April R. Smith

An examination of environmental and genetic contributions to the determinants of suicidal behavior among male twins

The purpose of the present study was to examine the relative association of genetic and environmental factors with individual differences in each of the proximal, jointly necessary, and sufficient causes for suicidal behavior, according to the Interpersonal-Psychological Theory of Suicide (IPTS; Joiner, 2005). We examined data on derived scales measuring acquired capability, belongingness, and burdensomeness (the determinants of suicidal behavior, according to theory) from 348 adolescent male twins. Univariate biometrical models were used to estimate the magnitude of additive genetic (A), non-additive genetic (D), shared environmental (C), and non-shared environmental (E) effects associated with the variance in acquired capability, belongingness, and burdensomeness. The best fitting model for the acquired capability allowed for additive genetic and environmental effects, whereas the best fitting model for burdensomeness and belongingness allowed for shared and non-shared environmental effects. The present research extends prior work by specifying the environmental and genetic contributions to the components of the IPTS, and our findings suggest that belongingness and burdensomeness may be more appropriate targets for clinical intervention than acquired capability as these factors may be more malleable or amenable to change.

Exercise caution: over-exercise is associated with suicidality among individuals with disordered eating.

We conducted four studies to examine the relationship between over-exercise and suicidality. Study 1 investigated whether over-exercise predicted suicidal behavior after controlling for other eating disorder behaviors in a patient sample of 204 women (144 with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) Bulimia Nervosa [BN]). Study 2 tested the prospective association between over-exercise and acquired capability for suicide (ACS) in a sample of 171 college students followed for 3-4 weeks. Study 3 investigated whether pain insensitivity accounted for the relationship between over-exercise and ACS in a new sample of 467 college students. Study 4 tested whether ACS accounted for the relationship between over-exercise and suicidal behavior in a sample of 512 college students. In Study 1, after controlling for key covariates, over-exercise was the only disordered eating variable that maintained a significant relationship with suicidal behavior. In Study 2, Time 1 over-exercise was the only disordered eating behavior that was associated with Time 2 ACS. In Study 3, pain insensitivity accounted for the relationship between over-exercise and ACS. In Study 4, ACS accounted for the relationship between over-exercise and suicidal behavior. Over-exercise appears to be associated with suicidal behavior, an association accounted for by pain insensitivity and the acquired capability for suicide; notably, this association was found across a series of four studies with different populations.

Status update: maladaptive Facebook usage predicts increases in body dissatisfaction and bulimic symptoms.

BACKGROUND The current study examined the effects of online social evaluations and comparisons on body dissatisfaction and bulimic symptoms. METHODS We tested the effects of maladaptive Facebook usage (defined as the tendency to seek negative social evaluations and/or engage in social comparisons via Facebook) on body dissatisfaction and bulimic symptoms in a sample of 232 college females followed for approximately 4 weeks. RESULTS Results provided evidence that maladaptive Facebook usage significantly predicted increases in bulimic symptoms and episodes of over-eating approximately four weeks later. Body dissatisfaction was found to fully mediate the relationship between maladaptive Facebook usage and increases in over-eating episodes, whereas body dissatisfaction partially mediated the relationship between maladaptive Facebook usage and increases in bulimic symptoms more broadly. LIMITATIONS Limitations include the use of a novel measure of maladaptive Facebook usage due to the absence of an existing measure and a non-clinical sample. CONCLUSIONS The results of this study suggest that reducing maladaptive Facebook usage may be a fruitful target for interventions aimed at reducing body dissatisfaction and symptoms of eating pathology.

