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1.
J Consult Clin Psychol ; 89(6): 528-536, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34264700

RESUMO

OBJECTIVE: Despite considerable evidence that supports perceived burdensomeness (PB) and thwarted belongingness (TB) as risk factors for suicidal ideation (SI), far less is known about the direction of effects between these constructs in treatments for suicidal adolescents. The present study examined bidirectional relations between PB, TB, and adolescents' suicidal ideation (SI) during a 16-week randomized clinical trial. METHOD: 129 depressed and suicidal adolescents completed PB, TB, and SI measures at three time points: baseline (T1), mid-treatment (T2), and treatment completion (T3). Random-intercept cross-lagged panel models (RI-CLPM) examined within-subject direction of effects between interpersonal variables (PB & TB) and suicidal ideation (SI) in the first and second halves of treatment. RESULTS: Within-subjects, autoregressive paths indicated significant carryover in PB and SI. In the first half of treatment, a significant cross-lagged path indicated that T1 PB predicted change in T2 SI, and in the last half of treatment change in T2 SI predicted change in T3 PB. There were no significant auto-regressive or cross-lagged effects for TB. CONCLUSIONS: In the first half of treatment, baseline PB predicted fewer reductions in SI suggesting that PB initially moderated adolescents' response to treatment. However, in the last half of treatment, initial reductions in SI predicted subsequent reductions in PB suggesting that adolescents' initial response to treatment decreased their perceptions of burdening others. The clinical and treatment implications of these bidirectional findings are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Depressão/terapia , Terapia Familiar/métodos , Suicídio/prevenção & controle , Suicídio/psicologia , Adolescente , Feminino , Humanos , Relações Interpessoais , Masculino , Relações Pais-Filho , Teoria Psicológica , Psicoterapia/métodos , Fatores de Risco , Ideação Suicida , Inquéritos e Questionários
2.
J Consult Clin Psychol ; 87(12): 1137-1148, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31647277

RESUMO

OBJECTIVE: Although there are currently several efficacious treatments for depressed and suicidal adolescents, less is known about predictors and moderators of adolescents' treatment response. A growing literature has identified family functioning as a prognostic indicator of adolescents' likelihood of benefiting from treatment. The current study tested both observational and perceived measures of family functioning as indicators of adolescents' response to 2 treatment conditions. METHOD: The sample consisted of 129 depressed and suicidal adolescents (Mage = 14.96, 82.9% female, 56% Black/African American) who were randomized to attachment-based family therapy or family-enhanced nondirective supportive therapy (Diamond et al., 2019). Baseline assessments of family functioning included ratings of parent-adolescent communication coded with the Goal-Corrected Partnership in Adolescence Coding System (Lyons-Ruth, Hennighausen, & Holmes, 2005) and adolescent and parent reports of Family Conflict and Cohesion from the Self-Report of Family Functioning (Bloom, 1985). RESULTS: Adolescents who engaged in more uncooperative communication with their parents during a 10-min conflict discussion showed greater reductions in depressive symptoms in both treatments. Adolescents from traditionally underserved (non-White or lower income) families showed greater reductions in suicidal ideation in both treatments. CONCLUSIONS: Attachment-based family therapy and family-enhanced nondirective supportive therapy were most effective for adolescents from traditionally underserved families and adolescents who engaged in less cooperative communication with their caregivers. Observational ratings of parent-adolescent communication were better prognostic indicators of treatment response than were self-reported indicators of global family functioning. Implications for generalizing these results to other treatments for depressed and suicidal adolescents are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Comportamento do Adolescente , Comunicação , Depressão/terapia , Terapia Familiar/métodos , Apego ao Objeto , Avaliação de Resultados em Cuidados de Saúde , Relações Pais-Filho , Ideação Suicida , Adolescente , Técnicas de Observação do Comportamento , Feminino , Humanos , Masculino , Autorrelato
3.
J Am Acad Child Adolesc Psychiatry ; 58(9): 897-906, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30877051

