Implicit and explicit self-esteem in currently depressed individuals with and without suicidal ideation

In the present study, we have further explored implicit self-esteem in currently depressed individuals. Since suicidal ideation is associated with lower self-esteem in depressed individuals, we measured both implicit and explicit self-esteem in a population of currently depressed (CD) individuals, with and without suicidal ideation (SI), and in a group of non-depressed controls (ND). The results indicate that only CD individuals with SI show a discrepancy between their implicit and explicit self-esteem: that is, they exhibit high implicit and low explicit self-esteem. CD individuals without SI exhibit both low implicit and low explicit self-esteem; and ND controls exhibit both normal implicit and normal explicit self-esteem. These results provide new insights in the study of implicit self-esteem and the combination of implicit and explicit self-esteem in depression.     

A binational school survey of depressive symptoms, drug use, and suicidal ideation.

New findings are presented from a survey of depressive symptoms, illicit drug use, and suicidality among 4,157 adolescents attending school in six border cities in Texas and neighboring Tamaulipas, Mexico. Among the Texas youth, 48.08% scored above 16 on the Center for Epidemiologic Studies' Depression Scale (CES-D); 21% reported illicit drug use in the past month; and 23.43% said they had thought about killing themselves during the past week. Rates were lower among the Mexican youth: 39.41% had high CES-D scores; 4.95% reported drug use and 11.57% reported current suicidal ideation. Multivariate models are presented to show the linkage between psychological distress, drug use, and suicidality in this sample of border youth.     

Relations between suicidal ideation and dimensions of depressive symptoms in high-school students

The aim of the study was to evaluate the link between the different dimensions of depressive symptoms and suicidal ideation in adolescents. A sample of 1057 adolescents completed the CES-D (Center for Epidemiological Studies Depression Scale) and three additional items measuring suicidal ideation. The four dimensions of depressive symptoms on the CES-D (Depressed Affect, Loss of Positive Affect, Somatic and Retarded Activity, Interpersonal) were entered into regression analyses predicting the presence of any suicidal ideation and of the wish to kill oneself among participants with moderate/severe depressive symptoms (n=271). For both boys and girls Depressed Affect was the main significant predictor of the presence of any suicidal ideation and of the wish to kill oneself. There were two additional significant predictors for boys: Loss of Positive Affect positively predicted the presence of any suicidal ideation; Somatic and Retarded Activity negatively predicted the presence of the wish to kill oneself.     

Self-destructive tendencies and depression as predictors of suicidal ideation in teenagers

In male teenagers, scores on a self-destructive inventory were more strongly associated with the presence of suicidal ideation than scores on a depression inventory. For female teenagers, scores on the depression inventory were more strongly associated with suicidal ideation.     

青少年自杀意念与生活事件及自尊水平的关系

目的 探讨青少年自杀意念的现状及自杀意念与生活事件、自尊水平的关系.方法 采取分层整群随机抽样的方法,抽取长沙市和湘潭市2836例青少年学生,采用自制一般情况问卷、自杀意念问卷、青少年生活事件量表和自尊量表进行调查.结果 青少年自杀意念的检出率为23.4％.有无自杀意念两组在生活事件量表各因子及自尊水平上差异有统计学意义(P＜0.05).自杀意念的危险因素包括女性、单亲家庭、家庭经济差、家庭暴力、负性生活事件以及低自尊水平.结论 青少年自杀意念的产生与负性生活事件、不良家庭环境、低自尊水平有密切联系.     

Social relationships as predictors of depression and suicidal ideation in older adults

The prevalence of depression and suicidal ideation among older adults is considered to be a major mental health concern among this age group. The present study investigated the human relatedness variables of marital status, social support resources and sense of belonging as predictors of depression and suicidal ideation in older adults. A community sample of 110 older adults (M age 76.67 years, SD = 8.11) completed the Social Support Subscale of the Coping Resources Inventory, the Sense of Belonging Instrument, the Zung Depression Inventory and the Suicide Subscale of the General Health Questionnaire. Results indicated that fewer social support resources were associated with higher levels of depression and suicidal ideation. Sense of belonging to the community was not an additional predictor of mental health. The results of the present study suggest that enhancing social support resources in older adults could reduce depression and suicidal ideation.     

