Re-examining the latent structure of suicidal thoughts using taxometric analysis: Implications for testing ideation to action theoretical models of suicidal thoughts and behavior

A central question in psychological science concerns whether psychological constructs are best conceptualized as dimensional or consist of one or more categories. The present study uses contemporary taxometric procedures to examine the latent structure of suicidal thoughts, with implications for how suicidal thoughts and behavior (STB) ought to be conceptualized, assessed, measured, and managed. Three nonredundant taxometric procedures (MAMBAC, MAXEIG, and L-Mode) were performed on various sets of indicators, and analyses were replicated across two large samples that included large numbers of individuals reporting current and recent STB. Results provide further evidence that the latent structure of suicidal thoughts is best understood as dimensional. However, inconsistent findings across studies and the relatively small number of taxometric studies conducted to date both suggest that it is premature to draw clear or definitive conclusions about the latent structure of STB being dimensional or categorical based on taxometric evidence. We report a meta-analysis of the current literature which evidences this ambiguity. We provide a detailed, critical discussion of the STB taxometric literature and outline key directions for future taxometric studies in this area, particularly how taxometric analysis relates to testing ‘ideation to action’ theoretical models, which hypothesize that the development of suicidal ideation and the progression from suicide desire to attempting suicide are distinct processes with distinct explanations/mechanisms. It remains entirely possible that qualitatively distinct types of STB (e.g., representing ideation vs. action) or populations have different latent structures indicating different levels of risk

Profiles of Risk for Suicidal Behavior in Past and Current United States Military Personnel: Latent Profile Analysis of Current Risk Factors

Person-centered approaches are underutilized to identify people with shared risk profiles. In this study, an at-risk sample of 773 past/current military personnel (Mage = 31.3 years, SD = 6.8) with current ideation (90.6%) and/or a prior suicide attempt (43.9%) were assessed using latent profile analysis. Variables included prior suicide attempts, suicidal ideation, alcohol/drug use, insomnia, depression, belongingness, burdensomeness, and post-traumatic stress disorder symptoms. Three classes emerged: Low Symptoms (N = 502), Elevated Suicidality (N = 176), and Elevated Substance Use (N = 95). At 1-month follow-up, the Elevated Suicidality and Elevated Substance Use classes had the highest odds of suicidal behavior. The finding concerning the Elevated Substance Use class suggests it may represent a distinct short-term risk group in military personnel

Pretreatment Intervention Increases Treatment Outcomes for Patients with Anxiety Disorders

The current study evaluated the utility of a pretreatment intervention aimed at increasing treatment attendance. We extended past work by evaluating whether this intervention was associated with less impairment at termination. Given that patients with anxiety disorders demonstrate high rates of premature termination, we assessed whether these patients would be particularly likely to benefit. The sample included 172 patients at a community outpatient mental health clinic. Patients were assigned to the intervention condition (asked to imagine attending therapy sessions) or an information control condition. Number of sessions attended and termination Clinician Global Impressions (CGI) served as outcome variables. Contrary to prior work, the two conditions did not significantly differ on outcomes. Yet, patients with anxiety disorders in the intervention condition attended the most sessions and had least termination symptom severity. This intervention may provide a simple yet powerful method to increase treatment adherence and effectiveness for patients with anxiety disorders

Relapse Prevention in Major Depressive Disorder: Mindfulness-Based Cognitive Therapy Versus an Active Control Condition

ObjectiveWe evaluated the comparative effectiveness of mindfulness-based cognitive therapy (MBCT) versus an active control condition (ACC) for depression relapse prevention, depressive symptom reduction, and improvement in life satisfaction.MethodNinety-two participants in remission from major depressive disorder with residual depressive symptoms were randomized to either an 8-week MBCT or a validated ACC that is structurally equivalent to MBCT and controls for nonspecific effects (e.g., interaction with a facilitator, perceived social support, treatment outcome expectations). Both interventions were delivered according to their published manuals.ResultsIntention-to-treat analyses indicated no differences between MBCT and ACC in depression relapse rates or time to relapse over a 60-week follow-up. Both groups experienced significant and equal reductions in depressive symptoms and improvements in life satisfaction. A significant quadratic interaction (Group × Time) indicated that the pattern of depressive symptom reduction differed between groups. The ACC experienced immediate symptom reduction postintervention and then a gradual increase over the 60-week follow-up. The MBCT group experienced a gradual linear symptom reduction. The pattern for life satisfaction was identical but only marginally significant.ConclusionsMBCT did not differ from an ACC on rates of depression relapse, symptom reduction, or life satisfaction, suggesting that MBCT is no more effective for preventing depression relapse and reducing depressive symptoms than the active components of the ACC. Differences in trajectory of depressive symptom improvement suggest that the intervention-specific skills acquired may be associated with differential rates of therapeutic benefit. This study demonstrates the importance of comparing psychotherapeutic interventions to active control conditions

Relapse Prevention in Major Depressive Disorder: Mindfulness-based Cognitive Therapy versus an Active Control Condition.

