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.

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.

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).

Child abuse and suicidality in the context of the Interpersonal Psychological Theory of Suicide: A network analysis.

OBJECTIVES: While there is evidence for an association of child abuse with suicidality in the course of life, the underlying mechanisms remain unclear. The Interpersonal Psychological Theory of Suicide (IPTS) provides a theoretical framework to investigate this relationship. The present study examines how different subtypes of child abuse are related to suicidal ideation and to attempts in the context of the IPTS. METHODS: 146 psychiatric inpatients (M = 37.9 years, 62% female) with an acute suicidal crisis (n = 71) or a recent suicide attempt (n = 74) were examined at baseline (T0) and six (T1) months later. We measured emotional, physical, and sexual abuse, the constructs of the IPTS (thwarted belongingness, perceived burdensomeness, and capability for suicide) and suicidal ideation as well as suicide attempts. Using the statistics program R, a network analysis of all named constructs was conducted. Centrality measures were computed. RESULTS: Emotional abuse was the most central kind of abuse in the network and had a direct relationship with suicide attempts and an indirect relationship with suicidal ideation via perceived burdensomeness. Physical and sexual abuse showed no significant relations with the different constructs of the IPTS. CONCLUSION: The major limitation of this study was the modest sample size which reduced the number of variables able to be included in the network. Regarding child abuse, the results underline that emotional abuse plays a central role in this network and may be important for suicide risk assessment. Future research should address this topic in a larger sample. PRACTITIONER POINTS: Emotional abuse was the most central kind of abuse in this network analysis. Sexual abuse was the only kind of abuse with a direct relation to suicidal ideation. Capability for suicide had just a marginal position in the network analysis. Early interventions addressing the effects of child abuse are recommended. Replications in larger samples and with more relevant variables are needed.

Predicting suicidal ideation in a longitudinal high-risk sample: Multilevel analyses and 12-month trajectories.

BACKGROUND: The Interpersonal Theory of Suicide states that suicidal ideation (SI) results from perceived burdensomeness (PB) and thwarted belongingness (TB). Cross-sectional studies found associations with SI. This study examined the prospective prediction of SI. METHODS: Three hundred and eight inpatients reporting severe SI or a recent suicide attempt were assessed four times within 12 months. The prediction of SI was examined using multilevel analyses, group comparisons, and logistic regression analyses. RESULTS: Cross-sectionally, PB and TB were associated with SI. Prospectively, neither PB nor TB predicted SI. We found no autocorrelation of SI over time. Patients with persistent and fluctuating SI reported higher PB at T0. PB predicted the persistence of SI over 12 months. CONCLUSION: Results emphasize cross-sectional associations between PB, TB, and SI. PB and TB could not predict the intensity of SI over time. SI did not predict itself over time. PB was associated with a persistent trajectory of SI over 12 months.

[Fears in Dealing with Suicidal Patients: A Comparative Examination of Licensed Psychotherapists and Psychotherapeutic Trainees]. / Ängste im Umgang mit suizidalen Patient/innen: Eine vergleichende Untersuchung von approbierten Psychotherapeut/innen und Psychotherapeut/innen in Ausbildung.

OBJECTIVE: A patient's suicide is the most frequently mentioned occupational fear of psychotherapists. In the present study, fears in dealing with suicidal patients shall be specified - regarding licensed psychotherapists (LP) as well as psychotherapeutic trainees (PT). The results were compared to an analogous examination from 1996. METHODS: N=271 psychologists, thereof n=90 licensed psychotherapists and n=181 psychotherapeutic trainees, participated in an online survey. Fears in dealing with suicidal patients and occupational experiences with suicidal patients were investigated using a German Questionnaire of Capturing Therapists' Fears with Suicidal Patients by Dorrmann (2016). Furthermore, suicide-linked knowledge was examined with a short self-designed test. The following hypotheses were investigated: (1) LP have less fears in dealing with suicidal patients than PT, (2) PT and LP differ from each other regarding their suicide-linked knowledge and occupational experience, (3) the results of the current survey show less fears in dealing with suicidal patients than the results of a preceding survey by Dorrmann (1996). Eventually, the following exploratory issue was considered: Does the status (LP vs. PT) have impact on the fears while being mediated by the occupational experience as well as the suicide-linked knowledge? RESULTS: The following fears are most commonly mentioned by therapists: fear of feelings of guilt/self-blame after a suicide/attempted suicide, fear of misjudgment and the associated consequences, fear of legal consequences after a suicide/attempted suicide and fear of accusations by others (relatives of the patient/colleagues) after a suicide/attempted suicide. Psychotherapeutic trainees report higher fears dealing with suicidal patients than approbated psychotherapists. Professional experience mediates the correlation between professional status and fears. In comparison, therapists today report less fears than 20 years ago. CONCLUSION: Therapists are mainly afraid of the consequences of a suicide/attempted suicide. However, in total, fears are represented in a more moderate form and seem to be less distinctive than 20 years ago. It can be assumed that an increasing professionalization of the therapeutic interaction with suicidal patients has led to a reduction of therapists' fears.

