Suicidal Ideation and Eating Disorder Symptoms in Adolescents: The Role of Interoceptive Deficits

Eating disorder symptoms and suicidal ideation are relatively common, and often begin to emerge in adolescence. Interoceptive deficits, or the inability to perceive and accurately identify the physiological condition of the body, is an established risk factor for both eating disorders and suicidal thoughts and behaviors. Despite this, longitudinal research examining the temporal dynamics between these variables is scarce, especially within adolescent samples. Using a three-wave longitudinal design, the present study tested bidirectional relationships between interoceptive deficits, eating disorder symptoms, and suicidal ideation to examine whether interoceptive deficits predicted eating disorder symptoms and suicidal ideation over the course of a year among a sample of adolescents. Participants were 436 community adolescents recruited from local middle- and high-schools. Data were collected at baseline, 6-month follow-up, and 12-month follow-up. Study measures assessed current suicidal ideation, eating disorder symptom severity, and interoceptive deficits. Autoregressive cross-lagged modeling was conducted in MPlus. We found baseline eating disorder symptoms significantly predicted suicidal ideation at 6-month follow-up when controlling for baseline suicidal ideation. Baseline interoceptive deficits significantly predicted eating disorder symptoms 6-months later, while 6-month follow-up interoceptive deficits significantly predicted 12-month follow-up suicidal ideation. Our findings highlight the need for early and regular assessment of suicidal ideation and eating disorder symptoms in adolescents. Given that interoceptive deficits was a shared risk factor for both conditions within this sample, these results underscore the need for targeted interventions aimed at improving interoception.     

Self-Reported Interoceptive Sensibility Does Not Moderate the Relationship Between Eating Disorder Symptoms and Suicidal Thoughts and Behaviors

Past research has demonstrated a strong relationship between eating disorders (EDs) and suicidality (i.e., suicidal thoughts, plans, and attempts), and preliminary work within the framework of the interpersonal psychological theory of suicide (Joiner, 2007) suggests that potentially painful ED behaviors (binge eating, purging, fasting, excessive exercise) may contribute to increased risk of suicide through heightened pain tolerance and increased capability of suicide. However, additional explanations are needed for why only some individuals with EDs actually engage in suicidal behaviors (i.e., attempt suicide), whereas others do not. A growing body of literature suggests that interoceptive deficits (a disconnection from one’s own bodily sensations and emotions; IDs) might be a factor linking eating disorders and suicide. To better understand this relationship, the current study tests the moderating effects of self-reported IDs on the relations between ED behaviors and suicidality and past suicide attempts in a transdiagnostic ED sample (N = 181). We hypothesized that ED behaviors would directly relate to suicidality, but that IDs would moderate the relationship between ED behaviors and past suicide attempts, such that those high in IDs would demonstrate a stronger relationship between ED behaviors and suicide attempts. Contrary to our hypothesis, IDs did not moderate the relationship; instead, fasting and purging had significant and strong main effects on suicidality and past suicide attempts without moderation effects. Results suggest that fasting and purging may be important ED behaviors to consider in the relationship between EDs and suicidality. Future directions include further examining the relationship between IDs, suicidality, and EDs using measures of IDs that better encompass physical (as opposed to emotional) aspects of IDs.     

青少年身体不满意与自杀意念的关系:一个有调节的中介模型

为考察青少年对身体的满意度和自杀意念的关系，探讨自尊是否在青少年身体不满意和自杀意念的关系中起中介作用，以及这个过程是否受到友谊质量的调节作用。采用身体不满意量表、自杀意念量表、自尊量表和友谊质量量表对来自湖北、安徽、河南、吉林四省六所高中的802名高一学生进行调查，结果显示：（1）身体不满意对自杀意念具有显著的正向预测作用；（2）自尊在身体不满意和自杀意念的关系中起部分中介作用；（3）友谊质量在身体不满意通过自尊影响自杀意念的中介模型后半段起调节作用，即在友谊质量较低的青少年中，自尊对自杀意念的影响更大。因此，青少年身体不满意和自杀意念之间存在有调节的中介效应。     

Gender Differences in PTSD diagnostic Criteria and Suicidal Ideation in a South African Police Sample

The study examined gender effects on PTSD symptoms to predict of suicidal ideation in a sample of South African police. A male (N = 161) and a female group (N = 56) of South African police officers were assessed by means of the Posttraumatic Diagnostic Scale and a short version of the Adult Suicide Ideation Questionnaire. Linear and stepwise regressions were used to determine which PTSD symptom criteria best predict suicide ideation. Hyperarousal was the primary predictor of suicide ideation in males. For females, intrusive memories was the primary predictor of suicide ideation, and of general problems.     