Obsessive compulsive symptoms in individuals at clinical risk for psychosis: association with depressive symptoms and suicidal ideation

Obsessive-compulsive symptoms, particularly aggressive obsessions, are prevalent in schizophrenia patients and associated with other symptom severity, suicidal ideation and functional impairment. In a psychosis-risk cohort, obsessive-compulsive diagnosis and symptoms were assessed in terms of prevalence and content, and for associations with clinical measures. Obsessive-compulsive symptoms were prevalent in the CHR cohort, as was suicidal ideation. The presence and severity of aggressive obsessions were associated with depression, suicidal ideation and social impairment. The high prevalence of aggressive obsessions and associated suicidal ideation in a clinical high risk cohort, and their relationship to depression, is relevant for risk assessment and treatment strategies.     

Suicidal ideation and depressive symptoms among bipolar patients as predictors of the health and well‐being of caregivers

Objectives: Few studies have addressed the physical and mental health effects of caring for a family member with bipolar disorder. This study examined whether caregivers’ health is associated with changes in suicidal ideation and depressive symptoms among bipolar patients observed over one year. Methods: Patients (N = 500) participating in the Systematic Treatment Enhancement Program for Bipolar Disorder and their primary caregivers (N = 500, including 188 parental and 182 spousal caregivers) were evaluated for up to one year as part of a naturalistic observational study. Caregivers’ perceptions of their own physical health were evaluated using the general health scale from the Medical Outcomes Study 36‐item Short‐Form Health Survey. Caregivers’ depression was evaluated using the Center for Epidemiological Studies of Depression Scale. Results: Caregivers of patients who had increasing suicidal ideation over time reported worsening health over time compared to caregivers of patients whose suicidal ideation decreased or stayed the same. Caregivers of patients who had more suicidal ideation and depressive symptoms reported more depressed mood over a one‐year reporting period than caregivers of patients with less suicidal ideation or depression. The pattern of findings was consistent across parent caregivers and spousal caregivers. Conclusions: Caregivers, rightly concerned about patients becoming suicidal or depressed, may try to care for the patient at the expense of their own health and well‐being. Treatments that focus on the health of caregivers must be developed and tested.     

A 2–4 year follow up of depressive symptoms, suicidal ideation, and suicide attempts among adolescent psychiatric inpatients

One hundred eleven (58%) of 191 adolescent inpatients previously admitted to the emergency wards at the Child and Adolescent Psychiatric Clinics in the cities of Uppsala and Göteborg participated in a 2–4 year follow-up evaluation. The prevalence, incidence, and stability of depressive symptoms, suicidal ideation, and suicide attempts among the adolescents, and predictors of follow-up functioning were examined. Although a majority of the patients substantially reduced their depressive symptoms over the 2–4 year period, a smaller group (13%), mainly girls (94%), continued reporting high symptom levels at follow-up, and one out of five adolescents had moderate-severe levels of suicidal ideation. The accumulated frequency of suicide attempts among the patients shortly prior to hospitalization and during the follow-up was 59% including two patients who committed suicide. Significant predictors of depressive symptom severity at follow-up were depressive symptom scores and V-diagnoses at inpatient assessment. Previous suicide attempts before hospitalization, high levels of self-reported depressive symptoms and nonintact family status at inpatient assessment predicted suicide attempts during the follow-up period. The high prevalence of attempted and completed suicide in this clinical group underscores the importance of developing effective treatments for suicidal adolescents.     

Negative and depressive symptoms in suicidal schizophrenics

The aim of this study was to determine the value of positive, negative and depressive symptoms, and of the dexamethasone suppression test (DST), in differentiating schizophrenics with and without a history of suicide. Fifty-seven hospitalized patients with schizophrenia were assessed at the end of a neuroleptic free interval with the Brief Psychiatric Rating Scale (BPRS), the Hamilton Rating Scale for Depression (HRSD), and with a dexamethasone challenge. Suicide attempters were significantly more likely to meet criteria for major depression than nonattempters. Scores on the HRSD differentiated the two groups whereas the sums of positive and negative symptom items from the BPRS did not. DST a.m. and p.m. cortisol values differentiated suicide attempters from nonattempters and HRSD scores correlated significantly with cortisol levels. This study confirms the importance of depressive symptoms in schizophrenic patients with a history of suicide. Assessment of the hypothalamic-pituitary-adrenal axis in schizophrenia may also provide useful information.     

