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An examination of episodic future thinking in the emergency department among youth experiencing suicidal thoughts and behaviors

Pollak, Olivia H; Shin, Ki Eun; Baroni, Argelinda; Gerson, Ruth S; Bell, Kerri-Anne; Tezanos, Katherine M; Fernandes, Sara N; Robinaugh, Donald J; Schacter, Daniel L; Spirito, Anthony; Cha, Christine B
Youth experiencing suicidal thoughts and/or behaviors (STBs) frequently present to emergency departments for acute psychiatric care. These settings offer a transitory yet pivotal opportunity to assess, intervene on, and plan continued care for STBs. This study examined a clinically relevant, understudied aspect of psychological functioning among youth experiencing STBs in the emergency department: episodic future thinking, or the ability to imagine discrete autobiographical future events. A sample of 167 youths (10-17 years) presenting to a pediatric psychiatric emergency department for STBs completed a performance-based measure of episodic future thinking assessing richness in detail and subjective characteristics of imagined future events. STB recurrence was assessed 6 months later. Immediately following a suicide-related crisis, youth demonstrated mixed abilities to imagine their future: they generated some concrete future event details but did not subjectively perceive these events as being very detailed or likely to occur. Older adolescents (i.e., 15-17) generated more episodic details than pre-/younger adolescents (i.e., 10-14), particularly those pertaining to actions or sensory perceptions. There was no evidence linking less detailed episodic future thinking and greater likelihood of STBs following the emergency department visit; instead, hopelessness was a more robust risk factor. Findings underscore the importance and clinical utility of better understanding the psychological state of youth during or immediately following a suicide-related crisis. In particular, assessing youths' future thinking abilities in the emergency department may directly inform approaches to acute care delivery.
PMID: 37162586
ISSN: 1435-165x
CID: 5544572

Using Behavioral Measures to Assess Suicide Risk in the Psychiatric Emergency Department for Youth

Shin, Ki Eun; Baroni, Argelinda; Gerson, Ruth S.; Bell, Kerri Anne; Pollak, Olivia H.; Tezanos, Katherine; Spirito, Anthony; Cha, Christine B.
Suicide screening is critical in pediatric emergency departments (EDs). Behavioral measures of suicide risk may complement self-report measures. The current study examines suicide-specific behavioral measures and tests their potential short-term within-person effects among respondents, ability to discriminate future suicide attempt from suicidal ideation, and translation into interpretable categorical composite scores. The sample included 167 youth (10"“17 years), presenting for suicide-related reasons to a pediatric psychiatric ED. During their ED visit, participants completed the Death/Life Implicit Association Test (IAT) and the Suicide Stroop Task. Recurrent suicidal thoughts and attempts were assessed within 6 months of the ED visit via medical records and email surveys. Youth displayed a decrease in the levels of distress and self-injurious desires (negative mood, desire to hurt themselves, and desire to die) after completing the behavioral tasks. The Death/Life IAT prospectively differentiated with 68% accuracy between youth who attempted suicide after their ED visit and those who had suicidal ideation but no attempt, p = 0.04, OR = 5.65, although this effect became marginally significant after controlling for self-report and demographic covariates. Neither the Suicide Stroop Task, nor the categorical composite scores predicted suicide attempts, ps = 0.08"“0.87, ORs = 0.96"“3.95. Behavioral measures of suicide risk administered in the ED do not appear to increase distress or self-injurious desires. They may be able to distinguish those who go on to attempt suicide (vs. consider suicide) within six months after discharge.
SCOPUS:85148757506
ISSN: 0009-398x
CID: 5445892

Inconsistencies in self-reports of suicidal ideation and attempts across assessment methods

Deming, Charlene A; Harris, Julia A; Castro-Ramirez, Franckie; Glenn, Jeffrey J; Cha, Christine B; Millner, Alexander J; Nock, Matthew K
Suicide researchers commonly use a variety of assessment methods (e.g., surveys and interviews) to enroll participants into studies and assign them to study conditions. However, prior studies suggest that different assessment methods and items may yield different responses from participants. This study examines potential inconsistencies in participants' reports of suicidal ideation (SI) and suicide attempt (SA) across commonly used assessment methods: phone screen interview, in-person interview, self-report survey, and confidential exit survey. To test the reliability of the effects, we replicated the study across two samples. In both samples, we observed a notable degree of inconsistent reporting. Importantly, the highest endorsement rates for SI/SA were on a confidential exit survey. Follow-up assessments and analyses did not provide strong support for the roles of purposeful inaccuracy, random responding, or differences in participant experiences/conceptualizations of SI. Although the reasons for such inconsistencies remain inconclusive, results suggest that classification of suicidal/control participants that uses multiple items to capture a single construct, that uses a Graded Scale to capture a broad spectrum of thoughts and behaviors, and that takes into account consistency of responding across such items may provide clearer and more homogenous groups and is recommended for future study. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
PMID: 33705163
ISSN: 1939-134x
CID: 4874182

Consensus Statement on Ethical & Safety Practices for Conducting Digital Monitoring Studies with People at Risk of Suicide and Related Behaviors

Nock, Matthew K; Kleiman, Evan M; Abraham, Melissa; Bentley, Kate H; Brent, David A; Buonopane, Ralph J; Castro-Ramirez, Franckie; Cha, Christine B; Dempsey, Walter; Draper, John; Glenn, Catherine R; Harkavy-Friedman, Jill; Hollander, Michael R; Huffman, Jeffrey C; Lee, Hye In S; Millner, Alexander J; Mou, David; Onnela, Jukka-Pekka; Picard, Rosalind W; Quay, Heather M; Rankin, Osiris; Sewards, Shannon; Torous, John; Wheelis, Joan; Whiteside, Ursula; Siegel, Galia; Ordóñez, Anna E; Pearson, Jane L
OBJECTIVE:Digital monitoring technologies (e.g., smart-phones and wearable devices) provide unprecedented opportunities to study potentially harmful behaviors such as suicide, violence, and alcohol/substance use in real-time. The use of these new technologies has the potential to significantly advance the understanding, prediction, and prevention of these behaviors. However, such technologies also introduce myriad ethical and safety concerns, such as deciding when and how to intervene if a participant's responses indicate elevated risk during the study? METHODS:We used a modified Delphi process to develop a consensus among a diverse panel of experts on the ethical and safety practices for conducting digital monitoring studies with those at risk for suicide and related behaviors. Twenty-four experts including scientists, clinicians, ethicists, legal experts, and those with lived experience provided input into an iterative, multi-stage survey, and discussion process. RESULTS:Consensus was reached on multiple aspects of such studies, including: inclusion criteria, informed consent elements, technical and safety procedures, data review practices during the study, responding to various levels of participant risk in real-time, and data and safety monitoring. CONCLUSIONS:This consensus statement provides guidance for researchers, funding agencies, and institutional review boards regarding expert views on current best practices for conducting digital monitoring studies with those at risk for suicide-with relevance to the study of a range of other potentially harmful behaviors (e.g., alcohol/substance use and violence). This statement also highlights areas in which more data are needed before consensus can be reached regarding best ethical and safety practices for digital monitoring studies.
PMCID:8372411
PMID: 34414359
ISSN: 2575-5609
CID: 5213772