Substance Misuse among a Diverse Psychiatric Inpatient Sample: Suicidal Thoughts and Behaviors and Motivation to Change.

Suicidal thoughts and behaviors (STBs) are among the most common reasons for admission to psychiatric inpatient units and a large percentage of these patients also engage in substance misuse. Yet, no known studies have examined whether patients with STBs admitted to inpatient psychiatry units are motivated to change their substance misuse and, if so, whether they benefit from MET-CBT for substance misuse while on the inpatient unit. This study assesses the relationship between STB and motivation to improve substance misuse among 321 (61.1% male, Mage = 35.3 years, 59.8% non-Hispanic/Latin White) patients admitted to an inpatient psychiatric unit with a substance use disorder (SUD) or substance misuse who attended at least one group MET-CBT session, 50.2% of whom were admitted to an inpatient unit for STBs. Patients admitted for STBs reported greater motivation to reduce substance misuse than patients admitted without documented STB, and they did not differ from patients without documented STBs on the number of MET-CBT sessions attended, or ratings of session helpfulness (which were high). Patients admitted for STBs reported significantly increased motivation to change substance misuse after attending MET-CBT for SUD. These findings indicate that psychiatric inpatients with STBs report motivation to change substance misuse as well as willingness to attend MET-CBT for their SUD.

Interpersonal Risk Factors, Sexual and Gender Minority Status, and Suicidal Ideation: Is BDSM Disclosure Protective?

Suicidal ideation is elevated among individuals who engage in BDSM practices and those with sexual and gender minority (SGM) identities. There is limited research on the intersectionality of these identities and how they relate to suicidal ideation, especially within a theoretical framework of suicide risk, such as the interpersonal theory of suicide. Thus, we tested the indirect relation between BDSM disclosure and suicidal ideation through thwarted belongingness and perceived burdensomeness, as well as the moderating role of SGM identity on these indirect associations. Participants were 125 (Mage = 28.27 years; 64% cisgender men) individuals recruited via online BDSM-related forums who endorsed BDSM involvement and recent suicidal ideation. Results indicated significant moderated mediation, such that BDSM disclosure was indirectly negatively related to suicidal ideation through lower thwarted belongingness, but not perceived burdensomeness, among SGM individuals. This was due to the significant relation between BDSM disclosure and thwarted belongingness. There were no significant moderated mediation or indirect effects related to perceived burdensomeness. We also provide supplemental analyses with positive ideation (i.e., positive thoughts toward life) as the criterion variable. In conclusion, BDSM disclosure appears to be protective against suicidal ideation through thwarted belongingness but only for SGM individuals. This work furthers our understanding of the impact of intersecting marginalized identities on suicide risk and resilience. Implications, limitations, and future directions are further discussed.

An analysis of suicidal thoughts and behaviors among transgender and gender diverse adults.

PURPOSE: Suicidal thoughts and behaviors (STBs) remain a pressing public health problem for transgender and gender diverse (TGD) persons. The goal of this study was to apply social-ecological and minority stress frameworks to identify individual and interpersonal-level TGD-specific STB risk and protective factors. METHODS: This is a secondary analysis of the 2015 United States Transgender Health Survey, a comprehensive cross-sectional health assessment of a national sample of TGD adults (N = 27,658). Chi-square and Analysis of Variance (ANOVA) were used to identify bivariate correlates of 12-month and lifetime suicidal ideation (SI) and suicide attempt (SA). Logistic regression was employed to identify the strongest STB risk and protective factors across levels. RESULTS: Sexual minority identification, racial minority identification, and having a disability were lifetime STB risk factors. TGD identity, sexual minority identification, racial minority identification (SA only), lower education, lower income, military experience, having a disability, and being uninsured were 12-month STB risk factors. Psychological distress was the most robust STB risk factor. Workplace discrimination, family rejection, healthcare discrimination, and childhood bias-based victimization were lifetime STB risk factors. All forms of discrimination and victimization (with the exception of family rejection for SI) were 12-month STB risk factors. Family and coworker support were protective factors for lifetime SA (but not SI) and all 12-month STBs. Being less out about TGD identity was a protective factor for STBs (except for 12-month SI). CONCLUSION: Findings support social-ecological and minority stress STB risk frameworks. Recommendations are provided for a comprehensive approach to TGD suicide prevention.

Indirect effects of soldier healthy eating and physical activity on suicidal ideation through psychological health symptoms in active-duty military.

