E. Samuel Winer

Sleep disorders and the interpersonal-psychological theory of suicide: Independent pathways to suicidality?

BACKGROUND Although sleep disorders are a risk factor for suicidal behavior little research has examined why sleep disorders confer suicide risk. The present study examined the relation between two sleep disorders, insomnia symptoms and nightmares, and suicide risk in the context of Joiners interpersonal-psychological theory of suicide (IPTS). METHODS The present study utilized two large samples (N=747 and 604) recruited from two large public universities in the Southeast. Both studies included measures of insomnia symptoms, nightmares, depressive symptoms, and prior suicide attempts. In addition, study one contained a measure of suicide risk. RESULTS In study 1, the relations between insomnia symptoms and both suicide risk and prior attempts were not significant after controlling for the IPTS. However, nightmares were related to both suicide risk and suicide attempts independent of the IPTS. Furthermore, nightmares nearly missed significance in the prediction of suicide risk (p=0.054) and significantly predicted suicide attempts even after controlling for depressive symptoms. In study 2, both insomnia and nightmares were found to be significantly associated with prior suicide attempts after controlling for the IPTS and depressive symptoms. LIMITATIONS The study is limited by its use of a college sample and cross-sectional design. CONCLUSIONS These studies suggest that the IPTS may not explain the relation between sleep problems and suicidality. More research is needed to understand the mechanism by which sleep disorders confer suicide risk, which is clinically relevant as it may inform specific interventions to reduce the adverse effects of sleep disorders.

Anhedonia predicts suicidal ideation in a large psychiatric inpatient sample.

This study examined the relationship among symptoms of anhedonia and suicidal ideation at baseline, at termination, and over time in 1529 adult psychiatric inpatients. Anhedonia was associated with suicidality cross-sectionally at baseline and at termination. In addition, change in anhedonia from baseline to termination predicted change in suicidality from baseline to termination, as well as level of suicidality at termination; moreover, anhedonia remained a robust predictor of suicidal ideation independent of cognitive/affective symptoms of depression. Symptom-level analyses also revealed that, even after accounting for the physical aspect of anhedonia (e.g., loss of energy), loss of interest and loss of pleasure were independently associated with higher levels of suicidal ideation at baseline, over time, and at discharge. Loss of interest was most highly predictive of suicidal ideation, providing support for recent differential conceptualizations of anhedonia. Taken together, these findings indicate that the manner in which anhedonia is conceptualized is important in predicting suicidal ideation, and that anhedonia symptoms warrant particular clinical attention in the treatment of suicidal patients.

Distinguishing Mediational Models and Analyses in Clinical Psychology: Atemporal Associations Do Not Imply Causation.

PURPOSE A popular way to attempt to discern causality in clinical psychology is through mediation analysis. However, mediation analysis is sometimes applied to research questions in clinical psychology when inferring causality is impossible. This practice may soon increase with new, readily available, and easy-to-use statistical advances. Thus, we here provide a heuristic to remind clinical psychological scientists of the assumptions of mediation analyses. APPROACH We describe recent statistical advances and unpack assumptions of causality in mediation, underscoring the importance of time in understanding mediational hypotheses and analyses in clinical psychology. Example analyses demonstrate that statistical mediation can occur despite theoretical mediation being improbable. CONCLUSION We propose a delineation of mediational effects derived from cross-sectional designs into the terms temporal and atemporal associations to emphasize time in conceptualizing process models in clinical psychology. The general implications for mediational hypotheses and the temporal frameworks from within which they may be drawn are discussed.

