Psychoneurometric assessment of dispositional liabilities for suicidal behavior: phenotypic and etiological associations.

BACKGROUND: Can core genetic liabilities for suicidal behavior be indexed using psychological and neural indicators combined? The current work addressed this question by examining phenotypic and genetic associations of two biobehavioral traits, threat sensitivity (THT) and disinhibition (DIS) - operationalized as psychoneurometric variables (i.e., composites of psychological-scale and neurophysiological measures) - with suicidal behaviors in a sample of adult twins. METHODS: Participants were 444 identical and fraternal twins recruited from an urban community. THT was assessed using a psychological-scale measure of fear/fearlessness combined with physiological indicators of reactivity to aversive pictures, and DIS was assessed using scale measures of disinhibitory tendencies combined with indicators of brain response from lab performance tasks. Suicidality was assessed using items from structured interview and questionnaire protocols. RESULTS: THT and DIS each contributed uniquely to prediction of suicidality when assessed psychoneurometrically (i.e., as composites of scale and neurophysiological indicators). In addition, these traits predicted suicidality interactively, with participants high on both reporting the greatest degree of suicidal behaviors. Biometric (twin-modeling) analyses revealed that a high percentage of the predictive association for each psychoneurometric trait (83% for THT, 68% for DIS) was attributable to genetic variance in common with suicidality. CONCLUSIONS: Findings indicate that psychoneurometric assessments of biobehavioral traits index genetic liability for suicidal behavior, and as such, can serve as innovative targets for research on core biological processes contributing to severe psychopathology, including suicidal proclivities and actions.

Why did peri-pandemic suicide death rates decrease among non-Hispanic white people while increasing among most people of color?

INTRODUCTION: While suicides in the United States decreased during the COVID-19 pandemic, statistically significant decreases have been limited to White people throughout a large portion of 2020. METHODS: This paper outlines possible explanations for racial/ethnic differences in suicidality in the early pandemic phases. RESULTS: We propose both distal (i.e., tele-mental health usage, internet and technology access, employment protections, and economic security) and proximal (cultural beliefs, coping strategies, clustering, pulling together, and embracing life) factors that may have helped build and foster community and mental wellness. However, this paper argues these factors did not extend, or did not extend as much, to many communities of color. CONCLUSIONS: We argue that these disparities are due to the myriad effects of discrimination and systemic racism, encapsulated broadly by the minority stress theory, and provide suggestions for relief and research.

Examination of the relationship between obesity and suicidal ideation.

OBJECTIVE: The relationship between obesity and suicidal ideation and behavior (suicidality) is not well understood, and conventional suicide risk factors do not adequately explain the associations observed. Thus, the current study aimed to further examine the relationship between body mass index (BMI; kg m(-2)) and suicidal ideation as well as potential mechanisms of this relationship. METHODS: Two hundred seventy-one adults (n=151 undergraduates; n=120 obesity treatment participants) completed self-report questionnaires assessing relevant variables, including suicidal ideation, perceived burdensomeness, thwarted belongingness and current height/weight used to calculate BMI. RESULTS: There was a significant, quadratic relationship between BMI and suicidal ideation (b=0.001, t=2.21, P=0.03, partial r=0.14) and between BMI and perceived burdensomeness (b=0.003, t=2.50, P=0.013, partial r=0.16), such that as BMI increased, these positive associations became more pronounced. Additionally, perceived burdensomeness partially mediated the relationship between BMI and suicidal ideation. CONCLUSIONS: Individuals with a higher BMI demonstrated increased suicidal ideation as well as greater feelings of perceived burdensomeness. These results provide novel information regarding potential mechanisms explaining the obesity-suicidal ideation association.

Prospectively predicting dietary restraint: the role of interpersonal self-efficacy, weight/shape self-efficacy, and interpersonal stress.

OBJECTIVE: This study investigated how the precursors of interpersonal self-efficacy and weight/shape self-efficacy would interact in the face of interpersonal stress to prospectively predict dietary restraint. Three models were explored, each with a different type of interpersonal stress: stress from same sex friendships, opposite sex friendships, or romantic relationships. METHOD: At Time 1 (T1), participants (N = 406) reported on their typical levels of interpersonal self-efficacy and weight/shape self-efficacy, and recent (past 28 days) dietary restraint. At Time 2 (T2), 11 weeks after T1, participants reported on their recent (past 28 days) levels of dietary restraint at that time. Between T1 and T2, participants completed inventories weekly on the previous week's interpersonal stressors. RESULTS: Consistent with prediction, low interpersonal self-efficacy and high weight/shape self-efficacy combined with high interpersonal stress (whether from same sex friendships, opposite sex friendships, or romantic relationships) to predict the highest levels of T2 dietary restraint after controlling for T1 levels. DISCUSSION: These results further link the interpersonal domain with dietary restraint and elucidate characteristics of women particularly apt to increase dietary restraint in response to interpersonal stress.

