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We still have little understanding of short-term predictors of suicidal thoughts and behaviors (STBs). Prior research links increased negative affect to STBs, but the vast majority of earlier work is limited by measuring negative affect at one time point and aiming to predict STBs months or years in the future. Recently, intensive longitudinal studies have shown that negative affect is associated with suicidal thoughts over relatively short, clinically useful time periods; however, the specific patterns and types of negative affect that predict STBs remain unclear. Using ecological momentary assessment (EMA) data from psychiatric inpatients hospitalized for suicide risk (n = 83), this study sought to test whether the patterns (means and variability) of two types of negative affect (anxiety/agitation and shame/self-hatred, which were derived from a larger EMA battery) during hospitalization predict STBs in the 4 weeks after discharge: an extremely high-risk time for suicidal behavior. The mean—but not the variability—of both anxiety/agitation and shame/self-hatred during hospitalization predicted the number of days with suicidal thoughts after discharge. The mean and the variability of shame/self-hatred—but not anxiety/agitation—predicted post-discharge suicide attempt. We discuss implications for assessment and treatment of suicidal individuals and propose key directions for future research. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s42761-021-00058-6.

Objective: Digital monitoring technologies (e.g., smart-phones and wearable devices) provide unprecedented opportunities to study potentially harmful behaviors such as suicide, violence, and alcohol/substance use in real-time. The use of these new technologies has the potential to significantly advance the understanding, prediction, and prevention of these behaviors. However, such technologies also introduce myriad ethical and safety concerns, such as deciding when and how to intervene if a participant’s responses indicate elevated risk during the study? Methods: We used a modified Delphi process to develop a consensus among a diverse panel of experts on the ethical and safety practices for conducting digital monitoring studies with those at risk for suicide and related behaviors. Twenty-four experts including scientists, clinicians, ethicists, legal experts, and those with lived experience provided input into an iterative, multi-stage survey, and discussion process. Results: Consensus was reached on multiple aspects of such studies, including: inclusion criteria, informed consent elements, technical and safety procedures, data review practices during the study, responding to various levels of participant risk in real-time, and data and safety monitoring. Conclusions: This consensus statement provides guidance for researchers, funding agencies, and institutional review boards regarding expert views on current best practices for conducting digital monitoring studies with those at risk for suicide—with relevance to the study of a range of other potentially harmful behaviors (e.g., alcohol/substance use and violence). This statement also highlights areas in which more data are needed before consensus can be reached regarding best ethical and safety practices for digital monitoring studies.

Suicide researchers commonly use a variety of assessment methods (e.g., surveys and interviews) to enroll participants into studies and assign them to study conditions. However, prior studies suggest that different assessment methods and items may yield different responses from participants. This study examines potential inconsistencies in participants' reports of suicidal ideation (SI) and suicide attempt (SA) across commonly used assessment methods: phone screen interview, in-person interview, self-report survey, and confidential exit survey. To test the reliability of the effects, we replicated the study across two samples. In both samples, we observed a notable degree of inconsistent reporting. Importantly, the highest endorsement rates for SI/SA were on a confidential exit survey. Follow-up assessments and analyses did not provide strong support for the roles of purposeful inaccuracy, random responding, or differences in participant experiences/conceptualizations of SI. Although the reasons for such inconsistencies remain inconclusive, results suggest that classification of suicidal/control participants that uses multiple items to capture a single construct, that uses a Graded Scale to capture a broad spectrum of thoughts and behaviors, and that takes into account consistency of responding across such items may provide clearer and more homogenous groups and is recommended for future study. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Death/Suicide Implicit Association Test (IAT) is effective at detecting and prospectively predicting suicidal thoughts and behaviors. However, traditional IAT scoring procedures used in all prior studies (i.e., D-scores) provide an aggregate score that is inherently relative, obfuscating the separate associations (i.e., “Me = Death/Suicide,” “Me = Life”) that might be most relevant for understanding suicide-related implicit cognition. Here, we decompose the D-scores and validate a new analytic technique called the Decomposed D-scores (“DD-scores”) that creates separate scores for each category (“Me,” “Not Me”) in the IAT. Across large online volunteer samples (N > 12,000), results consistently showed that a weakened association between “Me = Life” is more strongly predictive of having a history of suicidal attempts than is a stronger association between “Me = Death/Suicide.” These findings replicated across three different versions of the IAT and were observed when calculated using both reaction times and error rates. However, among those who previously attempted suicide, a strengthened association between “Me = Death” is more strongly predictive of the recency of a suicide attempt. These results suggest that decomposing traditional IAT D-scores can offer new insights into the mental associations that may underlie clinical phenomena and may help to improve the prediction, and ultimately the prevention, of these clinical outcomes.

