Taylor A. Burke

Non-suicidal self-injury prospectively predicts interpersonal stressful life events and depressive symptoms among adolescent girls

Non-suicidal self-injury (NSSI) is the deliberate self-harm of ones tissue, engaged in without lethal intent, and occurs frequently among late adolescents. Although research has indicated that NSSI predicts depression, the potential psychosocial mechanisms through which engagement in NSSI makes one susceptible to future depressive symptoms remain unclear. The present study examined whether NSSI increases the risk of experiencing stressful life events, which, in turn, heightens the risk for subsequent depressive symptoms. Drawn from a sample specifically selected for adolescents at high and low risk for developing bipolar spectrum disorders, a total of 110 late-adolescents (mean age=18.74, SD=.69; 73% female) were administered measures of lifetime and past year engagement in NSSI and current depressive symptomatology. Approximately 6 months later, they completed a measure of depressive symptoms and a questionnaire and interview assessing life events that occurred over the 6-month interval. Results suggest that the frequency of lifetime and past year NSSI predicted the occurrence of interpersonal stressful life events beyond the effects of initial depressive symptoms, but only for late adolescent girls. Results further suggest that higher levels of interpersonal stressful life events mediated the relationship between NSSI frequency and prospective increases in depressive symptoms among girls.

Negative cognitive styles synergistically predict suicidal ideation in bipolar spectrum disorders: a 3-year prospective study.

Rates of suicidal ideation and behavior are extremely high in bipolar spectrum disorders (BSDs). However, relatively little work has evaluated potentially synergistic relationships between cognitive and emotion-regulatory processes proposed by theoretical models of suicidality in BSDs. The present study evaluated whether negative cognitive style and subtypes of rumination would exacerbate the impact of self-criticism on suicidal ideation in a prospective study of individuals with BSDs. Seventy-two young adults with BSDs (bipolar II, bipolar NOS, or cyclothymia) completed diagnostic interviews and trait measures of self-criticism, negative cognitive style, and brooding and reflective rumination at a baseline assessment. The occurrence of suicidal ideation was assessed as part of diagnostic interviews completed every 4 months for an average of 3 years of follow-up. Negative cognitive style and reflective rumination strengthened the association between self-criticism and the prospective occurrence of suicidal ideation across follow-up. Individuals with high levels of self-criticism in conjunction with negative cognitive style or reflective rumination were most likely to experience the onset of suicidal ideation. Self-criticism may work synergistically with negative cognitive style and rumination to confer risk for suicidal ideation in bipolar spectrum disorders. These results support theoretical models of suicidality in BSDs and indicate that evaluating and understanding negative cognitive styles may help to identify individuals who are at risk of suicide.

The Interaction of Affective States and Cognitive Vulnerabilities in the Prediction of Non-Suicidal Self-Injury

Non-suicidal self-injury (NSSI) is a serious public health concern and remains poorly understood. This study sought to identify both cognitive and affective vulnerabilities to NSSI and examine their interaction in the prediction of NSSI. A series of regressions indicated that low levels of positive affect (PA) moderated the relationships between self-criticism and brooding and NSSI. The associations of self-criticism and brooding with greater frequency of NSSI were attenuated by higher levels of PA. The interaction of cognitive and affective vulnerabilities is discussed within the context of current NSSI theory.

Subjective pain during NSSI as an active agent in suicide risk

Non-suicidal self-injury (NSSI) has been identified as a correlate and predictor of suicidal ideation and attempts. Given the high-rates of NSSI presence among adolescents and young adults, it is important to identify specific characteristics of NSSI that might place individuals who engage in this behavior at highest risk for suicidal behavior. NSSI is thought to increase the acquired capability for suicide via habituation to self-harm, though the NSSI characteristics most responsible for this relationship are unclear. The current study examined three characteristics of NSSI (frequency, number of methods, and subjective pain) that may help to elucidate this risk relationship. University students (N=997) with a history of NSSI completed measures assessing lifetime NSSI frequency, number of NSSI methods employed, and subjective experience of pain during NSSI, as well as suicide attempt (SA) history. Results indicated that NSSI frequency, number of NSSI methods, and subjective pain experienced during NSSI were each positively associated with SA history. Further, subjective pain experienced during NSSI moderated the relationship between NSSI frequency and SA history, such that the association between NSSI frequency and SA history was stronger for individuals who experienced lower levels of subjective pain.