Examining a psychosocial interactive model of binge eating and vomiting in women with bulimia nervosa and subthreshold bulimia nervosa.

The current study tested a psychosocial interactive model of perfectionism, self-efficacy, and weight/shape concern within a sample of women with clinically significant bulimic symptoms, examining how different dimensions of perfectionism operated in the model. Individuals with bulimia nervosa (full diagnostic criteria or subthreshold) completed measures of bulimic symptoms, multidimensional perfectionism, self-efficacy, and weight/shape concern. Among those who were actively binge eating (n=180), weight/shape concern was associated with binge eating frequency in the context of high perfectionism (either maladaptive or adaptive) and low self-efficacy. Among those who were actively vomiting (n=169), weight/shape concern was associated with vomiting frequency only in the context of high adaptive perfectionism and low self-efficacy. These findings provide support for the value of this psychosocial interactive model among actively binge eating and purging samples and for the importance of considering different dimensions of perfectionism in research and treatment related to bulimia nervosa.

Predicting bulimic symptoms: an interactive model of self-efficacy, perfectionism, and perceived weight status.

An interactive model of perfectionism, perceived weight status, and self-efficacy was tested on 406 women to predict the bulimic symptoms of binge eating and inappropriate compensatory behaviors separately. This longitudinal study assessed hypothesized vulnerabilities of high perfectionism and low self-efficacy and the stressor of feeling overweight at Time 1 and then gathered weekly assessments of binge eating, vomiting, laxative use, fasting, and diet pill use for 11 weeks. As predicted, results showed that perfectionism, weight perception, and self-efficacy interacted to prospectively predict binge eating. In particular, women high in perfectionism who felt they were overweight and who had low self-efficacy reported the most number of weeks of binge eating. This interactive model did not predict inappropriate compensatory behaviors. Future directions and clinical implications are discussed.

Ten-year stability and predictive validity of five bulimia-related indicators.

OBJECTIVE: The authors examined the temporal stability and predictive utility of bulimic symptoms and related variables over the course of 10 years, from 1982 to 1992. METHOD: The subjects were 459 women who were aged 18-22 years in 1982 and were surveyed in both 1982 and 1992. Each respondent completed five subscales of the Eating Disorders Inventory (bulimia, drive for thinness, maturity fears, perfectionism, and interpersonal distrust) and answered questions based on the DSM-III criteria for bulimia nervosa. RESULTS: The temporal stability of bulimic symptoms and related variables was relatively high. Bulimic status in 1982 conferred an approximately 15-fold increase in risk 10 years later. Drive for thinness and, to lesser degrees, maturity fears and perfectionism received support as long-term predictors of bulimic symptoms. CONCLUSIONS: Bulimic symptoms display high temporal stability and thus may affect long-term functioning and well-being. Later symptoms are related to scores on specific subscales of the Eating Disorders Inventory administered 10 years earlier. Assessment and therapy should be conducted accordingly.

Parameters of suicidal crises vary as a function of previous suicide attempts in youth inpatients.

OBJECTIVES: Although suicidal crises demand an enormous amount of clinical attention, surprisingly little empirical research has been conducted on the parameters of suicidal crises in general, and in children and adolescents in particular. On the basis of past conceptual work on the unique characteristics of multiple suicide attempters, as well as work on the effect of previous suicidal and depressive experience on later functioning, the authors developed predictions regarding the intensity and duration of suicidal crises in youths presenting to inpatient psychiatry units. Specifically, it was hypothesized that multiple attempt status would relate significantly to intensity of suicidal crises and would relate more strongly to intensity than to duration of crises. METHOD: Data on past suicide history and self-rated symptoms were collected for 50 suicidal patients, all of whom were available at follow-up. RESULTS: Findings conformed to prediction: Multiple attempters experienced more intense but not more long-lasting crises; the relation between multiple attempt status and crisis intensity exceeded that between multiple attempt status and crisis duration. CONCLUSIONS: Previous suicidal experience may alter the parameters of current suicidal crises. Implications of these findings for suicide risk and clinical assessment and management are discussed.

Help negation after acute suicidal crisis.

This study represents one of the first efforts to empirically differentiate between suicidal patients who complete treatment and those who voluntarily withdraw after resolution of the immediate crisis and, accordingly, before formally beginning treatment or within the first 2 days. Participants were contrasted across a range of variables, including suicide ideation, depression, hopelessness, problem solving, life stress, diagnoses in accordance with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987), and characterological features. Results indicate the high-risk nature of those withdrawing prematurely from treatment and suggest that this behavior potentially represents another manifestation of overall maladaptive coping, consistent with prominent avoidant, negativistic, and passive-aggressive personality traits.