The suicide rate within the military continues to rise. New approaches for prevention are needed which capitalize on existing strengths, are scalable at multiple levels, and promote mental fortitude. Healthy eating (HE) and physical activity (PA) represent scalable practices and methods for promoting mental health and protective factors within the military. A cross-sectional sample of N = 1019 active-duty Soldiers completed self-report measures of HE, PA, major depressive disorder (MDD) symptoms, generalized anxiety disorder (GAD) symptoms, and suicidal ideation (SI). Moderated mediation analyses using bootstrapping techniques were used to determine if HE and PA interact to relate to lower SI through reduced psychological health (PH) symptoms. Results indicated an indirect effect of HE on presence versus absence of past month SI through GAD symptoms at moderate-to-high levels of cardiovascular PA. A similar pattern was demonstrated for strength training PA where HE had an indirect effect on past month SI through GAD symptoms at only high levels of strength training PA. HE was indirectly related to lower MDD symptoms at all levels of cardiovascular PA and moderate to high levels of strength training PA. Study limitations and implications for secondary suicide prevention strategies within the military are discussed.

Psychometric properties of the interpersonal needs questionnaire (INQ-15) in Army soldiers: Implications and future directions.

The Interpersonal Theory of Suicide posits that two unmet interpersonal needs, thwarted belongingness and perceived burdensomeness, interact to predict suicide desire. These two constructs are frequently assessed using the 15-item Interpersonal Needs Questionnaire (INQ-15); however, this measure has never been validated in military service members. The current study analyzed the psychometric properties of the INQ-15 in a sample of (N = 1096) military personnel stationed overseas. Results indicated that the two-factor model of the INQ-15 had a poor model fit in this population; however, a bifactor model with two specific factors representing TB and PB demonstrated good fit. As seen in previous research, perceived burdensomeness was more strongly related to suicidal ideation severity than thwarted belongingness. Implications and future directions for research are discussed.

Perceptions of purpose, cohesion, and military leadership: A path analysis of potential primary prevention targets to mitigate suicidal ideation.

Rates of suicide in the US Army continue to rise, and by some accounts exceed the general population. This increase has renewed efforts to identify protective factors that may inform novel suicide prevention strategies. Previous research has demonstrated that a sense of purpose in life and perceived cohesion with military peers are related to a reduction in the severity of suicidal ideation (SI). Additionally, research in military samples supports decreased SI in Soldiers who endorse that their leaders convey a sense of purpose and meaning in their shared mission. However, no work has investigated whether these leadership styles relate to a sense of felt purpose and perceived cohesion in Soldiers and thus the indirect effect of these leadership styles on SI. Active duty Army Soldiers (n = 1,160) completed self-report measures of purpose in life (PiL), perceived cohesion, ethical leadership, loneliness, and SI. Indirect effect analyses were conducted to determine how leadership behaviors indirectly relate to SI through PiL and perceived cohesion. Indirect effect analyses revealed that ethical leadership had an indirect effect on reduced SI through increased PiL. In the same parallel indirect effect analysis, ethical leadership was related to less SI through increased perceived cohesion and decreased loneliness sequentially. Enhanced leadership training that effectively increases Soldier purpose may be an important primary prevention tool to mitigate the effect of suicide risk factors. This primary prevention strategy may help augment existing suicide surveillance and clinical prevention efforts to reduce Soldier risk for suicide.

Allegiance effects in mindfulness-based interventions for psychiatric disorders: A meta-re-analysis.

Objectives: A recent meta-analysis reported that mindfulness-based interventions (MBIs) outperform specific active control conditions but not evidence-based treatments (EBTs) across various psychiatric conditions. Given both comparison conditions represent bona fide treatments, the superiority of MBIs over other bona fide treatments is unexpected. The current study examined researcher allegiance (RA) as a potential source of bias that may explain this result. Method: All studies from the original meta-analysis that compared MBIs with bona fide psychological treatments were included. RA was independently coded using established methods. A series of meta-analyses examined the RA-outcome association and the degree to which RA may account for the effect of EBT status. Results: Sixty independent comparisons (n = 5,627) were included. MBIs outperformed bona fide treatment comparisons overall (g = 0.13), but effects were smaller with EBT comparisons. RA towards MBIs was associated with larger effects. No evidence for superiority of MBIs was found when RA was absent or balanced. Further, EBT status no longer predicted effects when controlling for RA. Conclusions: RA appears to be a potential source of bias in MBI research that should be considered when interpreting existing studies (clinical trials, meta-analyses) and planning future studies. RA may account for smaller effects when using EBT comparisons.

Alcohol use and the interpersonal theory of suicide in American Indian young adults.