Habitual starvation and provocative behaviors: Two potential routes to extreme suicidal behavior in anorexia nervosa

Anorexia nervosa (AN) is perhaps the most lethal mental disorder, in part due to starvation-related health problems, but especially because of high suicide rates. One potential reason for high suicide rates in AN may be that those affected face pain and provocation on many fronts, which may in turn reduce their fear of pain and thereby increase risk for death by suicide. The purpose of the following studies was to explore whether repetitive exposure to painful and destructive behaviors such as vomiting, laxative use, and non-suicidal self-injury (NSSI) was a mechanism that linked AN-binge-purging (ANBP) subtype, as opposed to AN-restricting subtype (ANR), to extreme suicidal behavior. Study 1 utilized a sample of 787 individuals diagnosed with one or the other subtype of AN, and structural equation modeling results supported provocative behaviors as a mechanism linking ANBP to suicidal behavior. A second, unexpected mechanism emerged linking ANR to suicidal behavior via restricting. Study 2, which used a sample of 249 AN patients, replicated these findings, including the second mechanism linking ANR to suicide attempts. Two potential routes to suicidal behavior in AN appear to have been identified: one route through repetitive experience with provocative behaviors for ANBP, and a second for exposure to pain through the starvation of restricting in ANR.

Muscularity versus leanness: An examination of body ideals and predictors of disordered eating in heterosexual and gay college students

The aim of the current study was to add to the growing body of research on men with eating disorders by examining the association between different types of body dissatisfaction (muscularity and body fat) and disordered eating in heterosexual and gay men. Two hundred four participants (over one-third were gay) completed measures assessing disordered eating, muscularity and body fat dissatisfaction, and sexual orientation. Body fat dissatisfaction, but not muscularity dissatisfaction, predicted disordered eating, dietary restraint, and concerns about weight and eating in gay and heterosexual men. These findings were consistent across all measures of body fat and muscularity dissatisfaction, providing stronger evidence that body fat dissatisfaction may be a greater risk factor for disordered eating in both gay and heterosexual college aged men than muscularity dissatisfaction.

Do major depressive disorder and dysthymic disorder confer differential risk for suicide

BACKGROUND Although there has been a tremendous amount of research examining the risk conferred for suicide by depression in general, relatively little research examines the risk conferred by specific forms of depressive illness (e.g., dysthymic disorder, single episode versus recurrent major depressive disorder [MDD]). The purpose of the current study was to examine differences in suicidal ideation, clinician-rated suicide risk, suicide attempts, and family history of suicide in a sample of outpatients diagnosed with various forms of depressive illness. METHODS To accomplish this aim, we conducted a cluster analysis using the aforementioned suicide-related variables in a sample of 494 outpatients seen between January 2001 and July 2007 at the Florida State University Psychology Clinic. Patients were diagnosed using DSM-IV criteria. RESULTS Two distinct clusters emerged that were indicative of lower and higher risk for suicide. After controlling for the number of comorbid Axis I and Axis II diagnoses, the only depressive illness that significantly predicted cluster membership was recurrent MDD, which tripled an individuals likelihood of being assigned to the higher risk cluster. LIMITATIONS The use of a cross-sectional design; the relatively low suicide risk in our sample; the relatively small number of individuals with double depression. CONCLUSIONS Our results demonstrate the importance of both chronicity and severity of depression in terms of predicting increased suicide risk. Among the various forms of depressive illness examined, only recurrent MDD appeared to confer greater risk for suicide.

Examination of the relationship between obesity and suicidal ideation

Objective:The relationship between obesity and suicidal ideation and behavior (suicidality) is not well understood, and conventional suicide risk factors do not adequately explain the associations observed. Thus, the current study aimed to further examine the relationship between body mass index (BMI; kg m−2) and suicidal ideation as well as potential mechanisms of this relationship.Methods:Two hundred seventy-one adults (n=151 undergraduates; n=120 obesity treatment participants) completed self-report questionnaires assessing relevant variables, including suicidal ideation, perceived burdensomeness, thwarted belongingness and current height/weight used to calculate BMI.Results:There was a significant, quadratic relationship between BMI and suicidal ideation (b=0.001, t=2.21, P=0.03, partial r=0.14) and between BMI and perceived burdensomeness (b=0.003, t=2.50, P=0.013, partial r=0.16), such that as BMI increased, these positive associations became more pronounced. Additionally, perceived burdensomeness partially mediated the relationship between BMI and suicidal ideation.Conclusions:Individuals with a higher BMI demonstrated increased suicidal ideation as well as greater feelings of perceived burdensomeness. These results provide novel information regarding potential mechanisms explaining the obesity-suicidal ideation association.

