Sasha M. Rojas

Understanding PTSD comorbidity and suicidal behavior: associations among histories of alcohol dependence, major depressive disorder, and suicidal ideation and attempts.

Individuals with posttraumatic stress disorder (PTSD) are at an elevated risk for experiencing suicidal thoughts and actions. However, a relative dearth of research has examined factors that may impact this relation, such as common co-occurring disorders. Utilizing the National Comorbidity Survey-Replication data, the current study examined comparisons between comorbid PTSD and major depressive disorder (MDD) and comorbid PTSD and alcohol dependence (AD) in relation to suicidal ideation and suicide attempts. It was hypothesized that comorbid MDD would be associated with an elevated likelihood of suicidal ideation, while comorbid AD would be associated with an elevated likelihood of suicide attempt history. Results indicated that only PTSD-AD was significantly associated with an elevated likelihood of endorsing histories of both suicidal ideation and suicide attempts. These findings suggest that AD may be a critical risk factor for acquiring the capability for suicide attempts.

The independent effects of child sexual abuse and impulsivity on lifetime suicide attempts among female patients

Child sexual abuse (CSA) is a causal agent in many negative adulthood outcomes, including the risk for life-threatening behaviors such as suicide ideation and suicide attempts. Traumatic events such as CSA may pose risk in the healthy development of cognitive and emotional functioning during childhood. In fact, high impulsivity, a risk factor for suicidal behavior, is characteristic of CSA victims. The current study aims to understand the relations among CSA, impulsivity, and frequency of lifetime suicide attempts among a female patient sample admitted for suicidal behavior. Participants included 177 female patients between the ages of 18 and 63 years admitted at two hospitals in Buenos Aires, Argentina. Number of previous suicide attempts and CSA were assessed via structured interviews, while impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). A model of structural equations was employed to evaluate the role of impulsivity in the relation between CSA and suicide attempts. CSA (β=.18, p<.05) and impulsivity (β=.24, p<.05) were associated with the number of previous suicide attempts. However, impulsivity was not significantly associated with CSA (β=.09, p>.05). CSA and impulsivity are independently associated with lifetime suicide attempts among female patients with recent suicidal behavior.

Posttraumatic Stress Disorder and Suicidal Behavior: Indirect Effects of Impaired Social Functioning

Social functioning is negatively impacted by the presence of PTSD, while increasing risk of suicidal behavior among individuals with PTSD. However, little research has examined the specific role of social functioning in the association between PTSD and suicidal behavior. Parallel multiple indirect effects analyses were performed to understand the unique indirect effects of four aspects of social functioning. Indirect effects of PTSD on suicidal ideation were significant through three pathways: interpersonal conflict, perceived family support, and interpersonal apprehension. Perceived family support was the only indirect pathway significantly associated with suicide attempt. Findings suggest that social functioning should be assessed and potentially targeted during treatment to help modify the risk for suicidal behavior among individuals with PTSD.

Lifetime histories of PTSD, suicidal ideation, and suicide attempts in a nationally representative sample of adolescents: Examining indirect effects via the roles of family and peer social support

