Risk factors for suicide attempts among rural youth with a history of suicidal ideation.

Youths in rural areas have approximately double the risk for suicide than do urban youth. This study analyzed data from 580 youth aged 10 to 17-years-old who endorsed lifetime suicidal ideation on intake at three large rural behavioral health centers. Results indicated that a five-factor model including older age, number of inpatient hospitalizations, gender (female), impaired legal functioning, and higher impulsivity accounted for the most variance in differentiation between ideators and attempters. These results advance our assessment of rural youth who may be at increased risk for a suicide attempt.

Latent class analysis of bipolar disorder symptoms and suicidal ideation and behaviors.

Individuals with bipolar disorder are at increased risk of dying by suicide compared to healthy controls and those with unipolar depression. Previous studies show that depressive symptoms and mixed episodes of mania and depression are related to suicide. However, most of these studies adopt a variable-centered approach to understanding how specific symptoms relate to suicidal ideation, without addressing how these symptoms and symptom profiles relate to suicidal behaviors. OBJECTIVES: Using latent class analysis, this study adopts a person-centered approach to examine whether subtypes of patients with bipolar disorder differ in their levels of suicidal ideation and behaviors. METHODS: A total of 150 patients from a behavioral health outpatient clinic were recruited. Latent classes were generated based on self reports of their depressive and manic symptoms. RESULTS: Five classes of patients with bipolar disorder were identified, namely, a minimal symptom, mania, moderately depressed, severely depressed, and mixed depression-mania subtypes. Those in the severely depressed and mixed depression-mania groups reported significantly higher levels of suicidal ideation and behaviors compared to the other groups. CONCLUSIONS: Our findings provide further support for the strong relationship between depressive symptoms and suicidality. These findings are significant as they shed light on the different suicide risk profiles among a heterogenous group of patients with bipolar disorder. Name of clinical trial: Suicidal Behavior in Patients Diagnosed with Bipolar Disorder: The Roles of Biological and Childhood and Adult Environmental Risk Factors. ClinicalTrials.gov Identifier: NCT02604277.

Illness Perception and Job Satisfaction in Patients Suffering from Migraine Headaches: Trait Anxiety and Depressive Symptoms as Potential Mediators.

BACKGROUND AND OBJECTIVES: Migraine headache is the seventh leading cause of disability worldwide causing adverse outcomes in many aspects of an individual's life. Many psychological aspects affect chronic migraine (CM): illness perception, anxiety, depressive symptoms, and job satisfaction. This observational study aimed to examine the association among illness perception, anxiety, depressive symptoms, and job satisfaction, connected to migraine and its features. METHODS: Ninety-eight individuals with CM treated with OnabotulinumtoxinA were recruited from the Regional Referral Headache Centre of Sant'Andrea Hospital in Rome. They completed 4 questionnaires (Brief Illness Perception Quality of Life, Enjoyment and Satisfaction Questionnaire, State-Trait Anxiety Inventory, Beck Depression Inventory-II) and a socio-anamnestic form. RESULTS: This cross-sectional study examined 2 mediational models. The first one demonstrated an indirect mediating effect of trait anxiety on the association between illness perception and job satisfaction (ab = -0.217, 95% CI [-0.37, -0.09]). In the second model, depressive symptoms mediated the association between illness perception and job satisfaction (ab = -0.186, 95% CI [-0.33, -0.04]). CONCLUSIONS: In our study, levels of anxiety and depressive symptoms showed a mediational effect on the association between illness perception and job fulfillment. It is important to develop interventions aimed at improving the quality of life of individuals with CM and to increase knowledge about headache and psychological consequences.

The Role of Depressive Symptoms in Suicide Attempt in Rural China.

Depression is a well-established predictor of suicidal behaviors, yet its effects among Chinese rural suicide attempters are understudied. In this study, we examined the role of depressive symptoms with other common risk factors, such as impulsivity, among medically serious suicide attempters. A case-controlled study was conducted in 13 rural counties in China. Medically serious suicide attempters (n = 791) and 791 nonsuicidal controls matched for sex and age range (±3 years) in the same location were recruited and interviewed to obtain information with regard to demographics, depressive symptom severity, and psychological strain measures. Both depressive symptoms, assessed with the Center for Epidemiological Studies Depression Scale, and psychological strains predicted suicide attempt risk, and psychological strains significantly predicted depressive symptoms. Depressive symptoms fully mediated the relations between value strain, deprivation strain, and suicide attempt risk, and partially mediated the associations among aspiration strain, coping strain, and suicide attempt risk. The reduction of psychological strains may help decrease both depression and suicidal behaviors.