Development and validation of the Specific Loss of Interest and Pleasure Scale (SLIPS)

BACKGROUND Anhedonia, or loss of pleasure and/or interest in people or things, is a key component of many forms of psychopathology. Extant anhedonia measures only assess current state or longstanding trait anhedonia, which risks discounting recent changes. Thus, we created the Specific Loss of Interest and Pleasure Scale (SLIPS), to assess recent changes in anhedonia. METHODS Four studies assessed the reliability and validity of the SLIPS through factor and internal consistency analyses, convergent and divergent validity analyses, and incremental validity analyses in individuals reporting non-clinical and clinical levels of psychopathology. RESULTS The SLIPS was internally consistent, converged with existing state measures of anhedonia and depression, and diverged from general measures of affect and trait anticipatory and consummatory pleasure. Furthermore, the SLIPS predicted recent changes in anhedonia independent of existing measures. Moreover, in respondents reporting moderate or severe symptoms of depression, only the SLIPS was associated with recent changes in anhedonia. LIMITATIONS Prospective limitations included a resulting one factor solution and the potential that the method of scaling influenced results. However, these limitations were offset by empirical verification and the unique strength of the scaling of the SLIPS. CONCLUSIONS The SLIPS is the first validated measure that allows for the assessment of recent changes in anhedonia in non-clinical and clinical samples. Results suggest that the SLIPS offers unique clinical utility by discriminating changes in anhedonia within at-risk and clinically depressed groups.

The Association between Anhedonia, Suicidal Ideation, and Suicide Attempts in a Large Student Sample

Depression is a significant risk factor for suicide. Evidence suggests that anhedonia may be a symptom of depression that is uniquely associated with suicidality. However, exactly how anhedonia is related to suicide is unclear. To provide more specific evidence regarding this association, we investigated relationships between anhedonia, suicidal ideation, and suicide attempts. A large combined undergraduate sample completed the novel Specific Loss of Interest and Pleasure Scale (SLIPS), the Center of Epidemiological Studies Depression Scale (CES-D), and the Suicidal Behaviors Questionnaire—Revised (SBQ-R). Anhedonia was associated with suicidal ideation, even when accounting for depressive symptoms. Additionally, anhedonia was not associated with suicide attempts when symptoms of depression were held constant. The current study provides novel evidence regarding the relationship between anhedonia and risk of attempting suicide. Future research can examine the role anhedonia plays in the unfolding of suicidal behavior over time.

Unpacking sleep and suicide in older adults in a combined online sample

OBJECTIVE Duration of insomnia symptoms and nightmares are related to suicidal risk in young adults independent of current symptoms of insomnia, nightmares, anxiety, depression, and PTSD. However, this relation has yet to be examined among older adults, despite older adults being at higher risk of suicidal behavior. Further, the current study aims to replicate previous research among younger adults showing that insomnia symptoms and nightmares are associated with suicide risk independent of the interpersonal psychological theory of suicide (IPTS). METHODS The present study utilized 167 participants age 55 and older obtained by combining two independent mTurk data collections of adults in the United States. RESULTS In the current sample, duration of nightmares was associated with suicide risk in older adults independent of symptoms of current insomnia and nightmares, duration of insomnia, and symptoms of PTSD, anhedonia, and the IPTS. CONCLUSIONS Our findings suggest that the duration of nightmares (i.e., how long someone has been experiencing nightmares) predict substantial variance in suicide risk among older adults in addition to the risk factors typically examined. Thus, assessment of sleep dysfunction is important when assessing suicide risk among older adults.

Presence and Persistence of Sleep-Related Symptoms and Suicidal Ideation in Psychiatric Inpatients

BACKGROUND Although sleep is an important risk factor for suicidal behavior, research has yet to examine the association between sleep problems and suicidality across the course of inpatient treatment. This study examined the relationship among sleep-related symptoms and suicidal ideation across inpatient treatment. AIMS To examine whether poor sleep at admission longitudinally predicts less improvement in suicidal ideation over the course of treatment. Further, to examine whether suicidal ideation is reduced in patients whose sleep does not improve. METHOD The study utilized the Beck Depression Inventory (BDI)-II, which contains items measuring depressive symptoms, sleep-related symptoms, and suicidal ideation. The study sample consisted of 1,529 adult psychiatric inpatients. Patients were assessed at admission, biweekly, and at treatment termination. RESULTS Admission fatigue, loss of energy, and change in sleep pattern were associated with higher levels of suicidal ideation at admission and discharge. Fatigue at admission predicted suicidal ideation at termination independent of admission depression and suicidal ideation. Individuals whose sleep did not improve over the course of treatment had significantly higher suicidal ideation scores at termination relative to those whose sleep symptoms improved, after controlling for sleep, depression, and suicidal ideation scores at admission. CONCLUSION These findings suggest that persistence of sleep-related symptoms warrants clinical attention in the treatment of suicidal patients.