Agreement between self- and clinician-rated suicidal symptoms in a clinical sample of young adults: explaining discrepancies.

This study compared self- versus clinician-rated suicide assessment among participants referred for suicidal ideation or behavior, with emphasis on understanding self- versus clinician-rated discrepancies. A total of 328 participants in a suicide-treatment project completed baseline measures of symptoms and personality (including self-report and clinician-rated indexes of suicidal tendency), and portions of the sample completed follow-up assessments at 6, 12, and 18 months. A high rate of discrepancy between self- and clinician ratings of suicidal tendency was noted: the nature of this discrepancy was such that clinicians were likely to see patients as high in suicidal tendency, whereas patients were less likely to see themselves as such. Data on future symptoms indicated that patients' self-ratings contained considerable predictive value. Variables such as history of previous attempts and histrionic personality style may help explain self-versus clinician-rated discrepancies.

The interpersonal consequences of inflated self-esteem in an inpatient psychiatric youth sample.

This study tested R. F. Baumeister, L. Smart, and J. M. Boden's (1996) theory of inflated self-esteem with an inpatient psychiatric youth sample. Participants were assessed on their self-reported self-esteem, self-reported interpersonal problems, and peer rejection (measured by evaluations from 3 or 4 peers). Consistent with the hypotheses, those with low self-esteem reported the most interpersonal problems, followed consecutively by the moderate self-esteem group and then the high self-esteem group, who reported the fewest interpersonal problems. Also in line with the hypotheses, those with low and high self-esteem were rejected by their peers when compared with the moderate self-esteem group. Thus, the high self-esteem group was rejected by their peers but did not themselves report interpersonal problems. These findings provide further support for Baumeister et al.'s theory and generalize the theory to a clinical setting.

The price of soliciting and receiving negative feedback: self-verification theory as a vulnerability to depression theory.

The hypothesis that people who seek and receive negative feedback are vulnerable to increases in depressed symptoms was tested among 100 undergraduates and their roommates. Students and roommates completed questionnaires on their views of each other and on their own levels of negative feedback seeking, depressed and anxious symptoms, negative and positive affect, and self-esteem. Three weeks later, students and roommates completed the same questionnaires. Results were, in general, consistent with prediction. Students who reported an interest in their roommates' negative feedback and who lived with a roommate who viewed them negatively were at heightened risk for increases in depressed symptoms. These results could not be explained in terms of the variables' relations to trait self-esteem. The symptom specificity of the effect was moderately supported. Implications for work on interpersonal vulnerability to depression are discussed.

Shyness and low social support as interactive diatheses, with loneliness as mediator: testing an interpersonal-personality view of vulnerability to depressive symptoms.

Interpersonal approaches to depression are surveyed; it is suggested that interpersonal inhibition, as opposed to interpersonal excess, has been underemphasized as an antecedent of depression. It is proposed that shyness is a vulnerability factor for depressive symptoms in the absence but not in the presence of social support and that loneliness mediates the relation between shyness and depressive symptom increases. Undergraduates (N = 172) reported on their levels of shyness, social support, loneliness, positive and negative affect, and depressive symptoms, and returned 5 weeks later to complete a similar set of assessments. Results supported hypotheses. Participants who were shy and unsupported were likely to experience increases in depressive symptoms and decreases in positive affect, whereas other students were not. This effect was partially mediated by increases in loneliness and was specific to depressive symptoms and low positive affect; it did not apply to negative affect.

Excessive reassurance-seeking predicts depressive but not anxious reactions to acute stress.

The authors hypothesized that excessive reassurance-seeking would prospectively predict changes in depressive symptoms, even controlling for changes in anxious symptoms, and would not predict changes in anxious symptoms controlling for changes in depressive symptoms. This prediction was supported in a study of 1,005 air force cadets. Participants completed measures of excessive reassurance-seeking and depressive and anxious symptoms before basic training, and completed symptom measures again following basic training. This study, together with others, demonstrates that excessive reassurance-seeking is an important depression-related variable that deserves serious attention as a potential vulnerability factor.

Tripartite structure of positive and negative affect, depression, and anxiety in child and adolescent psychiatric inpatients.

The tripartite model of depression and anxiety suggests that depression and anxiety have shared (generalized negative affect) and specific (anhedonia and physiological hyperarousal) components. In one of the 1st studies to examine the structure of mood-related symptoms in youngsters, this model was tested among 116 child and adolescent psychiatric inpatients, ages 8-16 (M = 12.46; SD = 2.33). Consistent with the tripartite model, a 3-factor (Depression, Anxiety, and Negative Affect) model represented the observed data well. Follow-up analyses suggested that a nonhierarchical arrangement of the 3 factors may be preferable to a hierarchical one.