Self-Criticism and Depressive Symptoms: Mediating Role of Self-Compassion.

Self-compassion is gaining recognition as a resilience factor with implications for positive mental health. This study investigated the role of self-compassion in alleviating the effect of self-criticism on depressive symptoms. Participants were 147 urban, low-income African Americans with a recent suicide attempt. They were administered measures of self-criticism, depressive symptoms, and self-compassion. Results from this cross-sectional investigation showed that self-criticism was positively associated with depressive symptoms and negatively associated with self-compassion, and self-compassion was negatively associated with depressive symptoms. Bootstrapping analysis revealed that self-compassion mediated the self-criticism-depressive symptoms link, suggesting that self-compassion ameliorates the negative impact of self-criticism on depressive symptoms. Our findings suggest that low-income African Americans with recent suicide attempt histories may benefit from interventions that focus on enhancing self-compassion. These results also highlight self-compassion as a positive trait with promise to improve people's quality of life and suggest that self-compassion-focused interventions are consistent with a positive psychology framework.

Body uneasiness is associated with food addiction symptoms: A cross-sectional study.

The main aim of the present study was to investigate the association between food addiction (FA) symptoms and body uneasiness in a nonclinical sample, while controlling for potential confounding variables. Participants (N = 395; 123 men) were administered self-report measures assessing FA, binge eating severity, body uneasiness, depressive symptoms, emotion dysregulation and socio-demographic variables. Body uneasiness was independently associated with FA symptoms (standardized beta coefficients ranging between 0.41 [p < 0.001] and 0.22 [p < 0.001]), even when controlling for the presence of other variables. This finding suggests that body uneasiness may be a crucial symptom in the development and/or maintenance of FA symptoms.

Differences in clinical characteristics between bipolar patients with current psychotic symptoms and those who have never been psychotic.

BACKGROUND: Psychotic symptoms are common in bipolar disorder (BD). Data suggest that BD patients with or without psychotic symptoms may differ from each other with regards to some clinical features of BD (e.g., age at onset, suicidality, psychiatric comorbidity, number of hospitalizations). However, the literature in this area is relatively scarce and not always conclusive. Therefore, the objective of the current study was to investigate whether the presence of psychotic symptoms is associated with clinical characteristics of patients with BD. SUBJECTS AND METHODS: We enrolled 365 hospitalized patients who were diagnosed with BD according to the ICD-10 criteria. After we excluded 196 patients without current psychotic symptoms but psychotic mood episodes in their medical history, our final sample consisted of 169 patients (i.e., 89 BD patients presenting with current psychotic symptoms and 80 BD patients who were hospitalized in the same period, but who did not have psychotic symptoms either currently or during their previous hospitalizations). Clinically available data were collected, systematized and statistically processed according to the aims of the study. RESULTS: Early age of onset, bipolar-I diagnosis, comorbid personality disorder, number of hospitalizations and suicidality were significantly more common in the psychotic group compared to the never-psychotic group. On the contrary, sedative/hypnotics dependence was more frequent in the never-psychotic group. CONCLUSIONS: Our results support the notion that the presence of psychotic symptoms in the context of BD may be associated with various other clinical features of this disease.

A Review of Psychometrically Tested Instruments Assessing Suicide Risk in Adults.

OBJECTIVE: Identify suicidal ideation and behavior screening instruments with the strongest psychometric properties, using the Interpersonal-Psychological Theory of Suicidal Behavior. METHODS: Information databases PsycINFO and PubMed were systematically searched, and articles evaluating the psychometric properties of instruments assessing suicidal ideation and behavior ( n = 2,238) were reviewed. International populations and articles with diverse methodologies were integrated. RESULTS: Review of records resulted in the inclusion of 51 articles that assessed 16 instruments. The majority of studies used the English language version (68.6%) and included U.S. populations (65.7%). However, global populations and non-English language versions were also represented. CONCLUSION: More diverse population representation, and non-English versions of instruments, is required to improve generalizability of assessment measures. Including underrepresented groups and non-English instruments will promote culturally and linguistically sensitive instruments that may better assess suicide risk in diverse populations.

