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.

Perseverative Thinking about Suicide Questionnaire (PTSQ): Validation of a new measure to assess suicide-specific rumination.

BACKGROUND: Suicide-specific rumination has been shown to be associated with lifetime suicide attempts as well as suicide intent and might be an important risk factor for the transition from suicidal ideation to suicidal behavior. Based on this background, the wording of the items of an often-used self-report measure assessing core characteristics of rumination was adapted to assess specifically suicide-specific rumination. METHODS: The entire study sample comprised N = 1689 participants from the German healthcare sector. A total of 721 participants with a history of suicidal ideation (68% female; Mage = 30.63, SDage = 8.41, range: 18-81 years) who had completed five measures assessing suicide-specific rumination, suicidal ideation, depression, hopelessness, and resilience were included for the present examination. Factorial validity (Exploratory [EFA] to determine the appropriate number of factors and confirmatory factor analyses [CFA] after randomly splitting of the sample to validate the EFA solution), construct validity, and reliability were evaluated. RESULTS: The EFA revealed a one-factor solution consisting of four items, which could be confirmed within a CFA (RMSR = 0.006; RMSEA = 0.039; CFI = 0.999; TLI = 0.998). Internal consistency was excellent with Cronbachs α = 0.93. Construct validity was given with moderate to high positive correlations with suicidal ideation (0.76), depression (0.55), and hopelessness (0.38) and negative correlation with resilience (-0.31). Participants with recent suicidal ideation and/or lifetime suicide attempt reported significantly more suicide-specific rumination than those with only lifetime suicidal ideation. CONCLUSION: A new 4-item measure for suicide-specific rumination was developed and could be shown to be a reliable and valid instrument in a large German sample. Results emphasize the potential importance of suicide-specific rumination for the understanding of trajectories of suicidal ideation and suicide risk assessments.

Brief Self-Report Measure of Agitation: A Psychometric Investigation in a German Sample.

To perform repeated measurements in clinical practice without putting unnecessary strain on patients, short instruments are needed. The Brief Self-Report Measure of Agitation (BAM) is a short measure assessing agitation, which has been associated with suicidal ideation and behavior. However, its reliability and validity have not been examined in an independent sample. A non-clinical sample of N = 429 participants aged between 18-81 (M = 27.36, SD = 9.67; 82.3% female) was surveyed online. A confirmatory factor analysis was conducted and reliability was investigated. The validity of the BAM was examined by calculating correlations and an ANOVA for differences in BAM scores between subgroups. BAM items significantly loaded onto one factor (factor loadings: ≥ .62) and the measure was found to have good reliability (Cronbach's α = .83) and convergent/discriminant validity. Participants with recent suicidal ideation and those with recent suicidal ideation and lifetime suicide attempts had significantly higher BAM scores than participants without suicidal ideation/suicide attempt. Results indicate good validity and reliability for the measurement of agitation with the German version of the BAM in the present sample. Thereby, we introduce a brief instrument in German for repeated assessment of agitation in research and clinical practice.

[Psychological Abnormalities in Children from the Perspective of Parents with a Mental Disorder]. / Psychische Auffälligkeiten bei Kindern aus Sicht des psychisch erkrankten Elternteils.

BACKGROUND: There is increased risk for children with a mentally ill parent to get a mental illness. In Germany, it is assumed that the risk for psychological abnormalities in children with a mentally ill parent is increased by a factor of 2,4. The aim of this study was to give an overview of psychological abnormalities in children with mentally ill parents. METHODS: Patients were asked about their children and possible psychological abnormalities in their children during their stay in a psychiatric ward. Data of n=118 children (51,7%) of psychiatric inpatients could be used for analyses. RESULTS: One-fourth of the children showed psychological abnormalities. According to their parent, one fourth was also in psychotherapeutic/psychiatric treatment. There were no differences in the abnormalities associated with sociodemographic factors of the parent. CONCLUSION: Our results show that children of a mentally ill parent also suffer from psychological abnormalities. More explicit analyses of the care situation of these children as well as data from direct interviews with them are needed.