Implicit and explicit self-esteem discrepancies in people with psychogenic nonepileptic seizures

PurposeSelf-esteem (SE), or one's sense of competence and worth, is reduced in many mental and physical disorders. Low SE is associated with perceived stigma and disability and poor treatment outcomes. The present study examined implicit and explicit SE (automatic and deliberate views about the self) in people with epilepsy and people with psychogenic nonepileptic seizures (PNESs). Discrepancies between implicit SE and explicit SE have been found to correlate with psychological distress in disorders often associated with PNESs but are relatively unexplored in PNESs. We hypothesized that, compared with epilepsy, PNESs would be associated with lower self-reported SE and greater discrepancies between implicit SE and explicit SE.MethodsThirty adults with PNESs, 25 adults with epilepsy, and 31 controls without a history of seizures were asked to complete the Rosenberg Self-esteem Scale as a measure of explicit SE and an Implicit Relational Assessment Procedure as a measure of implicit SE. The State–Trait Anxiety Inventory and Patient Health Questionnaire—15 (a somatic symptom inventory) were also administered.ResultsWe found significant group differences in explicit (p < 0.001) but not implicit SE. Patients with PNESs reported lower SE than the other groups. No group differences were found in implicit SE. Implicit–explicit SE discrepancies were larger in the group with PNESs than in the other groups (p < 0.001). Higher frequency of PNESs (but not epileptic seizures) was associated with lower explicit SE (r_s = − .83, p < 0.01) and greater SE discrepancies (i.e., lower explicit relative to implicit SE; r_s = .65, p < 0.01). These relationships remained significant when controlling for anxiety and somatization.ConclusionPatients with PNESs had lower explicit SE than those with epilepsy or healthy controls. In keeping with our expectations, there were greater discrepancies between implicit SE and explicit SE among patients with PNESs than in the other groups. Our results, including the strong relationship between PNES frequency, anxiety, and explicit–implicit SE discrepancies, support the interpretation that PNESs serve to reduce cognitive dissonance, perhaps protecting patients' implicit SE.     

Personality predictors of outcome for adolescents hospitalized for suicidal ideation

OBJECTIVE: Recent cross-sectional studies of adolescents have noted an association between the personality traits of perfectionism and self-criticism and suicidal ideation. The present study was undertaken to examine the relationship between personality dimensions and the outcome of treatment of adolescents hospitalized for suicidal ideation or behavior. METHOD: The study group was composed of 78 adolescents who were admitted to an adolescent psychiatric inpatient unit for suicidal ideation or attempts. Subjects completed measures of self-criticism, interpersonal dependency, self-oriented perfectionism, and socially prescribed perfectionism as well as the broad, higher-order trait neuroticism. Depression symptoms, hopelessness, and suicidal ideation were assessed at the beginning (time 1) and end (time 2) of their inpatient treatment. Readmissions were identified by review of medical records 1 year after hospital discharge. RESULTS: After controlling for baseline symptoms, neuroticism was associated with posttreatment depression and suicidal ideation. After controlling for time 1 symptoms and neuroticism in multiple regression analyses, self-criticism was associated with post-treatment hopelessness and depression. Logistic regression analysis was used to identify predictors of readmission. Baseline suicidal ideation and neuroticism were predictive of psychiatric readmission within 1 year of discharge. CONCLUSIONS: Neuroticism and self-criticism are potentially useful predictors of outcome in suicidal adolescents and can be assessed quickly and reliably. Therapeutic interventions directed at self-criticism (e.g., cognitive-behavioral therapy) may be useful in the treatment of suicidal adolescents.     

