Sleep disturbances predict active suicidal ideation the next day: an ecological momentary assessment study.

BACKGROUND: Sleep disturbances are an underestimated risk factor for suicidal ideation and behavior. Previous research provided preliminary support of a temporal relationship between sleep disturbances and suicidal ideation. The present study therefore sought to investigate the prospective association between sleep disturbances, passive and active suicidal ideation, and further psychological risk factors, such as state impulsivity and depression. METHODS: Seventy-three psychiatric inpatients (71% female) with unipolar depressive disorder and current or lifetime suicidal ideation took part in an ecological momentary assessment (EMA). Participants filled out a baseline assessment and data were collected via smartphones over a 6-days period. Multilevel analyses with sleep disturbance as predictor for active and passive suicidal ideation, state impulsivity, and depression were carried out. RESULTS: Patients with sleep disturbance experienced more active suicidal ideation, but no passive suicidal ideation, the following day. Of the four state impulsivity items, one item was significantly associated with sleep disturbance. Sleep disturbance had no effect on next-day depression. Limiting factors are the small and homogeneous sample along with the rather short observation period in an inpatient setting. CONCLUSIONS: The micro-longitudinal study provides preliminary support for sleep disturbance as a proximal risk factor for next-day active suicidal ideation. Clinically, results indicate to consider the evaluation and treatment of sleep disturbances for an improved risk assessment and prevention of suicide.

Association of real-time assessed mood, affect and suicidal ideation in psychiatric inpatients with unipolar depression.

Previous research provided preliminary support of a potential reinforcing effect of suicidal ideation demonstrating reduced negative affect and increased positive affect after thinking about suicide. The present study therefore sought to investigate the role of mood and affect as a proximal risk factor of suicidal ideation in a high-risk sample. Seventy-four psychiatric inpatients (72% female) with unipolar depression and current and/or lifetime suicidal ideation aged 18 to 85 years (M = 37.6, SD = 14.3) took part in an ecological momentary assessment (EMA) over 6 days. Multilevel analyses were calculated. Analyses revealed negative valence of mood and low positive affect to be predictors of subsequent intensity of suicidal ideation (active, passive) as well as predictors of change in suicidal ideation (active, passive) since the last measurement. High negative affect only predicted intensity of passive suicidal ideation. Suicidal ideation (active, passive) was prospectively associated with subsequent negative valence of mood and lower positive affect as well as with higher intensity of negative affect. Suicidal ideation (active, passive) also predicted the change in valence of mood, positive affect and negative affect since the last measurement. Mood and affect should be taken into account as important proximal risk factors of active and passive suicidal ideation. The results do not support the idea of a reinforcing effect of suicidal ideation. In fact, they show a pattern of reduced subsequent positive affect, negative valence of mood and increased negative affect. Replication studies with larger samples and longer EMA follow-ups are needed.

Short defeat and entrapment scale: A psychometric investigation in three German samples.

BACKGROUND: The present study aimed to validate the German version of the Short Defeat and Entrapment Scale (SDES). METHODS: Validity and reliability were established in an online (N = 480), an outpatient (N = 277) and an inpatient sample (N = 296). Statistical analyses included confirmatory factor analyses (CFA) and group differences in defeat and entrapment. RESULTS: For the online and the inpatient sample, the CFA indicated a two-factor solution, whereas for the outpatient sample both one- and two-factor solutions fitted the data equally well. Scale properties for the two-factor solution (defeat and entrapment subscale) were excellent. Thus, further analyses were based on this solution. For the online and the outpatient sample, suicidal ideators and suicide attempters scored significantly higher in defeat and entrapment than non-ideators and non-attempters. LIMITATIONS: Limiting factors of the study were the different measures across the samples and the cross-sectional design of the study. CONCLUSION: Though results were partly mixed, we found support for a two-factor solution of the instrument showing excellent psychometric properties in all three samples. The two-factor solution is further expected to have higher clinical utility than a one-factor solution. Suicidal ideators and suicide attempters in the online and outpatient sample showed higher scores in defeat and entrapment than non-ideators and non-attempters, emphasizing these two concepts as predictors for suicidal ideation. All in all, the present study supports the general validity and reliability of the SDES. However, future investigations based on prospective data are warranted.

[Suicidality: Theoretical Concepts, Risk Assessment and Treatment Options]. / Suizidalität: Theoretische Konzepte, Risikoabschätzung und Behandlungsansätze.