Suicide is the second leading cause of death for American Indian (AI) young adults. Alcohol use is a well-established risk factor for suicide. On average, AIs ages 12 to 20 exhibit the second-highest rate of binge drinking compared to all other ethnic groups. The current study investigated the relation between alcohol use and suicide ideation in an AI sample and examined these relations in the context of the interpersonal theory of suicide (ITS). It was hypothesized that perceived burdensomeness and thwarted belongingness would each significantly moderate the relations between alcohol use and suicide ideation in an AI sample. College students who self-identified as American Indian (N = 84) completed measures of alcohol use and associated problems, perceived burdensomeness and thwarted belongingness, and suicidality. Results indicated that perceived burdensomeness significantly moderated the relation between alcohol use and suicide ideation, and this interaction was significant at high levels of perceived burdensomeness. However, thwarted belongingness was not a significant moderator of the relation between alcohol use and suicide ideation. Findings suggest that AI young adults who engage in increased alcohol use may be at increased risk for suicide, especially if they also experience stronger perceptions of being a burden on others. The current study provides support for continued examinations of the relationship between alcohol use and suicide to inform culturally appropriate interventions for AI young adults.

Mindfulness-based cognitive therapy for the treatment of current depressive symptoms: a meta-analysis.

Mindfulness-based cognitive therapy (MBCT) appears to be a promising intervention for the prevention of relapse in major depressive disorder, but its efficacy in patients with current depressive symptoms is less clear. Randomized clinical trials of MBCT for adult patients with current depressive symptoms were included (k = 13, N = 1046). Comparison conditions were coded based on whether they were intended to be therapeutic (specific active controls) or not (non-specific controls). MBCT was superior to non-specific controls at post-treatment (k = 10, d = 0.71, 95% confidence interval [CI] [0.47, 0.96]), although not at longest follow-up (k = 2, d = 1.47, [-0.71, 3.65], mean follow-up = 5.70 months across all studies with follow-up). MBCT did not differ from other active therapies at post-treatment (k = 6, d = 0.002, [-0.43, 0.44]) and longest follow-up (k = 4, d = 0.26, [-0.24, 0.75]). There was some evidence that studies with higher methodological quality showed smaller effects at post-treatment, but no evidence that effects varied by inclusion criterion. The impact of publication bias appeared minimal. MBCT seems to be efficacious for samples with current depressive symptoms at post-treatment, although a limited number of studies tested the long-term effects of this therapy.

Hormone therapy, gender affirmation surgery, and their association with recent suicidal ideation and depression symptoms in transgender veterans.

BACKGROUND: Access to transition-related medical interventions (TRMIs) for transgender veterans has been the subject of substantial public interest and debate. To better inform these important conversations, the current study investigated whether undergoing hormone or surgical transition intervention(s) relates to the frequency of recent suicidal ideation (SI) and symptoms of depression in transgender veterans. METHODS: This study included a cross-sectional, national sample of 206 self-identified transgender veterans. They self-reported basic demographics, TRMI history, recent SI, and symptoms of depression through an online survey. RESULTS: Significantly lower levels of SI experienced in the past year and 2-weeks were seen in veterans with a history of both hormone intervention and surgery on both the chest and genitals in comparison with those who endorsed a history of no medical intervention, history of hormone therapy but no surgical intervention, and those with a history of hormone therapy and surgery on either (but not both) the chest or genitals when controlling for sample demographics (e.g., gender identity and annual income). Indirect effect analyses indicated that lower depressive symptoms experienced in the last 2-weeks mediated the relationship between the history of surgery on both chest and genitals and SI in the last 2-weeks. CONCLUSIONS: Results indicate the potential protective effect that TRMI may have on symptoms of depression and SI in transgender veterans, particularly when both genitals and chest are affirmed with one's gender identity. Implications for policymakers, providers, and researchers are discussed.

Experiencing racial microaggressions influences suicide ideation through perceived burdensomeness in African Americans.

Racial microaggressions are a contemporary form of subtle discrimination that occur in everyday exchanges, and are associated with a variety of negative mental health outcomes, including suicide ideation. Previous work (e.g., Torres-Harding, Andrade, & Romero Diaz, 2012) has identified 6 dimensions of racial microaggressions: invisibility, criminality, low-achieving/undesirable culture, sexualization, foreigner/not belonging, and environmental invalidations. The current study examined whether the 6 dimensions of racial microaggressions were associated with increased suicide ideation through perceived burdensomeness and thwarted belongingness among 135 African American young adults. Results indicated that perceived burdensomeness, but not thwarted belongingness, mediated the relationship between 3 racial microaggression dimensions (i.e., invisibility, low-achievement/undesirable culture, and environmental invalidations) and suicide ideation. These results imply that for African American college students, experiencing certain dimensions of racial microaggressions was associated with higher levels of perceived burdensomeness, which in turn was related to increased levels of suicide ideation. Clinical and societal implications are discussed. This study found that specific types of racial microaggressions were associated with higher levels of perceptions of being a burden on others, which in turn was associated with higher levels of suicide ideation in a sample of African Americans. These findings are important as they demonstrate 1 possible avenue through which racial microaggressions can negatively impact mental health. (PsycINFO Database Record

Historical loss thinking and symptoms of depression are influenced by ethnic experience in American Indian college students.

