Loneliness predicts suicidal ideation and anxiety symptoms in long-term childhood cancer survivors

Background/ObjectiveLong-term childhood cancer survivors (CCS) are at risk for adverse late effects. However, not all of them are well understood. The present study addressed loneliness, a previously under-researched mental health risk in cancer survivor populations. We assessed the prevalence of loneliness and its impact on psychological symptoms over time. Method: A registry-based sample of N = 633 adult long-term CCS underwent medical and psychological assessments and took part in a follow-up survey 2.5 years later. Psychological symptoms (somatic, anxiety, depression symptoms, and suicidal ideation) were measured using the Patient Health Questionnaire. We calculated linear regression models of symptoms at follow-up to investigate the impact of loneliness over time (controlling for symptoms at baseline and relevant confounders). Results: Loneliness was reported by 17.70% of CCS. In multivariate linear regression analyses, loneliness was still predictive of more severe anxiety symptoms and suicidal ideation over two years later. Loneliness did not predict somatic and depression symptoms at follow-up (which increased with age). Conclusions: Loneliness affected a significant number of CCS and was a risk factor for persistent anxiety symptoms and suicidal ideation. The extent to which young cancer patients’ re-integration into society is successful could thus have important implications for well-being in adulthood.     

Within-Family Differences in Internalizing Behaviors: The Role of Children’s Perspectives of the Mother-child Relationship

The goal of this exploratory, within-family, longitudinal study was to examine whether children’s perspectives of the mother-child relationship explained within-family differences in children’s responses to a shared family stressor (maternal depressive symptoms) over time. Children (ages 8 to 15 years; N = 68) residing in 34 families were drawn from a general population study in the UK. Predictor variables were assessed at Time 1 and change in internalizing behavior from Time 1 to Time 2 (2 years later) was examined. As children were nested within families, data were analyzed using multilevel modeling, controlling for previous child behavior. Child perspective of the mother-child relationship, in interaction with maternal depressive symptoms, was found to explain within-family differences in internalizing over time. Children with a negative perspective (compared to mothers’ perspectives) were the most vulnerable to the adverse effects of maternal depressive symptoms.     

Protective Effects of Maternal and Peer Support on Depressive Symptoms during Adolescence

The current study examined the contributions of maternal and peer support to depressive symptoms in early to mid-adolescence and variation in these contributions across age, gender, and race. Five waves of data on maternal support, peer support, and depressive symptoms were collected on rural youth (N = 3,444) at 6 month intervals. Multilevel modeling was used to evaluate within and between-person effects of maternal and peer support on depressive symptoms. Within-person effects of peer support did not vary by age, gender, or race. At the between-person level, peer support predicted levels of depressive symptoms at age 12, but this effect became nonsignificant after controlling for maternal support. Within-person effects of maternal support did not vary with age but were qualified by gender and race. Between-person effects of maternal support on depressive symptom levels at age 12 and slopes varied across race and gender, respectively. Findings highlight the robustness of the protective effects of maternal and peer support during adolescence among girls and white youth.     

Dynamic Associations between Maternal Depressive Symptoms and Adolescents’ Depressive and Externalizing Symptoms

The current prospective study investigated transactional relations between maternal depressive symptoms and children’s depressive and externalizing symptoms. Participants included 240 children (M age = 11.86 years, SD = 0.56; 53.9% female) and their mothers who were part of a 6-year longitudinal study. Measures of maternal depression (Beck Depression Inventory), child depression (Children’s Depression Inventory), and children’s externalizing symptoms (Youth Self-Report Form) were assessed annually. Data analyses using dynamic latent difference score structural equation models indicated that the observed relations between mothers’ and adolescents’ symptoms were stable across the 6 years. Higher levels of maternal depressive symptoms predicted subsequent elevations in children’s depressive symptoms and in their externalizing problems over time. Among mothers with high initial levels of depression, children’s depressive symptoms predicted subsequent declines in mothers’ depressive symptoms. Children’s externalizing problems were not related to subsequent change in maternal symptoms.     