An Assessment of Suicide-Related Knowledge and Skills Among Health Professionals

OBJECTIVE The present studies sought to examine the association between gatekeeper training and suicide knowledge among a diverse set of health care workers (case managers, clinicians, administrators, nurses, physicians, support staff). An additional aim of the current studies was to investigate knowledge about suicide among health care workers as well as their confidence in their training and skills. METHOD A naturalistic and uncontrolled group comparison study of two large groups (n = 1,336 and 1,507) of community health workers was conducted by having participants complete a brief online survey that assessed suicide-related knowledge, as well as confidence in training, skills, and support. RESULTS In Study 1, participants with Applied Suicide Intervention Skills Training (ASIST) outperformed those without ASIST training in terms of their knowledge about suicidal behavior and their confidence in their skills. In Study 2, participants with Question, Persuade, and Refer (QPR) training outperformed those with Essential Learnings Suicide Prevention (Online) training and those with No Training on suicide knowledge items; both QPR and Online trained workers reported greater confidence in their skills than workers with No Training. Across both studies, physicians and clinicians tended to score the highest on suicide knowledge and skills items. CONCLUSIONS Overall, health care workers appear to be knowledgeable about suicidal behavior, but there are some specific gaps in their knowledge, such as the rates of suicide in special populations. Participants with ASIST and QPR training demonstrated greater knowledge and skills related to suicidal behavior as compared with participants without gatekeeper training.

The impact of perceived social support and negative life events on bulimic symptoms

OBJECTIVE The purpose of the current study was to evaluate the relationship between social support, negative life events, and disordered eating using a longitudinal design. More specifically, we examined whether the interaction between perceived social support and occurrence of negative life events would predict symptoms of eating disorders. METHOD Two hundred seventy female undergraduate students completed self-report questionnaires at two time points to assess perceived social support, negative life events experienced, and current psychopathology. RESULTS Low social support and a greater number of negative life events interacted to predict increased bulimic symptoms, but not restrictive eating tendencies or symptoms of depression or anxiety. DISCUSSION Low perceived social support in the face of negative events may exacerbate bulimic symptoms. Management of interpersonal problems and the enhancement of social skills may be important targets in the treatment of eating disorders.

Psychological correlates of purging disorder as compared with other eating disorders: An exploratory investigation

OBJECTIVE Keel et al. introduced the diagnostic category of purging disorder (PD), an eating disorder characterized by recurring purging behaviors in the absence of objective binges. The current study sought to investigate psychological correlates among individuals with a lifetime diagnosis of PD as compared to those with other eating disorders, and those with no eating disorder. METHOD The current sample included 294 ethnically diverse undergraduate women. Subjects diagnosed with different types of eating disorders [i.e., anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD)] were compared to one another, as well as to individuals with no eating disorder on a variety of indices. RESULTS Women with PD displayed similar levels of drive for thinness as women with AN and BED. Individuals with BN and BED exhibited anxiety levels significantly higher than those with PD. Those with PD displayed levels of impulsivity that were significantly higher than those of individuals with AN or BED, but significantly lower than those of individuals with BN. They also displayed similar levels of bulimic symptoms as those with AN and BED; however, analysis of item 53 on the EDI revealed that those with PD had similar levels of purging ideation as those with BN. Women with any eating disorder diagnosis were more likely to have a comorbid Axis I disorder than women in the non-eating disorder group. CONCLUSION Our data replicated and extended the findings of Keel et al. and gave further support to the validity and distinctiveness of PD.