Socioeconomic status and anxiety as predictors of antidepressant treatment response and suicidal ideation in older adults

BACKGROUND: Separate reports from the maintenance treatment for late-life depression (MTLD) trials have shown that low socioeconomic status (SES) and anxiety symptoms at the time of treatment initiation predict lower levels of response to antidepressant treatment and higher levels of suicidal ideation in older adults. AIM: To determine whether SES and anxiety independently contribute to worse treatment outcomes, as indicated by persistence of depressive symptoms during treatment and the persistence of suicidal ideation. Consistent with prior evidence that sociodemographic factors and clinical history are both prognostic of depression treatment efficacy, we hypothesized that SES and pre-existing anxiety symptoms will both predict lower levels of response to treatment and higher levels of suicidal ideation. METHOD: Secondary analyses of data from the MTLD trials. RESULTS: Regression analyses which controlled for comorbid anxiety indicated that residents of middle- and high-income census tracts were more likely to respond to treatment (HR, 1.63; 95%CI, 1.08-2.46) and less likely to report suicidal ideation during treatment (OR, 0.51; 95%CI, 0.28-0.90) than residents of low income census tracts. The same regression models indicated that pre-existing anxiety symptoms were independently related to lower treatment response (HR, 0.73; 95%CI, 0.60-0.89) and higher risk of suicidal ideation (OR, 1.45; 95%CI, 0.98-2.14). CONCLUSION: These findings demonstrate the importance of treating anxiety symptoms during the course of treatment for late-life depression and, at the same time, addressing barriers to treatment response related to low SES.     

Associations between loneliness, depressive symptoms and perceived togetherness in older people

This study explores the associations of loneliness with depressive symptoms in a five-year follow-up and describes how the six dimensions of perceived togetherness explain loneliness and depressive symptoms at baseline. The data were collected on 207 residents of Jyväskylä, central Finland, who at baseline in 1990 were aged 80; and 133 residents who at follow-up in 1995 were aged 85. Loneliness was assessed using a questionnaire item with four preset response options, perceived togetherness using the Social Provisions Scale, and depressive symptoms using the CES-D scale. A recursive structural equation model showed that in women but not in men, depressive symptoms predicted more experiences of loneliness. Those who were lonely were more depressed (CES-D score 16 or over) and experienced less togetherness than those who were not. Loneliness was explained by reliable alliance, social integration and attachment; and depressive symptoms were explained by guidance, reassurance of worth, reliable alliance and attachment. A common feature in both loneliness and depressive symptoms was a lower level of perceived emotional togetherness in social interaction.     

Coping and thought suppression as predictors of suicidal ideation in depressed older adults with personality disorders

Suicide rates are higher among older adults than any other age group and suicidal ideation is one of the best predictors of completed suicide in older adults. Despite this, few studies have evaluated predictors of suicidal ideation and other correlates of death by suicide (e.g. hopelessness) among older adults. Even fewer studies on this topic have been conducted among samples characterized as poor responders to treatments (e.g. depressed individuals with co-occurring personality disorder). The purpose of this study was to examine coping styles and thought suppression as predictors of a suicide risk composite score in a sample of depressed older adults with co-occurring personality disorders. Based on the extant literature, it was hypothesized that maladaptive coping (i.e. emotional and avoidance coping) and chronic thought suppression would significantly predict suicide risk. The results of this study indicated that elevated emotional coping and thought suppression were associated with increased suicide risk. Contrary to hypotheses, lower avoidance coping was associated with increased risk, although this finding is moderated by Axis II diagnosis Thus, treatments that focus on decreasing emotional coping and chronic thought suppression may result in decreased suicidal ideation and hopelessness for older adults with depression and Axis II pathology.     

Indicators of pretreatment suicidal ideation in adults with major depressive disorder

Morris DW, Trivedi MH, Husain MM, Fava M, Budhwar N, Wisniewski SR, Miyahara S, Gollan JK, Davis LL, Daly EJ, Rush AJ. Indicators of pretreatment suicidal ideation in adults with major depressive disorder. Objective: In order to evaluate the presence of treatment emergent suicidal ideation (SI), it becomes necessary to identify those patients with SI at the onset of treatment. The purpose of this report is to identify sociodemographic and clinical features that are associated with SI in major depressive disorder (MDD) patients prior to treatment with a selective serotonin reuptake inhibitor. Method: This multisite study enrolled 265 out‐patients with non‐psychotic MDD. Sociodemographic and clinical features of participants with and without SI were compared post hoc. Results: Social phobia, bulimia nervosa, number of past depressive episodes, and race were independently associated with SI by one or more SI measure. Conclusion: Concurrent social phobia and bulimia nervosa may be potential risk factors for SI in patients with non‐psychotic MDD. Additionally, patients with more than one past depressive episode may also be at increased risk of SI.     