Compared to other mental disorders the evidence about clinical management of patients with suicidality is rather limited. Nevertheless, in the past few years a very positive development occured concerning the development and validation of psychological theories on suicidality as well as the development of specific treatment programs. An overview about the current state of knowledge is presented in the article.

[Psychometric Properties and Dimensionality of the German Beck Scale for Suicide Ideation (BSS): Validation in a Sample of Psychiatric Patients]. / Psychometrische Eigenschaften und Faktorstruktur der deutschen Version der Beck-Suizidgedanken-Skala (BSS): Validierung an einer Stichprobe psychiatrischer Patienten.

OBJECTIVE: The present study examines dimensionality, reliability and convergent validity of the German Beck Scale for Suicidal Ideation (BSS) in a clinical sample. METHODS: 308 inpatients after suicide attempts/acute suicidality participated in the study (53,6% female). Of those, 224 completed the full BSS and self-report questionnaires assessing depression (DESC), hopelessness (BHS), interpersonal variables (INQ) and defeat (DS-d)/entrapment (ES-d). Dimensionality was investigated by confirmatory factor analysis (CFA, models with 1, 2, 3 and 5 factors) and convergent validity was investigated by correlational analysis (Pearson). RESULTS: In total, the 5-factor model achieved the best fit. Yet, model fit is comparable between all tested models without considering the RMSEA model. The multidimensional models result in similar subscales. Subscales reflecting passive death wishes (α>0,80), active suicidal ideation (α>0,73) and suicide-related behaviors (α>0,70) achieve acceptable internal consistency. The BSS sum score and the subscales assessing passive and active suididal thoughts correlate moderately positive with DESC, BHS, INQ and DS-d/ES-d (r between 0,25 and 0,66) while the behavior-related scale shows smaller (r between 0,14 und 0,27) or no associations (INQ, thwarted belongingness). CONCLUSION: The CFAs do not provide clear evidence for either an uni- or a multidimensional structure of the BSS. In the light of this finding, use of the BSS score is limited despite evidence supporting its reliability and convergent validity.

The association of trait impulsivity and suicidal ideation and its fluctuation in the context of the Interpersonal Theory of Suicide.

BACKGROUND: Although the relationship of trait impulsivity and suicidal behavior is well established, its relationship with suicidal ideation and its fluctuation still remains unclear. Our aim is to examine (1) the relationship of trait impulsivity and suicidal ideation and behavior in the context of the Interpersonal Psychological Theory of Suicide (IPTS) and (2) the association of trait impulsivity with the fluctuation of suicidal ideation in an inpatient sample with unipolar depression. METHOD: Eighty-four inpatients with unipolar depression and current and/or lifetime suicidal ideation were assessed with a baseline assessment including trait impulsivity, suicidal ideation, suicidal behavior and the constructs of the IPTS. Seventy-four of these patients underwent a 6-day ecological momentary assessment (EMA) with 10 assessments per day across six days assessing passive and active suicidal ideation. Mean squared successive differences (MSSD) across EMA assessments of suicidal ideation were calculated to test fluctuation as an indicator of temporal variability. Correlation analyses were conducted to test the associations. RESULTS: There were no associations of trait impulsivity with suicidal ideation, thwarted belongingness and perceived burdensomeness, except the rather low but significant association between thwarted belongingness and the attention subdomain of trait impulsivity (r = 0.23*, p ≤ 0.05). Moreover, trait impulsivity showed a significant positive correlation with capability for suicide but not with the two subdomains of capability for suicide. The only significant but rather low correlation was identified between the motor aspect of trait impulsivity and fearlessness about death (r = 0.26, p ≤ 0.01). Suicidal behavior showed a positive correlation with trait impulsivity, but not with the different subdomains of trait impulsivity. Trait impulsivity showed a significant correlation with the MSSD of passive suicidal ideation (r = 0.26, p ≤ 0.05), but not with active suicidal ideation. Furthermore, the motor aspect of trait impulsivity (BIS motor) showed a significant correlation (r = 0.32, p ≤ 0.01) with the MSSD of passive suicidal ideation, but not with active suicidal ideation or the MSSD total score. CONCLUSION: Overall the findings are in line with our assumptions and the IPTS and underline that trait impulsivity is related to suicidal behavior and the fluctuation of suicidal ideation, but not to suicidal ideation itself. Thus, trait impulsivity seems to act as a distal risk factor via capability for suicide and it seems to play a role for the dynamics of suicidal ideation. The results have to be investigated in larger samples, with a higher risk of suicide and in prospective studies. Moreover, the role of the fluctuation of suicidal ideation for the prediction of suicide risk should be investigated in future studies.