Psychopathy, antisocial personality, and suicide risk.

H. Cleckley (1976) maintained that psychopaths are relatively immune to suicide, but substantial evidence exists for a relationship between antisocial deviance and suicidal acts. This study was the first to explicitly examine suicidal history among psychopathic individuals as defined by R. D. Hare's (1991) Psychopathy Checklist--Revised (PCL-R). Male prison inmates (N = 313) were assessed using the PCL-R and DSM-III-R and DSM-IV criteria (American Psychiatric Association, 1987, 1994) for antisocial personality disorder (APD), and they completed A. Tellegen's (1982) Multidimensional Personality Questionnaire (MPQ). Presence or absence of prior suicide attempts was coded from structured interview and prison file records. Suicide history was significantly related to PCL-R Factor 2 (which reflects chronic antisocial deviance) and to APD diagnosis but was unrelated to PCL-R Factor 1, which encompasses affective and interpersonal features of psychopathy. Higher order MPQ dimensions of Negative Emotionality and low Constraint were found to account for the relationship between history of suicidal attempts and antisocial deviance, indicating that temperament traits may represent a common vulnerability for both.

Self-verification and depression among youth psychiatric inpatients.

According to self-verification theory (e.g., W.B. Swann, 1983), people are motivated to preserve stable self-concepts by seeking self-confirming interpersonal responses, even if the responses are negative. In the current study of 72 youth psychiatric inpatients (36 boys; 36 girls; ages 7-17, M = 13.18; SD = 2.59), the authors provide the 1st test of self-verification theory among a youth sample. Participants completed self-report questionnaires on depression, self-esteem, anxiety, negative and positive affect, and interest in negative feedback from others. The authors made chart diagnoses available, and they collected peer rejection ratings. Consistent with hypotheses, the authors found that interest in negative feedback was associated with depression, was predictive of peer rejection (but only within relatively longer peer relationships), was more highly related to cognitive than emotional aspects of depression, and was specifically associated with depression, rather than being generally associated with emotional distress. The authors discuss implications for self-verification theory and for the phenomenology of youth depression.

When depression breeds contempt: reassurance seeking, self-esteem, and rejection of depressed college students by their roommates.

To test Coyne's (1976b) theory of depression, students' levels of depressive symptoms, reassurance seeking, and self-esteem were assessed at Time 1, and their same-gender roommates' appraisals of them were assessed 5 weeks later. Mildly depressed students engaged in the type of reassurance seeking described by Coyne. Among men, but not women, mildly depressed students were rejected if they strongly sought reassurance and had low self-esteem but not if they did not seek reassurance or had high self-esteem. Although induction of depressed symptoms in roommates did occur, this contagion effect did not account for the depression-rejection relationship. The prediction that unsupportive, intolerant, or unempathic others would be particularly likely to respond with rejection to reassurance-seeking depressed students with low self-esteem received partial support. Implications for future work on the interpersonal aspects of depression are discussed.

The Modified Scale for Suicidal Ideation: factors of suicidality and their relation to clinical and diagnostic variables.

The authors conducted the 1st large-sample factor-analytic study of the Modified Scale for Suicidal Ideation (MSSI; I. W. Miller, W. H. Norman, S. B. Bishop, & M. G. Dow, 1986) on a sample of 330 suicidal young adults. Factor analyses revealed 2 MSSI factors: Suicidal Desire and Ideation (ongoing thoughts or desires about suicide) and Resolved Plans and Preparation (intense thoughts, plans, and courage and capability to commit suicide). The Resolved Plans and Preparation factor was more related to Attempt versus Ideator status than was the Suicidal Desire and Ideation factor. The Suicidal Desire and Ideation factor was more highly related to depressotypic indicators than was the other factor, suggesting that level of depression, although predictive of ideation, may not be as strong a correlate of preparation. Comparison of depression- and anxiety-related diagnostic groups on the MSSI factors revealed little difference, consistent with previous work highlighting the occurrence of suicidality across diagnostic groups. These findings have implications for the structure of suicidality, as well as its clinical assessment.

Depressive reactions to failure in a naturalistic setting: a test of the hopelessness and self-esteem theories of depression.

We tested the hopelessness and self-esteem theories of depression and an integration of the two by examining whether a stable, global attributional style (attributional diathesis) and low self-esteem interacted with the outcomes students received on a midterm examination to predict their subsequent depressive reactions over the course of 5 days. Students' immediate depressive reactions (on receipt of grades) were predicted solely by the examination outcome, whereas their enduring depressive reactions during the following 4 days were predicted by the Attributional Diathesis x Low Self-Esteem x Failure interaction. The results also indicated that the three-way interaction predicted enduring depressive reactions through the mediating role of hopelessness.