Behavioral measures are increasingly used to assess suicidal thoughts and behaviors. Some measures, such as the Suicide Stroop Task, have yielded mixed findings in the literature. An understudied feature of these behavioral measures has been their psychometric properties, which may affect the probability of detecting significant effects and reproducibility. In the largest investigation of its kind, we tested the internal consistency and concurrent validity of the Suicide Stroop Task in its current form, drawing from seven separate studies (N = 875 participants, 64% female, aged 12 to 81 years). Results indicated that the most common Suicide Stroop scoring approach, interference scores, yielded unacceptably low internal consistency (rs = -.09-.13) and failed to demonstrate concurrent validity. Internal consistency coefficients for mean reaction times (RTs) to each stimulus type ranged from rs = .93-.94. All scoring approaches for suicide-related interference demonstrated poor classification accuracy (AUCs = .52-.56) indicating that scores performed near chance in their ability to classify suicide attempters from nonattempters. In the case of mean RTs, we did not find evidence for concurrent validity despite our excellent reliability findings, highlighting that reliability does not guarantee a measure is clinically useful. These results are discussed in the context of the wider implications for testing and reporting psychometric properties of behavioral measures in mental health research. ispartof: Psychological Assessment vol:31 issue:8 pages:1052-1061 ispartof: location:United States status: published

Background Human decision making exhibits a mixture of model-based and model-free control. Recent evidence indicates that arbitration between these two modes of control (“metacontrol”) is based on their relative costs and benefits. While model-based control may increase accuracy, it requires greater computational resources, so people invoke model-based control only when potential rewards exceed those of model-free control. We used a sequential decision task, while concurrently manipulating performance incentives, to ask if symptoms and traits of psychopathology decrease or increase model-based control in response to incentives. Methods We recruited a nonpatient population of 839 online participants using Amazon Mechanical Turk who completed transdiagnostic self-report measures encompassing symptoms, traits, and factors. We fit a dual-controller reinforcement learning model and obtained a computational measure of model-based control separately for small incentives and large incentives. Results None of the constructs were related to a failure of large incentives to boost model-based control. In fact, for the sensation seeking trait and anxious-depression factor, higher scores were associated with a larger incentive effect, whereby greater levels of these constructs were associated with larger increases in model-based control. Many constructs showed decreases in model-based control as a function of severity, but a social withdrawal factor was positively correlated; alcohol use and social anxiety were unrelated to model-based control. Conclusions Our results demonstrate that model-based control can reliably be improved independent of construct severity for most measures. This suggests that incentives may be a useful intervention for boosting model-based control across a range of symptom and trait severity.

Contains fulltext : 201988.pdf (Publisher’s version ) (Closed access) Suicide is a leading cause of death worldwide. Despite decades of clinical and theoretical accounts that suggest that suicidal thoughts and behaviors are efforts to escape painful emotions, little prior research has examined decision making involved in escaping aversive states. We compared the performance of 85 suicidal participants to 44 nonsuicidal psychiatric patients on a novel reinforcement learning task with choices to make either active (i.e., "go") or passive responses (i.e., "no-go") to either escape or avoid an aversive stimulus. We used a computational cognitive model to isolate decision-making biases. We hypothesized that suicidal participants would exhibit a relatively elevated bias for making active responses to escape an aversive state and would show worse performance when escape required a passive response (i.e., "doing nothing" to escape). Our hypotheses were supported: The computational model revealed that suicidal participants exhibited a higher bias for an active response to escape compared with nonsuicidal psychiatric controls, suggesting that this finding was not just the result of the presence of psychopathology. The bias parameter also accounted for unique variance in predicting group status among several constructs previously related to suicidal thoughts and behaviors. This study provides a new method for testing escape decision making and does so using a computational cognitive model, allowing us to precisely index processes underlying suicidal and related behaviors. Future research examining escape decision making from a computational perspective could help link neural processes or environmental stressors to suicidal thoughts or behaviors. 13 p.

OBJECTIVE: Prior research indicates that adults’ implicit identification with death can be used to predict suicidal thoughts and behaviors (STBs) in the community. However, no studies have examined whether this effect is found among adolescents—a group for whom suicide is the 2(nd) leading cause of death. The current study tested the utility of implicit identification with death, using a Death Implicit Association Test (Death IAT), for detecting and predicting STBs in adolescents. METHOD: Participants were 141 adolescents aged 12–19 years (81.6% female; 74.5% White) with a current psychiatric disorder and/or currently receiving outpatient psychiatric treatment. All participants completed the Death IAT and self-report measures of STBs at baseline, as well as self-report measures of STBs at 6-month and 1-year follow-ups. RESULTS: At baseline, stronger implicit identification with death (higher Death IAT score) was related to greater suicide ideation (SI) frequency, severity, and duration, but did not differ based on suicide attempt history. Prospectively, higher Death IAT scores predicted any occurrence (but not frequency) of SI over the subsequent year, but not when controlling for prior SI. Death IAT scores were higher among adolescents with prior attempts who reattempted suicide over the follow-up. Examination of stimuli-level results suggested that Death IAT differences may be driven by responses on trials with specific words, including “Suicide” and “Die”. CONCLUSIONS: Implicit identification with death may be a useful behavioral indicator of suicide risk in adolescents. Preliminary findings suggest that the Death IAT may aid in predicting STBs among youth receiving outpatient treatment.

There is concern that the COVID-19 pandemic may cause increased risk of suicide. In the current study, we tested whether suicidal thinking has increased during the COVID-19 pandemic and whether such thinking was predicted by increased feelings of social isolation. In a sample of 55 individuals recently hospitalized for suicidal thinking or behaviors and participating in a 6-month intensive longitudinal smartphone monitoring study, we examined suicidal thinking and isolation before and after the COVID-19 pandemic was declared a national emergency in the United States. We found that suicidal thinking increased significantly among adults (odds ratio [ OR] = 4.01, 95% confidence interval [CI] = [3.28, 4.90], p < .001) but not adolescents ( OR = 0.84, 95% CI = [0.69, 1.01], p = .07) during the onset of the COVID-19 pandemic. Increased feelings of isolation predicted suicidal thinking during the pandemic phase. Given the importance of social distancing policies, these findings support the need for digital outreach and treatment.