OBJECTIVE: Recent research has indicated that historical loss may play an important role in the experience of depression symptoms in American Indian/Alaska Native people. Increased frequency of historical loss thinking has been related to symptoms of depression and other pervasive psychological outcomes (i.e., substance abuse) in American Indian and Canadian First Nations communities. The current study investigated how aspects of ethnic minority experience relate to the incidence of historical loss thinking and symptoms of depression in American Indian adults. METHOD: Data are presented from 123 self-identified American Indian college students (ages 18-25, 67.50% female) who participated in the study in return for course credit and/or entrance into a raffle for gift cards. Participants completed the Adolescent Historical Loss Scale (AHLS), Scale of Ethnic Experiences (SEE), and the Center for Epidemiologic Studies-Depression Scale (CES-D). Indirect effects of ethnic experience on symptoms of depression through historical loss thinking were calculated with nonparametric bootstrapping procedures. RESULTS AND CONCLUSIONS: Results indicated that a strong ethnic identification, desire to predominantly socialize with other American Indians, and perceptions of discrimination were associated with increased historical loss thinking. Feelings of comfort and assimilation with the mainstream American culture were negatively related to historical loss thinking. Only perception of discrimination was directly related to symptoms of depression; however, ethnic identification and the preference to predominantly socialize with other American Indians were both indirectly related to elevated depressive symptoms through increased historical loss thinking. The clinical implications for these results are discussed. (PsycINFO Database Record

Dual tobacco use among college students: contexts of use, self-perceptions, and attitudes toward quitting.

Aggressive marketing of smokeless tobacco (SLT) appears to have led to an increase in dual tobacco use. The current study examines the situational contexts, self-perceptions, and cessation attitudes/behaviors that relate to dual use. Participants (N = 1,242) at a large, Southwestern university completed a self-report measure of demographic and tobacco use variables in 2010. Data were analyzed using chi-square and one-way ANOVA techniques. Findings suggest that type of tobacco use varies by setting and that dual users are more likely than sole users to perceive themselves as regular tobacco users. Limitations and implications for future research and interventions are discussed.

Interpersonal suicide risk for American Indians: investigating thwarted belongingness and perceived burdensomeness.

American Indians (AIs) experience increased suicide rates compared with other groups in the United States. However, no past studies have examined AI suicide by way of a recent empirically supported theoretical model of suicide. The current study investigated whether AI suicidal ideation can be predicted by two components: thwarted belongingness and perceived burdensomeness, from the Interpersonal-Psychological Theory of Suicide (T. E. Joiner, 2005, Why people die by suicide. Cambridge, MA: Harvard University Press). One hundred seventy-one AIs representing 27 different tribes participated in an online survey. Hierarchical regression analyses showed that perceived burdensomeness significantly predicted suicidal ideation above and beyond demographic variables and depressive symptoms; however, thwarted belongingness did not. Additionally, the two-way interaction between thwarted belongingness and perceived burdensomeness significantly predicted suicidal ideation. These results provide initial support for continued research on the components of the Interpersonal-Psychological Theory of Suicide, an empirically supported theoretical model of suicide, to predict suicidal ideation among AI populations.

Negative Urgency, (Lack of) Premeditation, and Sensation Seeking: Indirect Relationships with Suicidal Ideation through Thwarted Interpersonal Needs.