Patterns of adverse childhood experiences and depressive symptoms: self-esteem as a mediating mechanism

Social Psychiatry and Psychiatric Epidemiology - There is a growing interest in the co-occurring natures of adverse childhood experiences (ACEs) and unmeasured types of adversity. The current body...     

Longitudinal associations among academic achievement and depressive symptoms and suicidal ideation in elementary schoolchildren: disentangling between- and within-person associations

Prior cross-sectional and unidirectional longitudinal research has investigated the associations among academic achievement, depressive symptoms, and suicidal ideation without distinguishing between-person effects from within-person effects. Our study aimed to examine the longitudinal relations among academic achievement, depressive symptoms, and suicidal ideation in a sample of elementary school children at the within-person level using cross-lagged panel models (CLPMs) and random intercept cross-lagged panel models (RI-CLPMs). Also, multiple models replicated these findings by using three measures of academic achievement (i.e., objective academic achievement, subjective academic achievement, and teacher-assigned academic achievement). A sample of 715 Chinese elementary schoolchildren completed self-report measures of subjective academic achievement, depressive symptoms, and suicidal ideation on five occasions, using 6-month intervals. Objective academic achievement data were obtained from school records and teacher-assigned academic achievement data were reported by teachers. The results showed that: (a) In CLPMs, objective academic achievement negatively predicted suicidal ideation. However, RI-CLPMs supported the negative effect of suicidal ideation on objective academic achievement. (b) The CLPMs revealed reciprocal associations between subjective and teacher-assigned academic achievement and depressive symptoms, respectively. However, RI-CLPMs only provided support for the negative effect of depressive symptoms on subjective academic achievement. (c) Both the CLPMs and the RI-CLPMs showed bidirectional relations between depressive symptoms and suicidal ideation. These findings highlight that mental health problems (e.g., depressive symptoms and suicidal ideation) serve as antecedents of academic performance and that it is beneficial to distinguish between between-person and within-person effects in research informing the development of prevention and intervention programs.

     

Retrospective analysis of psychomotor agitation, hypomanic symptoms, and suicidal ideation in unipolar depression

In bipolar depression, psychomotor agitation is relatively common and often is associated with other noneuphoric hypomanic symptoms and suicidal ideation. Our goal in this retrospective study was to ascertain the co-occurrence of agitation, bipolar features, and suicidal ideation in unipolar disorder. We retrospectively evaluated 314 inpatients with DSM-IV major depressive disorder (MDD) and no other Axis I diagnosis with the National Institutes of Mental Health (NIMH) Life Chart Method and the Operational Criteria for Psychotic Illness (OPCRIT) checklist to ascertain their symptom profiles across all episodes. Univariate and multivariate comparisons were performed between the subgroups with and without psychomotor agitation (OPCRIT item 23> or =1). Agitated depression (AD, a major depressive episode with psychomotor agitation) was present in 19% of the sample. Compared to nonagitated counterparts, patients with AD were older and had lower educational levels and more dysphoria, insomnia, positive thought disorder, and psychotic manifestations. Hypomanic symptoms other than agitation were relatively uncommon (<10%) and more represented in subjects with AD. No significant differences emerged between AD and control groups with respect to most bipolar validators (gender, familiarity, recurrence). Patients with AD had higher levels of suicidal ideation than non-AD controls; however, such a difference was no longer significant after controlling for psychotic features. Excessive self-reproach, early awakening, diurnal changes, poor appetite, and hypomanic symptoms were independently associated with suicidal thoughts in nonpsychotic MDD. Incomplete information on drug treatment, exclusion of patients with Axis I comorbidity, and tertiary care setting were the most important limitations of the study. Although we failed to support the bipolar nature of MDD-AD by common validators, probably because we used a more heterogeneous definition of agitation compared to similar studies, our data confirm the association of agitation with hypomanic symptoms and suicidal thoughts in major depression, and emphasize the complex phenomenology of AD in an inpatient setting.