Loneliness and Suicidal Risk in Young Adults: Does Believing in a Changeable Future Help Minimize Suicidal Risk Among the Lonely?

This study examined loneliness and future orientation as predictors of suicidal risk, namely, depressive symptoms and suicide ideation, in a sample of 228 college students (54 males and 174 females). Results of regression analyses indicated that loneliness was a significant predictor of both indices of suicidal risk. The inclusion of future orientation was found to significantly augment the prediction model of both depressive symptoms and suicide ideation, even after accounting for loneliness. Noteworthy, beyond loneliness and future orientation, the Loneliness × Future Orientation interaction term was found to further augment both prediction models of suicidal risk. Consistent with the notion that future orientation is an important buffer of suicidal risk, among lonely students, those with high future orientation, compared to low future orientation, were found to report significantly lower levels of depressive symptoms and suicide ideation. Some implications of the present findings for studying both risk and protective factors associated with suicidal risk in young adults are discussed.     

A Five‐Month Longitudinal Study of Psychache and Suicide Ideation: Replication in General and High‐Risk University Students

Shneidman's (1993) model of psychache as the cause of suicide was evaluated in a 5‐month longitudinal study of psychological pain and suicide ideation. Replicating across general (N = 683) and high‐risk undergraduates (N = 262), psychache was significantly associated with suicide ideation, and change in psychache was significantly associated with change in suicide ideation. For general suicide ideation and suicide preparation, these significant results were maintained even when depression and hopelessness were statistically controlled. This research is a unique contribution being the first large‐sample longitudinal study that evaluates and supports Shneidman's psychache causal model of suicidality in general and high‐risk groups.     

Distress Tolerance and Anxiety Sensitivity Cognitive Concerns: Testing the Incremental Contributions of Affect Dysregulation Constructs on Suicidal Ideation and Suicide Attempt

Empirical work has suggested relationships among suicide-related outcomes and several constructs related to affect dysregulation, notably anxiety sensitivity (AS) and distress tolerance (DT). However, important questions remain, including the relative contributions of these affect regulation variables as well as the direct contribution of DT on suicidal ideation and prior attempts. The current study sought to better elucidate the nature of these relationships by examining AS, DT, and suicidal ideation and attempt in a clinical sample (N = 192). Consistent with prior work and prediction, findings revealed a significant relationship between the AS cognitive concerns subfactor and suicidal ideation and suicide attempt history after accounting for the effects of DT, gender, and depressive symptoms. In addition, depressive symptoms significantly moderated the relationship between the AS cognitive concerns subfactor and suicidal ideation. After accounting for the influence of AS, analyses revealed that DT approached significance in predicting suicidal ideation, but did not significantly predict suicide attempt history. These results suggest that elevated AS cognitive concerns are particularly relevant to suicide in the context of depressive symptoms. Clinicians may benefit from implementing AS reduction strategies with individuals who endorse elevated suicide risk as well as elevated AS cognitive concerns.     

The positive role of hope on the relationship between loneliness and unhappy conditions in Hungarian young adults: How pathways thinking matters!

ABSTRACT

In this study, we examined loneliness and hope components as predictors of unhappy conditions (viz., anxious symptoms, depressive symptoms, & suicidal ideation) in young adults. The sample was comprised of 489 Hungarian college students. Results of conducting hierarchical regression analyses indicated that loneliness and hope pathways (but not hope agency) were important unique predictors of anxious symptoms, depressive symptoms, and suicidal ideation. Moreover, in part, consistent with the notion that hope might buffer the negative effects of loneliness on unhappy conditions, evidence for a significant Loneliness × Hope Pathways interaction effect in predicting each of the three indices of unhappy conditions was found. In contrast, the Loneliness × Hope Agency interaction effect was not found to be significant. Some implications of the present findings for the study and treatment of unhappy conditions in adults are discussed.     