OBJECTIVE: Differences in how impulsivity is conceptualized, along with a myopic focus on impulsivity's relationship with historical suicidal behaviors, have resulted in limited implications made from prior research regarding impulsivity and suicidal thoughts and behaviors. The current study investigated the indirect effect facets of impulsivity may have on suicidal ideation, specifically, through thwarted interpersonal needs. METHODS: Participants were N = 424 undergraduate students who completed a cross-sectional survey. Participants completed the Urgency, Premeditation, Perseverance, Sensation Seeking, Impulsive Behavior Scale (UPPS), the Adult Suicide Ideation Questionnaire (ASIQ), and the Interpersonal Needs Questionnaire (INQ). Parallel mediation models were run to examine the relation between facets of impulsivity, perceived burdensomeness, thwarted belongingness, and suicidal ideation. RESULTS: Thwarted belonginess and perceived burdensomeness significantly accounted for the variance in the relation between negative urgency and suicidal ideation. Neither thwarted belongingness nor perceived burdensomeness significantly explained variance in the relation between (lack of) premeditation and suicidal ideation. Conversely, perceived burdensomeness and thwarted belonginess significantly explained the inverse relation between sensation seeking and suicidal ideation (i.e., greater sensation seeking was related to lower perceived burdensomeness and thwarted belongingness and in turn lower suicidal ideation). CONCLUSION: Negative urgency, in particular, is related to suicidal ideation through thwarted interpersonal needs. Future research should continue to differentiate between various types of impulsivity and its relationship with both suicidal ideation and behaviors utilizing both cross-sectional and ambulatory assessments of these constructs.HIGHLIGHTSNegative urgency is related to suicidal ideation.Negative urgency is related to thwarted interpersonal needs.Thwarted interpersonal needs partially explain the relation between negative urgency and suicidal ideation.

Back to the roots of perceived burdensomeness: The potential role of perceived contribution.

BACKGROUND: The Interpersonal-Psychological Theory of Suicide (IPTS), identifies perceived burdensomeness as a critical factor in the development of suicidal ideation. Measurement of perceived burdensomeness using the INQ in research has predominantly focused on liability toward others. Recent studies have demonstrated the role of perceived contribution toward others as an aspect of perceived burdensomeness. This study proposes a hypothesized transactional model of perceived burdensomeness, in which perceived burdensomeness can be viewed as the balance between perceived contributions and perceived liability to others. METHOD: Participants (n = 1112) were college students (M age = 18.86 years, SD = 1.50) who completed survey measures. Participants were predominantly cisgender women (73.6%), heterosexual (78.8%), and white (58.3%). RESULTS: Perceived contribution was negatively associated with perceived burdensomeness, suicidal ideation, and psychological pain after controlling for perceived liability. Further, the difference between perceived contributions and perceived liability accounted for variability in suicidal ideation after controlling for INQ perceived burdensomeness. DISCUSSION: The inclusion of perceived contribution as an element of perceived burdensomeness may offer new opportunities for clinical formulation and intervention. Future research is needed to further evaluate the proposed transactional model of perceived burdensomeness.

Examining aspects of psychological flexibility within the integrated motivational-volitional model of suicidal behavior: A prospective investigation.

BACKGROUND: According to the integrated motivational-volitional model of suicide, feelings of entrapment are related to the emergence of suicidal ideation (SI). However, this relation can be moderated by certain protective factors. METHODS: This study examined whether aspects of psychological flexibility (i.e., experiential avoidance, experiential acceptance, harnessing) moderated the relation between aspects of entrapment and SI severity in college students experiencing SI (N = 553) both cross-sectionally and when SI severity was measured 1 week later (N = 247). RESULTS: At baseline, experiential acceptance, but not experiential avoidance or harnessing, significantly moderated the relation between external entrapment and SI severity and internal entrapment and SI severity. No aspects of psychological flexibility prospectively moderated relations between entrapment and SI severity. CONCLUSIONS: Aspects of psychological flexibility may influence immediate vulnerability to SI severity among young adults experiencing feelings of entrapment. Implications for clinical interventions influencing changes in psychological flexibility are discussed.

The Virtual Hope Box mobile application: A systematic review of the literature.

INTRODUCTION: The Virtual Hope Box (VHB) mobile application is an adapted version of the conventional hope box intervention that is used in several evidence-based treatments for suicide behaviors. The VHB is an award-winning app developed by a collaboration between the Departments of Defense and Veterans Affairs. Multiple studies have assessed the utility and effectiveness of the VHB for use in suicide prevention, but no reviews of the literature have been conducted. METHODS: Authors performed a review of the literature using PsycINFO, EBSCOhost, and PubMed. 15 articles were ultimately included. RESULTS: Results were categorized into three areas: (1) efficacy and effectiveness, (2) feasibility, awareness, and usage in high-risk populations, and (3) implementation approaches to increase use among patients and providers. Existing evidence for the VHB supports its feasibility and acceptability, especially among military and veteran populations. Only one study investigated effectiveness in a randomized control trial. Although the VHB developers have disseminated the app nationally, low adoption rates among veteran patients and VA providers remain. Studies found that educational implementation strategies can improve utilization rates. CONCLUSIONS: Future research should examine suicide behaviors as outcomes, approaches to incorporating the VHB into treatment, and a range of populations.