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Ren LN, Pang JS, Jiang QN, Zhang XF, Li LL, Wang J, Li JG, Ma YY, Jia W. Self-compassion, automatic thoughts, and mental pain in depression: Mediating effects and clinical implications. World J Psychiatry 2025; 15:101105. [DOI: 10.5498/wjp.v15.i4.101105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 11/17/2024] [Accepted: 02/07/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND Depression is a leading global health concern with high suicide rates and recurrence. Cognitive models suggest that mental pain and automatic thoughts are central to depression's impact. The hypothesis is that self-compassion will be negatively associated with mental pain, mediated by automatic thoughts.
AIM To determine the mediating role of automatic thoughts in the relationship between self-compassion and mental pain in individuals with depression.
METHODS This cross-sectional study included 389 inpatients with depression from Tianjin Anding Hospital. Participants completed the Self-Compassion Scale-Chinese Version (SCS-C), Automatic Thought Questionnaire (ATQ), and Orbach & Mikulincer Mental Pain Scale-Chinese Version (OMMP). Data were analyzed using Pearson correlations, multiple linear regressions, and mediation analysis.
RESULTS The SCS-C total score was 68.95 ± 14.89, ATQ was 87.02 ± 28.91, and OMMP was 129.01 ± 36.74. Correlation analysis showed mental pain was positively associated with automatic thoughts (r = 0.802, P < 0.001) and negatively with self-compassion (r = -0.636, P < 0.001). Regression analysis indicated automatic thoughts (β = 0.623, P < 0.001) and self-compassion (β = -0.301, P < 0.001) significantly predicted mental pain. Mediation analysis confirmed automatic thoughts partially mediated the relationship between self-compassion and mental pain (ab = -0.269, 95%CI: -0.363 to -0.212).
CONCLUSION Self-compassion is inversely related to mental pain in depression, with automatic thoughts playing a mediating role. These findings suggest potential therapeutic targets for alleviating mental pain in depressed patients.
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Affiliation(s)
- Li-Na Ren
- Department of Psychiatry, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Ji-Song Pang
- Department of Psychiatry, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Qiao-Na Jiang
- Department of Psychiatry, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Xiao-Fei Zhang
- Department of Psychiatry, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Lu-Lu Li
- Department of Psychiatry, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Jing Wang
- Department of Psychiatry, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Jian-Gong Li
- Department of Psychiatry, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Yan-Yan Ma
- Department of Psychiatry, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China
| | - Wei Jia
- Department of Geriatrics, Ningxian People's Hospital, Qingyang 745200, Gansu Province, China
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Brand C, Haas C, Dreischulte T, Falkai P, Gensichen J, Lukaschek K. [Managing suicidal patients in general practices : A qualitative study on barriers and facilitating factors]. DER NERVENARZT 2025:10.1007/s00115-025-01826-6. [PMID: 40163192 DOI: 10.1007/s00115-025-01826-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/03/2025] [Indexed: 04/02/2025]
Abstract
BACKGROUND Patients with suicidal intent often visit their general practitioner (GP) before attempting suicide; however, GPs may struggle to address suicidality and recognize warning signs. This qualitative study explores GPs' experiences in managing suicidal patients, identifying key challenges and facilitating factors. METHODS We conducted semi-structured interviews with 21 GPs. The interviews were transcribed and analyzed using Kuckartz's qualitative content analysis. RESULTS The GPs strive to balance professional detachment with empathy when addressing suicidal ideation, despite time constraints. They refine their communication skills through peer exchange and self-directed learning. The need for practice-oriented training and improved professional networks was strongly emphasized. CONCLUSION Effective suicide prevention requires strong interpersonal skills and sensitive decision making. To effectively fulfil their role, GPs need both organizational and emotional support.
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Affiliation(s)
- Constantin Brand
- Institut für Allgemeinmedizin, Klinikum der Universität München, LMU München, München, Deutschland
| | - Carolin Haas
- Institut für Allgemeinmedizin, Klinikum der Universität München, LMU München, München, Deutschland
- DFG Graduiertenkolleg "POKAL" (DFG-GrK 2621), München, Deutschland
| | - Tobias Dreischulte
- Institut für Allgemeinmedizin, Klinikum der Universität München, LMU München, München, Deutschland
| | - Peter Falkai
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, LMU München, München, Deutschland
| | - Jochen Gensichen
- Institut für Allgemeinmedizin, Klinikum der Universität München, LMU München, München, Deutschland
| | - Karoline Lukaschek
- Institut für Allgemeinmedizin, Klinikum der Universität München, LMU München, München, Deutschland.