Fear of missing out and depressive symptoms during the COVID-19 pandemic

During the early stages of the COVID-19 pandemic, governments issued public health safety measures (e.g., “stay-at-home” ordinances), leaving many people “missing out” on integral social aspects of their own lives. The fear of missing out, popularly shortened as, “FoMO,” is a felt sense of unease one experiences when they perceive they may be missing out on rewarding and/or enjoyable experiences. Among 76 participants (ages M = 69.36, SD = 5.34), who were at risk for hospitalization or death if infected with COVID-19, we found that FoMO was associated with depressive symptoms at Time 1, even when controlling for perceived stress, loneliness, and fear of COVID-19. However, FoMO did not predict future depressive symptoms, about 1 week later, when controlling for Time 1 depressive symptoms. These findings provide further evidence that FoMO is associated with depressive symptoms in a short period of time even when accounting for other powerful social factors such as loneliness. Future research should explore the potential causal relationships between FoMO and depression, especially those that may establish temporal precedence.     

Multidimensional Future Time Perspective as Moderators of the Relationships between Suicide Motivation,Preparation, and Its Predictors

The moderating impact of future time perspective (FTP) components on the relationships of hopelessness, depressive symptoms, and psychache with suicide motivation and preparation was investigated. In a sample of first year college students (N = 87) recruited on the basis of elevated suicide ideation and depressive symptoms, future thinking, optimism, and future connectedness attenuated the relationship of suicide motivation with depressive symptoms and hopelessness. Future thinking moderated the impact of depressive symptoms on suicide preparation. No moderating effects were found for psychache. This study demonstrates that FTP may buffer against the worst effects of salient suicide predictors among high‐risk students.     

The problem-solving diathesis in depression,hopelessness, and suicide ideation: A longitudinal analysis

The problem-solving deficit (PSD) diathesis-stress model of suicide behavior proposed by Clum, Patsiokas, and Luscomb (1979) and expanded by Schotte and Clum (1982, 1987) was examined in a short-term longitudinal test. The present study assessed the relationship between problem-solving deficits at Time 1—prior to the stressor (a D or F on a midterm examination)—and adjustment at Time 2—after the Stressor. Evidence was found for an additive predictive relationship for stress and problem-solving deficits to Time 2 measures of depressive symptoms, hopelessness, and suicide ideation. Evidence was also found that PSD × Stress interactions uniquely predicted the three criteria. The results of this study were taken as evidence of problem-solving deficits functioning as a diathesis for depression, hopelessness, and suicide ideation.     

Post Traumatic Stress,Context, and the Lingering Effects of the Hurricane Katrina Disaster among Ethnic Minority Youth

This study examined the stability of post traumatic stress disorder (PTSD) symptoms in a predominantly ethnic minority sample of youth exposed to Hurricane Katrina. Youth (n = 191 grades 4th thru 8th) were screened for exposure to traumatic experiences and PTSD symptoms at 24 months (Time 1) and then again at 30 months (Time 2) post-disaster. PTSD symptoms did not significantly decline over time and were higher than rates reported at earlier time points for more ethnically diverse samples. Younger age, female sex, and continued disrepair to the child’s home predicted stable elevated PTSD symptoms. Findings are consistent with predictions from contextual theories of disaster exposure and with epidemiological data from adult samples suggesting that the incidence of PTSD post Katrina is showing an atypical pattern of remittance. Theoretical, applied, and policy implications are discussed.     

Adolescent Suicidal Ideation Subgroups and their Association with Suicidal Plans and Attempts in Young Adulthood

Suicidal ideation during adolescence is quite common. Longitudinal ideation patterns may predict adolescents at greatest risk of progressing to more serious suicidal behaviors. We enumerated suicidal ideation trajectory subgroups and estimated subgroup association with later suicidal plans and attempts using data collected across a 13‐year period from 552 Caucasian adolescents. Three subgroups were found: non‐ideators (no ideation), decreasers (ideation decreased), and increasers (ideation persisted or increased). Probability of planning a suicide was greatest among increasers (females: .54, males: 51, p < .01). Probability of attempting suicide was greatest among male decreasers (.36, p < .01) and female increasers (.25, p < .01).     

