. In a random-effects meta-analysis with robust variance estimation, we assessed the effect of the psychological intervention on suicide outcomes in trials in which suicide was explicitly assessed as an outcome with clinical scales with established psychometric properties. Risk of bias was assessed with the Cochrane risk-of-bias tool (version 2).
Of the 469 randomised trials we identified in which a psychological intervention was compared with an inactive control in people with depression, 251 excluded people judged at risk of suicide. Any assessment of suicide was included in only 45 trials, 12 of which assessed suicidal ideation or risk as an outcome. These 12 trials included 3930 participants, 2795 (71%) of whom were female and 1135 (29%) of whom were male; data for age and ethnicity were not consistently reported. Psychological interventions for depression were associated with a small reduction in suicidal ideation and risk in 11 trials (one trial reported only follow-up data) after the intervention (standardised mean difference -0·31 95% CI -0·60 to -0·03) but not at follow-up (-0·49 -1·31 to 0·32). Suicide-related adverse events were reported in 25 trials, and suicide-related serious adverse events (eg, suicide attempts, deaths by suicide) were reported in 13 trials. Heterogeneity was substantial across all analyses, and prediction intervals crossed zero.
Trials of psychological interventions for depression rarely report assessments of suicide. Psychological interventions might reduce suicidal ideation in patients with depression, but more randomised controlled trials are required to clarify this effect. Monitoring and reporting of suicide-related adverse events should be improved in trials of psychological interventions for depression, and future trials should incorporate outcomes related to suicidal thoughts or behaviours.
None.
For the Spanish translation of the abstract see Supplementary Materials section.
Depression and anxiety often coexist in patients with end-stage-kidney disease. Recently, studies showed that a composite ‘general distress score’ which combines depression and anxiety symptoms ...provides a good fit in dialysis and oncology patients. We aim to investigate if the three most frequently used self-report questionnaires to measure depression and anxiety in dialysis patients are sufficiently unidimensional to warrant the use of such a general distress score in two cohorts of dialysis patients.
This study includes two prospective observational cohorts of dialysis patients (total n = 749) which measured depression and anxiety using Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Hospital Anxiety and Depression Scale (HADS). Confirmatory factor analyses was used to investigate both a strictly unidimensional model and a multidimensional bifactor model that includes a general distress, depression and anxiety factor. The comparative fit index (CFI) and The Root Mean Square Error of Approximation (RMSEA) were used as model fit indices.
Factor analysis did not show a good fit for a strictly unidimensional general distress factor for both the BDI/BAI and HADS (CFI 0.690 and 0.699, RMSEA 0.079 and 0.125 respectively). The multidimensional model performed better with a moderate fit for the BDI/BAI and HADS (CFI 0.873 and 0.839, RMSEA 0.052 and 0.102).
This data shows that the BDI/BAI and HADS are insufficiently unidimensional to warrant the use of a general distress score in dialysis patients without also investigating anxiety and depression separately. Future research is needed whether the use of a general distress score might be beneficial to identify patients in need of additional (psychological) support.
Internet-based guided self-help is efficacious for panic disorder, but it is not known whether such treatment is effective for milder panic symptoms as well.
To evaluate the effectiveness of Don't ...Panic Online, an Internet-based self-help course for mild panic symptoms, which is based on cognitive behavioral principles and includes guidance by email.
A pragmatic randomized controlled trial was conducted. Participants (N=126) were recruited from the general population and randomized to either the intervention group or to a waiting-list control group. Inclusion criteria were a Panic Disorder Severity Scale-Self Report (PDSS-SR) score between 5-15 and no suicide risk. Panic symptom severity was the primary outcome measure; secondary outcome measures were anxiety and depressive symptom severity. Measurements were conducted online and took place at baseline and 12 weeks after baseline (T1). At baseline, diagnoses were obtained by telephone interviews.
Analyses of covariance (intention-to-treat) showed no significant differences in panic symptom reduction between groups. Completers-only analyses revealed a moderate effect size in favor of the intervention group (Cohen's d=0.73, P=.01). Only 27% of the intervention group finished lesson 4 or more (out of 6). Nonresponse at T1 was high for the total sample (42.1%). Diagnostic interviews showed that many participants suffered from comorbid depression and anxiety disorders.
