Nina Hallensleben

The German version of the Interpersonal Needs Questionnaire (INQ) - Dimensionality, psychometric properties and population-based norms

PURPOSE The Interpersonal Needs Questionnaire (INQ) assesses the two interpersonal constructs perceived burdensomeness (PB) and thwarted belongingness (TB) that lead to suicidal ideation, according to the interpersonal theory of suicide (IPTS). The present study investigates dimensionality and psychometric properties of the German version of the INQ in a population-based representative sample and delivers norm values. METHODS The German INQ as well as measures of depression and past suicidality were administered to a population-based representative sample of the German general population (n=2513) to analyze its dimensionality and construct validity by confirmatory factor analysis and correlational analysis. RESULTS Results of the confirmatory factor analysis were in line with the assumption of two-dimensionality of the INQ. The two subscales showed very good internal consistencies (α ≥ 0.89) as well as correlations with depression and suicidality that indicate convergent validity. There were no gender effects but slight age effects in the scores of both subscales. Population-based norms are provided. LIMITATIONS Convergent validity was solely examined with measures of depression and suicidal thoughts instead of further suitable constructs like loneliness and social support. Divergent validity was not investigated in the study. CONCLUSION The German version of the INQ shows good psychometric properties making it a promising tool for assessing PB and TB. The provided norms enable researchers to compare INQ scores of their samples with reference values of a population-based representative sample.

Dimensionality, psychometric properties and population-based norms of the German version of the Revised Acquired Capability for Suicide Scale (ACSS-FAD).

The aim of the present study was the validation of the Acquired Capability for Suicide Scale-Fearlessness about Death (ACSS-FAD) in a large population sample to further establish its reliability and validity, and to provide norm values. We assessed the ACSS-FAD, measures of depression, history of suicidal behavior, and anxiety in a representative sample of the German population (N=2513) and analyzed its dimensionality, invariance across sex and construct validity by means of confirmatory factor analysis, correlational analysis and analysis of variance. The one-factorial structure achieved satisfactory model fit after introducing several correlating error terms. Across sex, partial scalar invariance could be established. Depression and anxiety showed negative associations with the ACSS-FAD while no relation with past suicidal behavior was found. Because mean scores in the ACSS-FAD were affected by sex and age group, sex and age-specific norm values were calculated. Our findings support the one-factorial structure of the ACSS-FAD when the measurement model is slightly modified, pointing out the need of revising the wording of some items. The validity of the measure should be further examined in clinical samples.

Investigating the Dynamics of Suicidal Ideation

Background: Although the fluctuating nature of suicidal ideation (SI) has been described previously, longitudinal studies investigating the dynamics of SI are scarce. Aim: To demonstrate the fluctuation of SI across 6 days and up to 60 measurement points using smartphone-based ecological momentary assessments (EMA). Method: Twenty inpatients with unipolar depression and current and/or lifetime suicidal ideation rated their momentary SI 10 times per day over a 6-day period. Mean squared successive difference (MSSD) was calculated as a measure of variability. Correlations of MSSD with severity of depression, number of previous depressive episodes, and history of suicidal behavior were examined. Results: Individual trajectories of SI are shown to illustrate fluctuation. MSSD values ranged from 0.2 to 21.7. No significant correlations of MSSD with several clinical parameters were found, but there are hints of associations between fluctuation of SI and severity of depression and suicidality. Limitations: Main limitation of this study is the small sample size leading to low power and probably missing potential effects. Further research with larger samples is necessary to shed light on the dynamics of SI. Conclusion: The results illustrate the dynamic nature and the diversity of trajectories of SI across 6 days in psychiatric inpatients with unipolar depression. Prediction of the fluctuation of SI might be of high clinical relevance. Further research using EMA and sophisticated analyses with larger samples is necessary to shed light on the dynamics of SI.

German adaptation of the Resources for Enhancing Alzheimer’s Caregiver Health II: study protocol of a single-centred, randomised controlled trial

BackgroundCaring for a family member with dementia is extremely stressful, and contributes to psychiatric and physical illness among caregivers. Therefore, a comprehensive programme called Resources for Enhancing Alzheimer’s Caregiver Health II (REACH II) was developed in the United States to enhance the health of Alzheimer’s caregivers. REACH II causes a clear reduction of the stress and burdens faced by informal caregivers at home. The aim of this protocol is to adapt, apply, and evaluate this proven intervention programme in a German-speaking area for the first time. This newly adapted intervention is called Deutsche Adaption der Resources for Enhancing Alzheimer’s Caregiver Health (DeREACH).MethodsA total of 138 informal caregivers at home are recruited in a single-centred, randomised controlled trial. The intervention (DeREACH) consists of nine home visits and three telephone contacts over six months, all of which focus on safety, psychological well-being and self-care, social support, problem behaviour and preventive health-related behaviours. A complex intervention assessment on effectiveness will be adopted when the primary outcome – namely, the reduction of caregiver burden – and other secondary outcomes, including changes with regard to anxiety and depression, somatisation, health-related quality of life, and perceived social support, are measured at baseline, as well as immediately and three months after the intervention. The change from baseline to post-intervention assessment with regard to the primary outcome will be compared between treatment and control group using t-tests for independent samples.DiscussionIt is anticipated that this study will show that DeREACH effectively reduces caregiver burden and therefore works under the conditions of a local German health-care system. If successful, this programme will provide an effective intervention programme in the German-speaking area to identify and develop the personal capabilities of informal caregivers to cope with the burdens of caring for people with dementia.Trial registrationNCT01690117

Testing the main prediction of the Interpersonal Theory of Suicide in a representative sample of the German general population

OBJECTIVE To evaluate the main prediction of the Interpersonal Theory of Suicide (IPTS): 3-way-interaction of perceived burdensomeness (PB), thwarted belongingness (TB), and acquired capability (AC) for the prediction of suicidal behavior in a representative population sample. METHOD A total of 2513 participants completed measures of suicidal behavior, TB, PB, acquired capability (AC-FAD), and symptoms of depression and anxiety. RESULTS The two-way-interaction of TB and PB, and the three-way interaction of TB, PB and AC-FAD predict suicidality. LIMITATIONS Given the cross-sectional nature of the data, conclusions on causality should be handled carefully. CONCLUSION The main prediction of the IPTS has been proven in a general population sample.