Suicidal behaviour in the social environment: Does exposure moderate the relationship between an individual's own suicidal ideation and behaviour?

INTRODUCTION: Suicidal behaviour still cannot be sufficiently predicted. Exposure to suicidal behaviour in the personal social environment is assumed to moderate the individual's transition from suicidal ideation to suicidal behaviour within the integrated motivational-volitional model of suicidal behaviour (IMV model). This study aimed to investigate this moderating effect in a German high-risk sample. METHODS: We interviewed 308 psychiatric inpatients (53% female) aged 18 to 81 years (M = 36.9, SD = 14.30) admitted after attempted suicide (53%) or due to an acute suicidal crisis (47%) regarding exposure events in their social environment. Four types of exposure events were analysed using moderation analyses: familial suicides/suicide attempts and non-familial suicides/suicide attempts. Additionally, the numbers of reported exposure events were compared between patients with and without a recent suicide attempt as well as between patients with lifetime suicide attempts and lifetime suicidal ideation. RESULTS: Neither moderating effects of exposure events on the relationship between lifetime suicidal ideation and recent suicidal behaviour nor group differences between suicidal ideators and suicide attempters regarding the exposure events were found. CONCLUSIONS: Exposure events might have differential and possibly protective effects on suicidal behaviour-depending on type and quality (intensity, personal relevance and recency) of event-and on the outcome (suicide vs. suicide attempt).

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.

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.

Sex differences in entrapment in a multinational sample: a network analysis perspective.

Background: The concept of entrapment has been highlighted as a transdiagnostic element that manifests itself in disorders such as depression, anxiety, and suicidal ideation. Although research has been conducted in different contexts independently, a comprehensive multi-country study to assess gender differences in entrapment through network analysis has not yet been carried out. The objective of this study was to evaluate the entrapment network in men and women at the multinational level. Methods: A sample of 2,949 participants, ranging in age from 18 to 73 years from six countries (Germany, Iran, Spain, Slovakia, El Salvador, and Peru), was considered. They completed the entrapment scale. A network analysis was performed for both men and women to identify the connectivity between indicators and the formation of clusters and domains, in addition to the centrality assessment in both sex groups. Results: The study findings revealed the presence of a third domain focused on external interpersonal entrapment in the network of men and women. However, in relation to the interconnectivity between domains, variations were evidenced in both networks, as well as in centrality, it was reported that men present a greater generalized entrapment in various aspects of life, while women tend to experience a more focused entrapment in expressions of intense emotional charge. Conclusion: The multinational study identified variations in the structure of entrapment between genders, with three domains (internal, external, and external-interpersonal) and differences in the interaction of indicators and groupings, as well as discrepancies in centrality.

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.

Attachment and need to belong as moderators of the relationship between thwarted belongingness and suicidal ideation.

BACKGROUND: In the Interpersonal Theory of Suicide, thwarted belongingness is presented as a main predictor for suicidal ideation. Studies only partially support this prediction. The aim of this study was to examine whether the heterogenous results are due to moderating effects of attachment and the need to belong on the association between thwarted belongingness and suicidal ideation. METHODS: Four hundred forty-five participants (75% female) from a community sample aged 18 to 73 (M = 29.90, SD = 11.64) filled out online questionnaires about romantic attachment, their need to belong, thwarted belongingness, and suicidal ideation cross-sectionally. Correlations and moderated regression analyses were conducted. RESULTS: The need to belong significantly moderated the relationship between thwarted belongingness and suicidal ideation and was associated with higher levels of anxious attachment and avoidant attachment. Both attachment dimensions were significant moderators of the relationship between thwarted belongingness and suicidal ideation. CONCLUSION: Anxious and avoidant attachment as well as a high need to belong are risk factors for suicidal ideation in people with thwarted belongingness. Therefore, attachment style and need to belong should both be considered in suicide risk assessment and therapy.

[Need of Help and Social Support of Parents with a Mental Disorder]. / Hilfsbedarf und soziale Unterstützung bei psychisch erkrankten Elternteilen mit minderjährigen Kindern.

