Search

Disturbances in interpersonal functioning are prevalent in individuals with suicidality. Foundational for interpersonal functioning is theory of mind (ToM), a social-cognitive ability that allows individuals to understand the thoughts and feelings of others. Recent work has begun to investigate ToM performance in individuals with suicidality, though no review has quantitatively aggregated findings from these varied studies. The current study investigated the relations between ToM and suicidality with meta-analysis.We identified and meta-analyzed 15 studies that presented data for 2,895 participants (617 of whom had reported at least one suicide attempt).Results indicated a significant, negative relation between ToM and suicidality with a medium overall effect size (Deficits in ToM associated with suicidality hold promise for risk-identification, treatment, and prevention work.HighlightsTheory of mind (ToM) abilities are critical for effective interpersonal functioning.Meta-analytics results indicate that ToM deficits are associated with suicidality.Identifying such suicidality-related ToM deficits may inform risk-identification, treatment, and prevention work.

Maternal depression is associated with cognitive, emotional, and behavioral problems in offspring, but the substantial heterogeneity of depression precludes a full understanding of these associations. Variation in course of depression, characterized by severity or chronicity, may be related differentially to children's development. The current meta-analytic review examined the relations of these characteristics of maternal depression to children's developmental outcomes. Twenty-nine studies were identified and reviewed; the majority (93%) of studies reported a negative association between some aspect of maternal depression and children's adjustment. Separate meta-analyses revealed significant effect sizes for severity (Fisher's z = -.243) and chronicity (adjusted Fisher's z = -.337) of maternal depression and children's cognitive or behavioral functioning. Findings are synthesized across features of maternal depression; methodological limitations within the empirical literature are discussed; and recommendations for future research are suggested. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

BACKGROUND: Theory of mind (ToM) is a social-cognitive skill that involves the ability to understand the thoughts and feelings of others. Evidence is mixed regarding the extent of ToM ability in individuals with depression. METHODS: We conducted a meta-analysis of 43 studies to investigate the strength of the association between ToM and depression. RESULTS: Results indicated significant, small- to moderate impairment in ToM with a medium overall effect size (g = −.398) in individuals with depression. Moderator analyses compared effect sizes across groups for the following variables: ToM content, process, and sample type. Additionally, meta-regression analyses tested age and gender as continuous moderators. LIMITATIONS: The cross-sectional nature of included studies limits this meta-analysis from clarifying temporal or bidirectional relations. CONCLUSIONS: We discuss findings in the context of the extant developmental, cognitive, social, and clinical literatures. We also suggest several possible explanations for these findings and offer implications for intervention.

Background Comorbidity of substance use disorders (SUDs) with mood disorders and other psychiatric conditions is common. Parenting processes and family functioning are impaired in adolescents with SUDs and mood disorders, and parent/family factors predict intervention response. However, limited research has examined the relationship between parent/family factors and mood symptom treatment response in adolescents with comorbid SUDs and psychiatric conditions. Method This study examined the predictive effects of parenting processes and family functioning on depressive symptoms and suicidal ideation (SI) in a randomized controlled trial of integrated cognitive-behavioral therapy vs. treatment as usual for 111 adolescents with comorbid SUDs and psychiatric disorders. Measures of parenting processes, family functioning, depressive symptoms, and SI were completed at baseline and 3-, 6-, and 12-month follow-ups. Exploratory analyses involved mixed-effects regression models. Results Across treatment conditions, depressive symptoms and SI improved over 12 months. Family functioning domains of family roles (d=0.47) and affective involvement (d=0.39) significantly improved across treatment conditions over 12 months. Higher baseline parental monitoring predicted improved trajectory of depressive symptoms (d=0.44) and SI (d=0.46). There were no significant predictive effects for baseline family functioning or other parenting processes (listening, limit setting). Limitations Limitations include the modest sample, attrition over follow-up, and generalizability to samples with higher rates of mood disorders and/or uncomplicated mood disorders. Conclusions Parental monitoring may be an important prognostic indicator of depressive symptoms and SI in adolescents with co-occurring SUDs and psychiatric conditions, and therefore may be useful to assess and target in treatment, in addition to family functioning.