The Relationship of Suicidal Ideation to Objective and Subjective Executive Functioning

Prior research on executive ability and suicidal ideation (SI) has frequently failed to account for either symptom or performance validity. Similarly, studies have not adequately examined both objective performance on executive tests and subjective report of executive deficits in relationship to SI. The purpose of this study was to address these gaps in research by accounting for performance validity, symptom validity, and considering self-reported executive complaints with objective performance. We hypothesized that (a) increases in self-reported SI on the Personality Assessment Inventory (PAI; Morey, 1991 Morey, L. C. (1991). Personality Assessment Inventory: Professional manual. Tampa, FL: Psychological Assessment Resources. [Google Scholar]) Suicidal Ideation subscale would be related to poorer performance on objective and subjective tests of executive function and (b) level of self-reported depressive symptoms would moderate the relationship between SI and measures of executive function, such that individuals with higher levels of both depressive symptoms and executive dysfunction would be more likely to experience higher levels of SI. No measure of executive function was related to SI when accounting for demographic variables and depressive symptoms. Wisconsin Card Sort Test categories completed was the only measure of executive function to interact significantly with depressive symptoms to predict SI (β = .43). Of particular note, self-reported executive dysfunction was highly correlated with Beck Depression Inventory?II ( Beck, Steer, &; Brown, 1996 Beck, A. T., Steer, R. A., &; Brown, G. K. (1996). Beck Depression Inventory (2nd ed.). San Antonio, TX: The Psychological Corporation. [Google Scholar]) scores (r = .78). Clinical implications and future directions for research are discussed.     

青少年网络被欺负与自杀意念的关系:自尊和情绪应对方式的链式中介作用

为探讨青少年网络被欺负、自尊、情绪应对方式和自杀意念的关系,采用网络被欺负量表、自尊量表、中学生应对方式量表和自杀意念量表对来自湖北、河南、安徽三省六所高中的802名高一学生进行调查,结果发现：网络被欺负直接影响自杀意念,且存在三条间接路径：通过自尊的单独中介作用影响自杀意念;通过情绪应对方式的单独中介作用影响自杀意念;通过自尊和情绪应对方式的链式中介作用影响自杀意念。研究有助于了解青少年网络被欺负对自杀意念的影响机制,对预防以及减少青少年自杀行为具有一定的现实意义。     

The Relative Contribution of Diagnostic and Psychosocial Variables to Severity of Suicidal Ideation

The present study examined the relative contribution of diagnostic and psychosocial factors to the prediction of severity of suicidal ideation in a sample of 78 college students. Using hierarchical regression analyses to control for each set of factors, psychosocial variables were found to consistently predict level of suicidal ideation. In contrast, diagnostic variables including diagnosis of substance abuse and composite scores for depression and anxiety were unrelated to level of suicidality. An examination of individual diagnoses revealed no predictable relationships with severity of suicidality in this population. The results were discussed from several methodological viewpoints.     

Interoceptive sensitivity,body image dissatisfaction,and body awareness in healthy individuals

Relationships among interoceptive sensitivity (IS), body image dissatisfaction, body mass index (BMI), and self‐reported body awareness were investigated in a cross‐sectional study. Eighty‐two Norwegian high school students and 70 Hungarian undergraduate university students participated in the study. Subjects completed two questionnaires (Body Image Ideals Questionnaire – BIQ; Body Awareness Questionnaire – BAQ) followed by the assessment of interoceptive sensitivity using the Mental Tracking Method (MTM). An inverse, medium‐level relationship between body image dissatisfaction and IS was found in both the Norwegian and the Hungarian samples. The relationships between IS and self‐reported body awareness, and between body image dissatisfaction and BMI were uniformly non‐significant in both samples. Predictors of body image dissatisfaction were resting heart rate, gender, and IS in the regression analysis after controlling for BMI, age, and nationality. The negative relationship between IS and body image dissatisfaction described in patients with anorexia nervosa also exists in healthy individuals. There is no direct connection between IS and self‐reported body awareness.     