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Levkovich I, Omar M. Evaluating of BERT-based and Large Language Mod for Suicide Detection, Prevention, and Risk Assessment: A Systematic Review. J Med Syst 2024; 48:113. [PMID: 39738935 PMCID: PMC11685247 DOI: 10.1007/s10916-024-02134-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 12/16/2024] [Indexed: 01/02/2025]
Abstract
Suicide constitutes a public health issue of major concern. Ongoing progress in the field of artificial intelligence, particularly in the domain of large language models, has played a significant role in the detection, risk assessment, and prevention of suicide. The purpose of this review was to explore the use of LLM tools in various aspects of suicide prevention. PubMed, Embase, Web of Science, Scopus, APA PsycNet, Cochrane Library, and IEEE Xplore-for studies published were systematically searched for articles published between January 1, 2018, until April 2024. The 29 reviewed studies utilized LLMs such as GPT, Llama, and BERT. We categorized the studies into three main tasks: detecting suicidal ideation or behaviors, assessing the risk of suicidal ideation, and preventing suicide by predicting attempts. Most of the studies demonstrated that these models are highly efficient, often outperforming mental health professionals in early detection and prediction capabilities. Large language models demonstrate significant potential for identifying and detecting suicidal behaviors and for saving lives. Nevertheless, ethical problems still need to be examined and cooperation with skilled professionals is essential.
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Affiliation(s)
- Inbar Levkovich
- Tel-Hai Academic College, 2208, Qiryat Shemona, Upper Galilee, Israel.
| | - Mahmud Omar
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Jobes DA, Mandel AA, Kleiman EM, Bryan CJ, Johnson SL, Joiner TE. Facets of Suicidal Ideation. Arch Suicide Res 2024; 28:1263-1278. [PMID: 38174735 DOI: 10.1080/13811118.2023.2299259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
According to SAMHSA (2023), approximately 16,600,000 American adults and teens reported having serious thoughts of suicide in 2022. While suicide prevention has primarily focused on suicide deaths and attempts, we contend that suicidal ideation (SI) deserves more in-depth investigation and should be an essential intervention target on its own. In support of this point, we provide three examples of ways to improve specificity in understanding of SI through the study of controllability of SI, the language used to assess SI, and measuring SI in real time. We also consider qualitative work on the content of SI, its treatment, and definitional considerations. We thus call for an increased general focus on SI within research, clinical care, and policy.
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Adini-Spigelman E, Gvion Y, Haruvi Catalan L, Barzilay S, Apter A, Brunstein Klomek A. Comparative Effectiveness of Ultra-Brief, IPT-A Based Crisis Intervention for Suicidal Children and Adolescents. Arch Suicide Res 2024; 28:1249-1262. [PMID: 38169321 DOI: 10.1080/13811118.2023.2298499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND In recent years, suicidal thoughts and behaviors have become increasingly common among children and adolescents, leading to an elevation in the number of visits to emergency departments in pediatric hospitals. In Israel, the rising demand for mental health treatment due to suicidal distress is also salient, creating prolonged wait periods and low case acceptance rates. Addressing the urgent need for streamlined interventions, the present study outlines the design and results of a non-inferiority effectiveness trial of an ultra-brief suicide crisis intervention based on Interpersonal Psychotherapy for Adolescents (IPT-A-SCI). METHODS 309 children and adolescents presenting to the Depression and Suicide Clinic at Schneider Children's Medical Center of Israel with depressive and anxiety symptoms and/or suicidal ideation/behavior were assigned to either IPT-A-SCI, Treatment as Usual (TAU), or waitlist condition. Assessments were conducted pre- and post-intervention/after five sessions/five weeks (as secondary assessments) in accordance with group assignment. RESULTS At secondary assessment, post IPT-A-SCI, suicide ideation, and behavior as well as depression and anxiety symptoms significantly decreased, with no group differences observed between IPT-A-SCI, TAU, and control groups. CONCLUSION IPT-A-SCI is feasible and as effective as the standard treatment in reducing suicidal, depressive, and anxiety symptoms among children and adolescents.