This study examined effects of an adolescent depression prevention program on maternal criticisms and positive remarks, whether the extent of adolescents' depression accounted for effects, and whether effects of the program on maternal criticisms and positive remarks differed by adolescents' gender. Participants were 298 adolescent (Mage = 14.79, SD = 1.36; 59% female) offspring of mothers with histories of depression; youth were randomized to either a cognitive-behavioral prevention (CBP) program or usual care (UC). At baseline and 9-month postintervention evaluations, mothers were administered the Five-Minute Speech Sample to measure number of criticisms and positive remarks made during an open-ended description of their child and their relationship. Adolescents' depression from pre- through postintervention was assessed with interviews. A hierarchical generalized linear model showed a significant condition-by-gender interaction, indicating that, controlling for baseline criticism, at postintervention mothers of girls in CBP made significantly more criticisms than did mothers of girls in UC, whereas mothers of boys in CBP made fewer criticisms than did mothers of boys in UC. The extent of adolescents' depression from pre- through postintervention partially mediated the relation between intervention condition and mothers' criticisms, for boys but not for girls. Second, controlling for preintervention positive remarks, at postintervention, mothers of youth in CBP made significantly more positive remarks about their child than did mothers of youth in UC, regardless of gender; this relation was not mediated by adolescent depression from pre- through postintervention. We suggest possible explanations for the observed effects of CBP on mothers' criticisms and positive remarks. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Suicidal ideation (SI) and attempts (SA) are prevalent in late adolescence and emerging adulthood. Prior research has identified perceived support as a correlate of SI and SA. Less is known, though, about the role of perceived support in differentiating among suicidal outcomes and between the incremental escalation of suicidal outcomes from SI to SA to serious suicide attempts (SSA).Using ordinal regression, we used Wave 1 and 2 data from the National Longitudinal Study of Adolescent to Adult Health (N = 4500; 53% female; MCross-sectional results indicated that youths with higher perceived support were less likely to have suicidal ideation. Longitudinal results showed that youths with higher perceived support at Wave 1 were less likely to have suicidal ideation or serious suicide attempts at Wave 2. Transitional model results revealed that higher perceived support at Wave 1 was negatively associated with escalation in suicidal outcomes from Wave 1 to 2.We discuss findings in the context of theories of suicide and discuss implications for suicide risk identification, intervention, and prevention efforts in late adolescence and emerging adulthood.

Background The current study identifies predictors and moderators of substance use outcomes for 111 adolescents with co-occurring substance use and psychiatric disorders who participated in a randomized controlled trial that compared the effectiveness of two home-based treatments: an integrated cognitive behavioral therapy (I-CBT) protocol, in which masters-level clinic staff received intensive training and ongoing supervision in the use of this protocol versus a treatment-as-usual (TAU) comparison condition in which therapists received a continuing education–style CBT workshop in the same protocol. Method The study conducted exploratory predictor and moderator analyses of marijuana and heavy alcohol use outcomes using candidate variables across four domains of psychological characteristics: adolescent substance use, adolescent psychiatric symptoms, parent, and family. Results Regardless of treatment condition, low parental monitoring at baseline, as assessed by a videotaped interaction task, but not self-report, predicted greater percentage of marijuana use and heavy alcohol use days over the 6-month follow-up period. If parents entered treatment with low levels of parental monitoring, adolescents in the I-CBT condition reduced their percentage of heavy alcohol use days significantly more than adolescents in TAU over the 6-month follow-up period. Greater adolescent aggression and parental emotion dysregulation at baseline also predicted greater percentage of marijuana use days over the 6-month follow-up period for the sample as a whole. Adolescents in the I-CBT condition who reported low positive urgency at baseline reduced their percentage of heavy alcohol use days significantly more than adolescents in TAU care over the 6-month follow-up period. Conclusion The article discusses implications for clinical decision-making, improving treatment effectiveness, and tailoring interventions for adolescents with co-occurring substance use and psychiatric disorders.

Research on the relations between irritability and suicidality among adults has rarely compared or differentiated between tonic versus phasic irritability. The current cross-sectional study investigated the role of both tonic and phasic irritability in relation to lifetime suicidal ideation, plans, and attempts. The study included adult participants who completed the suicidality module from the National Comorbidity Survey – Replication (NCS-R) (N = 7683 for suicidal ideation and N = 1223 for suicidal plan and attempt). The NCS-R used lay-administered, standardized diagnostic interviews. Phasic and tonic irritability were assessed with individual screener items from the World Health Organization Composite International Diagnostic Interviews (CIDI). The current study used logistic regression, weighted Cox proportional hazard model, and multinomial logit regression, adjusting for sex, race/ethnicity, age, education, and marital status. Both types of irritability were included simultaneously in the models. Results indicated that both types of irritability were significantly associated with increased odds of suicidal ideation (phasic: Odds Ratio 2.72 [2.35,3.14]); tonic: OR 2.34 [2.04,2.68]), age of first-time suicidal ideation (phasic: Adjusted Hazard Ratio 2.87 [2.27, 3.63]; tonic: AHR 2.12 [1.76,2.54]), and suicide attempt (phasic: OR 1.53 [1.13,2.07]); tonic: OR 1.44 [1.11,1.89]). Only tonic but not phasic irritability was associated with suicide plans (OR 1.39 [1.08,1.79]). When suicide attempts were divided into those that were impulsive versus planned and compared them to no suicide attempt, both types of irritability were associated planned attempts, (phasic: OR 1.53 [1.13,2.07]); tonic: OR 1.44 [1.11,1.89]) but only phasic irritability was related to impulsive attempts (OR 1.70 [1.10,2.64]). Phasic and tonic irritability show differential relations to and can serve as differential markers for suicide-related outcomes in adults.

