Prevalence of suicidal ideation in German psychotherapy outpatients: A large multicenter assessment.

BACKGROUND: Suicidal ideation is a major concern in clinical practice. Yet, little is known about prevalence rates of suicidal ideation in patients undergoing outpatient psychotherapeutic treatment. Therefore, the aim of the current study is to assess the prevalence of suicidal ideation in a large sample of psychotherapy outpatients in Germany. The data analyzed in this study is taken from the KODAP-project on the coordination of data collection and analysis at German university-based research and training outpatient clinics for psychotherapy. METHODS: A total of N = 10,357 adult outpatients (64.4 % female; age: M(SD) = 35.94 (13.54), range: 18-92 years of age) starting cognitive-behavioral therapy at one of 27 outpatient clinics in Germany were included in the current study. Prevalence of suicidal ideation was assessed with the Suicide Item (Item 9) of the Beck-Depression Inventory II. RESULTS: Suicidal ideation was reported by 36.7 % (n = 3795) of the participants. Borderline Personality Disorder, Posttraumatic Stress Disorder, and recurrent Major Depression were the diagnoses most strongly associated with the presence and severity of suicidal ideation. LIMITATION: Suicide ideation was assessed only with the respective item of the Beck Depression Inventory II. CONCLUSION: Suicidal ideation is very common among adult patients who start psychotherapy in Germany. A well-founded knowledge of risk assessment in suicidal patients and suicide-specific treatment options is therefore highly relevant.

Validation of the motivational phase of the integrated motivational-volitional model of suicidal behavior in a German high-risk sample.

BACKGROUND: The Integrated Motivational-Volitional (IMV) model of suicidal behavior proposes in its motivational phase that perceptions of defeat and entrapment (total, internal and external entrapment) lead to the development of suicidal ideation and that thwarted belongingness and perceived burdensomeness moderate this process. The aim of this study was to test the motivational phase of the IMV model cross-sectionally in a German sample of psychiatric inpatients. METHODS: A total of 308 psychiatric inpatients (53% female) aged 18 to 81 years (M = 36.92, SD = 14.30) were included in the study and investigated within 14 days after psychiatric admission due to suicide attempt (53%) or acute suicidal crisis (47%). Statistical analyses included a mediation analysis and moderation analyses. RESULTS: Results demonstrate a simple mediation of defeat via entrapment (total, internal and external entrapment) on suicidal ideation. The interaction between thwarted belongingness and perceived burdensomeness was confirmed as a motivational moderator. LIMITATIONS: Limiting factors of the present study are the cross-sectional design and the retrospective assessment of suicidal ideation. CONCLUSION: The main assumptions of the motivational phase of the IMV model could empirically be confirmed. Perceptions of defeat, internal and external entrapment, thwarted belongingness, and perceived burdensomeness should be taken into account with regard to prevention, risk assessment and interventions of suicidal ideation and attempts. However, future investigations based on prospective data are warranted.

The role of childhood abuse for suicidality in the context of the interpersonal theory of suicide: An investigation in German psychiatric inpatients with depression.

BACKGROUND: Several studies provide evidence for a relationship between childhood abuse and suicidality across the lifespan. To examine this association in the context of the Interpersonal Psychological Theory of Suicide (IPTS), we investigated whether its constructs thwarted belongingness, perceived burdensomeness and capability for suicide are potential mediators. METHODS: Eighty-four German psychiatric inpatients with unipolar depression (M = 37.6 years, 69% female) and current or lifetime suicidal ideation were included. For the assessment we used the Childhood Trauma Screener (CTS), the Rasch-based Screening for Depression (DESC-I), the Interpersonal Needs Questionnaire (INQ), the German Capability for Suicide Questionnaire (GCSQ), the Beck Scale for Suicide Ideation (BSS) and the Suicide Behaviors Questionnaire-Revised (SBQ-R). Simple and multiple mediator analyses were applied. RESULTS: Most patients (70%) had experienced childhood abuse. Emotional abuse showed an indirect association with suicidal ideation via thwarted belongingness and perceived burdensomeness, whereas physical and sexual abuse were indirectly related to suicide risk via capability for suicide. LIMITATIONS: The small sample size and the cross-sectional design are limiting factors of the present study. CONCLUSIONS: Childhood abuse is a common experience of inpatients with unipolar depression. This study showed its indirect effects on suicidal ideation and risk for suicide, mediated by the constructs of the IPTS. Further research should investigate this issue in other populations and clinicians should be aware of the devastating effects of childhood abuse.

Predicting suicidal ideation by interpersonal variables, hopelessness and depression in real-time. An ecological momentary assessment study in psychiatric inpatients with depression.

OBJECTIVE: To extend evidence on the short-term variability of passive and active suicidal ideation (SI) and the association with suggested proximal risk factors such as interpersonal variables (perceived burdensomeness [PB], thwarted belongingness [TB], hopelessness, and depression) in real-time. METHODS: This is an observational study using a prospective design applying ecological momentary assessments (EMA). Eligible for study inclusion were inpatients with unipolar depression, current or lifetime suicidal ideation, and fluent German. Over six days, 74 participants rated their momentary level of passive and active SI, PB, TB, depressiveness, and hopelessness up to 10 times per day on smartphones. Data was collected from August 2015 to July 2017. Compliance was excellent (89.7%). RESULTS: Mean squared successive differences supported temporal instability for all variables. According intra-class correlations, between 25% and 47% of variance was accounted for by within-person variability. Multilevel analysis demonstrated significant positive associations between hopelessness, depressiveness, PB, and TB with passive SI. Prospectively, hopelessness and PB remained predictors of passive SI. For active SI, hopelessness, depression, PB, and TB were significantly associated cross-sectionally. Prospectively, hopelessness, PB, and the interaction PBxTB predicted active SI. All models were controlled for previous level of SI. CONCLUSIONS: This study provides further evidence on the short-term variability of SI in very short time frames implying the need of assessing SI repeatedly in clinical and research settings. The associations between interpersonal variables and passive and active SI were only partial in line with assumptions of the Interpersonal Theory of Suicide. Overall, the effects were small warranting further investigation.