Anxiety in Children with Mood Disorders: A Treatment Help or Hindrance?

This study examined the role of comorbid anxiety in treatment outcome for children with mood disorders (N = 165; age 8–11) participating in Multi-Family Psychoeducational Psychotherapy (MF-PEP). Assessments occurred at baseline, 6, 12, and 18 months for two randomly assigned groups: immediate treatment and 1-year wait-list. Most children (69%) had comorbid anxiety disorders. Baseline comorbid anxiety, as reported on the Children’s Interview for Psychiatric Syndromes (ChIPS), was associated with higher Children’s Depression Rating Scale- Revised (CDRS-R) scores but not Young Mania Rating Scale (YMRS) scores. Higher levels of anxiety symptoms were associated with lower Children’s Global Assessment Scale (C-GAS) scores. Participation in MF-PEP did not significantly reduce anxiety symptoms (p = 0.62). However, presence of comorbid anxiety did not impede reduction in depressive (CDRS-R, p = 0.74) or manic (YMRS scores, p = 0.94) symptoms following MF-PEP. More baseline anxiety symptoms were associated with greater improvement in C-GAS scores post-treatment (p = 0.02). Implications are discussed.     

Romantic relationship quality during the COVID-19 pandemic: The longitudinal associations with relationship loneliness and depression

The COVID-19 pandemic created significant strain on both mental health and romantic relationships. Therefore, we examined longitudinal associations between romantic relationship quality, relationship loneliness, and depressive symptoms over 6 months of the COVID-19 pandemic. We surveyed 122 couples (n = 244 individuals) in approximately May, September, and November 2020. Using a dyadic mediation model, findings indicated that relationship quality at Time 1 was positively associated with depression at Time 3 for men, but not for women. A significant indirect effect of relationship quality on depression via relationship loneliness at Time 2 was found for both men and women. Self-mastery, or feeling in control of one's life circumstances, was an important covariate of women's depressive symptoms. Overall, these findings highlight relationship loneliness as particularly salient for mental health and demonstrate the importance of high-quality relationships for promoting well-being during stressful events, such as global pandemics.     

Cognitive Vulnerability to Depression in Canadian and Chinese Adolescents

The goal of the current study was to compare diathesis-stress and transactional models of cognitive vulnerability to depression in samples of Canadian (n = 118) and Chinese (n = 405) adolescents. We utilized a six-month multi-wave, longitudinal design in order to examine whether (a) perceived control moderated the association between the occurrence of dependent interpersonal stressors and subsequent increases in depressive symptoms (i.e., a diathesis-stress perspective) and (b) dependent interpersonal stressors mediated the association between perceived control and subsequent increases in depressive symptoms (i.e., a transactional perspective). Results from idiographic, time-lagged, hierarchical linear modeling analyses indicated that for Canadian adolescents both diathesis-stress and transactional models were significant predictors of depressive symptomology. When examining the diathesis-stress model, boys, but not girls, who reported lower perceived control, reported higher levels of depressive symptoms following the occurrence of dependent interpersonal stress. Gender differences, however, were not present in the transactional model. In contrast, transactional, but not diathesis-stress, models were significant in Chinese adolescents, and gender differences did not emerge. Overall, these results may reflect culturally-relevant differences in the etiology of depression in Canadian and Chinese adolescents.     