Suicide risk characteristics among aborted, interrupted, and actual suicide attempters.

Few studies have investigated suicide risk characteristics associated with interrupted and aborted suicide attempts. The present study aimed to empirically examine whether assessing a history of interrupted and aborted suicide attempts is valuable when assessing suicide risk, given the relative lack of literature in this area to date. To inform this question, the current study examined differences in risk factors for suicidal behavior among individuals who have carried out a suicide attempt, individuals who report having a history of only interrupted and/or aborted suicide attempts, and non-attempter controls. Approximately 447 undergraduates (M=21.10 years; SD=4.16; 77.6% female) completed measures of carried out suicide attempts, interrupted suicide attempts, aborted suicide attempts, acquired capability for suicide, suicide likelihood, depressive symptoms, suicidal ideation, and non-suicidal self-injury. Results suggest that a faction of individuals endorse interrupted and/or aborted suicide attempts (8.7%), but do not endorse carried out suicide attempts, even in non-clinical samples. Furthermore, results suggest that there are few clinically meaningful differences between those with a history of carried out suicide attempts and interrupted/aborted suicide attempts, suggesting that individuals with a history of these lesser studied suicidal behaviors are an important group to target for suicide risk intervention.

Measuring Acquired Capability for Suicide Within an Ideation-to-Action Framework.

Objective: Despite the large literature on risk factors for suicide-related outcomes, few studies have examined risk for acting on suicidal thoughts among suicide ideators. The current study aimed to fill this gap by examining the role of acquired capability, as well as its hypothesized facilitator, painful and provocative events (PPEs), as motivators for behavior among individuals along the suicide continuum. Method: Undergraduates reporting suicidal ideation, suicide plans, suicide attempts without intent to die, or suicide attempts with intent to die (N = 546) completed a measure of acquired capability for suicide, as well as assessments of exposure to PPEs. Results: Our findings demonstrated that acquired capability for suicide did not distinguish between individuals falling along the ideation-to-action spectrum. Among the several PPEs assessed, the frequency of nonsuicidal self-injury, and the presence of childhood emotional abuse, physical abuse, and physical neglect each significantly differentiated between groups, with individuals having a history of a suicide attempt with the intent to die reporting the highest levels. Conclusions: These findings implicate the PPEs that may be most important to assess in determining suicide risk, and, further, call into question the utility of acquired capability in differentiating between individuals along the suicide continuum.

Differential Reporting of Adolescent Stress as a Function of Maternal Depression History

The depression–distortion hypothesis posits that depressed mothers report child characteristics in a negatively-biased manner, motivating research on discrepant reporting between depressed mothers and their children. However, the literature has predominately focused on report discrepancies of youth psychopathological and behavioral outcomes, with limited focus on youth stress despite the marked increase of stressful events during adolescence. The current study investigated whether the presence versus absence of a maternal history of major depressive disorder differentially influenced reporting of adolescent stress when compared to her child’s report, utilizing a community sample of diverse adolescents. As hypothesized, mothers with a history of depression were more likely to report more youth stress than their children reported. Specifically, mothers with a history of depression were more likely than nondepressed mothers to report more familial, social, and youth-dependent stressors relative to their children; nondepressed mothers were more likely to report less independent stressors than their children.