Perceived stress, depressive symptoms, and suicidal ideation in undergraduate women with varying levels of mindfulness.

Research has demonstrated that perceived stress and depression are risk factors for suicidal ideation in young adults, particularly women attending college. Female undergraduate students (N = 928) were administered measures assessing their levels of stress, depressive symptoms, suicidal thoughts, and mindfulness. A moderated-mediation analysis was conducted to examine the complex associations among these variables. Results indicated that mindfulness moderated the mediated effect of depressive symptoms on perceived stress and suicidal ideation. Specifically, the indirect effect was stronger in college women with lower levels of mindfulness as compared to those students who reported higher mindfulness. Thus, teaching mindfulness techniques on college campuses may be an important strategy for preventing suicide, especially among young adult women experiencing stress and depressive symptoms.

Emotion Regulation and Mentalization in People at Risk for Food Addiction.

Researchers investigated the association among food addiction, difficulties in emotion regulation, and mentalization deficits in a sample of 322 Italian adults from the general population. All participants were administered the Italian versions of the Yale Food Addiction Scale (I-YFAS), the Difficulties in Emotion Regulation Scale, the Mentalization Questionnaire, the Binge Eating Scale, and the Michigan Alcohol Screening Test. Of respondents, 7.1% reported high food-addiction symptoms (ie, 3 or more symptoms of food addiction on the I-YFAS). In bivariate analyses, high food-addiction symptoms were associated with more difficulties in emotion regulation and mentalization deficits. In the multivariate analysis, high food-addiction symptoms remained independently associated with mentalization deficits, but not with difficulties in emotion regulation. Our data suggest that mentalization may play an important role in food addiction by making it difficult for an individual to understand his or her own inner mental states as well as the mental states of others, especially when powerful emotions arise.

Psychiatric comorbidity and suicidal ideation in psoriasis, melanoma and allergic disorders.

OBJECTIVE: Psychiatric disorders and suicide risk (especially in psoriasis) are frequent and disabling conditions in patients with skin diseases. The aim of this study was to examine the risk of suicide and stressful life events in a sample of patients with skin disease. METHODS: A sample of 242 dermatological patients (142 women and 100 men), 112 of which had psoriasis, 77 had melanoma, and 53 were suffering with chronic allergic diseases. Patients were administered the MINI International Neuropsychiatric Interview (MINI), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and the Columbia-Suicide Severity Rating Scale (C-SSRS). Patients were also asked about their experiences with stressful life events. RESULTS: Patients with psoriasis were more likely to have a history of psychiatric disorders (36.6% vs. 13.2% χ2(1) = 9.55; p = 0.002) compared to patients with allergies. Specifically, patients with psoriasis more likely had a diagnosis of a mood disorder (16.1% vs. 3.9% χ2(1) = 6.85; p = 0.009; 16.1% vs. 0% χ2(1) = 9.56; p = 0.002) and reported past suicidal ideation (33.9% vs. 15.6% χ2(1) = 7.89; p = 0.005; 33.9% vs. 18.9% χ2(1) = 3.96; p = 0.047) as compared to those with melanoma and allergy. CONCLUSIONS: The results from this study suggest that patients affected by psoriasis have an increased risk of psychiatric comorbidities and suicidal ideation compared to those who have other dermatological disorders.

Two Studies of Connectedness to Parents and Suicidal Thoughts and Behavior in Children and Adolescents.

