Decoding Suicide Decedent Profiles and Signs of Suicidal Intent Using Latent Class Analysis.

Importance: Suicide rates in the US increased by 35.6% from 2001 to 2021. Given that most individuals die on their first attempt, earlier detection and intervention are crucial. Understanding modifiable risk factors is key to effective prevention strategies. Objective: To identify distinct suicide profiles or classes, associated signs of suicidal intent, and patterns of modifiable risks for targeted prevention efforts. Design, Setting, and Participants: This cross-sectional study used data from the 2003-2020 National Violent Death Reporting System Restricted Access Database for 306 800 suicide decedents. Statistical analysis was performed from July 2022 to June 2023. Exposures: Suicide decedent profiles were determined using latent class analyses of available data on suicide circumstances, toxicology, and methods. Main Outcomes and Measures: Disclosure of recent intent, suicide note presence, and known psychotropic usage. Results: Among 306 800 suicide decedents (mean [SD] age, 46.3 [18.4] years; 239 627 males [78.1%] and 67 108 females [21.9%]), 5 profiles or classes were identified. The largest class, class 4 (97 175 [31.7%]), predominantly faced physical health challenges, followed by polysubstance problems in class 5 (58 803 [19.2%]), and crisis, alcohol-related, and intimate partner problems in class 3 (55 367 [18.0%]), mental health problems (class 2, 53 928 [17.6%]), and comorbid mental health and substance use disorders (class 1, 41 527 [13.5%]). Class 4 had the lowest rates of disclosing suicidal intent (13 952 [14.4%]) and leaving a suicide note (24 351 [25.1%]). Adjusting for covariates, compared with class 1, class 4 had the highest odds of not disclosing suicide intent (odds ratio [OR], 2.58; 95% CI, 2.51-2.66) and not leaving a suicide note (OR, 1.45; 95% CI, 1.41-1.49). Class 4 also had the lowest rates of all known psychiatric illnesses and psychotropic medications among all suicide profiles. Class 4 had more older adults (23 794 were aged 55-70 years [24.5%]; 20 100 aged ≥71 years [20.7%]), veterans (22 220 [22.9%]), widows (8633 [8.9%]), individuals with less than high school education (15 690 [16.1%]), and rural residents (23 966 [24.7%]). Conclusions and Relevance: This study identified 5 distinct suicide profiles, highlighting a need for tailored prevention strategies. Improving the detection and treatment of coexisting mental health conditions, substance and alcohol use disorders, and physical illnesses is paramount. The implementation of means restriction strategies plays a vital role in reducing suicide risks across most of the profiles, reinforcing the need for a multifaceted approach to suicide prevention.

The Joint Operations of Teacher-Student and Peer Relationships on Classroom Engagement among Low-Achieving Elementary Students: A Longitudinal Multilevel Study.

Although both teacher-student relationship (TSR) and peer relationship (PR) have been found important for the development of students' classroom engagement, little research has been done regarding the joint operations of these two factors. Guided by a developmental systems framework, this study examined longitudinal between-person and within-person associations between TSR/ PR and classroom engagement in a sample of 784 low-achieving students in the first three years of elementary school. A multidimensional approach was used to distinguish positive and negative dimensions of TSR, as well as peer liking and disliking. At the between-person level, results showed that students' classroom engagement was positively predicted by positive TSR and PR liking and was negatively predicted by negative TSR and PR disliking. Both positive and negative TSR interacted with PR disliking at the between-person level, such that the associations between positive/negative TSR and classroom engagement were stronger for students with lower levels of PR disliking. At the within-person level, changes in classroom engagement were associated with contemporaneous year-to-year changes in positive/negative TSR and PR disliking. No within-person level interaction effects were found. Cross-level interaction showed that the effects of within-person negative TSR on classroom engagement were stronger for students with lower overall levels of PR disliking. Findings highlighted the importance of using a multilevel multidimensional approach to understand the joint operations of TSR and PR in the development of classroom engagement in low-achieving students in early elementary school.

Are there reciprocal interplays among Chinese adolescents', fathers', and mothers' depression at the within-family level? A family systems perspective.