Researchers, clinicians, and patients are increasingly using real-time monitoring methods to understand and predict suicidal thoughts and behaviors. These methods involve frequently assessing suicidal thoughts, but it is unknown if asking about suicide repeatedly is iatrogenic. We tested two questions about this approach: (1) does repeatedly assessing suicidal thinking over short periods of time increase suicidal thinking? (2) is more frequent assessment of suicidal thinking associated with more severe suicidal thinking? In a real-time monitoring study (N = 81, number of surveys = 9,819), we found no evidence to support the notion that repeated assessment of suicidal thoughts is iatrogenic.

The Self-Injurious Thoughts and Behaviors Interview (SITBI) is a widely used measure of the presence, frequency, and characteristics of suicide and self-harming thoughts and behaviors. In response to advances in the conceptualization of these outcomes, and the potential for online data collection, we created a revised version of the SITBI (SITBI-R) and tested its psychometric properties via in-person interview and online self-report formats. Across two studies, the SITBI-R demonstrated strong psychometric properties for both assessment formats. In Study 1, outcomes measured via the SITBI-R showed convergent validity with those assessed with the Columbia Suicide Severity Rating Scale, another interview assessing suicidal thoughts and behaviors. The SITBI-R also showed strong alternate-forms reliability across nearly all outcomes assessed via both assessment formats. In Study 2, the SITBI-R showed strong test-retest reliability via the online assessment format. Across both studies, reliability was strongest for more recent outcomes (e.g., past year vs. lifetime) and for more commonly assessed outcomes of suicidal thoughts, plans, and attempts than for other, less commonly assessed behaviors (e.g., suicide gestures, interrupted suicide attempts, and aborted suicide attempts). The results of these two studies suggest that the SITBI-R provides reliable and valid measurement of key self-injurious outcomes both in person and online. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Suicide is a leading cause of death worldwide and perhaps the most puzzling and devastating of all human behaviors. Suicide research has primarily been guided by verbal theories containing vague constructs and poorly specified relationships. We propose two fundamental changes required to move toward a mechanistic understanding of suicide. First, we must formalize theories of suicide, expressing them as mathematical or computational models. Second, we must conduct rigorous descriptive research, prioritizing direct observation and precise measurement of suicidal thoughts and behaviors and of the factors posited to cause them. Together, theory formalization and rigorous descriptive research will facilitate abductive theory construction and strong theory testing, thereby improving the understanding and prevention of suicide and related behaviors.

Persistent suicide ideation (SI) is known to be a risk factor for subsequent suicidal behaviors. Reducing SI persistence among people with a history of SI consequently might be a useful target for preventive intervention; however, basic information is lacking about patterns and predictors of SI persistence. We report preliminary retrospective data on annual SI persistence in a representative sample of 3,501 U.S. Army soldiers with lifetime SI from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Reports about age-of-onset and number of years with SI were used to estimate two definitions of persistence: persistence beyond year-of-onset and proportional annual persistence (i.e., percentage of years with SI since year-of-onset). Results revealed that for 47.8% of respondents with lifetime SI, their SI did not persist beyond the year-of-onset. For the 52.2% whose SI did persist beyond the year-of-onset, the median (interquartile range) proportional annual persistence was 33% (17-67%). Significant predictors of increased persistence were different for respondents with preenlistment SI onset (prior histories of attention-deficit/hyperactivity disorder [ADHD], bipolar disorder, and panic disorder) and postenlistment SI onset (male, combat support military occupation specialty, prior histories of ADHD, panic disorder, and posttraumatic stress disorder). These predictors of persistence are different from the predictors of SI onset, suggesting that secondary preventive interventions to reduce SI persistence may need to focus on different factors than primary preventive interventions to reduce SI onset. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Prior research has shown that most known risk factors for suicide attempts in the general population actually predict suicide ideation rather than attempts among ideators. Yet clinical interest in predicting suicide attempts often involves the evaluation of risk among patients with ideation. We examined a number of characteristics of suicidal thoughts hypothesized to predict incident attempts in a retrospective analysis of lifetime ideators (N = 3,916) drawn from a large (N = 29,982), representative sample of United States Army soldiers. The most powerful predictors of first nonfatal lifetime suicide attempt in a multivariate model controlling for previously known predictors (e.g., demographics, mental disorders) were: recent onset of ideation, presence and recent onset of a suicide plan, low controllability of suicidal thoughts, extreme risk-taking or "tempting fate," and failure to answer questions about the characteristics of one's suicidal thoughts. A predictive model using these risk factors had strong accuracy (area under the curve [AUC] = .93), with 66.2% of all incident suicide attempts occurring among the 5% of soldiers with highest composite predicted risk. This high concentration of risk in this retrospective study suggests that a useful clinical decision support model could be constructed from prospective data to identify those with highest risk of subsequent suicide attempt. (PsycINFO Database Record

The current report presents data on lifetime prevalence of suicide ideation and nonfatal attempts as reported by the large representative sample of U.S. Army soldiers who participated in the Consolidated All Army Survey (AAS) of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS; n=29,982). We also examine associations of key Army career characteristics with these outcomes. Prevalence estimates for lifetime suicidal ideation are 12.7% among men and 20.1% among women, and for lifetime suicide attempts are 2.5% and 5.1%, respectively. Retrospective age-of-onset reports suggest that 53.4%–70.0% of these outcomes had pre-enlistment onsets. Results revealed that, for both men and women, being in the Regular Army, compared with being in the National Guard or Army Reserve, and being in an enlisted-rank, compared with being an officer, is associated with increased risk of suicidal behaviors and that this elevated risk is present both before and after joining the Army.