The Internet-based guided self-help course appears to be ineffective for individuals with panic symptoms. However, intervention completers did derive clinical benefits from the intervention.
Nederlands Trial Register: NTR1639; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1639 (Archived by WebCite at http://www.webcitation.org/6ITZPozs9).
Background: Persons bereaved by suicide are reluctant to ask
for social support when they experience feelings of guilt and blame. A web-based
peer forum may provide a safe and anonymous place for ...mutual support.
Aims: This study examined the mental health changes of
visitors of two online support forums for persons bereaved by suicide and their
experiences with the forum over 1 year. Method: Visitors of two
forums completed self-report measures at baseline and at 6 and 12 months'
follow-up. Repeated measures analyses were used to study changes in well-being,
depressive symptoms, and complicated grief. Additionally, participants were
interviewed about their experiences with the forum. Results:
The 270 participants were mostly female, low in well-being, with high levels of
depressive symptoms and complicated grief. Suicidal risk was high for
5.9%. At 12 months, there were small to medium-sized significant
improvements in well-being and depressive symptoms (p <
.001) and nearly as much for grief (p = .08). About two
thirds reported benefit from visiting the forum. Because of the pre-post
design we cannot determine whether a causal relationship exists between the form
and changes in mental health. Conclusion: After 1 year some
positive changes but a large group was still struggling with their mental
health. Interviews indicate that the forum was valued for finding
recognition.
Symptoms of anxiety are highly prevalent in dialysis patients and are associated with adverse clinical outcomes. Identifying symptom dimensions may help to understand the pathophysiology, improve ...screening and guide treatment. Currently, there are no data on symptom dimensions of anxiety in dialysis patients. This study aimed to identify the best fitting dimensional model for anxiety in dialysis patients and assess the association between symptom dimensions of anxiety and adverse clinical outcomes.
This study is a prospective observational cohort study including patients from 10 urban dialysis centers between 2012 and 2017. Anxiety symptoms were measured using the self-reported questionnaire Beck Anxiety Inventory. Confirmatory factor analysis was used to identify symptom dimensions. The association between dimensions and mortality, hospitalization and quality of life was investigated using stepwise cox, poisson and lineair regression models. Multivariable models included demographic, social, laboratory and clinical variables to adjust for possible confounding.
In total 687 chronic dialysis patients were included. A Somatic and Subjective anxiety dimension were identified. Only Somatic anxiety symptoms showed an association with increased risk of hospitalization and mortality (Rate Ratio 1.73 (1.45–2.06) p = .007 and Hazard Ratio 1.65 (1.15–2.37) p = .007 respectively). These associations were independent from somatic comorbidity. All symptom dimensions of anxiety showed an association with Quality of Life.
This study shows that anxiety is common in chronic dialysis patients and comprises of a somatic, subjective, and a total score. The discrimination between anxiety dimensions can be useful for clinical practice, as they are related to different clinical outcomes.
•Anxiety symptoms are very common in patients with kidney disease.•Better insight in these symptoms is needed to aid in screening and treatment.•This study identified several key symptom dimensions.•The somatic symptom dimensions was related to a decreased survival.•All dimensions of anxiety showed a marked effect on Quality of Life.
•Depressive episodes that co-occur with suicidal ideation could be different from depressive episodes without suicidal ideation in terms of symptom patterns.•Confirmatory factor analysis (CFA) ...implied a difference in latent variable structures between depressed patients with suicidal ideation and depressed patients without suicidal ideation.•Subsequent multiple-group CFA also showed violations of measurement invariance.•Hopelessness and overall anhedonia characterised depression among patients with suicidal ideation.
Suicidality could be associated with specific combinations of biological, social and psychological factors. Therefore, depressive episodes with suicidal ideation could be different from depressive episodes without suicidal ideation in terms of latent variable structures.