Suicidal Ideation and Associated Factors Among School-Going Adolescents in Harare,Zimbabwe

This study determined the prevalence and associated factors of suicidal ideation among school-going adolescents in Harare, Zimbabwe. Data on 1970 respondents were obtained from a cross sectional study of the Global School-based health survey. Respondents were selected using a two-stage probability sampling technique. The prevalence of suicidal ideation was 21.6%. Males were less likely to have suicidal ideation than females (OR=0.70; 95% CI 0.54,0.91). Worrying (OR=1.81; 95% CI 1.29,2.56), feeling of loneliness (OR=2.04; 95% CI 1.43,2.90), cigarette smoking (OR=1.87; 95% CI 1.11, 3.16), and drinking alcohol (OR=1.74; 95% CI 1.17, 2.60) were associated with suicidal ideation. Public health programs designed to control cigarette smoking and alcohol use may also impact positively on suicidal ideation.     

The Effect of Attachment Insecurity in the Development of Eating Disturbances across Gender: The Role of Body Dissatisfaction

The present study examined the effects of insecure attachment on the development of negative body image as a contributing factor to the development of disturbed-eating patterns in male and female university students. Participants were nonclinical male (n = 100) and female (n = 381) university students. Administering self-report questionnaires, the authors assessed demographic information (gender, age), anthropometric data (Body Mass Index [BMI], age), romantic attachment (ECRS-R; R. C. Fraley, N. G. Waller, & K. A. Brennan, 2000), body dissatisfaction (BSQ), and disturbed eating (EAT-26). The authors found body dissatisfaction to fully mediate the relationship between attachment anxiety and disordered eating in women. Body dissatisfaction mediated anxious attachment and dieting in men. In addition, attachment avoidance had a direct impact on eating behaviors for both genders, without the mediation of any variables measured in this study. The findings of the present study suggest that the anxiety and avoidance dimensions of attachment insecurity affect eating behaviors differently, and the effects are different across genders. The authors discuss results in the context of therapeutic interventions design.     

Understanding Women's Experiences of Defending Against Eating Disorder Symptoms: An Interpretive Phenomenological Analysis

Body dissatisfaction predicts eating disorder symptomatology for some women but not for others. To better understand this disparity, the authors interviewed 7 college women who reported body dissatisfaction and no engagement in eating disorder symptoms. The authors identified 4 factors that may protect body‐dissatisfied women from engaging in eating disorder symptoms.     

高中生自杀意念的素质-应激模型：多时段追踪研究

目的：探讨神经质人格和负性生活事件的跨层相互作用对自杀意念的影响。方法：采用自杀意念问卷、青少年生活事件问卷和大五人格量表-神经质分量表等自评量表对618名高中生进行评估,每三个月追踪1次,共追踪7次,历时21个月,用多层线性模型分析数据。结果：在控制了第一次自杀意念和性别的影响后,负性生活事件的主效应（b = 0.08, F(1, 2963) = 37.93, p < 0.001）、负性生活事件与神经质人格的相互作用（b = 0.03, F(1, 2963) = 4.35, p < 0.001）显著,而神经质人格的主效应不显著（b = 0.59, F(1, 557)= 3.05, p > 0.05）。结论：神经质人格和负性生活事件的跨层相互作用可以预测自杀意念的变化,支持素质-应激模型。     

The Relationship Between Nonsuicidal Self‐Injury and Suicidal Ideation

This correlational study was conducted with 403 undergraduate college students from 2 universities. The authors used path analysis and bootstrap regression to analyze the relationships between variables. Locus of control and family connectedness related to current nonsuicidal self‐injury (NSSI) engagement. However, when entered into the same regression, the variables current NSSI engagement and current NSSI number of methods used mediated all other relationships with suicidal ideation. Implications to current theories and clinical practice are provided.     

创伤暴露对青少年暴力行为和自杀意念的影响:创伤后应激障碍和抑郁的中介作用

采用创伤暴露问卷、基于DSM-5的创伤后应激障碍症状核查表、流调中心用抑郁量表和青少年行为问题调查表,在雅安地震3.5年后对地震极重灾区的703名中学生进行调查,考察创伤暴露对暴力行为和自杀意念的影响,并检验创伤后应激障碍和抑郁在其中的中介作用。结果发现：创伤暴露可以直接正向预测暴力行为和自杀意念,PTSD在创伤暴露对暴力行为和自杀意念的影响间起中介作用,抑郁仅在创伤暴露对自杀意念的影响间起中介作用,而在创伤暴露对暴力行为影响间的中介效应不显著。     