BACKGROUND: Although child maltreatment is a well documented risk factor for suicidal behavior, little is known about whether the timing of child maltreatment differentially associates with risk of suicidal ideation, suicide plans, or suicide attempts. The goal of this study was to examine whether a first exposure to physical or sexual abuse during specific developmental periods significantly elevated risk for suicidal behavior in adolescents. METHODS: Data came from the National Comorbidity Survey Adolescent Supplement, a population-based sample of US adolescents aged 13-18 years old (n = 9,272). Using discrete time survival analysis, we assessed the association between timing of first abuse (early childhood: ages 0-5; middle childhood: ages 6-10; adolescence: ages 11-18) and suicidal ideation, plans, and attempts. RESULTS: Exposure to either physical or sexual abuse increased the odds of reporting suicidal ideation (odds ratio [OR] = 5.06 and OR = 3.56, respectively), plans (OR = 3.63 and OR = 3.58, respectively), and attempts (OR = 5.80 and OR = 4.21, respectively), even after controlling for sociodemographic covariates and psychiatric disorders. However, the timing of physical and sexual abuse exposure was unassociated with suicidal behavior (all P values >.05). CONCLUSIONS: Exposure to child maltreatment is strongly associated with the risk for adolescent suicidal behaviors, though this association did not vary based on the timing of first exposure. These findings suggest that prevention efforts should be implemented throughout early development and target all children, regardless of when they were first exposed.© 2017 Wiley Periodicals, Inc. Language: en

The application of digital technology to psychiatry research is rapidly leading to new discoveries and capabilities in the field of mobile health. However, the increase in opportunities to passively collect vast amounts of detailed information on study participants coupled with advances in statistical techniques that enable machine learning models to process such information has raised novel ethical dilemmas regarding researchers' duties to: (i) monitor adverse events and intervene accordingly; (ii) obtain fully informed, voluntary consent; (iii) protect the privacy of participants; and (iv) increase the transparency of powerful, machine learning models to ensure they can be applied ethically and fairly in psychiatric care. This review highlights emerging ethical challenges and unresolved ethical questions in mobile health research and provides recommendations on how mobile health researchers can address these issues in practice. Ultimately, the hope is that this review will facilitate continued discussion on how to achieve best practice in mobile health research within psychiatry.L'application des technologies numériques à la recherche psychiatrique entraîne rapidement de nouvelles découvertes et capacités en matière de santé mobile. Cependant, la multiplication des opportunités de recueillir passivement d'immenses quantités d'informations détaillées sur les participants aux études combinée aux progrès des techniques statistiques permettant aux modèles d'apprentissage automatique de traiter de telles informations a soulevé de nouveaux dilemmes éthiques concernant l'obligation des chercheurs: (i) de surveiller les effets indésirables et d'intervenir en conséquence; (ii) d'obtenir un consentement pleinement éclairé et volontaire; (iii) de protéger la vie privée des participants; et enfin, (iv) d'améliorer la transparence des puissants modèles d'apprentissage automatique afin de garantir une application éthique et impartiale dans le domaine des soins psychiatriques. Ce rapport identifie les défis qui en découlent ainsi que les questions éthiques non résolues en matière de santé mobile. Il formule également des recommandations sur la façon dont les chercheurs en santé mobile peuvent résoudre ces problèmes dans la pratique. À terme, nous espérons que ce rapport favorisera la poursuite des discussions portant sur les moyens de définir des méthodes de recherche adéquates pour la santé mobile en psychiatrie.La aplicación de la tecnología digital a la investigación en psiquiatría está conduciendo rápidamente a descubrimientos y capacidades nuevas en el ámbito de la salud móvil. No obstante, el incremento de las oportunidades para recopilar pasivamente grandes volúmenes de información detallada sobre los participantes en los estudios, junto con los avances en las técnicas de estadística que permiten a los modelos de aprendizaje automático procesar tal información, ha planteado nuevos dilemas éticos relativos a los deberes de los investigadores: (i) hacer un seguimiento de los eventos adversos e intervenir en consecuencia; (ii) obtener un consentimiento voluntario plenamente informado; (iii) proteger la privacidad de los participantes; y (iv) aumentar la transparencia de los modelos potentes de aprendizaje automático para asegurar que puedan aplicarse de manera ética y justa en la atención psiquiátrica. En este análisis se destacan tanto los desafíos éticos nuevos como las cuestiones éticas aún sin resolver en la investigación sobre la salud móvil y se formulan recomendaciones sobre cómo los investigadores de la salud móvil pueden abordar dichas cuestiones en la práctica. En última instancia, se espera que este análisis facilite un debate continuo sobre cómo lograr las mejores prácticas en la investigación de la salud móvil dentro de la psiquiatría.يؤدي تطبيق التكنولوجيا الرقمية على أبحاث الطب النفسي إلى اكتشافات وقدرات جديدة، بشكل سريع، في مجال الصحة عبر الهاتف المحمول. ومع ذلك، فإن زيادة فرص جمع كميات هائلة من المعلومات التفصيلية بشكل سلبي عن المشاركين في الدراسة، إلى جانب التطورات في التقنيات الإحصائية التي تسمح لنماذج التعلم الآلي بمعالجة هذه المعلومات، قد أدت لإثارة معضلات أخلاقية غير مسبوقة تتعلق بواجبات الباحثين من أجل القيام بما يلي: (1) مراقبة الأحداث السلبية والتدخل وفقًا لذلك؛ و(2) الحصول على موافقة طوعية واعية بالكامل؛ و(3) حماية خصوصية المشاركين؛ و(4) زيادة شفافية نماذج التعلم الآلي القوية وذلك لضمان إمكانية تطبيقها بشكل أخلاقي وعادل في الرعاية النفسية. تسلط هذه المراجعة الضوء على التحديات الأخلاقية الناشئة، والمعضلات الأخلاقية غير المحسومة في أبحاث الصحة عبر الهاتف المحمول، وتقدم توصيات حول كيف يمكن للباحثين، في مجال الصحة عبر الهاتف المحمول، معالجة هذه القضايا في الممارسة العملية. وفي النهاية، نأمل أن تؤدي هذه المراجعة إلى تسهيل النقاش المستمر حول كيفية تحقيق أفضل الممارسات في أبحاث الصحة عبر الهاتف المحمول في مجال الطب النفسي.数字技术在精神病学研究中的应用正迅速带来移动医疗领域的新发现和新功能。然而，研究参与者被收集大量详细信息的机率增加，以及统计技术的进步，使机器学习模型能够处理此类信息，这就产生了关于研究人员职责的新型伦理困境：（i） 监测不良事件并进行相应的干预；（ii） 取得完全知情自愿的同意；（iii） 保护参与者的隐私；以及（iv） 提高强大的机器学习模型的透明度，以确保它们能够在精神病学保健中得到合乎道德和公平的应用。这篇文章强调了移动医疗研究中新出现的伦理挑战和未解决的伦理问题，并就移动医疗研究人员如何在实践中解决这些问题提出了建议。最终，我们希望这篇综述将有助于继续讨论如何实现移动医疗研究在精神病学中的最佳实践。.Использование цифровых технологий для проведения исследований в психиатрии способствует новым открытиям и появлению новых возможностей в сфере мобильного здравоохранения. Однако расширение возможностей пассивного сбора большого количества подробной информации об участниках исследования в сочетании с совершенствованием методов статистической обработки информации, позволяющих использовать модели машинного обучения для обработки такой информации, породило принципиально новые этические дилеммы в отношении таких обязанностей исследователей, как: (i) отслеживание нежелательных явлений и принятие соответствующих мер, (ii) получение полностью информированного добровольного согласия, (iii) защита конфиденциальности участников и (iv) повышение прозрачности мощных моделей машинного обучения, чтобы гарантировать их справедливое и этичное применение для оказания психиатрической помощи. В данном обзоре освещены возникающие этические проблемы и нерешенные этические вопросы исследований в области мобильного здравоохранения, а также содержатся практические рекомендации по их решению для исследователей в области мобильного здравоохранения. В конечном счете этот обзор должен посодействовать обсуждению вопроса применения наиболее совершенных практических методов для проведения исследований в психиатрии в рамках мобильного здравоохранения.