Controversy surrounds the reciprocity between adolescent and parental depression. Limited studies rigorously tested the transactional model of depression from a family systems perspective considering the involvement of all family members, particularly in non-Western nations, using advanced modeling approaches that disentangle between- and within-unit (i.e., family) variances (e.g., random intercept cross-lagged panel model [RI-CLPM]). This population-based multi-informant longitudinal study applied RI-CLPM to evaluate the temporal dynamics of the interrelations among adolescent, maternal, and paternal depression in 1,733 Chinese families assessed biannually. Findings from two large independent samples (primary sample [N = 1,733]; replication sample [N = 989]) converged to suggest, in macro timescales: (a) more depressed parents-especially mothers-generally have more depressed adolescents (between-family associations); (b) a family member becoming more depressed than usual co-occurred with other members becoming more depressed than usual in the same wave (within-family cofluctuations), with the mother-adolescent dyads exhibiting greater concordance than the father-adolescent dyads; and (c) a family member becoming more depressed than usual did not prospectively predict other members becoming more depressed than usual (i.e., no within-family reciprocal effects). While patterns of cross-lagged effects were consistently null across contexts, cofluctuations were stronger in rural than urban families and stronger in families with older adolescents. Overall, findings suggest that in macro timescales, the previously identified associations between adolescent and parental depression likely occurred at the trait-like between-family level and state-like within-family cofluctuations. Future studies employing micro timescales (e.g., daily) can complement macro-timescale analysis to provide greater temporal resolution of the within-family interplays of affective symptoms between family members. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Longitudinal impacts of adverse childhood experiences on multidimensional health outcomes: Predicting trajectories in mental, physical, and behavioral health.

BACKGROUND: Adverse childhood experiences (ACEs) elevate the risk of poor health later in life. OBJECTIVE: This study aims to provide a more comprehensive investigation of the multidimensional health risks associated with ACEs, to address a gap in the understanding of their longitudinal impact on mental, physical, and behavioral health domains. PARTICIPANTS AND SETTING: This study included 6, 504 participants (51.61 % females) from the National Longitudinal Study of Adolescent to Adult Health (1994-2018). METHODS: We utilized latent class growth analysis to identify trajectories from adolescence to adulthood in three health domains: depression (Mental Health, MH), self-report physical health (SRH), and binge drinking frequency (BDF). Binary logistic regression was then used to assess the unique contributions of different types of ACEs to these longitudinal health trajectories. RESULTS: Three to four trajectories were identified for MH (consistently low, decreasing, increasing), SRH (consistently low, decreasing, increasing, consistently high), and BDF (consistently low, decreasing, moderate). Regression results showed that experience of emotional abuse and witnessed community violence elevated the risk associated with unfavorable trajectories in the mental health and behavioral health domains, respectively. CONCLUSIONS: Individual ACEs differentially predicted mental, physical, and behavioral health trajectories, potentially through various pathways. Prevention of ACEs could mitigate health risks for adolescents and young adults across these domains.

The Indirect Effect of Sleep on the Association Between Protracted Social Stressors and Psychological Distress Among Hong Kong Young People.

PURPOSE: Hong Kong youth and young adults experienced unprecedented stress amid social unrest and the COVID-19 pandemic. Few studies have examined how these stressors were related to psychological distress among youth and young adults. This study assessed how psychological distress is associated with stress from social unrest, financial circumstances, and the COVID-19 pandemic, and whether poor sleep quality may explain these associations. METHODS: Participants of a representative phone survey included 1,501 Hong Kong youth and young adults (Mage = 26.1 (4.0); 48.2% female). We examined the associations between psychological distress and three types of stress (social unrest, financial, and COVID-19 stress), and the indirect effect of poor sleep. RESULTS: Eleven point nine percent, 4.1%, and 9.7% of respondents reported feeling very seriously distressed by social unrest, financial circumstances, and the COVID-19 pandemic, respectively. All three forms of stress were associated with poor sleep. The indirect effects of poor sleep on the association between all three forms of stress and psychological distress were identified. Moderated indirect effect analysis indicated that being female intensified the effect of COVID-19-related stress on psychological distress and that younger female youth and older male youth were more vulnerable to financial stress and social unrest stress (vs. older female youth and younger male youth). DISCUSSION: Sleep may be one mechanism that accounts for the association between psychological distress and protracted stressors among Hong Kong youth and young adults. These results suggest the importance of prioritizing sleep improvement in mental health interventions during times of societal change.

Psychological distress and everyday discrimination among Chinese international students one year into COVID-19: a preregistered comparative study.

BACKGROUND AND OBJECTIVES: During the COVID-19 pandemic, Chinese international students (CISs) experienced distress associated with both unique and universal stressors, among which everyday discrimination may be especially harmful. DESIGN: Cross-sectional design. METHODS: We compared distress between CISs (N = 381) and Chinese students in Chinese colleges (CSCCs; N = 305) and examined correlates of distress including the association between everyday discrimination and distress as well as moderators on this link. RESULTS: Compared to CSCCs, CISs reported greater depression and anxiety. Sensitivity analyses - multiple regressions controlling for covariates and coarsened exact matched (CEM) comparisons - replicated the results. 28.6% CISs reported suicidal ideation (PHQ-9 item 9) at least several days during the past two weeks. Within CISs, depression was associated with being older, female, non-heterosexual, increased everyday discrimination, decreased self-esteem, coping flexibility, perceived social support, and satisfaction with online learning. Anxiety was associated with being in undergraduate years, female, increased discrimination, decreased self-esteem, coping flexibility, and satisfaction with online learning. High perceived social support and being heterosexual weakened the association between discrimination and anxiety and depression, while high self-esteem strengthened the association between discrimination and anxiety. CONCLUSIONS: Our study underscored the distress experienced by CISs and highlighted risk/protective factors that may warrant attention.