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Grumet JG, Jobes DA. Zero Suicide - What About "Treat"? CRISIS 2024; 45:167-172. [PMID: 38698717 DOI: 10.1027/0227-5910/a000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Affiliation(s)
| | - David A Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, USA
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Santel M, Neuner F, Berg M, Steuwe C, Jobes DA, Driessen M, Beblo T. The Collaborative Assessment and Management of Suicidality compared to enhanced treatment as usual for inpatients who are suicidal: A randomized controlled trial. Front Psychiatry 2023; 14:1038302. [PMID: 36937739 PMCID: PMC10017970 DOI: 10.3389/fpsyt.2023.1038302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Background Although use of inpatient crisis hospital intervention for suicide risk is common, the evidence for inpatient treatments that reduce suicidal thoughts and behaviors is remarkably limited. To address this need, this novel feasibility pilot randomized controlled trial compared the use of the Collaborative Assessment and Management of Suicidality (CAMS) to enhanced treatment as usual (E-TAU) within a standard acute inpatient mental health care setting. Objectives We hypothesized that CAMS would be more effective than E-TAU in reducing suicidal thoughts and behaviors. As secondary outcomes we also investigated depressive symptoms, general symptom burden, reasons for living, and quality of the therapeutic relationship. Methods All patients were admitted due to acute suicidal thoughts or behaviors. They were randomly assigned to CAMS (n = 43) or E-TAU (n = 45) and assessed at four time points (admission, discharge, 1 month and 5 months after discharge). We used mixed-effects models, effect sizes, and reliable change analyses to compare improvements across and between treatment groups over time. Results Intent-to-treat analyses of 88 participants [mean age 32.1, SD = 13.5; n = 47 (53%) females] showed that both groups improved over time across all outcome measures with no significant between-group differences in terms of change in suicidal ideation, depression, reasons for living, and distress. However, CAMS showed larger effect sizes across all measures; for treatment completers CAMS patients showed significant improvement in suicidal ideation (p = 0.01) in comparison to control patients. CAMS patients rated the therapeutic relationship significantly better (p = 0.02) than E-TAU patients and were less likely to attempt suicide within 4 weeks after discharge (p = 0.05). Conclusions CAMS and E-TAU were both effective in reducing suicidal thoughts and symptom distress. Within this feasibility RCT the pattern of results was generally supportive of CAMS suggesting that inpatient use of CAMS is both feasible and promising. However, our preliminary results need further replication within well-powered multi-site randomized controlled trials. Trial registration DRKS-ID/ICTRP-ID: DRKS00013727. The trial was retrospectively registered in the German Clinical Trials Register, registration code/ DRKS-ID: DRKS00013727 on 12.01.2018 and also in the International Clinical Trials Registry Platform of the World Health Organization (identical registration code).
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Affiliation(s)
- Miriam Santel
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
- *Correspondence: Miriam Santel
| | - Frank Neuner
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Michaela Berg
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Carolin Steuwe
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - David A. Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, United States
| | - Martin Driessen
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
| | - Thomas Beblo
- Clinic of Psychiatry and Psychotherapy, University Hospital OWL of Bielefeld University, Bielefeld, Germany
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Yu H, Tian H, Fang T, Zhang Q, Wang L, Ma X, Li R, Cheng L, Zhuo C. Validity and reliability of a Chinese language suicide screening questionnaire-observer rating (CL-SSQ-OR) assessment for children/adolescents. Front Psychiatry 2023; 14:1147161. [PMID: 37205976 PMCID: PMC10188987 DOI: 10.3389/fpsyt.2023.1147161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/06/2023] [Indexed: 05/21/2023] Open
Abstract
Background A Suicide Screening Questionnaire-Observer Rating (SSQ-OR) has been used to assess risk of suicide among individuals and to help clinicians identify and rescue individuals attempting suicide. To prevent the risk of suicide in China, a Chinese language SSQ-OR (CL-SSQ-OR) needs to be introduced. Objective To test the validity and reliability of a CL-SSQ-OR. Method A total of 250 individuals were enrolled in this study. Each completed a CL-SSQ-OR assessment, Patient Health Questionnaire-9, and the Beck Scale for Suicide Ideation. Confirmatory factor analysis (CFA) was adopted to determine structural validity. Spearman correlation coefficients were adopted to determine criterion validity. An internal correlation coefficient (ICC) was used to test inter-consistency and Cronbach's α coefficient was used to test split-half reliability. Results CFA was conducted with use of the maximum variance method to evaluate the item results. All of the items received scores >0.40. In addition, good model fit indices were observed for the two-factor structure RMSEA = 0.046, TLI = 0.965, CFI = 0.977. The items' factor loading of the CL-SSQ-OR in the first factor ranged from 0.443 to 0.878. The items' factor loading of the CL-SSQ-OR in the second factor ranged from 0.400 to 0.810. The ICC of the total CL-SSQ-OR was 0.855. Cronbach's α was 0.873. Conclusion The CL-SSQ-OR described here demonstrates ideal psychometric properties and is found to be a suitable tool for screening Chinese children/adolescents who are at risk of suicide.