The law of least mental effort states that, everything else being equal, the brain tries to minimize mental effort expenditure during task performance by avoiding decisions that require greater cognitive demands. Prior studies have shown associations between disruptions in effort expenditure and specific psychiatric illnesses (e.g., schizophrenia and depression) or clinically-related symptoms and traits (e.g., anhedonia and apathy), yet no research has explored this issue transdiagnostically. Specifically, this research has largely focused on a single diagnostic category, symptom, or trait. However, abnormalities in effort expression could be related to several different psychiatrically-relevant constructs that cut across diagnostic boundaries. Therefore, we examined the relationship between avoidance of mental effort and a diverse set of clinically-related symptoms and traits, and transdiagnostic latent factors in a large sample (n = 811). Only lack of perseverance, a dimension of impulsiveness, was associated with increased avoidance of mental effort. In contrast, several constructs were associated with less mental effort avoidance, including positive urgency, distress intolerance, obsessive-compulsive symptoms, disordered eating, and a factor consisting of compulsive behavior and intrusive thoughts. These findings demonstrate that deviations from normative effort expenditure are associated with a number of constructs that are common to several forms of psychiatric illness.

Self-injurious behaviors (SIBs) are leading causes of death and injury. Unfortunately, disagreement regarding whether and how to classify suicidal and nonsuicidal SIBs has contributed to their misclassification, likely hindering clinical care and impeding scientific progress. The present study utilized a data-driven approach to facilitate classification and measurement of three forms of SIBs, with a particular focus on one with scant clinical and scientific attention: nonsuicidal overdoses (i.e. intentional overdoses where the person states that they had no intention of dying from the overdose). Results from this study demonstrated that nonsuicidal overdoses were similar to suicide attempts in terms of age of onset, and similar to nonsuicidal self-injury (NSSI) in terms of suicidal thoughts and desire to die when engaging in these behaviors. Nonsuicidal overdoses were unique from NSSI and suicide attempts in terms of the reported likelihood of dying from the behavior. The present study highlighted that current definitions for nonsuicidal behaviors (including requirements that the person has zero intent to die) may not accurately represent people's intent when engaging in these behaviors. Additionally, the present study highlighted that empirical analysis of SIBs can provide important insights for classification of SIBs.