[Psychometric Properties of the German Version of the Suicide Behaviors Questionnaire Revised (SBQ-R)]. / Psychometrische Eigenschaften der deutschen Version des Suicide Behaviors Questionnaire Revised (SBQ-R).

OBJECTIVES: The Suicide Behaviors Questionnaire-Revised (SBQ-R) was developed by Osman et al. (2001) to economically assess different aspects of suicidality. It consists of 4 items. There are several critical points concerning item construction: (1) temporal frame (e. g. retrospective vs. prospective) and (2) response labels of item 1 and 3 (e. g. 2 alternatives with the same scoring). Information about psychometric properties of the German version of the SBQ-R were not available until now. The SBQ-R is assumed to be a unidimensional measure and is evaluated using a total score, although its dimensionality has never been tested. METHODS: The SBQ-R and several measures for convergent validity were assessed in a representative sample of the German general population (N=2497). Convergent validity was tested against symptoms of depression and anxiety (PHQ-4), as well as the core constructs of the Interpersonal Theory of Suicidal Behavior (IPTS) (INQ, ACSS-FAD). Unidimensionality of the SBQ-R was tested using confirmatory factor analysis and intercorrelations with the convergent measures were calculated. RESULTS: The initial model fit of the unidimensional solution was unsatisfactory. After inclusion of a correlated error term of item 2 and item 4 based on modification indices, the model fit was very good. Moreover the SBQ-R showed satisfactory internal consistency (Cronbach's α=0.72). With the exception of the ACSS-FAD, all correlations with convergent measures were according to the theoretically proposed expectations. CONCLUSION: In principle the findings on the psychometric properties justify the use of the SBQ-R, although several critical points concerning item scoring remain unresolved. Moreover, sufficient unidimensional model fit was not possible without including correlated errors. Since suicidality is a frequently assessed construct in suicide research and as an exclusion criterion in clinical studies, it would be desirable to develop an economic, psychometrically sound and compelling instrument for the assessment of the different aspects of suicidality in future.

[Implicit Associations with Death: First Validation of the German Version of the Suicide Implicit Association Test (Suicide IAT)]. / Implizite Assoziationen mit dem Tod: Erste Validierung einer deutschen Version des Impliziten Assoziationstests für Suizidalität (Suizid-IAT).

Nock, Park, Finn, et al. 1 developed an implicit association test for suicide (suicide IAT) measuring the implicit association between 'death' and 'self'. They demonstrated that psychiatric patients, who already attempted suicide, showed stronger implicit associations with 'death' than with 'life' compared to patients without suicide attempt history. The present study had 2 aims: (1) to present a new German version of the suicide IAT and provide its first validation and (2) to investigate how implicit associations (suicide IAT) relate to suicidal ideation and behaviour, well-known risk factors such as depressiveness and hopelessness, and central concepts of the Interpersonal Theory of Suicide 2, Thwarted Belongingness and Perceived Burdensomeness. The sample consisted of 16 patients with a current Major Depression and suicidal ideation as well as 16 non-depressive, non-suicidal controls. Patients showed stronger associations between 'death' and 'self' than controls. We further found positive correlations between implicit associations with death and explicitly self-reported suicidal behaviour - controlled for depressiveness, hopelessness, and suicidal ideation. Our results confirm the validity of the German version of the suicide IAT and are discussed in the light of the Interpersonal Theory of Suicidal Behaviour 2 and recent suicide research.

Differences in Patient Health Questionnaire and Aachen Depression Item Bank scores between tablet versus paper-and-pencil administration.