From decision to action: Suicidal history and time between decision to die and actual suicide attempt.

A substantial proportion of suicide attempts seem to be realized in a sudden manner. However, it is unclear how suicide attempters showing a rapid transition from the decision to die to acting differ from suicide attempters showing a slower transition regarding their suicidal history. The main aim of this study was to determine the proportion of suicide attempters, who reported a rapid transition (≤5, ≤10, ≤180 min) between their decision to die and their actual attempt. Furthermore, attempter groups (≤ vs. >5, ≤ vs. >10 and ≤ vs. >180 min) were compared regarding suicidal history (ideation, plans, and number of lifetime as well as 12 month suicide attempts) as well as depression, hopelessness and trait impulsivity. In total, 118 inpatients (62.7% female; age: M = 38.71, SD = 14.71) hospitalized due to a recent suicide attempt were assessed using structured clinical interview measures assessing suicidal history and self-report instruments. Thirty-six percent reported a time period of ≤5 min, 44% a time period of ≤10 min and 73% a time period of ≤180 min between their decision to die and their attempt. Participants with a rapid transition (≤5, ≤10, ≤180 min) did not differ from participants with a slower transition (>5, >10, >180 min) regarding suicidal history, depression, hopelessness and trait impulsivity. Taken together, a rapid transition seems common, but nevertheless, rapidly realized suicide attempts cannot necessarily be characterized as impulsive.

Is the relationship between child abuse and suicide attempts mediated by nonsuicidal self-injury and pain tolerance?

Although there is evidence for an association of child abuse with lifetime suicidal behaviour, the underlying mechanisms remain unclear. In recent research, we found this relationship to be indirect and mediated by capability for suicide (CS). Emotional and sexual abuse were directly associated with CS. Based on the Interpersonal Psychological Theory of Suicide, the result for emotional abuse was surprising and raised the question for a missing link in this association. Consequently, this study examines nonsuicidal self-injury (NSSI) as an additional mediator (M1 ) between child abuse (X), pain tolerance (M2 ), and suicide attempts (Y). We included 308 psychiatric inpatients (M = 36.9 years, 53% female) with either an acute suicidal crisis (n = 146) or a recent suicide attempt (n = 157). For the assessment, we used the Childhood Trauma Screener (CTS), the German version of the self-injurious thoughts and behaviours interview (SITBI-G), the German Capability for Suicide Questionnaire (GCSQ), and a pressure algometer for measuring pain tolerance objectively. Serial mediator analyses were applied. All types of abuse showed relationships with NSSI, which itself was connected to suicidal behaviour in almost all models, whereas pain tolerance did not show the expected relations. The results suggest that NSSI is an important predictor for suicide attempts and should be considered in suicide risk assessment. Future research should address this topic in prospective studies with a more comprehensive assessment of child abuse. In summary, this study once again highlights the serious effects of child abuse and in particular the mediating role of NSSI.

Validation of the German capability for suicide questionnaire (GCSQ) in a high-risk sample of suicidal inpatients.

BACKGROUND: The German Capability for Suicide Questionnaire (GCSQ) was developed to measure fearlessness of death and pain tolerance - two constructs central to the Interpersonal Theory of Suicide. Initial scale development, definition of the factor structure and confirmation of the two-dimensional factor structure was performed in samples suffering from relatively low levels of suicide ideation/behavior. The present study aimed to validate the German Capability for Suicide Questionnaire (GCSQ) in a high-risk sample of suicidal inpatients. METHODS: Factor structure, reliability and validity were investigated in a sample of inpatients (N = 296; 53.0% female; age in years: M = 36.81, SD = 14.27) admitted to a hospital due to a recent suicide attempt or an acute suicidal crisis (in immediate need of inpatient treatment). To establish convergent validity, interview-based assessments of lifetime suicide attempts and non-suicidal self-injury as well as questionnaire-based assessments of painful and provocative events were used. Finally, stability of GCSQ-scores over a follow-up period of 12 months was assessed. RESULTS: Results indicated good psychometric properties, and provided additional evidence for construct validity and stability of the subscales over a one-year period, and demonstrated adequate fit of the data with respect to the original factor structure. CONCLUSIONS: Results suggest that the GCSQ is a brief, reliable, and valid measure of capability for suicide that can be used in clinic assessment and research.

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.

Pain persistence and lethality of suicide attempts.