Studies could already show that parents with a mental disorder have a high need for social support but the use of offered help is scarce. The main goal of this study was therefore to assess the need of help as well as the extent of social support of parents with mental illness. N = 100 psychiatric inpatients (49 % female) with underaged children were assessed for need of help, use of help and social support. 99 % of patients reported to have received help. 53 % of patients reported to have further need for social support. 36 % of patients reported a below-average extent of social support. There were sociodemographic differences in the extent of social support. Even though, parents with mental illness make use of offered help, they do not experience social support in the extent that they need it. This underlines the high need as well as the importance of social support for parents with mental illness.

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.

Ambivalent heroism? - Psychological burden and suicidal ideation among nurses during the Covid-19 pandemic.

AIM: During the Covid-19 pandemic, the risk for nurses' mental health has rapidly increased. The two main goals of this study were the examination of (1) the psychological burden and (2) of suicidal ideation and its associated risk factors one year after the Covid-19 pandemic begun. DESIGN: This was a cross-sectional online survey. METHODS: N = 1311 nurses (96.9% female) aged 18-63 years (M = 30.96, SD = 8.48) were assessed for various symptoms of psychological burden, suicidal ideation and behaviour and its risk factors. RESULTS: Almost half of participants (41.5%) reported heightened levels of depressive symptoms, 691 (52.7%) reported a medium to high risk for burnout. One fifth of participants (21.7%) reported suicidal ideation in the past 4 weeks. The direct contact to people with Covid-19 was not related to the extent of the psychological burden. Depression, agitation, perceived burdensomeness and previous suicide attempt were associated with suicidal ideation.

Trapped in my inner prison-Cross-sectional examination of internal and external entrapment, hopelessness and suicidal ideation.

BACKGROUND: Within the integrated motivational-volitional model of suicidal behavior, entrapment that consecutively leads to hopelessness is considered as a proximal risk factor for suicidal ideation. Entrapment can refer to both external and internal circumstances whereby results of recent studies indicate that internal entrapment plays a more important role than external entrapment in the development of suicidal ideation. It has been considered that to escape internal entrapment might be more complicated than to change external circumstances. However, it remains unclear whether the greater effect of internal entrapment on suicidal ideation is due to greater feelings of hopelessness. Therefore, the aim of this study was to address this research gap and to examine the effects of internal and external entrapment on hopelessness and suicidal ideation. METHODS: N = 454 participants from a community sample (75% female) aged between 18 and 73 years (M = 29.91, SD = 11.56) conducted a cross-sectional online survey. All participants were assessed for suicidal ideation, hopelessness, and internal as well as external entrapment. Pearson product-moment correlations and two mediation analyses were conducted. RESULTS: All constructs were significantly correlated. For both internal and external entrapment, an effect on suicidal ideation was found. Both effects were partially mediated by hopelessness, this mediation was larger for external entrapment. The completely standardized indirect effect used to compare the mediation models was larger for external entrapment than for internal entrapment. CONCLUSIONS: Hopelessness mediated the association between external entrapment as well as internal entrapment and suicidal ideation. This effect was larger for external entrapment.

The Mereology of Depression-Networks of Depressive Symptoms during the Course of Psychotherapy.

(1) Background: Research has shown that it is important to examine depressive symptoms in the light of the mereology (the ratio between one symptom and the whole disorder). The goal of this study was to examine changes in the symptom interrelations of patients undergoing cognitive behavioral therapy treatment (CBT) via network analyses. (2) Method: Outpatients with depressive symptoms (N = 401) were assessed with the Beck Depression Inventory three times (pretreatment, after 12 sessions, and post-treatment) during CBT. Gaussian graphical models were used to estimate the relationships among symptoms. (3) Results: The severity of depressive symptoms significantly decreased over the course of therapy, but connectivity in the networks significantly increased. Communities of symptoms changed during treatment. The most central and predictable symptom was worthlessness at baseline and after 12 sessions, and loss of energy and self-dislike at post-treatment. (4) Conclusion: The results indicate that the severity of depressive symptoms decreased during cognitive behavior therapy, while network connectivity increased. Furthermore, the associations among symptoms and their centrality changed during the course of therapy. Future studies may investigate individual differences and their impact on the planning of psychotherapeutic treatment.