Objective: We evaluated the comparative effectiveness of mindfulness-based cognitive therapy (MBCT) versus an active control condition (ACC) for depression relapse prevention, depressive symptom reduction, and improvement in life satisfaction. Method: Ninety-two participants in remission from major depressive disorder with residual depressive symptoms were randomized to either an 8-week MBCT or a validated ACC that is structurally equivalent to MBCT and controls for nonspecific effects (e.g., interaction with a facilitator, perceived social support, treatment outcome expectations). Both interventions were delivered according to their published manuals. Results: Intention-to-treat analyses indicated no differences between MBCT and ACC in depression relapse rates or time to relapse over a 60-week follow-up. Both groups experienced significant and equal reductions in depressive symptoms and improvements in life satisfaction. A significant quadratic interaction (Group × Time) indicated that the pattern of depressive symptom reduction differed between groups. The ACC experienced immediate symptom reduction postintervention and then a gradual increase over the 60-week follow-up. The MBCT group experienced a gradual linear symptom reduction. The pattern for life satisfaction was identical but only marginally significant. Conclusions: MBCT did not differ from an ACC on rates of depression relapse, symptom reduction, or life satisfaction, suggesting that MBCT is no more effective for preventing depression relapse and reducing depressive symptoms than the active components of the ACC. Differences in trajectory of depressive symptom improvement suggest that the intervention-specific skills acquired may be associated with differential rates of therapeutic benefit. This study demonstrates the importance of comparing psychotherapeutic interventions to active control conditions

Relapse prevention in major depressive disorder: Mindfulness-based cognitive therapy versus an active control condition.

OBJECTIVE: We evaluated the comparative effectiveness of Mindfulness-based cognitive therapy (MBCT) versus an active control condition (ACC) for depression relapse prevention, depressive symptom reduction, and improvement in life satisfaction. METHOD: Ninety-two participants in remission from Major Depressive Disorder with residual depressive symptoms were randomized to either an 8-week MBCT or a validated ACC that is structurally equivalent to MBCT and controls for non-specific effects (e.g., interaction with a facilitator, perceived social support, treatment outcome expectations). Both interventions were delivered according to their published manuals. RESULTS: Intention-to-treat analyses indicated no differences between MBCT and ACC in depression relapse rates or time to relapse over a 60-week follow-up. Both groups experienced significant and equal reductions in depressive symptoms and improvements in life satisfaction. A significant quadratic interaction (group x time) indicated that the pattern of depressive symptom reduction differed between groups. The ACC experienced immediate symptom reduction post-intervention and then a gradual increase over the 60-week follow-up. The MBCT group experienced a gradual linear symptom reduction. The pattern for life satisfaction was identical but only marginally significant. CONCLUSIONS: MBCT did not differ from an ACC on rates of depression relapse, symptom reduction, or life satisfaction, suggesting that MBCT is no more effective for preventing depression relapse and reducing depressive symptoms than the active components of the ACC. Differences in trajectory of depressive symptom improvement suggest that the intervention-specific skills acquired may be associated with differential rates of therapeutic benefit. This study demonstrates the importance of comparing psychotherapeutic interventions to active control conditions

Initial Validation of Brief Measures of Suicide Risk Factors: Common Data Elements used by the Military Suicide Research Consortium.

The Military Suicide Research Consortium (MSRC) developed a 57-item questionnaire assessing suicide risk factors, referred to as the Common Data Elements (CDEs), in order to facilitate data sharing and improve collaboration across independent studies. All studies funded by MSRC are required to include the CDEs in their assessment protocol. The CDEs include shortened measures of the following: current and past suicide risk, lethality and intent of past suicide attempts, hopelessness, thwarted belongingness, anxiety sensitivity, posttraumatic stress disorder symptoms, traumatic brain injury, insomnia, and alcohol abuse. This study aimed to evaluate the psychometric properties of the CDE items drawn from empirically validated measures. Exploratory factor analysis was used to examine the overall structure of the CDE items, and confirmatory factor analyses were used to evaluate the distinct properties of each scale. Internal consistencies of the CDE scales and correlations with full measures were also examined. Merged data from 3,140 participants (81.0% military service members, 75.6% male) across 19 MSRC-funded studies were used in analyses. Results indicated that all measures exhibited adequate internal consistency, and all CDE shortened measures were significantly correlated with the corresponding full measures with moderate to strong effect sizes. Factor analyses indicated that the shortened CDE measures performed well in comparison with the full measures. Overall, our findings suggest that the CDEs are not only brief but also provide psychometrically valid scores when assessing suicide risk and related factors that may be used in future research

Navigating Uncharted Waters: Considerations for Training Clinics in the Rapid Transition to Telepsychology and Telesupervision During COVID-19

The COVID-19 pandemic offers both challenges and opportunities for those who provide and receive psychological services. For training clinics tasked with educating the next generation of health service psychologists, providing vital mental health care to the community, and conducting clinical research, the pandemic offers an opportunity to consider how best to fulfill these crucial missions during a time of global uncertainty. The present paper reviews the recent, rapid move to telepsychology among North American university training clinics in response to the COVID-19 pandemic and offers relevant suggestions for mental health service providers rapidly transitioning to telepsychology moving forward. Data summarizing the response of university training clinics in health service psychology in the United States and Canada to physical distancing guidelines are presented, and considerations regarding best practices in service delivery and supervision via telepsychology are provided. While the present data focus on North American training clinics, the suggestions offered are relevant to any clinic tasked with providing high quality services and training mental health providers via telepsychology, particularly during the COVID-19 pandemic. Given the growing emphasis within health service psychology on increasing access to mental health services via telepsychology prior to the pandemic, as well as the benefits to psychology trainees in gaining competence in this valuable form of service delivery, this paper aims to provide timely guidance around the benefits, risks, and practical considerations regarding the maintenance of effective clinical care in training settings when rapidly implementing telepsychology