PURPOSE: To extend knowledge about measurement equivalence of depression measures assessed by tablet and paper-pencil administration, the present study evaluated the effect of mode of administration (MoA) on scale and item level for the Patient Health Questionnaire (PHQ-9) and the Aachen Depression Item Bank (ADIB) in elderly patients. METHODS: Primary care patients (N = 193, ≥60 years) were assessed following a crossover design in Leipzig, Germany. All participants filled out the PHQ-9 and the ADIB in both MoAs under study. Effects of MoA were analyzed by intra-class correlation, mixed-effects regression, and differential item functioning (DIF). Additionally, detection rates between both MoAs were compared using receiver operating characteristics analysis compared to a diagnostic interview (SCID-I, N = 163). RESULTS: No effect of MoA was found in the PHQ-9 on scale score or item level. Two ADIB items showed DIF according to MoA. In terms of discriminatory power, MoA did not influence detection rates of both instruments. CONCLUSIONS: In summary, our findings suggest that no severe effect of mode of administration on self-report assessments of depression should be expected. It can be concluded that tablets provide a valid way to electronically assess depressive symptoms in elderly patients. Yet changes in item presentation can influence the psychometric properties and require equivalence testing using sophisticated analyses on item level such as DIF.

[Review Model for the Assessment of Psychometric Instruments--Recommendations of the German College of Psychosomatic Medicine (DKPM)]. / Kriterienkatalog zur Beurteilung psychodiagnostischer Selbstbeurteilungsinstrumente--Empfehlung des Deutschen Kollegiums für Psychosomatische Medizin (DKPM).

OBJECTIVES: Psychometric instruments are commonly applied in psychotherapeutic research and care for the baseline assessment of symptoms, the planning of therapeutic interventions, the assessment of the longitudinal course of symptoms and outcomes of therapeutic interventions as well as quality management of care. Psychometric properties as well as economic aspects should be considered in the selection of specific instruments. It is assumed that users of psychometric instruments face a great variety of instruments and related information. For that reason, it seems challenging to absorb the current knowledge and to integrate it into clinical practice and research. Thus, it is likely that well-known, established and easily accessible instruments are commonly used, while new developed instruments might not be disseminated in research and healthcare. METHODS: Based on available international review models, the working group "Psychometrics and Psychodiagnostics" of the German College of Psychosomatic Medicine (DKPM) has developed and tested a review model specifically tailored for psychotherapeutic research and care. RESULTS: The different steps of development, as well as the final review model based on the consensus of the working group are presented. The review model contains 6 generic terms (reliability, validity, objectivity, reference groups and aspects of application) with 21 different criteria to be assessed with 0-3 asterisks (*). The criteria are clearly operationalized and the practical use of the review model is explained and discussed. CONCLUSIONS: With the review model for the assessment of psychometric instruments a well-defined evaluation system is made available for research and clinical practice which has been developed by an expert group. The review model facilitates systematic, transparent and comparative evaluation of psychometric instruments along clearly defined criteria. It also supports the selection of psychometric instruments in research and care. Next, the working group aims at disseminating and implementing the review model as well as the application and publication of reviews for different psychometric instruments based on the review model.

Examining heterogeneity in the affect-regulating function of suicidal ideation: Person-specific analyses in male inpatients with depression.

INTRODUCTION: Men have an increased risk to die by suicide compared to women but are underrepresented in suicide research. To improve individual risk prediction for suicide-related thoughts and behaviors (STBs), risk factors are increasingly being studied at an individual level. The possible affect-regulatory function of suicidal ideation has hardly been investigated ideographically and has not yet been tested in a male sample. METHODS: We investigated the bidirectional associations between suicidal ideation and negative and positive affect in a sample of n = 21 male inpatients with unipolar depression and a history of suicidal ideation both at the group level and at the individual level. Participants underwent an intensive ecological momentary assessment for 6 days with 10 data points per day. RESULTS: We found no evidence for an affect-regulatory function of suicidal ideation at the group level, neither for effects of affect on subsequent suicidal ideation (antecedent affect-regulatory hypothesis) nor for effects of suicidal ideation on subsequent affect (consequence affect-regulatory hypothesis). Person-specific analyses revealed substantial variability in strength and direction of the considered associations, especially for the associations representing the antecedent hypothesis. CONCLUSION: The demonstrated between-person heterogeneity points to the necessity to individualize the investigation of risk factors to enhance prediction and prevention of STBs.

Psychometric properties of the modified Suicide Stroop Task (M-SST) in patients with suicide risk and healthy controls.