RESUMO

OBJECTIVE: Although several treatments have been shown to be effective in treatment of youth suicidal thoughts and behaviors (STBs), there is a pressing need to account for the substantial variation in adolescents' response to and outcomes from these treatments. METHOD: Secondary analyses of data from a 16-week randomized trial of Attachment-Based Family Therapy (ABFT) and Family-Enhanced NonDirective Supportive Therapy (FE-NST) identified distinct classes of adolescents' treatment response. Established risk factors for STBs, along with treatment condition and sociodemographic variables, were then tested as predictors of class membership. RESULTS: Three patterns of adolescents' treatment response and outcome were identified: a) nonresponders (15.8%), b) good responders (57.5%), and c) partial responders (26.7%). After controlling for initial symptom severity, nonresponders were more likely to have higher levels of nonsuicidal self-injury and pessimism and were more likely to meet diagnostic criteria for major depressive disorder (MDD) than good or partial responders. Partial responders were more likely than good responders to meet criteria for MDD and to have higher perceived burdensomeness. CONCLUSION: Although most adolescents showed significant symptom reductions with both treatments, adolescents with higher pretreatment levels of pessimism, MDD, nonsuicidal self-injury, and perceived burdensomeness were less likely to show an optimal pattern of treatment benefit. The findings point to heterogeneity in treatment response that may require adapting treatments for adolescents with these pretreatment profiles. CLINICAL TRIAL REGISTRATION INFORMATION: Attachment-Based Family Therapy for Suicidal Adolescents; http://clinicaltrials.gov; NCT01537419.


Assuntos
Transtorno Depressivo Maior/terapia , Terapia Familiar/métodos , Apego ao Objeto , Ideação Suicida , Adolescente , Criança , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Philadelphia , Escalas de Graduação Psiquiátrica
4.
Attach Hum Dev ; 19(5): 447-462, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28002988

RESUMO

Insecure attachment styles have consistently been identified as risk factors for adolescent psychopathology and, more specifically, suicidal ideation. However, much less is known about the mechanisms that account for the relationship between attachment styles and severity of suicidal ideation within clinical samples. In the current study, adolescents' expectancies for caregiver availability and responsiveness were coded from transcripts of the Suicide Narrative Interview in a clinical sample of 129 depressed and suicidal adolescents. Results indicated that negative expectancies for caregiver availability in the Suicide Narrative Interview were associated both with attachment insecurity and with the intensity of adolescents' suicidal ideation. The implications of adolescents' expectancies for caregiver availability as targets for clinical intervention are discussed.


Assuntos
Cuidadores/psicologia , Apego ao Objeto , Suicídio/psicologia , Adolescente , Criança , Depressão/psicologia , Feminino , Humanos , Masculino , Fatores de Risco , Fatores Socioeconômicos , Ideação Suicida , Tentativa de Suicídio/psicologia
5.
Cancer ; 120(15): 2272-81, 2014 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-24888503

RESUMO

BACKGROUND: Young adults with cancer are at an increased risk of suicidal ideation. To the authors' knowledge, the impact of the patient-oncologist alliance on suicidal ideation has not been examined to date. The current study examined the relationship between the patient-oncologist therapeutic alliance and suicidal ideation in young adults with advanced cancer. METHODS: A total of 93 young adult patients (aged 20 years-40 years) with incurable, recurrent, or metastatic cancer were evaluated by trained interviewers. Suicidal ideation was assessed with the Yale Evaluation of Suicidality scale, dichotomized into a positive and negative score. Predictors included diagnoses of major depressive disorder and posttraumatic stress disorder, physical quality of life, social support, and use of mental health and supportive care services. The Human Connection Scale, dichotomized into a strong (upper third) and weak (lower two-thirds) therapeutic alliance, assessed the strength of the patients' perceived oncologist alliance. RESULTS: Approximately 22.6% of patients screened positive for suicidal ideation. Patients with a strong therapeutic alliance were found to be at reduced risk of suicidal ideation after controlling for confounding influences of cancer diagnosis, Karnofsky performance status, number of physical symptoms, physical quality of life, major depressive disorder, posttraumatic stress disorder, and social support. A strong therapeutic alliance was also associated with a reduced risk of suicidal ideation after controlling for mental health discussions with health care providers and use of mental health interventions. CONCLUSIONS: The patient-oncologist alliance was found to be a robust predictor of suicidal ideation and provided better protection against suicidal ideation than mental health interventions, including psychotropic medications. Oncologists may significantly influence patients' mental health and may benefit from training and guidance in building strong alliances with their young adult patients.