The German version of the Interpersonal Needs Questionnaire (INQ)--Dimensionality, psychometric properties and population-based norms.

PURPOSE: The Interpersonal Needs Questionnaire (INQ) assesses the two interpersonal constructs perceived burdensomeness (PB) and thwarted belongingness (TB) that lead to suicidal ideation, according to the interpersonal theory of suicide (IPTS). The present study investigates dimensionality and psychometric properties of the German version of the INQ in a population-based representative sample and delivers norm values. METHODS: The German INQ as well as measures of depression and past suicidality were administered to a population-based representative sample of the German general population (n=2513) to analyze its dimensionality and construct validity by confirmatory factor analysis and correlational analysis. RESULTS: Results of the confirmatory factor analysis were in line with the assumption of two-dimensionality of the INQ. The two subscales showed very good internal consistencies (α ≥ 0.89) as well as correlations with depression and suicidality that indicate convergent validity. There were no gender effects but slight age effects in the scores of both subscales. Population-based norms are provided. LIMITATIONS: Convergent validity was solely examined with measures of depression and suicidal thoughts instead of further suitable constructs like loneliness and social support. Divergent validity was not investigated in the study. CONCLUSION: The German version of the INQ shows good psychometric properties making it a promising tool for assessing PB and TB. The provided norms enable researchers to compare INQ scores of their samples with reference values of a population-based representative sample.

[Validation of the computerized adaptive assessment procedure RehaCAT related to functional and mental strain in a sample of rehabilitation patient suffering from musculoskeletal diseases]. / Validierung der computeradaptiven Assessmentprozedur RehaCAT hinsichtlich funktionaler und psychischer Belastungen bei Rehabilitanden mit muskuloskelettalen Erkrankungen.

The Rasch-based, computerized adaptive assessment procedure RehaCAT allows to assess the ICF-oriented dimensions "activities in daily living", "functionality upper extremities" and "functionality lower extremities" as well as "depression" economically and reliably in orthopaedic rehabilitation patients. This validation study aimed at analyzing the multivariate association of the RehaCAT dimensions with the commonly applied ODI, SF-12 and HADS-D assessment scales in a sample of rehabilitation patient suffering from musculoskeletal diseases (spine disease: 58,7%). By means of structural equation modeling high convergent and divergent validity of the RehaCAT dimensions could be proven in a sample of N=184 rehabilitation patients (71,2% inpatient and 28,8% outpatient). In the resulting model between 41% (functionality upper extremities) and 76% (activities in daily living) of the RehaCAT dimensions could be explained mainly by the theoretical assumed predictor constructs. Because of its psychometric foundation, economy and validity, the RehaCAT provides an optimal basis to assess central ICF-oriented constructs in orthopaedic rehabilitation.

[Confirmatory analysis of the dimensional structure of the ODI, the SF-12 and the HADS-D scales in a sample of rehabilitation patients with musculoskeletal diseases]. / Konfirmatorische Prüfung der dimensionalen Struktur des Oswestry Disability Index, des SF-12 und der HADS-D bei Rehabilitanden mit muskuloskelettalen Erkrankungen.

This study aimed at confirmatory testing the factorial structure of the established assessment instruments ODI, SF-12 and HADS-D by means of structural equation modeling in a sample of n=184 rehabilitation patients with musculo-skeletal diseases. According to local and global fit indices for each instrument an acceptable to good fit to the underlying theoretical model could be verified. For the ODI as well as for the HADS-D only single weak item-construct associations indicated shortcomings in the assumed model structure. For the SF-12 the constructs "physical health" and "mental health" could be validated after defining the additional first order factors "role - physical", "role - emotional" and "well-being", respectively. In general, the study findings proved the factorial validity of the instruments. Additionally, specific measurement properties on item and structural level could be identified which might enhance the understanding of construct definitions in rehabilitation patients with musculoskeletal diseases.

[Adaptive testing in rehabilitation: a way to economic assessment of patients' attributes]. / Adaptives Testen in der Rehabilitation - ein Weg zur ökonomischen Erhebung von Patientenmerkmalen*

For diagnostics and outcome measurement in clinical rehabilitation a multitude of questionnaires is used. In order to gain comparability of the diagnostic findings, generally, the same information is gathered of all patients, regardless of their state of health or how severely ill they are, by using identical groups of items. In this kind of assessment it is, however, problematic that (a) the assessment instrument usually only allows for adequate and reliable diagnostics of patients who suffer from injuries or illnesses of medium severity, and (b) that an uneconomic data collection is required because of an extensive set of items which may in individual cases be uninformative and unnecessary. This article shows how data assessment can be adjusted to the individual handicaps of the patient by using adaptive or tailored testing. Thus it can be ensured that the testing becomes more economical and results more precise. Furthermore, a high acceptance by the patients participating in the data collection can be achieved, as the test items submitted fit the ability of the patients adequately. Yet, adaptive test systems require a complex and very careful psychometrical development of the assessment procedure in such a way that in spite of presenting different items to patients, diagnostic outcomes are comparable between patients and for different points in time (e. g., pre-post comparison). This article shows the steps of development that have to be accomplished in order to set up a psychometrically sound adaptive test procedure. Moreover, it shows how its usage in the area of medical rehabilitation can be profitable for handlers and patients.