The Cognitive Model of Suicide proposes a suicide attentional bias in individuals with suicidal thoughts and behavior (STBs). The Suicide Stroop Task (SST) was developed as a behavioral measure to assess this attentional bias. However, prior studies demonstrated poor psychometric properties of the SST. Methods: We developed a modified Suicide Stroop Task (M-SST) and tested its psychometric properties in a sample of healthy controls (n = 30) and inpatients with STBs (n = 24). Participants (50% female, aged 18 to 61 years) completed the M-SST with neutral, positive, negative, suicide-related positive and suicide-related negative words. Interference scores were calculated by subtracting the mean reaction time (mean RT) of the neutral words from the mean RT of the suicide-related positive words (mean RTSuicide-Positive-mean RTNeutral) and suicide-related negative words (mean RTSuicide-Negative-mean RTNeutral), resulting in two suicide-specific interference scores. Similarly, interference scores were calculated for the positive and negative words by subtracting the mean RT of neutral words from the mean RT of positive and negative words. Results: When analyzed separately, patients with STBs showed greater interferences for suicide-related positive words (p = 0.039), and for suicide-related negative words (p = 0.016), however, we found no group differences in interference scores for positive and negative words, suggesting a suicide attentional bias in patients with STBs. Controlling for the repeated measure design, a repeated measure ANOVA failed to detect a significant group × interference interaction effect (p = 0.176), which limits the generalizability of the findings. However, the interference score of suicide-related negative words showed an adequate classification accuracy (AUC = 0.72, 95% CI [0.58-0.86], p = 0.006) for differentiating between healthy controls and patients with STBs. Moreover, the interference scores showed acceptable internal reliability for the total sample and only suicide-related interference scores were correlated with clinical characteristics, thus demonstrating convergent validity. Conclusion: The results provide preliminary evidence for a suicide attentional bias in individuals with STBs compared to healthy controls. The M-SST represents a promising tool for assessing a suicide attentional bias by revealing adequate psychometric properties. Future studies with larger samples are needed to confirm these preliminary findings.

Implicit measures of suicide vulnerability: Investigating suicide-related information-processing biases and a deficit in behavioral impulse control in a high-risk sample and healthy controls.

OBJECTIVE: Relevant implicit markers of suicidal thoughts and behaviors (STBs) have only been studied in isolation with mixed evidence. This is the first study that investigated a suicide attentional bias, a death-identity bias and a deficit in behavioral impulsivity in a high-risk sample and healthy controls. METHOD: We administered the Death Implicit Association Test, the Modified Suicide Stroop Task, and a Go/No-Go Task to inpatient suicide ideators (n = 42), suicide attempters (n = 40), and community controls (n = 61). RESULTS: Suicide ideators and attempters showed a suicide attentional bias and a death-identity bias compared to healthy controls. Ideators and attempters did not differ in these implicit information-processing biases. Notably, only attempters were more behaviorally impulsive compared to controls; however, ideators and attempters did not significantly differ in behavioral impulsivity. Moreover, implicit scores were positively intercorrelated in the total sample. CONCLUSION: In line with the Cognitive Model of Suicide, ideators and attempters display suicide-related information processing biases, which can be considered as implicit cognitive markers of suicide vulnerability. Furthermore, attempters have elevated levels of behavioral impulsiveness. These results are highly relevant in the context of crisis intervention strategies and warrant further research.

Torn between living or dying-analyses of influencing factors on suicide ambivalence and its longitudinally impact on suicidal ideation and behavior in a high-risk sample.

INTRODUCTION: Findings on the role of suicide ambivalence, an individual's wish to live (WL), and wish to die (WD) in the development of suicidality have been heterogenous. The main goal of this study was to examine associations of these constructs within the past week with sociodemographic factors and to longitudinally investigate their predictive power for suicidal ideation (SI) and suicide attempts (SA). METHODS: N = 308 patients (54% female; M = 36.92 years, SD = 14.30), admitted to a psychiatric ward due to suicidality, were assessed for all constructs after admission, after six, nine, and 12 months. Data were analyzed with univariate fixed-effect models and lagged mixed-effect regression models. RESULTS: Decreased, WL increased post-baseline. Gender showed no significant link to ambivalence, WD, and WL. Ambivalence and WD correlated negatively with age and positively with depressiveness. More participants in a relationship showed a WL compared with single/divorced/widowed participants. More single participants or those in a relationship showed ambivalence than divorced/widowed participants. More single participants showed a WD than participants in a relationship/divorced/widowed. Longitudinally, ambivalence and WD predicted SI and SA. CONCLUSION: The findings underscore the importance of taking suicide ambivalence and WD into account in risk assessment and treatment.