Assuntos
Neoplasias/psicologia , Relações Médico-Paciente , Ideação Suicida , Adulto , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Qualidade de Vida , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto Jovem
6.
Suicide Life Threat Behav ; 44(6): 668-81, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24806293

RESUMO

Eighty-five young adults exposed to a cluster of peer suicides as adolescents completed measures of attitudes toward suicide, grief, and social support. Closeness to the peers lost to suicide was positively correlated with grief and the belief that suicide is not preventable, with grief further elevated in close individuals with high social support from friends. Overall, social support was related to healthy attitudes about suicide including preventability, yet it was also related to some stigmatizing beliefs. Compared with 67 young adults who had not been exposed to a suicide cluster, the exposed sample was more likely to think that suicide is normal but more likely to think of it as incomprehensible.


Assuntos
Atitude Frente a Morte , Pesar , Grupo Associado , Apoio Social , Suicídio/psicologia , Adolescente , Feminino , Amigos/psicologia , Humanos , Estigma Social , Adulto Jovem
7.
J Pain Symptom Manage ; 48(3): 459-64, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24321508

RESUMO

CONTEXT: Recent studies have shown that patients' quality of life at the end of life (QOL@EOL) affects the psychosocial adjustment of bereaved family caregivers. OBJECTIVES: To examine the relationship between patients' QOL@EOL and the suicidal ideation of their surviving bereaved caregivers. METHODS: Data were derived from the Coping with Cancer (CwC1) Study, a U.S. National Cancer Institute-funded multicenter prospective cohort investigation of patients with advanced cancer and their caregivers, in which patients were enrolled September 2002 to February 2008. CwC1 data were used to examine changes in suicidal ideation in family caregivers before and after the patient's death (N = 127). Caregiver baseline suicidal ideation was assessed using the Yale Evaluation of Suicidality (YES) Scale a median of 4.1 months pre-loss; caregivers' perception of patients' QOL@EOL was assessed a median of 1.9 months postloss; and caregiver suicidal ideation in bereavement was assessed using the YES a median of 6.5 months postloss. Suicidal ideation was defined as a positive screen on the YES. We used multiple logistic regression analysis to examine the effect of caregivers' perceptions of patients' QOL@EOL on the suicidal ideation of bereaved caregiver's, adjusting for the caregiver's baseline suicidal ideation and confounding influences. RESULTS: Caregivers' perception of patients' QOL@EOL was significantly inversely related to caregivers' suicidal ideation postloss (adjusted odds ratio = 0.79, P = 0.023), after we adjusted for caregivers' baseline suicidal ideation, relationship to patient, and years of education. CONCLUSION: The more caregivers perceive their loved ones' QOL@EOL to be poor, the greater their risk for suicidal ideation in bereavement over and above prior levels of suicidal ideation. Caregivers of patients who have poor QOL@EOL appear to be a group of caregivers to target for reduction of suicidal risk.


Assuntos
Luto , Cuidadores/psicologia , Família/psicologia , Qualidade de Vida , Ideação Suicida , Doente Terminal , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Fatores Socioeconômicos , Fatores de Tempo
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