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Affiliation(s)
- Haiping Yu
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
- Department of Psychiatry, Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China
| | - Hongjun Tian
- Department of Psychiatry, Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China
- *Correspondence: Hongjun Tian,
| | - Tao Fang
- Department of Psychiatry, Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China
| | - Qiuyu Zhang
- Department of Psychiatry, Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China
| | - Lina Wang
- Department of Emergency Psychiatry, Tianjin Anding Hospital, Nankai University Affiliated Tianjin Anding Hospital, Tianjin Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Xiaoyan Ma
- Department of Emergency Psychiatry, Tianjin Anding Hospital, Nankai University Affiliated Tianjin Anding Hospital, Tianjin Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Ranli Li
- Department of Emergency Psychiatry, Tianjin Anding Hospital, Nankai University Affiliated Tianjin Anding Hospital, Tianjin Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Langlang Cheng
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
- Langlang Cheng,
| | - Chuanjun Zhuo
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
- Department of Psychiatry, Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China
- Department of Emergency Psychiatry, Tianjin Anding Hospital, Nankai University Affiliated Tianjin Anding Hospital, Tianjin Mental Health Center of Tianjin Medical University, Tianjin, China
- Chuanjun Zhuo,
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Marchand WR, Zhang C, Hamilton C, Presson AP, Nelson R, Yoo M, Garland EL, Nazarenko E, Herrmann T. Utilization and outcomes of a Whole Health model of care by Veterans with psychiatric illness. Complement Ther Med 2022; 71:102884. [PMID: 36096414 DOI: 10.1016/j.ctim.2022.102884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/16/2022] [Accepted: 09/08/2022] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The Veterans Health Administration (VHA) is implementing a model of healthcare known as Whole Health (WH). The goal of WH is to shift from a disease-oriented system to one that emphasizes health promotion and disease prevention as well as promotes the use of Complementary and Integrative Health. The aim of this project was to investigate utilization and outcomes of WH programming among Veterans with psychiatric disorders. DESIGN This was a retrospective study. Subjects were 7138 Veterans who had a mental health diagnosis. Descriptive data, as well as within- and between-subjects analyses were conducted to investigate utilization and outcomes. SETTING The study was conducted at a large VHA medical center. INTERVENTIONS Whole health interventions considered in this study were mindfulness training, health education, wellbeing, and nutrition classes as well as health coaching. Other whole health interventions, such as acupuncture and message were not evaluated. MAIN OUTCOME MEASURES Utilization of mental health treatment services, medication prescriptions, pain scores and suicide-related behaviors were the primary outcome measures. RESULTS There were 305 Veterans with at least one WH appointment. The existence of several specific psychiatric disorders was associated with WH utilization. The mean number of appointments completed per individual was 6.9 for all WH programming. Finally, WH participation was associated with decreased risk of suicide as well as reduced use of mental health services. There were no significant changes to other outcome variables. CONCLUSIONS WH programming shows promise to reduce suicide risk and the need for mental health services among this population. Additionally, WH services were underutilized and there was a lack of treatment engagement.
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Affiliation(s)
- W R Marchand
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America; University of Utah School of Medicine Department of Psychiatry, 501 Chipeta Way, Salt Lake City, UT 84108, the United States of America; Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, the United States of America.
| | - Chong Zhang
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Clayton Hamilton
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America
| | - Angela P Presson
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Richard Nelson
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Minkyoung Yoo
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Eric L Garland
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America; University of Utah, College of Social Work, 395 S 1500 E, Salt Lake City, UT 84112, the United States of America; University of Utah Center on Mindfulness and Integrative Health Intervention Development, 395 S 1500 E, Salt Lake City, UT 84112, the United States of America
| | - Elena Nazarenko
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America
| | - Tracy Herrmann
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America; University of Utah, Health Sciences Center, Department of Nutrition and Integrative Physiology, Salt Lake City, UT 84108, the United States of America
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