Investigating the role of hallucinatory experiences in the transition from suicidal thoughts to attempts.

OBJECTIVE: Psychotic experiences, including auditory hallucinatory experiences (HEs), are strongly associated with both suicidal thoughts and behaviour. This study examined their role in the ideation-to-attempt transition in adolescents, including their direct and indirect effect via potential mediators. METHOD: Participants were from an Australian prospective longitudinal cohort of 1669 adolescents (12-17 years); of which a subsample endorsing baseline suicidal ideation (n = 216) was the focus of most analyses. Suicidal thoughts and behaviours were measured using the Self-Harm Behaviour Questionnaire. The Diagnostic Interview Schedule for Children was used to assess auditory HEs. Potential mediators of interest were psychological distress and Interpersonal Theory of Suicide (IPTS) constructs. RESULTS: Among adolescents reporting suicidal ideation at baseline (n = 216), 6.5% had attempted suicide during follow-up. The size of auditory HEs' univariate effect suggests a possible strong relationship with increased risk of incident suicide attempts (OR = 2.40; 95%CI = 0.76-7.56); however, there was inadequate statistical power to produce a precise estimate. When HEs were accompanied by distress there was a nine-fold increased risk of acting on suicidal thoughts. Distress was independently associated with risk of attempt transition (OR = 4.09), whereas IPTS constructs were poor explanatory variables in most models. CONCLUSION: Adolescents with psychological distress and auditory HEs are at high risk of incident suicide attempts. Further investigations on the role of negative/distressing content of hallucinations in the ideation-to-attempt transition are warranted.

Predicting the incidence of non-suicidal self-injury in college students.

BACKGROUND: Despite increased awareness that non-suicidal self-injury (NSSI) poses a significant public health concern on college campuses worldwide, few studies have prospectively investigated the incidence of NSSI in college and considered targeting college entrants at high risk for onset of NSSI. METHODS: Using data from the Leuven College Surveys (n = 4,565; 56.8%female, Mage = 18.3, SD = 1.1), students provided data on NSSI, sociodemographics, traumatic experiences, stressful events, perceived social support, and mental disorders. A total of 2,163 baseline responders provided data at a two-year annual follow-up assessment (63.2% conditional response rate). RESULTS: One-year incidence of first onset NSSI was 10.3% in year 1 and 6.0% in year 2, with a total of 8.6% reporting sporadic NSSI (1-4 times per year) and 7.0% reporting repetitive NSSI (≥ 5 times per year) during the first two years of college. Many hypothesized proximal and distal risk factors were associated with the subsequent onset of NSSI (ORs = 1.5-18.2). Dating violence prior to age 17 and severe role impairment in daily life were the strongest predictors. Multivariate prediction suggests that an intervention focused on the 10% at highest risk would reach 23.9% of students who report sporadic, and 36.1% of students who report repetitive NSSI during college (cross-validated AUCs = .70-.75). DISCUSSION: The college period carries high risk for the onset of NSSI. Individualized web-based screening may be a promising approach for detecting young adults at high risk for self-injury and offering timely intervention.

Riding the emotional roller coaster: The role of distress tolerance in non-suicidal self-injury.

Non-Suicidal Self-Injury (NSSI) is the deliberate damage to one's bodily tissue without suicidal intent. The Emotional Cascade Model proposes NSSI functions as a distraction from 'cascades' of intense affect and rumination. Low distress tolerance is one factor thought to potentially amplify these cascades but has yet to be empirically tested. Using the Emotional Cascade Model as a framework, we investigated the moderating roles of rumination and distress tolerance in the relationship between affect intensity and NSSI. A sample of 400 university students between the ages of 17 and 62 years (M = 21.02, SD = 5.32) completed well-validated measures of NSSI, affect intensity, rumination, and distress tolerance. As expected, rumination was associated with history of NSSI but only among individuals who reported high levels of distress tolerance. Further, affect intensity was positively associated with NSSI frequency, but only at low levels of rumination and distress tolerance. These results provide promising insight into potential prevention and intervention initiatives that may target rumination and distress tolerance to reduce the likelihood and frequency of self-injury.