Individualized support for informal caregivers of people with dementia – effectiveness of the German adaptation of REACH II

BackgroundIndividualized, outreach and structured multicomponent interventions are a promising intervention approach to relieve the burden of informal caregivers of people with dementia. In this study, we adapted and evaluated a multicomponent intervention (Resources for Enhancing Alzheimer’s Caregiver Health II, REACH II), which was developed in the USA, to the German health-care system. Therefore the project is called the German adaptation of REACH II (in German: Deutsche Adaptation der REACH II, DE-REACH).MethodsThe effectiveness of DE-REACH was examined in a randomized, controlled trial on 92 informal caregivers of people with dementia. The intervention comprised 12 individual two-weekly sessions (9 at home with the informal caregiver and 3 via telephone) and combined five modules. The reduction of the burden of the informal caregivers was chosen as the primary outcome.ResultsThe results showed a great stabilizing effect of the intervention on caregiver burden (effect size d = 0.91), that is, comparing pre- and post-measurements the burden decreased very slightly in the intervention group whereas it increased very strongly in the control group. After a three-month follow-up period this effect decreased from a great to a moderate effect. There were also improvements as a result of the intervention in somatization, health-related psychological quality of life and the reaction of the informal caregivers in response to challenging behaviors of the relative with dementia. Moreover, the frequency of challenging behaviors of the affected person itself was reduced in favor of the intervention.ConclusionThe findings of this study provide further evidence for the impact of multicomponent support interventions for informal caregivers of people with dementia.Clinical trial registrationNCT01690117. Registered September 17, 2012.

Assessing suicidality in real time: A psychometric evaluation of self-report items for the assessment of suicidal ideation and its proximal risk factors using ecological momentary assessments.

Suicidal ideation is a major risk factor for suicidal behavior and has recently been shown to be fluctuating in studies applying ecological momentary assessments (EMAs). The aims of this study are to introduce a reliable and valid item set for assessing suicidal ideation and relevant proximal risk factors that can be used in future EMA studies within suicidology. Additionally, we provide data on the ability of the items to capture moment-to-moment variability and discuss feasibility aspects of EMA studies on suicidal ideation in a clinical sample. Psychiatric inpatients diagnosed with a depressive disorder (N = 74) rated a set of 28 items measuring suicidal ideation, thwarted belongingness, perceived burdensomeness, depression, anxiety, hopelessness, and positive affect 10 times per day on 6 consecutive days. In addition, these constructs were assessed by self-report questionnaires before and after the EMA period. Intraclass correlations and mean squared successive differences were calculated as indicators of item variability. Reliability was calculated at the prompt (within-person) and the person (between-person) level, applying an approach based on multilevel factor analysis. Convergent validity was assessed by correlating the EMA scores with a self-report questionnaire measuring the same constructs. All items demonstrated moment-to-moment-variability and substantial within-person variance. Moreover, all items and scales, except those assessing anxiety, showed satisfying reliability at the prompt and the person level, and correlations indicated convergent validity of the EMA item set. Compliance with the EMAs was excellent (89.7%). Researchers are encouraged to apply this useful tool in future EMA studies in the field of suicidology.

Psychometrische Eigenschaften der deutschen Version des Suicide Behaviors Questionnaire Revised (SBQ-R)

OBJECTIVES The Suicide Behaviors Questionnaire-Revised (SBQ-R) was developed by Osman et al. (2001) to economically assess different aspects of suicidality. It consists of 4 items. There are several critical points concerning item construction: (1) temporal frame (e. g. retrospective vs. prospective) and (2) response labels of item 1 and 3 (e. g. 2 alternatives with the same scoring). Information about psychometric properties of the German version of the SBQ-R were not available until now. The SBQ-R is assumed to be a unidimensional measure and is evaluated using a total score, although its dimensionality has never been tested. METHODS The SBQ-R and several measures for convergent validity were assessed in a representative sample of the German general population (N=2497). Convergent validity was tested against symptoms of depression and anxiety (PHQ-4), as well as the core constructs of the Interpersonal Theory of Suicidal Behavior (IPTS) (INQ, ACSS-FAD). Unidimensionality of the SBQ-R was tested using confirmatory factor analysis and intercorrelations with the convergent measures were calculated. RESULTS The initial model fit of the unidimensional solution was unsatisfactory. After inclusion of a correlated error term of item 2 and item 4 based on modification indices, the model fit was very good. Moreover the SBQ-R showed satisfactory internal consistency (Cronbachs α=0.72). With the exception of the ACSS-FAD, all correlations with convergent measures were according to the theoretically proposed expectations. CONCLUSION In principle the findings on the psychometric properties justify the use of the SBQ-R, although several critical points concerning item scoring remain unresolved. Moreover, sufficient unidimensional model fit was not possible without including correlated errors. Since suicidality is a frequently assessed construct in suicide research and as an exclusion criterion in clinical studies, it would be desirable to develop an economic, psychometrically sound and compelling instrument for the assessment of the different aspects of suicidality in future.