Background Theories connecting depression to emotional reactivity (ER) or cognitive reactivity (CR) have not clearly indicated whether ER and CR are between-person or within-person constructs. Most empirical tests of these theories have focused on either between- or within-person operationalizations of these constructs, but not both. Between- and within-person studies address qualitatively different questions and often generate very different results. Consequently, the goals of the current study were to examine the relation of depressive symptoms to both between- and within-person operationalizations of both ER and CR. Methods Participants were 160 undergraduate students who completed daily diary measures (assessing stress, negative emotions, and negative cognitions) and measures of depressive symptoms. Multilevel modeling (MLM) enabled examination of depressive symptoms to the within- and between-person components of ER and CR. Results: Depressive symptoms were positively related to within-person ER and CR but not to between-person operationalizations of ER and CR. Limitations The sample only included college students and only assessed depressive symptoms, not clinical diagnoses of major depression. Conclusions Important implications emerge for theory, practice, and future research. We recommend distinguishing between-person from within-person dimensions of ER and CR in future research.

Understanding influences and predictors of adolescent alcohol use is necessary for treatment and prevention efforts. Although parent, sibling, and peer substance use have demonstrated associations with adolescent drinking, there is a need to examine the unique predictive role of each variable across time. The purpose of the current study was to longitudinally examine the varying influences of parent, sibling, and peer substance use on adolescent drinking. Participants were 102 at-risk adolescents referred to a randomized intervention trial. Hierarchical multiple regressions were conducted to assess the utility of parent alcohol use, sibling alcohol use, and peer substance use to predict drinking outcomes in the referred adolescent at 3-, 6-, and 12-month follow-up assessments. Results indicated that sibling and peer substance use significantly predicted adolescent drinking frequency above and beyond parent alcohol use at all three time points and drinking quantity and frequency of intoxication at the 12-month follow-up. Peer substance use predicted high volume drinking episodes at all follow-ups and frequency of intoxication at the 3- and 6-month follow-up, whereas only sibling alcohol use predicted drinking quantity at the 3-month follow-up. Parent alcohol use was not a significant predictor of drinking outcomes at any time point. Both sibling and peer substance use were better predictors of adolescent drinking typology at different assessment time points compared to parent alcohol use. These findings highlight the importance of assessing and targeting sibling and peer substance use in intervention and prevention programs.

The current study conducted a preliminary test of whether community mental health clinic staff could implement a multicomponent cognitive behavioral treatment, developed for adolescents with substance misuse (alcohol and/or marijuana) and comorbid psychiatric symptoms. We randomized a total of 111 families, with an adolescent 12–18 years old, referred to a home-based services program for youth with co-occurring substance use and mental health problems, to receive treatment from either masters-level therapists who received intensive cognitive behavioral therapy (I-CBT) training or from masters-level therapists who took part in a typical brief continuing education–style CBT workshop (treatment as usual, or TAU). Each family's therapist and insurance company determined the frequency and intensity of treatment. We administered follow-up assessments at 3, 6, and 12 months. There was a small, but not statistically significant, reduction in the percent days of heavy drinking and marijuana use over time for both conditions, with the overall effect across the three follow-up points favoring the I-CBT condition. There were no differences on alcohol use days or other drug use. There was also a small, but nonsignificant, positive effect over time on externalizing symptoms, depressed mood, and anxiety, favoring the I-CBT condition. Youth in the I-CBT condition relative to TAU had significantly fewer juvenile justice contacts, while the pattern of costly service use varied, with higher rates at 6-month and lower rates at 12-month follow-ups. If therapists pay greater attention to parent training and provide more parent-adolescent communication sessions, outcomes may improve above standard community care. Training enhancements, to better meet the needs of community therapists and their clinic settings, may also produce better overall results for parents and adolescents.