Assessing suicidal thoughts and behaviors is difficult because at-risk individuals often fail to provide honest or accurate accounts of their suicidal thoughts or intentions. Research has shown that the Death Implicit Association Test (D-IAT), a behavioral test that measures implicit (i.e., outside of conscious control) associations between oneself and death concepts, can differentiate among people with different suicidal histories, such as those with different severity or recency of suicidal behaviors. We report here on the development and evaluation of a shorter and simpler version of the D-IAT called the Death Brief Implicit Association Test (D-BIAT). We recruited large (ns > 1,500) samples of participants to complete the original D-IAT and shorter D-BIAT via a public web-based platform and evaluated different scoring approaches, assessed the reliability and validity of the D-BIAT and compared it with the D-IAT. We found that the D-BIAT was reliable, provided significant group differences with effect sizes on par with the D-IAT, as well as similarly sized classification metrics (i.e., receiver operator characteristics). Although the D-IAT was nonsignificantly better on most outcomes, the D-BIAT is 1-1[1/2] minutes shorter and provided larger effect sizes for distinguishing between past year and lifetime attempters. Thus, there is a trade-off between administration time and improved outcomes associated with increased data. The D-BIAT should be considered for use where time or participant burden needs to be minimized, such as in clinical settings. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Objective For over 100 years impulsiveness has been cited as a key factor in why some people that think about killing themselves go on to attempt suicide. Yet prior studies are limited by not using experimental groups that can test this hypothesis and by treating impulsiveness as a unidimensional construct. To overcome these limitations, we compared suicide ideators and suicide attempters on several dimensions of impulsiveness. Method In Study 1 we compared inpatient suicide attempters who made an attempt within the prior two weeks (n = 30), current inpatient suicide ideators (n = 31), and community controls (n = 34) on several dimensions of impulsiveness using self-report and behavioral measures. In Study 2 (n = 346), we compared three similar groups based on lifetime and past year suicidal behaviors on several of the measures in Study 1. Results In Study 1, we found only that negative urgency was clearly elevated among attempters compared with ideators. In Study 2, there were no significant differences on any impulsiveness constructs, including negative urgency. Conclusions Results from the two studies suggest that attempters may not have significantly elevated trait impulsiveness, compared to ideators; however, attempters may have higher impulsiveness when in a negative state.

Using self-harm Implicit Association Tests (IATs), we sought to test whether (1) suicidal adolescents show implicit identification with self-harm and whether (2) IATs are reliable and sensitive to psychiatric change and (3) predict future suicide attempts. We administered 6 self-harm IATs to 71 adolescents from a psychiatric inpatient unit and assessed suicidal behaviors at admission, discharge and 3 months after discharge. Results were in the expected direction for each IAT but not statistically significant. After aggregating trials across IATs, suicide attempters showed increased implicit identification with self-harm, compared with non-suicidal controls. IATs showed good reliability and sensitivity to psychiatric change but did not prospectively predict suicide attempts. Adolescent suicide attempters may have stronger implicit associations with self-harm than non-suicidal controls.

Background Theoretical work and clinical observation suggest that many patients experience relief from negative affect after thinking about suicide, which may increase the likelihood of future suicidal thoughts. Accordingly, our objective was to examine whether the occurrence of suicidal thinking was followed by decreased negative affect and increased positive affect. Methods Participants were 43 adults who attempted suicide at least once in the past year (78% female, 78% White, M age = 23.28 years, SD age = 4.38 years) who completed 28 days of smartphone-based real-time monitoring, where they were signaled four times/day to report on current affect and whether they were having suicidal thoughts. Participants could initiate a survey whenever they had a suicidal thought. Results First, we examined changes in affect that occurred when suicidal thinking at the current time (T) but not at T + 1 (approximately 4–8 h later). Negative affect decreased and positive affect increased when participants went from a period when they were experiencing suicidal thoughts to a period where they were not. Second, to assess the time course of changes in affect, we examined changes in affect before and after participant-initiated reports of suicidal thinking. Positive affect increased and sadness decreased. Limitations Given its preliminary nature, the study has some limitations including insufficient power to expand beyond a 4–8 h timespan. Conclusions Findings provide preliminary evidence that suicidal thinking leads to shifts in affect. These shifts in affect may be reinforcing, helping to explain (in part) why suicidal thinking is so persistent for some patients.

Self-injurious thoughts and behaviors (SITBs), including nonsuicidal self-injury, suicidal thoughts, suicide attempts, and suicide death exhibit substantial sex differences. Across most countries, men die by suicide more frequently than women; yet, women think about and attempt suicide more frequently than men. Research on sex differences in nonsuicidal self-injury is less developed; however, nonsuicidal self-injury is historically understood as a primarily female phenomenon. This review describes current research on sex differences across SITBs with a focus on factors that moderate these effects, such as age, race, geographic region, and time. Additionally, this review describes factors that may help to explain why sex differences across SITBs exist, including differences in culture, access to lethal suicide methods, rates of mental illness, and utilization of health care. The role of gender, and particularly non-binary gender, is also discussed. Current understanding of these sex differences is described with an eye toward future research on this topic.