We tested hypotheses that greater connectedness to parent(s) is associated with lower risk for nonlethal suicidal thoughts and behavior (STB), termed direct protective effects, and that parent connectedness serves to moderate (lower) the risk for STB associated with psychopathology including major depressive episode (MDE), termed moderating protective effects. Independent samples of children and adolescents recruited for a multicenter study of familial alcoholism were studied. Generalized estimating equation models were used that adjusted for age, sex, and youth psychopathology variables. The sample for Study 1 was assessed at baseline and about 2- and 4-year follow-ups, with baseline characteristics of n = 921, M age = 14.3 ± 1.8 years, and 51.8% female. The sample for Study 2 was assessed at baseline and about 5-year follow-up, with baseline characteristics of n = 867, M age = 12.0 ± 3.2 years, and 51.0% female. In both studies, increased perceived connectedness to father but not mother was associated with lower risk for measures of STB, consistent with direct protective effects. In Study 1, measures of parent connectedness were associated with lower risk for STB but only for youth that did not experience MDE (or alcohol use disorder), inconsistent with moderating protective effects. Study 2 showed that connectedness to fathers was associated with lower risk for suicide plans or attempts (severe STB) but not frequent thoughts of death or dying (nonsevere STB). Improved connectedness to fathers may lower risk for STB in children and adolescents, consistent with direct protective effects. Hypotheses about moderating protective effects were not supported.

Depression and insomnia are independently associated with satisfaction and enjoyment of life in medication-overuse headache patients.

Objective Medication-overuse headache is often comorbid with emotional disturbances and disordered personality traits. The aim of the present study was to determine whether depression and insomnia complaints were associated with satisfaction and enjoyment with one's own life in medication-overuse headache patients, and whether insomnia complaints were able to explain part of the variance of Quality of Life explained by depression. Methods Participants were 187 consecutive adult outpatients admitted to the Regional Referral Headache Centre of the Sant'Andrea Hospital in Rome, Italy. Patients were administered the Quality of Life Enjoyment and Satisfaction Questionnaire, the Beck Depression Inventory - II, and the Athens Insomnia Scale. Results The Beck Depression Inventory was associated with all the dimensions of the Quality of Life Enjoyment and Satisfaction Questionnaire, with more severe depression being associated independently with lower satisfaction and enjoyment with one's own life. The Athens Insomnia Scale was independently and significantly associated only with physical health, such that patients with more insomnia complaints were 3.1 times ( p < 0.001) more likely to report lower physical health satisfaction. Conclusions Our findings confirmed that medication-overuse headache patients has a negative impact on quality of life and suggested that depression and insomnia were independently associated with satisfaction and enjoyment of life in medication-overuse headache patients. The early recognition and appropriate treatment of comorbid psychopathological symptoms are crucial to improve satisfaction and enjoyment of life in medication-overuse headache patients.

Procrastination and suicide proneness: A moderated-mediation model for cognitive schemas and gender.

This study examined the direct and indirect paths between procrastination and suicide proneness while considering gender differences. Participants included 547 undergraduates from a southeastern university. Procrastination was positively related to suicide proneness for both genders, although this relation was stronger for women. Moderated-mediation analyses with bootstrapping highlighted insufficient self-control schemas as a mediator in the relation between procrastination and suicide proneness. However, indirect pathways did not vary by gender. Results represent an extension of the Procrastination-Health Model by highlighting the contribution of cognitive factors in explaining the relation between procrastination and suicide proneness.

The Mindful Attention Awareness Scale: Further Examination of Dimensionality, Reliability, and Concurrent Validity Estimates.

We examined the factor structure and psychometric properties of the Mindful Attention Awareness Scale (MAAS) in a sample of 810 undergraduate students. Using common exploratory factor analysis (EFA), we obtained evidence for a 1-factor solution (41.84% common variance). To confirm unidimensionality of the 15-item MAAS, we conducted a 1-factor confirmatory factor analysis (CFA). Results of the EFA and CFA, respectively, provided support for a unidimensional model. Using differential item functioning analysis methods within item response theory modeling (IRT-based DIF), we found that individuals with high and low levels of nonattachment responded similarly to the MAAS items. Following a detailed item analysis, we proposed a 5-item short version of the instrument and present descriptive statistics and composite score reliability for the short and full versions of the MAAS. Finally, correlation analyses showed that scores on the full and short versions of the MAAS were associated with measures assessing related constructs. The 5-item MAAS is as useful as the original MAAS in enhancing our understanding of the mindfulness construct.

Mental Health Stress, Family Resources and Psychological Distress: A Longitudinal Mediation Analysis in African American Grandmothers Raising Grandchildren.