Identifying the relative importance of non-suicidal self-injury features in classifying suicidal ideation, plans, and behavior using exploratory data mining

Individuals with a history of non-suicidal self-injury (NSSI) are at alarmingly high risk for suicidal ideation (SI), planning (SP), and attempts (SA). Given these findings, research has begun to evaluate the features of this multi-faceted behavior that may be most important to assess when quantifying risk for SI, SP, and SA. However, no studies have examined the wide range of NSSI characteristics simultaneously when determining which NSSI features are most salient to suicide risk. The current study utilized three exploratory data mining techniques (elastic net regression, decision trees, random forests) to address these gaps in the literature. Undergraduates with a history of NSSI (N = 359) were administered measures assessing demographic variables, depression, and 58 NSSI characteristics (e.g., methods, frequency, functions, locations, scarring) as well as current SI, current SP, and SA history. Results suggested that depressive symptoms and the anti-suicide function of NSSI were the most important features for predicting SI and SP. The most important features in predicting SA were the anti-suicide function of NSSI, NSSI-related medical treatment, and NSSI scarring. Overall, results suggest that NSSI functions, scarring, and medical lethality may be more important to assess than commonly regarded NSSI severity indices when ascertaining suicide risk.

Initial Psychometric Validation of the Non-Suicidal Self-Injury Scar Cognition Scale

Given the growing literature on the detrimental psychological consequences of NSSI, it is surprising that scarce research has focused on the permanent physical consequences of NSSI, scarring to one’s tissue (Burke et al. Psychiatry Research 228, 416–424, 2015; Lewis The Journal of Nervous and Mental Disease, 204(1), 33–35 2016). Indeed, with recent research suggesting that upwards of half of those with a history of NSSI bear scarring as a result of the behavior (Burke et al. Comprehensive Psychiatry, 65, 79–87 2016), the psychological implications of scarring are important to understand. Given preliminary literature suggesting that the vast majority of individuals who bear NSSI scars ascribe a great deal of meaning to their scarring, and that this meaning varies widely, a psychometrically sound scale is needed to comprehensively and systematically assess NSSI scar-related cognitions. The present study examined the psychometric properties of the Non-Suicidal Self-Injury Scar Cognition Scale (NSSI-SCS). A sample of 110 undergraduates with at least one scar from NSSI completed the NSSI-SCS as well as measures of concurrent and divergent validity. Exploratory Factor Analysis was conducted to determine the factor structure of the NSSI-SCS. Results indicated that a five-factor solution offered the best fit for the data. Psychometric analyses support the validity of the NSSI-SCS given evidence of concurrent validity, divergent validity, and reliability. Future research should examine the test-retest reliability of the NSSI-SCS, as well as its sensitivity to change, particularly in the context of treatment research.

Personality disorder symptom severity predicts onset of mood episodes and conversion to bipolar I disorder in individuals with bipolar spectrum disorder.

Although personality disorders (PDs) are highly comorbid with bipolar spectrum disorders (BSDs), little longitudinal research has been conducted to examine the prospective impact of PD symptoms on the course of BSDs. The aim of this study is to examine whether PD symptom severity predicts shorter time to onset of bipolar mood episodes and conversion to bipolar I disorder over time among individuals with less severe BSDs. Participants (n = 166) with bipolar II disorder, cyclothymia, or bipolar disorder not otherwise specified completed diagnostic interview assessments of PD symptoms and self-report measures of mood symptoms at baseline. They were followed prospectively with diagnostic interviews every 4 months for an average of 3.02 years. Cox proportional hazard regression analyses indicated that overall PD symptom severity significantly predicted shorter time to onset of hypomanic (hazard ratio [HR] = 1.42; p < .001) and major depressive episodes (HR = 1.51; p < .001) and conversion to bipolar I disorder (HR = 2.51; p < .001), after controlling for mood symptoms. Results also suggested that cluster B severity predicted shorter time to onset of hypomanic episodes (HR = 1.38; p = .002) and major depressive episodes (HR = 1.35; p = .01) and conversion to bipolar I disorder (HR = 2.77; p < .001), whereas cluster C severity (HR = 1.56; p < .001) predicted shorter time to onset of major depressive episodes. These results support predisposition models in suggesting that PD symptoms may act as a risk factor for a more severe course of BSDs.