Brooding and Reflection as Subtypes of Rumination: Evidence from Confirmatory Factor Analysis in Nonclinical Samples using the Dutch Ruminative Response Scale

Previous research has shown that depressive rumination is an important vulnerability factor for experiencing depressive symptoms. The most widely used measure to assess depressive rumination is the Ruminative Response Scale (RRS). According to Treynor et al. (Cognitive Therapy and Research 27:247–259, 2003), the RRS contains two subscales, reflecting two different rumination subcomponents: brooding and reflection. The present study examined the psychometric properties of the RRS in two samples (N = 432 and N = 407). Based on a confirmatory factor analysis (CFA), results confirmed that a two-dimensional model with brooding and reflection factors provided an adequate fit to the data. Reliability, convergent and discriminant validity of the rumination subcomponents were appropriate. Furthermore, brooding but not reflection predicted depressive symptoms prospectively, even when accounting for concurrent depressive feelings. The results provide the first confirmatory factor-analytical support for the widely assumed two-factor model of the RRS and add to the accumulating body of evidence supporting the multidimensional nature of depressive rumination.     

Loneliness and Suicidal Ideation in Drug‐Using College Students

The college years are marked by social changes and behavioral experimentation which may increase risk of suicidal ideation. We propose a novel pathway for the development of suicidal thoughts between two established suicide risk factors, loneliness and drug use, which have not been examined in a nonclinical sample. Data were collected from 207 undergraduate drug‐using students at a large southeastern university. As hypothesized, suicidal ideation was positively correlated with both loneliness (r = .40) and drug use (r = .29). After controlling for several demographic variables, social desirability, and anxiety sensitivity, drug use was tested as a potential mediator in the loneliness–suicidal ideation link using a single‐mediator model. Results indicated a significant indirect (mediated) effect of loneliness on suicidal ideation via drug use (ab = 0.09, 95% CI: 0.02–0.18), suggesting that loneliness may contribute to suicidal ideation through increased drug use among college students. Identification of and intervention with students reporting loneliness and drug use may be a promising suicide prevention strategy on college campuses.     

Social Anxiety Symptoms and Suicidal Ideation in a Clinical Sample of Early Adolescents: Examining Loneliness and Social Support as Longitudinal Mediators

Recent research has shown that social anxiety may be related to increased risk for suicidal ideation in teens, although this research largely has been cross-sectional and has not examined potential mediators of this relationship. A clinical sample of 144 early adolescents (72 % female; 12–15 years old) was assessed during psychiatric inpatient hospitalization and followed up at 9 and 18 months post-baseline. Symptoms of social anxiety, depression, suicidal ideation, loneliness, and perceived social support were assessed via structured interviews and self-report instruments. Structural equation modeling revealed a significant direct relationship between social anxiety symptoms at baseline and suicidal ideation at 18 months post-baseline, even after controlling for baseline depressive symptoms and ideation. A second multiple mediation model revealed that baseline social anxiety had a significant indirect effect on suicidal ideation at 18 months post-baseline through loneliness at 9 months post-baseline. Social anxiety did not have a significant indirect effect on suicidal ideation through perceived social support from either parents or close friends. Findings suggest that loneliness may be particularly implicated in the relationship between social anxiety and suicidality in teens. Clinicians should assess and address feelings of loneliness when treating socially anxious adolescents.     

The Longitudinal Association of Being Bullied and Gender with Suicide Ideations,Self‐Harm,and Suicide Attempts from Adolescence to Young Adulthood: A Cohort Study

Longitudinal associations between being bullied during adolescence and suicide ideations, self‐harm, and suicide attempts into young adulthood were examined. A large representative sample was examined in 1998 (N  = 2,464, MA 13.7), 1999/2000, and 2012 to reassess the outcome measures. At all ages, bullied participants showed more suicide ideation, self‐harm, and suicide attempts, regardless of gender. Bullied females showed a decrease in suicide ideation from adolescence to adulthood, while bullied males showed an increase in suicide attempts in the same time period. Being bullied in adolescence strongly predicts suicidal behavior and self‐harm. Preventive efforts might reduce the risk of later suicidality.