OBJECTIVES: This study examines the effectiveness of a multidisciplinary intervention for African American grandmothers raising grandchildren on the relationship between dichotomized levels of mental health stress (low vs. high) and elevated levels of psychological distress, mediated by perceptions of family resources. METHOD: A nonrandom sample of African American grandmothers (N = 679) was assessed to test the predictive relations among study constructs in the context of a prospective mediational model. RESULTS: Perception of family resources contributes to lower psychological distress among custodial grandmothers exhibiting low and high levels of mental health stress. There was no significant difference in the strength of the mediated effects between the 2 mental health stress groups. CONCLUSION: The findings suggest appropriate resource-focused interventions can enhance grandmothers' subjective assessments of family resources and reduce psychological distress. However, additional research is needed to ascertain the consistency and generalizability of findings.

Depressive Symptoms and Suicidal Ideation in College Students: The Mediating and Moderating Roles of Hopelessness, Alcohol Problems, and Social Support.

OBJECTIVE: Mixed evidence for the associations among depression, hopelessness, alcohol problems, and suicidal ideation in college students may be due to the influence of social support. METHOD: A moderated-mediation analysis was conducted to examine relationships among suicide risk factors in 2,034 college students. RESULTS: Social support moderated the relation between depressive symptoms and hopelessness in predicting suicidal thoughts; specifically, the association between depressive symptoms and hopelessness was diminished among those students with high levels of social support. This resulted in attenuated indirect associations between depressive symptoms and suicidal ideation via hopelessness. Alcohol problems were associated with likelihood of experiencing suicidal ideation, but not severity. CONCLUSION: Social support may be a key variable for suicide prevention among college students.

Factor Structure of the Binge Eating Scale in a Large Sample of Obese and Overweight Patients Attending Low Energy Diet Therapy.

In the present study, we evaluated the dimensionality and psychometric properties of the Italian version of the Binge Eating Scale (BES) in a 669 (127 men and 542 women) obese and overweight patients seeking weight loss treatment. All participants were administered the Italian version of the BES. Fit statistics for the alternative SEM models demonstrated that both the one-factor and competing two-factor models had a comparable fit to the data. Thus, we selected the one-factor model as the most parsimonious. The BES had good internal consistency reliability (α = 0.89) with a moderate mean inter-item correlation (rii = 0.34). Given that we were not able to clearly determine the best model among the competing two-factor models and a comparable fit of these models with the one-factor model, we have suggested that the one-factor model is the best fitting model describing the dimensionality of the BES.

Optimism, well-being, and perceived stigma in individuals living with HIV.

Given the significant psychological challenges posed by HIV-related stigma for individuals living with HIV, investigating psychological resource factors for coping with HIV-related stigma is important. Optimism, which refers to generalized expectations regarding favorable outcomes, has been associated with enhanced psychological adaptation to health conditions, including HIV. Therefore, this cross-sectional study investigated associations among optimism, psychological well-being, and HIV stigma in a sample of 116 adults living with HIV and seeking mental health services. Consistent with study hypotheses, optimism was positively associated with psychological well-being, and psychological well-being was negatively associated with HIV-related stigma. Moreover, results of a full structural equation model suggested a mediation pattern such that as optimism increases, psychological well-being increases, and perceived HIV-related stigma decreases. The implications of these findings for clinical interventions and future research are discussed.

Parent-child conflict and drug use in college women: a moderated mediation model of self-control and mindfulness.

This cross-sectional study examined the association between parent-child conflict and illicit drug use in a sample of female college students (N = 928). The mediating roles of self-control and mindfulness, as well as an interaction between self-control and mindfulness, were examined in a moderated mediation model for the purposes of expanding etiological theory and introducing targets for the prevention and treatment of drug abuse. Whereas deficits in self-control were found to facilitate the positive relation observed between parent-child conflict and the likelihood of experiencing drug-related problems, an interaction between mindfulness and self-control helped explain the association between parent-child conflict and intensity of drug-related problems. Parent-child conflict was related to low mindfulness when self-control was low, and low mindfulness in turn was related to a higher intensity of drug-related problems. This association did not exist for women with high self-control. Findings are consistent with developmental research on the etiology of drug use and the protective properties of mindfulness and self-control. Mindfulness as a potential target of intervention for drug users with low self-control to prevent drug-related problems is explored.