Depression and PTSD in the aftermath of strict COVID-19 lockdowns: a cross-sectional and longitudinal network analysis.

Background: Post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) are two highly comorbid psychological outcomes commonly studied in the context of stress and potential trauma. In Hubei, China, of which Wuhan is the capital, residents experienced unprecedented stringent lockdowns in the early months of 2020 when COVID-19 was first reported. The comorbidity between PTSD and MDD has been previously studied using network models, but often limited to cross-sectional data and analysis. Objectives: This study aims to examine the cross-sectional and longitudinal network structures of MDD and PTSD symptoms using both undirected and directed methods. Methods: Using three types of network analysis - cross-sectional undirected network, longitudinal undirected network, and directed acyclic graph (DAG) - we examined the interrelationships between MDD and PTSD symptoms in a sample of Hubei residents assessed in April, June, August, and October 2020. We identified the most central symptoms, the most influential bridge symptoms, and causal links among symptoms. Results: In both cross-sessional and longitudinal networks, the most central depressive symptoms included sadness and depressed mood, whereas the most central PTSD symptoms changed from irritability and hypervigilance at the first wave to difficulty concentrating and avoidance of potential reminders at later waves. Bridge symptoms showed similarities and differences between cross-sessional and longitudinal networks with irritability/anger as the most influential bridge longitudinally. The DAG found feeling blue and intrusive thoughts the gateways to the emergence of other symptoms. Conclusions: Combining cross-sectional and longitudinal analysis, this study elucidated central and bridge symptoms and potential causal pathways among PTSD and depression symptoms. Clinical implications and limitations are discussed.

Antecedentes: El trastorno de estrés postraumático (TEPT) y el trastorno depresivo mayor (TDM) son dos resultados psicológicos altamente comórbidos que se estudian comúnmente en el contexto del estrés y trauma potencial. En Hubei, China, de la cual Wuhan es la capital, los residentes experimentaron cuarentenas estrictas sin precedentes en los primeros meses de 2020 cuando se informó por primera vez del COVID-19. La comorbilidad entre TEPT y TDM se ha estudiado previamente utilizando modelos de red, pero a menudo se limita a datos y análisis transversales.Objetivos: Este estudio tiene como objetivo examinar las estructuras de red transversales y longitudinales de los síntomas de TDM y TEPT utilizando métodos dirigidos y no dirigidos.Métodos: Mediante el uso de tres tipos de análisis de red: red no dirigido transversal, red no dirigido longitudinal y gráfico acíclico dirigido (DAG), examinamos las interrelaciones entre los síntomas de TDM y TEPT en una muestra de residentes de Hubei evaluados en abril, junio, agosto y octubre de 2020. Identificamos los síntomas centrales, los síntomas puente más influyentes y los vínculos causales entre los síntomas.Resultados: Tanto en redes transversales como longitudinales, los síntomas depresivos más centrales incluyeron tristeza y estado de ánimo deprimido, mientras que los síntomas de TEPT más centrales cambiaron de irritabilidad e hipervigilancia en la primera ola a dificultad para concentrarse y evitar posibles recordatorios en las oleadas posteriores. Los síntomas puente, mostraron similitudes y diferencias entre las redes transversales y longitudinales con irritabilidad/ira como el puente más influyente longitudinalmente. El DAG descubrió que la tristeza y los pensamientos intrusivos son las puertas de entrada a la aparición de otros síntomas.Conclusiones: Al combinar los análisis transversal y longitudinal, este estudio elucidó los síntomas centrales y puente y las posibles vías causales entre los síntomas de TEPT y de depresión. Se discuten las implicaciones clínicas y las limitaciones.

Domains of life satisfaction and perceived health and incidence of chronic illnesses and hospitalization: evidence from a large population-based Chinese cohort.

