Longitudinal assessment of the sleep suicide link in Veterans: methods and study protocol.

Although sleep disruption has emerged as a theoretically consistent and empirically supported suicide risk factor, the mechanistic pathways underlying the sleep-suicide link are less understood. This paper describes the methodology of a study intended to examine longitudinal mechanisms driving the link between sleep and suicide in Veterans at elevated suicide risk. Participants will be 140 Veterans hospitalized for suicide attempt or ideation with plan and intent or those identified through the Suicide Prevention Coordinator (SPC) office as being at acute risk. After study enrollment, actigraphy and ecological momentary assessment (EMA) data will be collected for 8 weeks, with follow-up assessments occurring at 2, 4, 6, 8, and 26 weeks. Participants respond to EMA questionnaires, derived from psychometrically validated assessments targeting emotional reactivity, emotion regulation, impulsivity, suicide risk, and sleep timing constructs, five times a day. First and last daily EMA target sleep parameters including sleep quantity, quality, timing, nightmares, and nocturnal awakenings. During follow-up assessments, participants will complete self-report assessments and interviews consistent with EMA constructs and the Iowa Gambling Task. The primary outcome for aim 1 is suicide ideation severity and for the primary outcome for aim 2 is suicide behavior. Findings from this study will improve our understanding of the dynamic interactions among sleep disturbance, emotion reactivity/regulation, and impulsivity to inform conceptual Veteran sleep-suicide mechanistic models. Improved models will be critical to optimizing the precision of suicide prevention efforts that aim to intervene and mitigate risk in Veteran populations, especially during a period of acute risk.

Differential time varying associations among affective states and suicidal ideation among adolescents following hospital discharge.

Suicide is a major public health problem among adolescents. Identifying factors that confer increased risk for suicidal ideation, particularly during the high-risk period following psychiatric hospitalization, is essential for preventing suicide in this population. Negative and positive affect are two such important modifiable risk factors. This study examined relationships between specific affective states and suicidal ideation, collected via daily diary, as continuous functions of time among discharged adolescents. Adolescents hospitalized for suicidal ideation and/or behavior responded to daily surveys for four weeks after discharge (N = 34; 952 observations). Time-varying effects models (TVEM) were used to predict same- and next-day suicidal ideation. Examining between-persons effects, adolescents reporting greater misery and less happiness compared to others had a significantly increased likelihood of same-day suicidal ideation; between-person anger was not significantly associated with suicidal ideation. Within-persons effects suggested that elevated same-day, but not previous-day, misery and anger were associated with suicidal ideation. Elevated within-person happiness was protective for same-day suicidal ideation, but was also associated with next-day suicidal ideation. These findings begin to clarify not only which, but when, specific affective processes influence suicidal ideation for discharged adolescents. These dynamic risk factors represent modifiable treatment targets relevant for real-time interventions.

Moderators of treatment response to an intervention for nonsuicidal self-injury in young adults.

Objective: Despite the prevalence and impact of nonsuicidal self-injury (NSSI), there are few treatments developed to treat the behavior specifically, and little is known about moderators of treatment response. The Treatment for Self-Injurious Behaviors (T-SIB), a brief, behavioral intervention, was developed to treat NSSI in young adults; a previous pilot randomized controlled trial (RCT) comparing T-SIB with treatment as usual (TAU) provided support for the intervention. This study examined demographic, clinical, and NSSI-related predictors of treatment outcome in the pilot RCT for T-SIB. Method: Young adults (N = 33) were randomized to receive T-SIB or treatment as usual; all participants were included in intent-to-treat analyses. The primary outcome of NSSI behaviors was assessed at baseline, posttreatment (9 weeks), and 3-month follow up, and potential moderators were assessed at baseline. Results: Greater lifetime and last year NSSI frequency was associated with fewer NSSI behaviors at posttreatment and follow up among participants in T-SIB. Anxious symptoms also moderated treatment outcomes, but other demographic and clinical variables did not. Conclusion: Previous research has shown that T-SIB is more effective than TAU overall; the current study suggests that T-SIB may be effective for individuals with more frequent NSSI and those with elevated anxiety. A larger evaluation of T-SIB is supported. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

An intervention for nonsuicidal self-injury in young adults: A pilot randomized controlled trial.

OBJECTIVE: Nonsuicidal self-injury (NSSI) is prevalent among young adults and associated with negative medical and psychological consequences, necessitating its treatment. However, few treatments have been developed to treat NSSI specifically, or to treat the behavior among individuals without borderline personality disorder. The purpose of this study was to investigate the Treatment for Self-Injurious Behaviors (T-SIB), a brief, behavioral intervention specifically developed to treat NSSI among young adults, in a pilot randomized controlled trial (RCT). METHOD: Young adults (N = 33; age: M = 22.36 years, SD = 3.40) meeting inclusion and exclusion criteria were randomly assigned to the treatment (T-SIB; n = 15) or treatment as usual (n = 18) condition. The sample was 93.9% female, 42.4% Caucasian, and 30.3% Hispanic/Latino. RESULTS: Feasibility and acceptability of the study and intervention were supported, and medium effects were found for decreased NSSI frequency in the T-SIB group using intent-to-treat analyses. CONCLUSION: Results of this study support the further evaluation of T-SIB in a larger RCT. (PsycINFO Database Record

In our own voice-family companion: reducing self-stigma of family members of persons with serious mental illness.

OBJECTIVE: This article reports preliminary findings from a novel, family peer-based intervention designed to reduce self-stigma among family members of people with serious mental illness. METHODS: A total of 158 primary caregivers of patients with schizophrenia were recruited from a large urban mental health facility (93 caregivers) or from a family and consumer advocacy organization (65 caregivers). Caregivers (N=122) who reported they perceived at least a moderate level of mental illness-related stigma were evaluated on measures of self-stigma, withdrawal, secrecy, anxiety, and social comparison and randomly assigned to receive one of two, one-session group interventions: a peer-led intervention (In Our Own Voice-Family Companion [IOOV-FC]) designed to stimulate group discussion or a clinician-led family education session, which delivered information about mental illness in a structured, didactic format. IOOV-FC consisted of playing a videotape of family members who describe their experiences coping with stigma, which was followed by a discussion led by two family peers who modeled sharing their own experiences and facilitated group sharing. RESULTS: Of 24 family members and ten consumers, 96% rated the videotape above a predetermined acceptability threshold on a 19-item scale assessing cultural sensitivity, respect for different stakeholders, relevance of content, and technical quality (α=.92). Caregivers receiving IOOV-FC with low to moderate pretreatment anxiety reported a substantial reduction in self-stigma (effect size=.50) relative to those receiving clinician-led family education (p=.017) as well as significant reductions in secrecy (p=.031). CONCLUSIONS: Peer-led group interventions may be more effective in reducing family self-stigma than clinician-led education, at least for persons reporting experiencing low to moderate anxiety levels on a standard questionnaire