Here we report on associations of retrospectively-reported temporally prior mental disorders and Army career characteristics with subsequent first onset of suicidal behaviors in a large, representative sample of U.S. Army soldiers who participated in the Consolidated All Army Survey (AAS) of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS; n=29,982). Results reveal that among men and women, all self-reported lifetime disorders measured (some assessed with screening scales) are associated with subsequent onset of suicide ideation. Among men, three disorders characterized by agitation and impulsiveness (intermittent explosive disorder, panic disorder, and substance disorders) predict the transition from suicide ideation to attempt. For both men and women, being in the Regular Army (vs. National Guard or Army Reserve) and being junior-rank enlisted (vs. being an officer) predict suicide attempts in the total sample. For men, a history of deployment and junior rank are predictors of suicide attempts after adjusting for pre-enlistment disorders but not accounting for pre- and post-enlistment disorders, suggesting that post-enlistment disorders account for some of the increased suicide risk among these career characteristics. Overall, these results highlight associations between mental disorders and suicidal behaviors, but underscore limitations predicting which people with ideation attempt suicide.

Decades of research suggest that social support is an important factor in predicting suicide risk and resilience. However, no studies have examined dynamic fluctuations in day-by-day levels of perceived social support. We examined such fluctuations over 28 days among a sample of 53 adults who attempted suicide in the past year (992 total observations). Variability in social support was analyzed with between-person intraclass correlations and root mean square of successive differences. Multi-level models were conducted to determine the association between social support and suicidal ideation. Results revealed that social support varies considerably from day to day with 45% of social support ratings differing by at least one standard deviation from the prior assessment. Social support is inversely associated with same-day and next-day suicidal ideation, but not with next-day suicidal ideation after adjusting for same-day suicidal ideation (i.e., not with daily changes in suicidal ideation). These results suggest that social support is a time-varying protective factor for suicidal ideation.

The network approach to psychopathology conceptualizes mental disorders as networks of mutually reinforcing nodes (i.e., symptoms). Researchers adopting this approach have suggested that network topology can be used to identify influential nodes, with nodes central to the network having the greatest influence on the development and maintenance of the disorder. However, because commonly used centrality indices do not distinguish between positive and negative edges, they may not adequately assess the nature and strength of a node's influence within the network. To address this limitation, we developed 2 indices of a node's expected influence (EI) that account for the presence of negative edges. To evaluate centrality and EI indices, we simulated single-node interventions on randomly generated networks. In networks with exclusively positive edges, centrality and EI were both strongly associated with observed node influence. In networks with negative edges, EI was more strongly associated with observed influence than was centrality. We then used data from a longitudinal study of bereavement to examine the association between (a) a node's centrality and EI in the complicated grief (CG) network and (b) the strength of association between change in that node and change in the remainder of the CG network from 6- to 18-months postloss. Centrality and EI were both correlated with the strength of the association between node change and network change. Together, these findings suggest high-EI nodes, such as emotional pain and feelings of emptiness, may be especially important to the etiology and treatment of CG. (PsycINFO Database Record

A functional neuroimaging study examined the long-term neural correlates of early adverse rearing conditions in humans as they relate to socio-emotional development. Previously institutionalized (PI) children and a same-aged comparison group were scanned using functional magnetic resonance imaging (fMRI) while performing an Emotional Face Go/Nogo task. PI children showed heightened activity of the amygdala, a region that supports emotional learning and reactivity to emotional stimuli, and corresponding decreases in cortical regions that support perceptual and cognitive functions. Amygdala activity was associated with decreased eye-contact as measured by eye-tracking methods and during a live dyadic interaction. The association between early rearing environment and subsequent eye-contact was mediated by amygdala activity. These data support the hypothesis that early adversity alters human brain development in a way that can persist into childhood, and they offer insight into the socio-emotional disturbances in human behavior following early adversity.

Early adversity, for example poor caregiving, can have profound effects on emotional development. Orphanage rearing, even in the best circumstances, lies outside of the bounds of a species-typical caregiving environment. The long-term effects of this early adversity on the neurobiological development associated with socio-emotional behaviors are not well understood. Seventy-eight children, who include those who have experienced orphanage care and a comparison group, were assessed. Magnetic resonance imaging (MRI) was used to measure volumes of whole brain and limbic structures (e.g. amygdala, hippocampus). Emotion regulation was assessed with an emotional go-nogo paradigm, and anxiety and internalizing behaviors were assessed using the Screen for Child Anxiety Related Emotional Disorders, the Child Behavior Checklist, and a structured clinical interview. Late adoption was associated with larger corrected amygdala volumes, poorer emotion regulation, and increased anxiety. Although more than 50% of the children who experienced orphanage rearing met criteria for a psychiatric disorder, with a third having an anxiety disorder, the group differences observed in amygdala volume were not driven by the presence of an anxiety disorder. The findings are consistent with previous reports describing negative effects of prolonged orphanage care on emotional behavior and with animal models that show long-term changes in the amygdala and emotional behavior following early postnatal stress. These changes in limbic circuitry may underlie residual emotional and social problems experienced by children who have been internationally adopted.

Many studies have linked the structure and function of frontostriatal circuitry to cognitive control deficits in attention deficit hyperactivity disorder (ADHD). Few studies have examined the role of white matter tracts between these structures or the extent to which white matter tract myelination and regularity correlate in family members with the disorder.Functional imaging maps from a go/nogo task were used to identify portions of the ventral prefrontal cortex and striatum involved in suppressing an inappropriate action (i.e., cognitive control) in 30 parent-child dyads (N=60), including 20 dyads (N=40) with ADHD and 10 dyads (N=20) without ADHD. An automated fiber-tracking algorithm was used to delineate white matter fibers adjacent to these functionally defined regions based on diffusion tensor images. Fractional anisotropy, an index of white matter tract myelination and regularity derived from diffusion tensor images, was calculated to characterize the associations between white matter tracts and function.Fractional anisotropy in right prefrontal fiber tracts correlated with both functional activity in the inferior frontal gyrus and caudate nucleus and performance of a go/nogo task in parent-child dyads with ADHD, even after controlling for age. Prefrontal fiber tract measures were tightly associated between ADHD parents and their children.Collectively, these findings support previous studies suggesting heritability of frontostriatal structures among individuals with ADHD and suggest disruption in frontostriatal white matter tracts as one possible pathway to the disorder.

