Introduction: Progress reducing suicide death will require randomized clinical trials (RCTs) specifically targeting suicide risk. Even large RCTs may not stipulate suicide death as the primary outcome, as suicide death is relatively uncommon. Therefore, RCTs may need to specify suicidal ideation as a proxy indicator of risk. There is no consensus on the best tool for measuring suicidal ideation within RCTs. We contrasted the psychometric performance of three suicidal ideation measures to address this need. Methods: We applied item response theory to the Beck Scale for Suicide Ideation (BSSI), the Columbia-Suicide Severity Rating Scale (C-SSRS), and the suicide item of the Hamilton Rating Scale for Depression (HRSD) for 101 outpatients with depression and suicidal ideation participating in a RCT with suicidal ideation as the primary outcome. Results: All measures of suicidal ideation were equally able to detect low and very high levels of suicidal ideation. Conclusions: The choice of the specific measure of suicidal ideation in a clinical trial may be dictated by time and financial resources versus the need for granularity in the interpretation of the scores.
Although it may be thought of as a childhood disorder, with up to 50% of children between ages 3-6 reporting them, 1 nightmares commonly persist into adulthood. In fact, 14% of college students 2 and 4.3% of older adults report frequent nightmares. 3 Nightmares are also very clinically-relevant. For instance, it is known that nightmares are a frequent symptom with posttraumatic stress disorder (PTSD), but some may not realize that the presence of nightmares before a trauma can increase the risk of developing PTSD. 4 Nightmares have also been shown to be comorbid with depression, 5,6 anxiety, 7 schizophrenia, 8,9 and suicide. [10][11][12] Even when not leading to psychopathology, nightmares are still associated with substantial daytime distress. 13,14 Given its high prevalence and notable comorbidities, there is a great need for theories, and subsequent validation research, to help us understand nightmares, and by proxy to better understand the mechanism by which nightmares contribute to psychopathology and suicide. Levin and Nielsen's Neurocognitive Model 15,16 fits the bill, as it is an exceptionally well thought-out and researched model of dysphoric dreams. The model proposes that nightmares may reflect problematic emotion regulation and highlights several brain structures that are likely implicated in nightmares: the amygdala, medial prefrontal cortex, hippocampus, and anterior cingulate cortex. However, one significant limitation of the model is that there is limited validation work that has been published. The theory was based upon a substantial amount of neurological research, but how do these areas actually respond in those who have nightmares?Recently, the anterior cingulate cortex 17 and medial prefrontal cortex 18 have been shown to be associated with nightmare frequency, but nightmare distress remains unexamined. Although this may sound inconsequential, it is extremely important as nightmare distress is the component that is most closely associated with psychopathology. 19 It is very possible that understanding nightmare distress will be key in understanding the association between psychopathology and nightmares, and may lead to new clinical breakthroughs to mitigate their effects.In an innovative new study featured in this issue of the Journal of Clinical Sleep Medicine, Marquis and colleagues 20 use SPECT imaging to examine brain activity while looking at neutral and negative pictures among 18 individuals who experience frequent nightmares. The results were consistent with research looking at the neural correlates of nightmare COMMENTARY A Meaningful Step Toward Understanding the Cause and Impact of Nightmares Commentary on Marquis et al. Nightmare severity is inversely related to frontal brain activity during waking state picture viewing.
This study examined the impact of social support from family, non-gender minority friends, gender minority friends, and religious groups on suicidal ideation, suicide attempt history, and the number of suicide attempts. Researchers hypothesized that these types of social support were associated with lower suicidal thoughts and behaviors. This research is a secondary analysis of the Virginia Transgender Health Initiative Survey (THIS) data set ( N = 350). Logistic regressions assessed suicidal ideation and attempts. Linear regression assessed the number of suicide attempts. Age was a covariate in all analyses. Social support from family ( B = -.419, SE = .119, p < .001) was negatively associated with suicidal ideation and was not associated with an attempt history or number of attempts. This finding suggests that increasing social support from family may be an important factor to consider for suicide prevention for gender minority individuals.
Objective We expand upon previous research examining the prevalence of exposure to suicide deaths by comparing these to natural and accidental deaths. Furthermore, we examine whether participants are more apt to lie about the cause of death for a suicide than for an accidental or natural death. Method The sample consisted of 1,430 respondents who were recruited via Amazon's Mechanical Turk to complete an online study. Participants completed measures to assess exposure to death, causes of death, and willingness to disclose the cause of death to others. Results Nearly all respondents (94.5%) had been exposed to a natural death, and most of our sample (63.2%) reported exposure to a suicide death. Among those affected by all three causes of death, RANOVA analysis also indicated that people lied about cause of suicide death to significantly more people than accidental or natural. Conclusions Overall, the current study presents updated prevalence rates of exposure to various types of death and replicates previous findings of a decrease in willingness to disclose suicides when compared with other causes of death.
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