Interactive Effects of Acute Suicidal Affective Disturbance and Pain Persistence on Suicide Attempt Frequency and Lethality
Abstract
Abstract.Background: Acute suicidal affective disturbance (ASAD) has been proposed as a suicide-specific entity that confers risk for imminent suicidal behavior. Preliminary evidence suggests that ASAD is associated with suicidal behavior beyond a number of factors; however, no study to date has examined potential moderating variables. Aims: The present study tested the hypotheses that physical pain persistence would moderate the relationship between ASAD and (1) lifetime suicide attempts and (2) attempt lethality. Method: Students (N = 167) with a history of suicidality completed self-report measures assessing the lifetime worst-point ASAD episode and the presence of a lifetime suicide attempt, a clinical interview about attempt lethality, and a physical pain tolerance task. Results: Physical pain persistence was a significant moderator of the association between ASAD and lifetime suicide attempts (B = 0.00001, SE = 0.000004, p = .032), such that the relationship between ASAD and suicide attempts strengthened at increasing levels of pain persistence. The interaction between ASAD and pain persistence in relation to attempt lethality was nonsignificant (B = 0.000004, SE = 0.00001, p = .765). Limitations: This study included a cross-sectional/retrospective analysis of worst-point ASAD symptoms, current physical pain perception, and lifetime suicide attempts. Conclusion: ASAD may confer risk for suicidal behavior most strongly at higher levels of pain persistence, whereas ASAD and pain perception do not influence attempt lethality.
References
1975). Classification of suicidal behaviors: I. Quantifying intent and medical lethality. The American Journal of Psychiatry, 132, 285–287.
(1999). Suicide ideation at its worst point: A predictor of eventual suicide in psychiatric outpatients. Suicide & Life-Threatening Behavior, 29, 1–9.
(2011). Impulsivity and suicidality: The mediating role of painful and provocative experiences. Journal of Affective Disorders, 129, 301–307. 10.1016/j.jad.2010.07.023
(1970). Psychological factors affecting pain tolerance. Journal of Psychosomatic Research, 14, 371–376. 10.1016/0022-3999(70)90003-6
(2004). Suicide intent and accurate expectations of lethality: Predictors of medical lethality of suicide attempts. Journal of Consulting and Clinical Psychology, 72, 1170–1174. 10.1037/0022-006X.72.6.1170
(2016). WISQARS: Web-based inquiry statistics query and reporting system. Retrieved from http://www.cdc.gov/ncipc/wisqars/default.htm
. (2017). The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research. Psychological Bulletin, 143, 1313–1345. 10.1037/bul0000123
(2013). Applied multiple regression/correlation analysis for the behavioral sciences. New York, NY: Routledge.
(2006). Alone but feeling no pain: Effects of social exclusion on physical pain tolerance and pain threshold, affective forecasting, and interpersonal empathy. Journal of Personality and Social Psychology, 91, 1–15. 10.1037/0022-3514.91.1.1
(2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175–191.
(2012). Nonsuicidal self-injury and diminished pain perception: The role of emotion dysregulation. Comprehensive Psychiatry, 53, 691–700. 10.1016/j.comppsych.2011.11.008
(2017). A social exclusion manipulation interacts with acquired capability for suicide to predict self-aggressive behaviors. Archives of Suicide Research. 10.1080/13811118.2017.1304309
(2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York, NY: Guilford Press.