The associations between non-suicidal self-injury and first onset suicidal thoughts and behaviors.

BACKGROUND: Theoretical and empirical literature suggests that non-suicidal self-injury (NSSI) is an important correlate of suicide risk. The present study was designed to evaluate: (a) whether NSSI is associated with increased odds of subsequent onsets of suicidal thoughts and behaviors (STB) independent of common mental disorders, (b) whether NSSI is associated with increased risk of transitioning from suicide ideation to attempt, and (c) which NSSI characteristics are associated with STB after NSSI. METHOD: Using discrete-time survival models, based on retrospective age of onset reports from college students (n = 6,393, 56.8% female), we examined associations of temporally prior NSSI with subsequent STB (i.e., suicide ideation, plan, and attempt) controlling mental disorders (i.e., MDD, Broad Mania, GAD, Panic Disorder, and risk for Alcohol Dependence). NSSI characteristics associated with subsequent STB were examined using logistic regressions. RESULTS: NSSI was associated with increased odds of subsequent suicide ideation (OR = 2.8), plan (OR = 3.0), and attempt (OR = 5.5) in models that controlled for the distribution of mental disorders. Further analyses revealed that NSSI was associated with increased risk of transitioning to a plan among those with ideation, as well as attempt among those with a plan (ORs = 1.7-2.1). Several NSSI characteristics (e.g., automatic positive reinforcement, earlier onset NSSI) were associated with increased odds of experiencing STB. LIMITATIONS: Surveys relied on self-report, and thus, there is the potential for recall bias. CONCLUSIONS: This study provides support for the conceptualization of NSSI as a risk factor for STB. Investigation of the underlying pathways accounting for these time-ordered associations is an important avenue for future research.

Psychotic experiences and psychological distress predict contemporaneous and future non-suicidal self-injury and suicide attempts in a sample of Australian school-based adolescents.

BACKGROUND: Recent cross-sectional studies have shown psychotic experiences (PEs) are associated with suicidal ideation and behaviours. We aimed to examine associations between psychotic experiences (including persistent PE), and contemporaneous and incident non-suicidal self-injury (NSSI) and suicide attempts. METHOD: Participants were from an Australian longitudinal cohort of 1896 adolescents (12-17 years). NSSI and suicide attempts were measured using the Self-Harm Behaviour Questionnaire. Items from the Diagnostic Interview Schedule for Children were used to assess psychotic experiences, and the General Health Questionnaire-12 measured psychological distress. RESULTS: Adolescents both psychologically distressed and endorsing psychotic experiences had increased odds of contemporaneous and incident NSSI and attempted suicide. Psychotic experiences alone did not predict future risk. Persistent psychotic experiences were associated with increased risk of NSSI and suicide attempts. CONCLUSIONS: Psychological distress with accompanying psychotic experiences and persistent psychotic experiences are important predictors of NSSI and suicide attempts. Screening these phenotypes in adolescents will assist in discerning those adolescents most at risk, providing opportunities for targeted suicide prevention strategies.

Confirmatory factor analysis of the COPE questionnaire on community drinkers and an alcohol-dependent sample.

OBJECTIVE: The COPE questionnaire has often been used as an efficient method of assessing a range of coping dimensions in many areas, including alcohol research. To date, however, this questionnaire has not been validated for use in community drinkers or alcohol-dependent samples. This study aimed to rectify this shortcoming in the literature. METHOD: Confirmatory factor analyses (CFA) were performed for 600 Australians (315 men, 285 women; 300 community drinkers and 300 individuals dependent on alcohol), in an attempt to confirm the 14 primary factors and the higher-order factor structure of the COPE. RESULTS: The results of the CFA showed that, whereas a 14-factor primary structure and the popular 3-factor higher-order structure were confirmed in the sample of community drinkers, the 4-factor model (COPE) was not confirmed. No support for any factor solution was found in the alcohol-dependent sample. CONCLUSIONS: It was concluded that the COPE has good psychometric properties when assessing community drinkers, but it is not an adequate tool for assessing dimensions of coping in an alcohol-dependent sample and should be used with extreme caution.