A suicide attentional bias as implicit cognitive marker of suicide vulnerability in a high-risk sample.

Introduction: Suicide risk assessment based on self-report questionnaires is considered as problematic because risk states are dynamic and at-risk individuals may conceal suicidal intentions for several reasons. Therefore, recent research efforts increasingly focus on implicit risk markers such as the suicide attentional bias (SAB) measured with the Suicide Stroop Task (SST). However, most SST studies failed to demonstrate a SAB in individuals with suicide risk and repeatedly demonstrated insufficient psychometrics of the SST. This study aimed to investigate a SAB using a modified SST (M-SST) and to test its psychometric properties. Method: We compared n = 61 healthy controls and a high-risk inpatient sample of n = 40 suicide ideators and n = 40 suicide attempters regarding interference scores of positive, negative and suicide-related words. Interference scores were calculated by subtracting the mean reaction time (mean RT) of the neutral words from the mean RT of the suicide-related words (mean RT Suicide -mean RT Neutral), resulting in a suicide-specific interference score. Similarly, interference scores were calculated for the positive and negative words by subtracting the mean RT of neutral words from the mean RT of positive and negative words. Results: A Group × Interference ANOVA showed a significant interaction effect (p <.001, ηp2 = .09), indicating that group effects significantly vary across interference type. Post hoc comparisons revealed that both ideators and attempters demonstrated greater interferences only for suicide-related words compared to healthy controls, indicating a SAB in patients, while a difference between ideators and attempters was lacking. The suicide interference score classified with an AUC = 0.73, 95% CI [0.65 - 0.82], p <.001, between controls and patients with STBs. The M-SST demonstrated good internal consistency and convergent validity. Discussion: The study adds evidence to the assumptions of the Cognitive Model of Suicide, viewing a SAB as a cognitive marker of suicide vulnerability independently of the engagement in suicidal behavior. The results' clinical implications are discussed in the context of recommended intervention strategies during an acute suicidal state. Future studies with the M-SST should include non-suicidal patient controls to investigate whether a SAB is uniquely related to suicidality.

Beyond one-size-fits-all suicide prediction: Studying idiographic associations of risk factors for suicide in a psychiatric sample using ecological momentary assessment.

The Interpersonal Psychological Theory of Suicide (IPTS) states that thwarted belongingness (TB), perceived burdensomeness (PB), and hopelessness are risk factors for suicidal ideation. This ecological momentary assessment (EMA) study aimed to (1) demonstrate that there is substantial between-person variability in the association between IPTS predictors and suicidal ideation, (2) identify clusters of patients for which the predictors differently predict suicidal ideation, and (3) examine whether identified clusters are characterized by specific patient characteristics. EMA data were collected ten times per day for six days in 74 psychiatric inpatients and was analyzed with dynamic structural equation modelling. Idiographic associations were obtained and clustered using k-means clustering. We found substantial between-person variability in associations between IPTS predictors and suicidal ideation. Four distinct clusters were identified and different risk factors were relevant for different clusters. In the largest cluster (n = 36), none of the IPTS predictors predicted suicidal ideation. Clusters in which associations between IPTS variables and suicidal ideation were stronger showed higher suicidal ideation, depression, and lower positive affect. These findings suggest that a one-size-fits-all model may not adequately reflect idiosyncratic processes leading to suicidal ideation. A promising avenue might be to use idiographic approaches to personalize prediction and interventions.

[Utilization of Outpatient Psychotherapy and Outpatient Psychiatric Treatment by Men and Women after Inpatient Treatment due to Suicide Attempt or Acute Suicidal Crisis]. / Inanspruchnahme ambulanter Psychotherapie und ambulanter psychiatrischer Behandlung von Männern und Frauen nach stationärer Behandlung aufgrund eines Suizidversuchs oder akuter suizidaler Krise.