(2010). Role of intense affects in predicting short-term risk for suicidal behavior: A prospective study. The Journal of Nervous and Mental Disease, 198, 220–225. 10.1097/NMD.0b013e3181d13d14
(2004). Desperation and other affective states in suicidal patients. Suicide & Life-Threatening Behavior, 34, 386–394. 10.1521/suli.34.4.386.53734
(2007). The role of intense affective states in signaling a suicide crisis. The Journal of Nervous and Mental Disease, 195, 363–368. 10.1097/NMD.0b013e318052264d
(2016). Limitations of a single-item assessment of suicide attempt history: Implications for standardized suicide risk assessment. Psychological Assessment, 28, 1026–1030. 10.1037/pas0000241
(2001). Pain insensitivity in the relatives of schizophrenia patients. Schizophrenia Research, 47, 265–273. 10.1016/S0920-9964(00)00064-5
(2010). Pain perception and nonsuicidal self-injury: A laboratory investigation. Personality Disorders, 1, 170–179. 10.1037/a0020106
(2003). Worst-point suicidal plans: A dimension of suicidality predictive of past suicide attempts and eventual death by suicide. Behaviour Research and Therapy, 41, 1469–1480. 10.1016/S0005-7967(03)00070-6
(2015). The Three-Step Theory (3ST): A new theory of suicide rooted in the "ideation-to-action" framework. International Journal of Cognitive Therapy, 8, 114–129. 10.1521/ijct.2015.8.2.114
(2016). A meta-analysis on pain sensitivity in self-injury. Psychological Medicine, 46, 1597–1612. 10.1017/S0033291716000301
(2017). Age changes in pain perception: A systematic-review and meta-analysis of age effects on pain and tolerance thresholds. Neuroscience & Biobehavioral Reviews, 75, 104–113. 10.1016/j.neubiorev.2017.01.039
(2017). Non-suicidal self-injury and frequency of suicide attempts: The role of pain persistence. Journal of Affective Disorders, 209, 254–261. 10.1016/j.jad.2016.11.028
(1988). Self-efficacy and perceived control: Cognitive mediators of pain tolerance. Journal of Personality and Social Psychology, 54, 149–160. 10.1037/0022-3514.54.1.149
(2010). Thresholds and tolerance of physical pain among young adults who self-injure. Pain Research & Management, 15, 371–377.
(2015). Single-item measurement of suicidal behaviors: Validity and consequences of misclassification. PloS One, 10, e0141606. 10.1371/journal.pone.0141606
(2011).
(Towards an integrated motivational–volitional model of suicidal behaviour. In R. C. O'ConnorS. PlattJ. GordonEds., International handbook of suicide prevention (pp. 181–198). Chichester, UK: John Wiley & Sons. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/9781119998556.ch11/summary2001). Fears, phobias, and preparedness: Toward an evolved module of fear and fear learning. Psychological Review, 108, 483–522. 10.1037/0033-295X.108.3.483
(2014). Suicidal behavior disorder as a diagnostic entity in the DSM-5 classification system: Advantages outweigh limitations. World Psychiatry, 13, 128–130. 10.1002/wps.20116
(1997). Thresholds and tolerance of physical pain in suicidal and nonsuicidal adolescents. Journal of Consulting and Clinical Psychology, 65, 646–652.
(1996). Tolerance for physical pain in suicidal subjects. Death Studies, 20, 327–341. 10.1080/07481189608252786
(1989). Is there a relation between the seriousness of suicidal intent and the lethality of the suicide attempt? Psychiatry Research, 27, 71–79. 10.1016/0165-1781(89)90011-5
(2015). Capability for suicide interacts with states of heightened arousal to predict death by suicide beyond the effects of depression and hopelessness. Journal of Affective Disorders, 188, 53–59. 10.1016/j.jad.2015.07.037
(2017). Acute suicidal affective disturbance: Factorial structure and initial validation across psychiatric outpatient and inpatient samples. Journal of Affective Disorders, 211, 1–11. 10.1016/j.jad.2016.12.057
(2004). Suicide rates among physicians: A quantitative and gender assessment (meta-analysis). American Journal of Psychiatry, 161, 2295–2302. 10.1176/appi.ajp.161.12.2295
(2013). Aberrant pain perception in direct and indirect non-suicidal self-injury: An empirical test of Joiner's interpersonal theory. Comprehensive Psychiatry, 54, 694–701. 10.1016/j.comppsych.2012.12.029
(2016). Acute suicidal affective disturbance: A confirmatory factor analysis among psychiatric inpatients. Journal of Psychiatric Research, 80, 97–104.
(2003). Are anaesthetists prone to suicide? A review of rates and risk factors. Anaesthesia and Intensive Care, 31, 434–445.
(2016). Construct validity of a proposed new diagnostic entity: Acute suicidal affective disturbance (ASAD). Journal of Affective Disorders, 189, 365–378. 10.1016/j.jad.2015.07.049
(2010). The interpersonal theory of suicide. Psychological Review, 117, 575–600. 10.1037/a0018697
(2011). Suicidal behavior on Axis VI: Clinical data supporting a sixth axis for DSM-V. Crisis, 32, 110–113. 10.1027/0227-5910/a000057
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