The interpersonal-psychological theory of suicide posits that elevated pain tolerance is necessary to engage in suicidal behaviour. It is assumed that suicidal intent only leads to lethal (or near lethal) suicide attempts when an individual has the capability to persist the pain involved in dying. The aim of this study was to assess whether objective pain persistence moderates the association between suicide intent and lethality of a recent suicide attempt. Ninety-seven inpatients, who were hospitalized due to a recent suicide attempt, were interviewed regarding lifetime suicide attempts as well as their most recent suicide attempt: Method of attempt, intention to die, medical risk of death, probability of an intervention, and physical condition following the attempt were inquired. Pain persistence was examined using a pressure algometer. Contrary to the expectation, pain persistence did not moderate the association between suicide intent and lethality of a recent suicide attempt, that is, medical risk of death, probability of an intervention, or physical condition following the attempt. Future studies are needed to examine method specific pain persistence for suicidal behaviour in a longitudinal study design.

Sense it and use it: interoceptive accuracy and sensibility in suicide ideators.

BACKGROUND: Interoceptive deficits have been found to be associated with suicidal ideation and behavior. However, an objective measure of interoceptive accuracy has not been investigated in participants with suicide ideation, by now. This study aimed at investigating interoceptive accuracy and sensibility in persons with and without suicide ideation (SI) while controlling for severity of depressive symptoms. METHOD: Ninety-five participants (age: M = 34.8, SD = 11.6, n = 56 female [58.9%]; n = 51 patients with a Major Depressive Disorder and n = 44 healthy participants) were assessed for interoceptive accuracy and sensibility, depression and SI. RESULTS: Twenty-five participants (26%) reported SI. They showed interoceptive accuracy comparable to persons without SI (t = -.81, p = .422), but significantly lower interoceptive sensibility. After controlling for severity of depressive symptoms in a hierarchical linear regression analysis, most associations between interoceptive sensibility and SI disappeared. CONCLUSION: Results suggest that suicide ideators do not lack the ability to perceive their own bodily signals but they feel less able to use them in a way that is advantageous for them. Differences between suicide ideators and non-ideators appear to be largely driven by depressive symptoms (depression bias).

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.

Calibration of an item bank in 474 orthopedic patients using Rasch analysis for computer-adaptive assessment of anxiety.

OBJECTIVE: To calibrate an item bank of anxiety-related questions for use in orthopedic patients within a computer-adaptive test. DESIGN: This is a psychometric study. SETTING: The sample of orthopedic patients was recruited in two orthopedic rehabilitation clinics in Germany. SUBJECTS: A total of 474 orthopedic rehabilitation patients were recruited for this study. INTERVENTIONS: Not applicable. MAIN MEASURES: The main measure is an adapted version of an existing anxiety item pool for cardiovascular rehabilitation patients. RESULTS: The results of the confirmatory factor analysis and Mokken analysis confirmed a one-factor structure and double monotonicity. An anxiety item bank (48 items) could be developed and calibrated using Rasch analysis. It fitted to the Rasch model with a non-significant item-trait interaction (χ2(203) = 172.59; P = .94) and was free of differential item functioning. Unidimensionality could be verified and the person separation reliability was .96. The category threshold parameters varied between 4.72 and 3.16 (7.88 logits). CONCLUSION: The unidimensional anxiety item bank provides the basis for a computer-adaptive test to assess a wide range of anxiety in rehabilitation patients with orthopedic diseases with very good psychometric characteristics.

Defeat and entrapment: more than meets the eye? Applying network analysis to estimate dimensions of highly correlated constructs.

BACKGROUND: Defeat and entrapment have been shown to be of central relevance to the development of different disorders. However, it remains unclear whether they represent two distinct constructs or one overall latent variable. One reason for the unclarity is that traditional factor analytic techniques have trouble estimating the right number of clusters in highly correlated data. In this study, we applied a novel approach based on network analysis that can deal with correlated data to establish whether defeat and entrapment are best thought of as one or multiple constructs. METHODS: Explanatory graph analysis was used to estimate the number of dimensions within the 32 items that make up the defeat and entrapment scales in two samples: an online community sample of 480 participants, and a clinical sample of 147 inpatients admitted to a psychiatric hospital after a suicidal attempt or severe suicidal crisis. Confirmatory Factor analysis (CFA) was used to test whether the proposed structure fits the data. RESULTS: In both samples, bootstrapped exploratory graph analysis suggested that the defeat and entrapment items belonged to different dimensions. Within the entrapment items, two separate dimensions were detected, labelled internal and external entrapment. Defeat appeared to be multifaceted only in the online sample. When comparing the CFA outcomes of the one, two, three and four factor models, the one factor model was preferred. CONCLUSIONS: Defeat and entrapment can be viewed as distinct, yet, highly associated constructs. Thus, although replication is needed, results are in line with theories differentiating between these two constructs.