The prevalence of mental health problems, including suicidal thoughts and behavior, increase during adolescence (Kessler et al., 2007; Nock et al., 2008). In fact, suicide is the second leading cause of death among adolescents, with a prevalence of 4.04 per 100,000 (Centers for Disease Control & Prevention, 2011). The prevalence of suicidal ideation and suicide attempts is even greater, with up to 17% of adolescents reporting having seriously considered attempting suicide and 8% having made a suicide attempt at least once in the past year (Kann et al., 2014). The current study focuses on advancing our understanding of how social support may influence links between psychopathology and suicidal thoughts and behaviors. Risk for suicidal behavior is elevated among adolescents experiencing difficulties with affective states and arousal indicative of mental health disorders (Cash & Bridge, 2009; Rojas, Leen-Feldner, Blumenthal, Lewis, & Feldner, 2015) In fact, the majority of adolescents reporting suicidal ideation or suicide attempts meet lifetime criteria for a mental health disorder (Nock et al., 2013). Among lifetime mental health diagnoses, posttraumatic stress disorder (PTSD) is a robust predictor of suicidal ideation in general (Sareen, Houlahan, Cox, & Asmundson, 2005) and among adolescents in particular (Mazza, 2000; Nock et al., 2013; Waldrop et al., 2007). Approximately 5% of adolescents have met criteria for PTSD at some point in their lives (Merikangas et al., 2010). Given the prevalence of PTSD and its link with suicidal thoughts and behaviors (Bridge, Goldstein, & Brent, 2006; Nock et al., 2013), there is a need to improve our understanding of factors that may shed light on this relation, such as social support. Social support is a key aspect of healthy functioning, and its absence is associated with both increased risk for (Barrett &Mizes, 1988; Grav, Hellzèn, Romild, & Stordal, 2012) and problems recovering from (Beattie & Longabaugh, 1997; Cohen &Wills, 1985; Filipas & Ullman, 2001; Scarpa, Haden, & Hurley, 2006) psychological disorders, including PTSD. Further, symptoms of psychopathology are associated with deteriorations in social support networks, which can in turn contribute to a worsening of symptoms (Hobfoll, 1989; Schnurr, Lunney, & Sengupta, 2004; Vranceanu, Hobfoll, & Johnson, 2007). Indeed, adults with PTSD often report difficulties in social support networks (Dutton, Adams, Bujarski, Badour, & Feldner, 2014; Kaniasty & Norris, 2008) and prospective evidence suggests elevated PTSD symptom severity predicts dysfunctional communication in dyadic relationships, but not vice versa (Fredman et al., 2016). For example, among military Veterans, PTSD relates positively to family adjustment problems following return from deployment (Sayers, Farrow, Ross, & Oslin, 2009). These recent results accord with a burgeoning literature suggesting PTSD among adults may impair important aspects of social support networks (Alderfer, Navsaria, & Kazak, 2009; Gold et al., 2007; Kaniasty & Norris, 2008; Taft et al., 2008Taft, Schumm, Panuzio, & Proctor, 2008). Similarly, elevated posttraumatic stress symptoms (PTSS) are associated with low social support and social withdrawal among adolescents (Trickey, Siddaway, Meiser-Stedman, Serpell, & Field, 2012). In fact, children rely on their parents for support more generally and traumatic experiences that disrupt family social networks exacerbate the effects to follow (Pine & Cohen, 2002). In their review of developmental factors conceptualized to influence PTSD among youth, Salmon and Bryant (2000) highlight how familial support may help youth successfully respond to a traumatic event (e.g., supporting adaptive affect regulation, promoting approach-oriented behavior). Consistent with this perspective, among youth between the ages of 8 and 14 years exposed to violence, inadequate social support (i.e., lower levels of mother support) was linked with elevated internalizing-type symptoms (e.g., depression; Kliewer, Lepore, Oskin, & Johnson, 1998). Similarly, in a large sample of adolescents exposed to a natural disaster, Bokszczanin (2008) observed greater distress in the context of low perceived parental support. Indeed, a number of studies suggest trauma-specific symptoms relate negatively to perceptions of social support (Berman, Kurtines, Silverman, & Serafini, 1996). Interestingly,

Self-disgust as a potential mechanism underlying the association between PTSD and suicide risk

Suicide risk is highly prevalent among individuals with posttraumatic stress disorder (PTSD). Self-disgust, defined as disgust directed internally and comprised of disgust with oneself (disgusting self) and with ones behaviors (disgusting ways), may impact this increased risk. The present study examined self-disgust as a putative mechanism linking PTSD symptoms with suicide risk. A sample of 347 trauma-exposed undergraduates completed measures of PTSD symptoms, suicide risk, self-disgust, and depressive symptoms. Controlling for depressive symptoms, a process model indicated PTSD symptoms were positively linked to suicide risk via increased disgusting self but not disgusting ways. Process models examining individual PTSD symptom clusters revealed positive, indirect links between all PTSD symptom clusters except alterations in arousal and reactivity and suicide risk via disgusting self. These findings expand on growing literature documenting the importance of self-disgust in trauma-related pathology by identifying connections with suicide risk. Future directions and clinical considerations are discussed.

The roles of sex, anxious reactivity to bodily arousal, and anxiety sensitivity in coping motives for cigarette smoking among adolescents.