Background: Adolescent depression and suicide are pressing public health concerns, and identifying key differences among suicide ideators and attempters is critical. The goal of the current study is to test whether depressed adolescent suicide attempters report greater anhedonia severity and exhibit aberrant effort–cost computations in the face of uncertainty. Methods: Depressed adolescents (n¼101) ages 13–19 years were administered structured clinical interviews to assess current mental health disorders and a history of suicidality (suicide ideators¼55, suicide attempters¼46). Then, participants completed self-report instruments assessing symptoms of suicidal ideation, depression, anhedonia, and anxiety as well as a computerized effort–cost computation task. Results: Compared with depressed adolescent suicide ideators, attempters report greater anhedonia severity, even after concurrently controlling for symptoms of suicidal ideation, depression, and anxiety. Additionally, when completing the effort–cost computation task, suicide attempters are less likely to pursue the difficult, high value option when outcomes are uncertain. Follow-up, trial-level analyses of effort–cost computations suggest that receipt of reward does not influence future decision-making among suicide attempters, however, suicide ideators exhibit a win–stay approach when receiving rewards on previous trials. Limitations: Findings should be considered in light of limitations including a modest sample size, which limits generalizability, and the cross-sectional design. Conclusions: Depressed adolescent suicide attempters are characterized by greater anhedonia severity, which may impair the ability to integrate previous rewarding experiences to inform future decisions. Taken together, this may generate a feeling of powerlessness that contributes to increased suicidality and a needless loss of life.

Autism spectrum disorders (ASD) are often associated with impairments in judgment of facial expressions. This impairment is often accompanied by diminished eye contact and atypical amygdala responses to face stimuli. The current study used a within-subjects design to examine the effects of natural viewing and an experimental eye-gaze manipulation on amygdala responses to faces. Individuals with ASD showed less gaze toward the eye region of faces relative to a control group. Among individuals with ASD, reduced eye gaze was associated with higher threat ratings of neutral faces. Amygdala signal was elevated in the ASD group relative to controls. This elevated response was further potentiated by experimentally manipulating gaze to the eye region. Potentiation by the gaze manipulation was largest for those individuals who exhibited the least amount of naturally occurring gaze toward the eye region and was associated with their subjective threat ratings. Effects were largest for neutral faces, highlighting the importance of examining neutral faces in the pathophysiology of autism and questioning their use as control stimuli with this population. Overall, our findings provide support for the notion that gaze direction modulates affective response to faces in ASD.

Adolescent decision-making has been described as impulsive and suboptimal in the presence of incentives. In this study we examined the neural substrates of adolescent decision-making using a perceptual discrimination task for which small and large rewards were associated with correctly detecting the direction of motion of a cloud of moving dots. Adults showed a reward bias of faster reaction times on trials for which the direction of motion was associated with a large reward. Adolescents, in contrast, were slower to make decisions on trials associated with large rewards. This behavioral pattern in adolescents was paralleled by greater recruitment of fronto-parietal regions important in representing the accumulation of evidence sufficient for selecting one choice over its alternative and the certainty of that choice. The findings suggest that when large incentives are dependent on performance, adolescents may require more evidence to accumulate prior to responding, to be certain to maximize their gains. Adults, in contrast, appear to be quicker in evaluating the evidence for a decision when primed by rewards. Overall these findings suggest that rather than reacting hastily, adolescents can be incentivized to take more time to make decisions when large rewards are at stake. A video abstract of this article can be viewed at http://youtu.be/1g4F5vzFDl0.

Cognitive control – the ability to exert control over thoughts, attention and behavior in order to achieve a goal – is essential to adaptive functioning and its disruption characterizes various neuropsychiatric and neurodegenerative disorders. In recent years, increased attention has been devoted to investigating the effects of training on performance and brain function, but little is known about whether cognitive control can be improved through training. To fill this gap, we designed a brief training targeting various components of cognitive control, including conflict monitoring and interference resolution. Twenty participants performed a 3-day training protocol, preceded and followed by identical pre- and post-training sessions, respectively, which included event-related potential (ERP) recordings. To detect transfer effects, the training and pre-/post-training sessions employed different tasks hypothesized to rely on similar interference resolution mechanisms. We hypothesized that training would selectively improve performance for high-interference (i.e., incongruent) trials and be associated with reduced amplitudes in the N2 component, a waveform known to index interference. Trial-to-trial behavioral adjustments were also analyzed to assess potential mechanisms of training-induced improvements. Relative to pre-training, participants showed reduced reaction time (RT) and N2 amplitude for incongruent, but not congruent, trials, suggesting improved interference resolution. Critically, participants showing the greatest reductions in interference effects during the course of the training displayed the largest pre- to post-training reductions in N2 amplitudes in a separate task, highlighting transfer effects. Overall, results suggest that a brief training can improve cognitive control, specifically the ability to inhibit task-irrelevant information.