Thought control strategies as predictors of borderline personality disorder and suicide risk.

BACKGROUND: Borderline Personality Disorder (BPD) is characterized by a pattern of instability in interpersonal relationships, affect, self-image and is marked by behavioral impulsivity including suicidal ideation and attempts. Additionally, individuals with BPD tend to engage in maladaptive ruminative thinking that is also related to suicidal ideation and attempts. Given these relations, this study aims to understand the 5 strategies of thought control (distraction, punishment, reappraisal, worry, and social control) as predictors of BPD symptoms and suicide risk. METHODS: The sample was collected at a Southeastern University using a convenience sample of undergraduate participants. The final sample (n = 403) had an age range of 18 to 27 (M  = 19.67, SD = 1.45), was 74.4% female and 25.6% male, and was primarily Caucasian (69.7%) and African American (24.8%). RESULTS: Results demonstrate that distraction was negatively associated with BPD and suicide risk while worry and punishment were positively associated with BPD and suicide risk across three different measures of BPD. Social control was negatively associated with suicide risk and BPD but only on one of the BPD measures. Lastly, reappraisal was positively related to BPD symptoms on two measures. LIMITATIONS: Given the sample characteristics, there may be limitations in the generalizability of the findings. CONCLUSIONS: The findings represent a first step towards examining thought control strategies as possible predictors of BPD symptoms and suicide that can inform clinical interventions designed to increase or decrease utilization of these specific strategies.

Screening for suicide risk in adult sleep patients.

Outpatient visits for sleep-related difficulties and the rate of suicide in the United States have both increased by more than 20% since 1999. Research suggests that anywhere from 75% to 91% of suicide decedents had contact with a physician within the year prior to fatally attempting suicide. Although the prevalence of such contacts among sleep clinicians is unknown, it is important to note that sleep disturbances in general are both a risk factor and potential warning sign for suicide. Screening for suicide risk among sleep patients is recommended, especially among those with a history of psychiatric and chronic medical conditions. Using evidence-based screening tools, such as the Columbia suicide severity rating scale, when screening patients for suicide risk is recommended despite the need for more research on the efficacy of suicide screening. For sleep clinic professionals who do not have the time to comprehensively assess and manage suicide risk, they are encouraged to implement suicide prevention policies within their departments and clinics and to follow the best available evidence to inform these policies. A protocol for screening for suicide risk in sleep clinics is outlined along with triage and documentation recommendations.

Sleep Disturbance, Activities of Daily Living, and Depressive Symptoms among Older Adults.

OBJECTIVE: Research suggests sleep disturbance plays a role in depression and risk for suicidal behavior (i.e., ideation, attempts, death by suicide). How sleep disturbance affects suicide risk is unclear and one's ability to perform activities of daily living (ADLs) may help explain this relation. This study examined associations between sleep problems, ADLs, and either depressive symptoms or suicide risk among older adults. We hypothesized that ADLs would mediate relations between sleep problems and depressive symptoms and suicide risk. METHOD: Participants (N = 134; age ≥65) were recruited through Amazon's Mechanical Turk. Participants completed questionnaires that assessed insomnia symptoms, nightmares, ADLs, depressive symptoms, and suicidal behaviors. RESULTS: Nightmares were associated with depressive symptoms and suicide risk but not independently associated with ADLs. Insomnia symptoms were associated with depressive symptoms, suicide risk, and ADLs. ADLs mediated the relation between insomnia symptoms and depressive symptoms. The insomnia symptom-suicidal behavior relation and the nightmare-suicidal behavior relation were significantly mediated by a pathway containing ADLs and depressive symptoms. DISCUSSION: ADLs help explain how insomnia symptoms and nightmares confer suicide risk among older adults, either independently or in association with depressive symptoms. CLINICAL IMPLICATIONS: Practitioners should attend to ADL performance when treating older adults with insomnia and depression.

What role do nightmares play in suicide? A brief exploration.

The suicide rate in the United States has climbed each year for more than a decade, highlighting the need for greater understanding of, and prevention strategies for suicidal behavior. Nightmares have been shown to be associated with suicidal behavior independent of several psychiatric risk factors for suicide, such as symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). The specific role of nightmares in contributing to suicide remains unclear due to the difficulty in delineating causal factors. However, the reporting, screening and treatment of nightmares continues to remain rare making progress difficult. Research is beginning to make some progress in uncovering the mechanisms by which nightmares increase suicide risk providing opportunities for intervention and prediction of suicidal behaviors.