BACKGROUND: Global life satisfaction has been consistently linked to physical health. A deeper and culturally nuanced understanding of which domains of satisfaction may be responsible for this association has implications for developing novel, scalable, and targeted interventions to improve physical health at the population level. OBJECTIVES: This cohort study draws participants from the China Family Panel Studies (CPFS), a nationally representative cohort of 10,044 Chinese adults to assess the independent associations between three important domains of life satisfaction (and their changes) and indicators of physical health. RESULTS: A total of 10,044 participants were included in the primary analysis (4,475 female [44.6%]; mean [SD] age, 46.2 [12.1] years). Higher baseline levels of satisfaction with job, marriage, and medical services were independently associated with better perceived physical health (0.04 < ß values < 0.12). Above and beyond their baseline levels, increases in satisfaction with job, marriage, and medical services were independently associated with better perceived physical health (0.04 < ß values < 0.13). On the contrary, only higher baseline levels of and increases in satisfaction with marriage showed prospective associations with lower odds of incidence of chronic health condition and hospitalization (0.84 < ORs < 0.91). CONCLUSIONS: These findings provide policymakers and interventionists interested in leveraging psychological health assets with rich information to rank variables and develop novel interventions aimed at improving wellbeing at the population level.

Psychopathology and resilience following strict COVID-19 lockdowns in Hubei, China: Examining person- and context-level predictors for longitudinal trajectories.

In Hubei, China, where the coronavirus disease (COVID-19) epidemic first emerged, the government has enforced strict quarantine and lockdown measures. Longitudinal studies suggest that the impact of adverse events on psychological adjustment is highly heterogenous. To better understand protective and risk factors that predict longitudinal psychopathology and resilience following strict COVID-19 lockdowns, this study used unsupervised machine learning to identify half-year longitudinal trajectories (April, June, August, and October, 2020) of three mental health outcomes (depression, anxiety, and posttraumatic stress disorder [PTSD]) among a sample of Hubei residents (N = 326), assessed a broad range of person- and context-level predictors, and applied least absolute shrinkage and selection operator (LASSO) logistic regression, a supervised machine learning approach, to select best predictors for trajectory memberships of resilience and chronic psychopathology. Across outcomes, most individuals remained resilient. Models with both person- and context-level predictors showed excellent predictive accuracy, except for models predicting chronic anxiety. The person-level models showed either good or excellent predictive accuracy. The context-level models showed good predictive accuracy for depression trajectories but were only fair in predicting trajectories of anxiety and PTSD. Overall, the most critical person-level predictors were worry, optimism, fear of COVID, and coping flexibility, whereas important context-level predictors included features of stressful life events, community satisfaction, and family support. This study identified clinical patterns of response to COVID-19 lockdowns and used a combination of risk and protective factors to accurately differentiate these patterns. These findings have implications for clinical risk identifications and interventions in the context of potential trauma. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Sleep profiles as a longitudinal predictor for depression magnitude and variability following the onset of COVID-19.

The coronavirus disease 2019 (COVID-19) has disrupted multiple domains of life including sleep. The present study used a longitudinal dataset (N = 671) and a person-centered analytic approach - latent profile analysis (LPA) - to elucidate the relationship between sleep and depression. We used LPA to identify profiles of sleep patterns assessed by Pittsburg Sleep Quality Index (PSQI) at the beginning of the study. The profiles were then used as a predictor of depression magnitude and variability over time. Three latent profiles were identified (medicated insomnia sleepers [MIS], inefficient sleepers [IS], and healthy sleepers [HS]). MIS exhibited the highest level of depression magnitude over time, followed by IS, followed by HS. A slightly different pattern emerged for the variability of depression: While MIS demonstrated significantly greater depression variability than both IS and HS, IS and HS did not differ in their variability of depression over time. Medicated insomnia sleepers exhibited both the greatest depression magnitude and variability than inefficient sleepers and healthy sleepers, while the latter two showed no difference in depression variability despite inefficient sleepers' greater depression magnitude than healthy sleepers. Clinical implications and limitations are discussed.

Depression Following COVID-19 Lockdown in Severely, Moderately, and Mildly Impacted Areas in China.

Background: The Coronavirus Disease 2019 (COVID-19) pandemic has led to overwhelming levels of distress as it spread rapidly from Wuhan, Hubei province to other regions in China. To contain the transmission of COVID-19, China has executed strict lockdown and quarantine policies, particularly in provinces with the highest severity (i.e., Hubei). Although the challenges faced by individuals across provinces may share some similarities, it remains unknown as to whether and how the severity of COVID-19 is related to elevation in depression. Methods: The present study compared depression among individuals who lived in mildly, moderately, and severely impacted provinces in China following the lockdown (N = 1,200) to norm data obtained from a representative sample within the same provinces in 2016 (N = 950), and examined demographic correlates of depression in 2020. Results: Residents in 2020, particularly those living in more heavily impacted provinces, reported increased levels of depression than the 2016 sample. Subsequent analyses of sub-dimensions of depression replicated the findings for depressed mood but not for positive affect, as the latter only declined among residents in the most severely impacted area. Increased depressed mood was associated with female, younger age, fewer years of education, and being furloughed from work, whereas reduced positive affect was associated with younger age and fewer years of education only. Conclusions: This study underscored the impact of COVID-19 on depression and suggested individual characteristics that may warrant attention.