In this study we compared latent variable structures between suicidal and non-suicidal depressed patients using confirmatory factor analysis (CFA), following a measurement invariance test procedure. Patients (N = 919) suffering from major depressive disorder were selected from the Netherlands Study of Depression and Anxiety (NESDA) and split into a group that showed no symptoms of suicidal ideation (non-SI; N = 691) and a suicidal ideation (SI) group that had one or more symptoms of suicidal ideation (N = 228). Depression and anxiety symptoms were measured using the short form of the Mood and Anxiety Symptoms Questionnaire (MASQ-D30).
CFA implied a difference in latent variable structures between the non-SI sample (CFI 0.957; RMSEA 0.041) and the SI sample (CFI 0.900; RMSEA 0.056). Subsequent multiple-group CFA showed violations of measurement invariance. The General distress and Anhedonic depression subscales were best indicated by hopelessness and lack of optimism in the SI sample and by dissatisfaction and not feeling lively in the non-SI sample. Overall, the SI sample had higher scores and lower inter-item correlations on the Anhedonic depression items.
We have included very mild cases of suicidal ideation in our SI sample.
On a latent variable level, depression with suicidal ideation differs from depression without suicidal ideation. Results encourage further research into the symptom structure of depression among suicidal patients.
Background: Every year, more than six million people lose a
loved one through suicide. These bereaved by suicide are at relatively high risk
for mental illnesses including suicide. The social stigma ...attached to suicide
often makes it difficult to talk about grief. Participating in online forums may
be beneficial for the bereaved by suicide, but it is unknown what they
communicate in these forums. Aims: What do the bereaved by
suicide communicate in online forums? We examined which self-help mechanisms,
grief reactions, and experiences with health-care services they shared online.
Method: We conducted a content analysis of 1,250 messages
from 165 members of two Dutch language forums for the bereaved by suicide.
Results: We found that sharing personal experiences
featured most prominently in the messages, often with emotional expressions of
grief. Other frequently used self-help mechanisms were expressions of support or
empathy, providing advice, and universality (recognition), while experiences
with health-care services featured only occasionally. Compared with previous
studies about online forums for somatic illnesses, the bereaved by suicide
communicated more personal experiences and engaged much less in chitchat.
Conclusion: Online forums appear to have relevant
additional value as a platform for talking about grief and finding support.
Recently, internet-based interventions have been proposed as effective treatments for people with panic disorder (PD). However, little is known about the clinical effects of integrating mobile ...technology into these interventions. Because users carry their smartphones with them throughout the day, we hypothesize that this technology can be used to significantly support individuals with monitoring and overcoming their PD symptoms. The aim of the present study is to evaluate the efficacy and cost-effectiveness of a newly developed hybrid intervention that combines internet/PC with smartphone delivery to treat the symptoms of PD. The intervention is based on cognitive behavioral therapy and consists of six modules over a total of six weeks.
A two-arm randomized controlled trial (RCT) will be conducted to evaluate the effects of a hybrid online training module for PD. Based on a power calculation (d =0.60; 1-β of 80%; α =0.05), 90 participants with mild to moderate panic symptoms with or without agoraphobia (as assessed by the Panic and Agoraphobia Scale) will be recruited from the general population and randomly assigned to either the intervention group or a six-month waitlist control group. The primary outcome measure will be the severity of panic symptoms. Secondary outcomes will include depression, quality of life, and an observer-based rating of panic severity. Furthermore, data regarding acceptance and the usability of the smartphone app will be assessed. Assessments will take place at baseline as well as eight weeks, three months, and six months after randomization. Moreover, a cost-effectiveness analysis will be performed from a societal perspective. Data will be analyzed on an intention-to-treat basis and per protocol.
To our knowledge, this RCT is one of the first to examine the efficacy of a hybrid online training for adult PD. This study seeks to contribute to the emerging field of hybrid online training. If the intervention is efficacious, then research on this hybrid online training should be extended. The cost-effectiveness analysis will also indicate whether online training is an economical tool for treating PD among adults.
German Clinical Trial Register: DRKS00005223 (registered on 15 August 2013).
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