Is suicide an option?: The impact of disability on suicide acceptability in the context of depression, suicidality, and demographic factors

BACKGROUND Suicide is a major clinical and public health issue, especially in people with disabilities. However, research on the acceptability of suicide in people with disabilities has not directly compared the relative acceptability of suicidality in people with and without disabilities. METHOD An online sample of five hundred American adults read five pairs of vignettes about individuals who were experiencing suicidal ideation following a life stressor. Each pair contained a disability and no-disability condition; a sixth pair of vignettes discussed suicidal ideation in an elderly individual and contained physical and cognitive disability conditions. Participants completed questions regarding the relative acceptability of suicidality for each vignette as well as demographic items and measures of suicidality, depressive symptoms, and attitude towards disability. RESULTS In all vignette five pairs, suicidality was seen as significantly more acceptable in the disability condition; this was true even when the participants themselves had disabilities or friends or family members with disabilities. Suicidality, depressive symptomology, and more negative attitudes towards disability predicted greater acceptability in both conditions; no factors predicted greater differences between the two conditions. LIMITATIONS The vignettes in this study focused primarily on individuals in their 20s and most did not compare two disabling conditions. CONCLUSIONS The greater social acceptability of suicidality in people with disabilities may be taken by individuals with disabilities who are suicidal as implicit permission to end their lives. The potential impact of such social influences should be assessed and addressed by clinicians and suicide prevention advocates.

Explaining Alcohol Use and Suicide Risk: A Moderated Mediation Model Involving Insomnia Symptoms and Gender

STUDY OBJECTIVES The purpose of the study was to examine whether insomnia symptoms and nightmares mediated the relation between alcohol use and suicide risk. Further, we examined whether this mediation was moderated by gender. DESIGN The study consisted of questionnaires administered online examining insomnia symptoms, nightmares, alcohol use, and suicide risk. SETTING University. PATIENTS OR PARTICIPANTS 375 undergraduate students at a large, public university in the southeastern United States. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Results indicated that insomnia symptoms significantly mediated the relation between alcohol use and suicide risk; however, this mediation was moderated by gender. For women, there was both a direct effect of alcohol use on suicide risk as well as an indirect effect of alcohol use through insomnia symptoms increasing suicide risk. For men, there was no direct effect of alcohol use on suicide risk, but there was a significant indirect effect of alcohol use increasing suicide risk through insomnia symptoms. Nightmares were not related to alcohol use, and the association between nightmares and suicide risk was found to be independent of alcohol use. CONCLUSIONS Insomnia symptoms are an important factor in explaining the mechanism by which alcohol use increases suicide risk.

Access is mainly a second-order process: SDT models whether phenomenally (first-order) conscious states are accessed by reflectively (second-order) conscious processes

Access can either be first-order or second-order. First order access concerns whether contents achieve representation in phenomenal consciousness at all; second-order access concerns whether phenomenally conscious contents are selected for metacognitive, higher order processing by reflective consciousness. When the optional and flexible nature of second-order access is kept in mind, there remain strong reasons to believe that exclusion failure can indeed isolate phenomenally conscious stimuli that are not so accessed. Irvines [Irvine, E. (2009). Signal detection theory, the exclusion failure paradigm and weak consciousness-Evidence for the access/phenomenal distinction? Consciousness and Cognition.] partial access argument fails because exclusion failure is indeed due to lack of second-order access, not insufficient phenomenally conscious information. Further, the enable account conforms with both qualitative differences and subjective report, and is simpler than the endow account. Finally, although first-order access may be a distinct and important process, second-order access arguably reflects the core meaning of access generally.