OBJECTIVE. Children of parents with depression are at increased risk for developing psychopathology. The purpose of the current longitudinal study was to examine the dynamic relations between parents’ depressive symptoms and children’s cognitions, specifically their attributions for the causes of life events. METHOD. Participants were 227 parent-child dyads with one parent (Mean(age)=42.19, SD=6.82, 76% female) and one child (Mean(age)=12.53, SD=2.33; 53% female) per family. Parents were either diagnosed with a current Major Depressive Disorder (n=129; 72.9% female) or were lifetime-free of mood disorders (n=98; 79.6% female). The Beck Depression Inventory II was used to obtain a dimensional measure of parents’ depressive symptoms, and the Children’s Attributional Style Questionnaire – Revised was used to assess children’s attributions of negative and positive events. Evaluations were conducted five times across 22 months. RESULTS. We used latent difference score modeling to examine the relations between changes in parents’ depressive symptoms and changes in children’s attributional style over time. The final model provided a close fit to the data: χ(2) =35.22, df=30, p=.24, comparative fit index=.995; root mean square error of approximation=.028, 90% confidence interval=.000 and .060; standardized root mean square residual=.024. Parents’ levels of depressive symptoms significantly predicted the worsening of children’s attributions (i.e., becoming more pessimistic) over the 22 months, whereas children’s attributions did not significantly predict changes in parents’ depressive symptoms at the next time point. CONCLUSIONS. Preventive interventions should aim to both reduce parents’ depression and teach children strategies for examining the accuracy of their beliefs regarding the causes of life events.

Background This study examined racial/ethnic differences in mental health treatment utilization for suicidal ideation and behavior in a nationally representative sample of adolescents. Method Data were drawn from the National Survey on Drug Use and Health. Participants included 4176 depressed adolescents with suicidal ideation and behavior in the previous year. Weighted logistic regressions were estimated to examine whether adolescent racial/ethnic minorities had lower rates of past-year treatment for suicidal ideation and behavior in inpatient or outpatient settings, while adjusting for age, depressive symptom severity, family income, and health insurance status. Results Among adolescents with any suicidal ideation and behavior, and suicide attempts specifically, non-Hispanic blacks and Native Americans were less likely than whites to receive outpatient treatment, and multiracial adolescents were less likely to be admitted to inpatient facilities. Apart from Hispanics, racial/ethnic minorities were generally less likely to receive mental health care for suicidal ideation, particularly within psychiatric outpatient settings. A pattern emerged with racial/ethnic differences in treatment receipt being greatest for adolescents with the least severe suicidal ideation and behavior. Limitations The cross-sectional data limits our ability to form causal inferences. Conclusion Strikingly low rates of treatment utilization for suicidal ideation and behavior were observed across all racial/ethnic groups. Certain racial/ethnic minorities may be less likely to seek treatment for suicidal ideation and behavior when symptoms are less severe, with this gap in treatment use narrowing as symptom severity increases. Native Americans were among the racial/ethnic groups with lowest treatment utilization, but also among the highest for rates of suicide attempts, highlighting the pressing need for strategies to increase mental health service use in this particularly vulnerable population.

Recent years have seen a considerable growth of interest in the study of life stress and non-suicidal self-injury (NSSI). The current article presents a systematic review of the empirical literature on this association. In addition to providing a comprehensive meta-analysis, the current article includes a qualitative review of the findings for which there were too few cases (i.e., < 3) for reliable approximations of effect sizes. Across the studies included in the meta-analysis, a significant but modest relation between life stress and NSSI was found (pooled OR = 1.81 [95% CI = 1.49–2.21]). After an adjustment was made for publication bias, the estimated effect size was smaller but still significant (pooled OR = 1.33 [95% CI = 1.08–1.63]). This relation was moderated by sample type, NSSI measure type, and length of period covered by the NSSI measure. The empirical literature is characterized by several methodological limitations, particularly the frequent use of cross-sectional analyses involving temporal overlap between assessments of life stress and NSSI, leaving unclear the precise nature of the relation between these two phenomena (e.g., whether life stress may be a cause, concomitant, or consequence of NSSI). Theoretically informed research utilizing multi-wave designs, assessing life stress and NSSI over relatively brief intervals, and featuring interview-based assessments of these constructs holds promise for advancing our understanding of their relation. The current review concludes with a theoretical elaboration of the association between NSSI and life stress, with the aim of providing a conceptual framework to guide future study in this area.