Defeat, entrapment, and suicidal ideation: Twelve-month trajectories.

BACKGROUND: Defeat and entrapment have been highlighted in the development of suicidal ideation within the Integrated Motivational-Volitional model of suicidal behavior. Research suggests that entrapment has to be differentiated into internal and external entrapment. The aim of this study was to investigate the associations between defeat, internal, external entrapment, and suicidal ideation within and prospectively over measurements. METHODS: A sample of 308 psychiatric inpatients (53% female) aged 18 to 81 years (M = 36.92, SD = 14.30) was assessed for the four constructs after admission to a psychiatric ward and six, nine, and twelve months later. Multilevel analyses were conducted to examine associations. RESULTS: Defeat was associated with (a change in) internal and external entrapment. Defeat predicted a change in internal entrapment over time. Defeat and internal, but not external, entrapment were associated with (a change in) suicidal ideation. Internal entrapment was able to predict suicidal ideation. Internal entrapment and defeat predicted a change in suicidal ideation over time. CONCLUSION: Results highlight the importance to distinguish between internal and external entrapment, and their specific association with suicidal ideation. Perceptions of internal entrapment are of central relevance when experiencing suicidal ideation and should be considered in clinical practice.

Listen to Your Heart-Ecological Momentary Assessment of Interoceptive Accuracy, Awareness and Sensibility: A Pilot Study.

Background: Interoception is a multi-facetted phenomenon including interoceptive accuracy, awareness and sensibility. Deficits in interoception have been associated with psychological distress. However, little is known about the course of interoception over time. The present study aimed at examining interoception in an ecological momentary assessment (EMA)-setting. Methods: A seven-day smartphone-based EMA was conducted in a community sample of sixty-one participants (age: M = 24.1, SD = 7.00, n = 54 female (88.5%)). To control for potential practice effects of repeated assessments during the EMA phase, participants were randomly assigned to a control (n = 30) and an interoception (n = 31) group. The latter was assessed for interoceptive accuracy, awareness and sensibility. Before and after the EMA phase, all participants were assessed for interoception in the laboratory. Results: Multilevel analyses revealed significant fluctuations for all three interoceptive facets, around 50% of variance was due to within-person variability. There were only practice effects for the subscale "Attention Regulation", measuring interoceptive sensibility. Conclusion: The facets of interoception can be assessed in an EMA-setting. Repeated interoceptive assessments do not necessarily lead to an improvement of participants' interoceptive abilities. It could be shown that all interoceptive facets fluctuate, which should be considered in future research.

Do Feelings of Defeat and Entrapment Change over Time? An Investigation of the Integrated Motivational-Volitional Model of Suicidal Behaviour Using Ecological Momentary Assessments.

(1) Background. Defeat and entrapment have been highlighted as major risk factors of suicidal ideation and behavior. Nevertheless, little is known about their short-term variability and their longitudinal association in real-time. Therefore, this study aims to investigate whether defeat and entrapment change over time and whether defeat predicts entrapment as stated by the integrated motivational-volitional model of suicidal behavior. (2) Methods. Healthy participants (n = 61) underwent a 7-day smartphone-based ecological momentary assessment (EMA) on suicidal ideation/behavior and relevant risk factors, including defeat and entrapment and a comprehensive baseline (T0) and post (T2) assessment. (3) Results. Mean squared successive differences (MSSD) and intraclass correlations (ICC) support the temporal instability as well as within-person variability of defeat and entrapment. Multilevel analyses revealed that during EMA, defeat was positively associated with entrapment at the same measurement. However, defeat could not predict entrapment to the next measurement (approximately two hours later). (4) Conclusion. This study provides evidence on the short-term variability of defeat and entrapment highlighting that repeated measurement of defeat and entrapment-preferably in real time-is necessary in order to adequately capture the actual empirical relations of these variables and not to overlook significant within-person variability. Further research-especially within clinical samples-seems warranted.