OBJECTIVE: The strongest predictor of suicide attempts is a previous suicide attempt. Individuals hospitalized for suicidal ideation and behavior face an increased risk of suicide following discharge. This study investigates the extent to which outpatient treatment services are utilized the first 6 months after discharge and whether men and women differ in this regard. METHOD: The study examines data of 124 individuals (with suicide attempts (lifetime), 59.7% female) on the use of outpatient treatment services in the 6 months after inpatient treatment. RESULTS: 37.9% (N=47) of individuals reported not having used any treatment services at all. Men were significantly less likely to make use of the services. CONCLUSION: Members of a group with an increased risk of suicide, to a large extent, fail to make use of outpatient treatment services. Discharge management should increasingly focus on (gender-specific) barriers and pave the way for treatment in outpatient.

[A short version of the Narcissistic Personality Inventory (NPI-15): dimensionality and psychometric properties in a representative sample of the German population]. / Psychometrische Überprüfung einer Kurzform des Narcissistic Personality Inventory (NPI-15): Dimensionalität und psychometrische Eigenschaften des NPI-15 in einer repräsentativen Bevölkerungsstichprobe.

The Narcissistic Personality Inventory (NPI) is a commonly used measure of narcissism. This study administered a 15 item short version of the NPI (NPI-15). Central aims of the present study were to examine its dimensionality, and to provide data on its psychometric properties. NPI-15 and Hospital Anxiety and Depression Scale (HADS-D) were assessed in a representative sample of the German population (N=2,512). According to Scree-plot and model fit, a solution with 2 or 3 factors seemed feasible. Because of factor loadings and item-level associations to depression/anxiety we decided to favour a 2-factor-solution. 2 subscales reflecting different facets of narcissism were compiled (leadership ability/personality [LA/LP], grandiosity [G]). The psychometric properties of these scales were good (LA/LP) respectively unsatisfactory (G). The validity of the NPI-15 needs to be further studied.

Study protocol for a feasibility study of microinterventions in smartphone-based assessments to reduce depressive rumination.

INTRODUCTION: Depression as well as suicidal ideation and behaviours share several precipitating and maintaining factors and are subject to the influence of overlapping constructs. One of these transdiagnostic constructs is rumination. For the treatment of rumination, a variety of interventions are already available. However, not everyone with a need receives psychotherapeutic treatment. And even if they do: implementing learnt strategies alone at home can be challenging for patients. Therefore, this study aims to test the feasibility of delivering microinterventions for the reduction of rumination in a smartphone-based setting with the goal to make these interventions accessible to a larger number of people and support their use in everyday life. METHODS AND ANALYSIS: The study's design is an uncontrolled-within-group design. Participants with at least mild depressive symptoms and reported rumination will be included and recruited via outpatient clinics as well as in the general population. The aim is to recruit at least N=70 participants. Participants first undergo a short telephone screening, a baseline assessment, a 7-day smartphone-based assessment including microinterventions in case participants report rumination and a postassessment. For feasibility purposes, primary outcomes relate to participants' compliance, their evaluation of the smartphone-based assessment as well as the microinterventions delivered during the assessment. As a secondary goal, clinical utility will be examined. Clinical outcomes (eg, depressive symptoms, rumination) will be measured at baseline and postassessment. ETHICS AND DISSEMINATION: The ethics committee of the institute of psychology of the university of Duisburg-Essen and University of Leipzig has approved the study. Study results will be disseminated to healthcare communities, in peer-reviewed science journals and at conferences. TRIAL REGISTRATION NUMBER: DRKS00031743.

Understanding suicidal ideation-a network analysis of the Interpersonal Needs Questionnaire.

INTRODUCTION: Identifying various interacting risk factors for suicidality is important to develop preventive measures. The Interpersonal-Psychological Theory of Suicidal Behavior (IPTS) postulates suicidal ideation resulting from the occurrence of Perceived Burdensomeness (PB) and Thwarted Belongingness (TB). Suicidal behavior ultimately occurs if people have a Capability for Suicide. In past studies, the validity of TB was often not empirically confirmed, questioning which of the aspects of TB are central and related to suicidal ideation and whether applied measurement methods adequately capture the construct. METHOD: Using a sample of 3,404 individuals from different clinical and nonclinical settings, 30% (1,023) of whom reported suicidal ideation, two network analyses were conducted on the Interpersonal Needs Questionnaire (INQ) and a variable mapping suicidal ideation. RESULTS: Analyses revealed that some items of the INQ were not related to suicidal ideation and the most central items did not have the strongest associations to suicidal ideation. CONCLUSION: Based on these results, a shortened version of the INQ with the four items that showed the strongest associations with suicidal ideation in the network analyses was suggested.