The Interplay Among Risk Factors for Suicidal Ideation and Suicide: The Role of Depression, Poor Health, and Loved Ones' Messages of Support and Criticism

When individuals who receive social support are in poor physical or mental health and are criticized or made to feel unwanted, they may perceive themselves as a burden. Poor physical health and depression were hypothesized to exacerbate the harmful effects on suicidal ideation of receiving critical negative messages and of receiving social support. These hypotheses were tested using secondary analyses of data from a sample of 533 unemployed married individuals who were assessed shortly after job loss, and 6 months later. The results of our analyses supported the hypotheses and demonstrated that for participants with poor health or high level of depressive symptoms an increase in critical messages and social support (from Time 1 to Time 2) predicted increased suicidal ideation. This relationship was not observed for non- depressed participants in good health. The results are discussed in terms of their implications for suicide prevention.     

抑郁在青少年核心自我评价与自杀意念间的中介作用:基于Bootstrap法和MCMC法的实证研究

考察抑郁在青少年核心自我评价与自杀意念间的中介作用。对502名高中生进行量表测评。通过偏差校正的Bootstrap法和有先验信息的MCMC法求出中介效应值的95%置信区间分别为[-.030,-.011]和[-.024,-.014],提示抑郁的中介效应显著。效应量k2、R2med分别为.124、.104,偏差校正的Bootstrap法抽样5000次后,构建的效应量的95%置信区间分别为[.070,.178]、[.063,.156],两种指标共同验证效应量为中等。研究结果说明抑郁在核心自我评价与自杀意念间起部分中介作用,效应量中等。     

创伤暴露对青少年暴力行为和自杀意念的影响:创伤后应激障碍和抑郁的中介作用

采用创伤暴露问卷、基于DSM-5的创伤后应激障碍症状核查表、流调中心用抑郁量表和青少年行为问题调查表,在雅安地震3.5年后对地震极重灾区的703名中学生进行调查,考察创伤暴露对暴力行为和自杀意念的影响,并检验创伤后应激障碍和抑郁在其中的中介作用。结果发现：创伤暴露可以直接正向预测暴力行为和自杀意念,PTSD在创伤暴露对暴力行为和自杀意念的影响间起中介作用,抑郁仅在创伤暴露对自杀意念的影响间起中介作用,而在创伤暴露对暴力行为影响间的中介效应不显著。     

Reconnecting to Internal Sensation and Experiences: A Pilot Feasibility Study of an Online Intervention to Improve Interoception and Reduce Suicidal Ideation

Risk factors that are strongly associated with suicide and are amenable to intervention are in need of discovery. This three-study investigation demonstrates that an intervention designed to improve interoception—one potential suicide risk factor—may reduce suicide-related outcomes. Study 1 included 136 undergraduate participants and found that relative to a control condition, participating in a progressive muscle relaxation exercise was associated with reduced implicit identification with suicide through greater body trust, which is one domain of interoception that is consistently linked to suicide-related outcomes. Study 2 included 97 MTurk participants and found that relative to a control condition, participating in a body functionality writing exercise was associated with greater awareness of the body as a whole. Study 3 was a pilot study of a four-session online intervention designed to increase interoception. Study 3 included a sample of 22 clinical participants who completed pre- and postintervention assessments. Participants rated the intervention as highly acceptable and moderately effective. Moreover, the intervention was associated with improvements in interoception and reductions in suicidal ideation, general psychological symptoms, and disordered-eating symptoms. Overall, these findings indicate that our online interoceptive awareness training is acceptable and may be associated with improvements in clinical outcomes. Randomized controlled trials are needed to explore whether the intervention’s purported mechanism—improved interoception—leads to changes in clinical outcomes.     

童年期心理虐待与忽视对高中生自杀意念的影响：述情障碍的中介作用和寻求意义感的调节作用

为了探讨童年期心理虐待与忽视与自杀意念之间的关系及其作用机制,本研究采用心理虐待与忽视量表、多伦多述情障碍量表、青少年自杀意念量表及生命意义感量表中的寻求意义感分量表对1074名高中生进行调查。结果表明：（1）童年期心理虐待与忽视对自杀意念有正向预测作用,并且能够通过述情障碍的中介作用影响高中生自杀意念;（2）寻求意义感调节了这一中介过程的直接路径和后半段路径,对后半段路径的调节作用存在性别差异。