Evidence suggests that smoking to cope among adolescents is associated with a number of problematic outcomes (e.g., greater smoking frequency, higher rates of dependence). It is thus imperative to better understand factors that may increase the likelihood of smoking to cope among adolescents. Research suggests anxiety sensitivity (AS) is associated with smoking to cope among adults, although the link between AS and coping motives for cigarette use among youth is less clear. Gender differences have also been noted in AS. The current study investigates this association using a biological challenge paradigm. Specifically, the indirect effects of anxious reactivity to bodily arousal on the relation between the physical and mental AS factors and coping motives for cigarette smoking were examined within a sample of 108 adolescent cigarette smokers. Gender was examined as a moderator. Results suggested significant indirect effects of self-reported anxiety in response to bodily arousal on the relation between physical AS and coping motives for cigarette smoking. This indirect effect was moderated by gender, such that it was significant for females but not males. Models examining AS mental concerns and psychophysiological responding to the challenge were not significant. These results suggest that, relative to their low AS counterparts, female adolescents high in physical concerns respond with elevated anxiety in response to interoceptive arousal and, in turn, endorse elevated coping-related smoking motives. Findings are discussed in terms of implications for understanding the nature and origins of coping-related smoking motives and how such information can be used to inform intervention efforts. (PsycINFO Database Record

Time Left for Intervention in the Suicidal Process in Borderline Personality Disorder

The objective of this study was to measure the duration of the suicidal process among patients diagnosed with Borderline Personality Disorder (BPD). The sample included 110 female patients who met DSM-IV-TR criteria for BPD and were consecutively admitted after suicide-related behavior. A total of 63 patients (58%) reported that their suicidal process lasted 10 minutes or less. After being adjusted, the β coefficient of impulsivity scales in women with a suicidal process ≤10 minutes was lower compared to those observed in women with >10 min (β = −0.03, 95% CI = −0.06 = −0.01, p < 0.01). Suicidal patients with BPD can be divided into two groups; patients who report a suicidal process less than 10 minutes show a higher degree of impulsivity.

Child Anxiety and Parental Anxiety Sensitivity are Related to Parent Sick Role Reinforcement

SYNOPSIS Objective. Parents can facilitate offspring anxiety in response to bodily arousal via “sick role reinforcement,” a process that may be important during adolescence. Although a sizeable body of work has examined the role of parent behavior in this process, no study to date has examined child-driven effects on parental sick role reinforcement. Furthermore, little work has examined whether parental factors are related to sick role reinforcement, including anxiety sensitivity. Design. The current study investigated the associations among these variables using a set of vignettes in which 225 parents were asked to imagine their adolescent offspring describing somatic sensations in either an anxious or non-anxious manner. Results. Effects of offspring descriptions, parental AS, and an interaction between the two emerged on parental sick role reinforcement behavior. Conclusions. These findings lay the groundwork for future work targeted at improving our understanding of the unique and interactive roles parents and offspring play in the sick role reinforcement process.

Differences between female suicidal patients with family history of suicide attempt and family history of completed suicide

BACKGROUND Family history of suicidal behavior and suicide are both risk factors for suicide. However, the effects of family history of suicide versus suicide attempts on patient suicidal behavior remain unclear. The aim of the present study was to understand if family history of suicide as compared to family history of suicide attempts or no family history of suicidal behavior evidences different associations with suicidal behavior among psychiatric patients. METHOD Participants included 157 female patients between the ages of 18 and 65years admitted at the Dr. Braulio A. Moyano Neuropsychiatric Womens Hospital. RESULTS Seventy-nine patients (50.3%) reported no family history of suicidal behavior (NFHSB), while 78 patients (49.7%) reported a family history of suicidal behavior. Specifically, 41 patients (26.1%) reported a family history of suicide attempt (FHSA) and 37 patients (23.6%) reported a family history of suicide (FHS). These groups showed significant differences between family history of psychopathology and number of previous suicide attempts. Patients with an FHSA were more likely to present with a greater number of previous suicide attempts as compared to patients with NFHSB and FHS. CONCLUSION There is an association between the number of suicide attempts and family history of suicide attempts in female patients hospitalized for suicidal behavior.

Determinants of mental and physical health-related quality of life among patients hospitalized for suicidal behavior

The current study was interested in exploring the clinical factors related to mental and physical health-related quality of life among patients hospitalized for suicidal behavior. A multicenter cross-sectional study was designed to compare data obtained form 246 patients hospitalized for suicide behavior. Results suggest that mental health-related quality of life was negatively associated with hopelessness while physical health-related quality of life was negatively associated with age, medical disease and the number of previous suicide attempts and positively associated with employment. Findings are discussed in the context of theoretical evidence and clinical implications.