Suicidal ideation (SI) is a common presenting problem for psychiatric hospitalizations in adolescents and often persists following discharge. This study examines whether distinct trajectories of SI could be delineated following hospitalization and the risk factors most strongly related to these trajectories. Adolescents (N = 104; 76 females; 28 males) were followed for 6 months after discharge from inpatient or partial hospitalization. Semi-parametric group modeling identified SI trajectory group membership. In all, 33.7% of adolescents fell in a Subclinical SI group, 43.3% in a Declining SI group, and 23.1% in a Chronic SI group. Multinomial logistic regression was utilized to examine baseline predictors of group membership. Emotion dysregulation differentiated Chronic SI from Declining SI. In multivariate analyses, adolescents endorsing greater non-acceptance of emotional responses (OR = 1.18) and more limited access to emotion regulation strategies (OR = 1.12) were more likely to belong to the Chronic SI than Declining SI trajectory. Those in the Chronic SI group also had the greatest number of suicide attempts and hospitalizations in the 6 months post-discharge. These results suggest that clinicians should closely monitor and address emotion dysregulation when assessing suicide risk. Greater dysregulation may require more intensive services in order to have an effect on chronic SI.

Since the formulation of the hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989) a quarter century ago, it has garnered considerable interest. The current paper presents a systematic review of this theory including its subsequent elaborations (Rose and Abramson’s [1992] developmental elaboration, Abela and Sarin’s [2002] weakest-link approach, Panzarella, Alloy, and Whitehouse’s [2006] expansion of the hopelessness theory, and the hopelessness theory of suicide [Abramson et al., 2000]), followed by recommendations for future study. Although empirical support was consistently found for several major components of the hopelessness theory, further work is required assessing this theory in relation to clinically significant phenomena. Among the most significant hindrances to advancement in this area is the frequent conceptual confusion between the hopelessness theory and the reformulated learned helplessness theory.

BACKGROUND: Although several risk factors for suicidal ideation (SI) have been identified in the research literature, there is a pressing need for studies evaluating markers of risk differentiating ideators from people who have attempted. According to the interpersonal theory of suicide, habituation to painful or provocative experiences increases one's acquired capability for suicide, a necessary component for the transition from SI to attempts. This theory further posits that the acquired capability for suicide should be unrelated to risk for SI. This study tested this theory by examining injection drug use, relative to less painful means of drug use, in relation to SI, suicide plans, and suicide attempts. METHODS: Data were drawn from the National Survey on Drug Use and Health (NSDUH), a nationally representative survey conducted annually. Participants included 10,203 adults with a history of injectable drug use and major depression. RESULTS: Injection drug use was positively associated with suicide attempts (Odds Ratio [OR] = 1.66, 95% confidence interval [CI] = 1.18-2.34), but not SI or suicide plans in the full sample. Injection drug use was also associated with suicide attempts (OR = 1.64, 95% CI = 1.14-2.35), but not plans, among ideators. Lastly, injection drug use was associated with the suicide attempts among suicide planners (OR = 1.76, 95% CI = 1.01-3.06). All analyses included sex, age, race/ethnicity, family income, substance use disorder symptom severity for injectable drugs, and depressive symptom severity as covariates. CONCLUSIONS: Consistent with the interpersonal theory of suicide, injection drug use was associated with specific risk for suicide attempts but not SI or suicide plans. Language: en

Although several risk factors for suicidal ideation (SI) have been identified in the research literature, there is a pressing need for studies evaluating markers of risk differentiating ideators from people who have attempted. According to the interpersonal theory of suicide, habituation to painful or provocative experiences increases one's acquired capability for suicide, a necessary component for the transition from SI to attempts. This theory further posits that the acquired capability for suicide should be unrelated to risk for SI. This study tested this theory by examining injection drug use, relative to less painful means of drug use, in relation to SI, suicide plans, and suicide attempts.Data were drawn from the National Survey on Drug Use and Health (NSDUH), a nationally representative survey conducted annually. Participants included 10,203 adults with a history of injectable drug use and major depression.Injection drug use was positively associated with suicide attempts (Odds Ratio [OR] = 1.66, 95% confidence interval [CI] = 1.18-2.34), but not SI or suicide plans in the full sample. Injection drug use was also associated with suicide attempts (OR = 1.64, 95% CI = 1.14-2.35), but not plans, among ideators. Lastly, injection drug use was associated with the suicide attempts among suicide planners (OR = 1.76, 95% CI = 1.01-3.06). All analyses included sex, age, race/ethnicity, family income, substance use disorder symptom severity for injectable drugs, and depressive symptom severity as covariates.Consistent with the interpersonal theory of suicide, injection drug use was associated with specific risk for suicide attempts but not SI or suicide plans.