Instagram Content Analysis in the Context of the Interpersonal Theory of Suicide.

The Interpersonal Theory of Suicide posits that interpersonal factors, specifically perceived burdensomeness and thwarted belongingness, increase suicidal ideation. Many modern social interactions take place over social media and, as such, examining social media content may offer a novel way to assess interpersonal relationships. In this preregistered study of 386 young adults, we examined the relationship between the amount of interaction with friends- and whether or not individuals interacted with family-related Instagram content and perceived burdensomeness, thwarted belongingness, and suicidal ideation. Instagram content was assessed via self-report and participants' Instagram profiles. Participants who endorsed interacting with family on Instagram demonstrated lower thwarted belongingness and suicidal ideation, but not perceived burdensomeness. Non-preregistered analyses of friend Instagram content demonstrated similar results. Consistent with the Interpersonal Theory, participants' interaction with family and frequency of interacting with friends on Instagram was associated with interpersonal variables and suicidal ideation but not aspects of acquired capability. Our study suggests that social media-based measures of interpersonal relationships are relevant to suicidality.

A Broad Examination of Mental Health Literacy Among College Students in the United States.

BACKGROUND: High levels of mental health literacy (MHL) have been linked to the ability to correctly recognize certain problems as mental health issues, which then may lead to effective help-seeking behaviors. Most research on MHL has focused on a limited number of psychiatric diagnoses, using Australian samples. OBJECTIVE: This study aimed to investigate various components of MHL in a large sample of undergraduate students in the United States. METHODS: We conducted a vignette-based study with 843 undergraduate students. Six psychiatric diagnoses (and two "non-disordered" scenarios) were represented in distinct vignettes. Participants rated the severity of each vignette character's problem, the helpfulness of numerous treatment options, and the likelihood that different etiological factors contributed to the character's problem. KEY RESULTS: Across all clinical vignettes, therapy/counseling was perceived to be the most helpful treatment. Participants rated "personal weakness/lack of willpower" as contributing the most to the alcohol use disorder (AUD) character's problems. Our hypothesis related to how perceptions of etiology may impact participants' perceptions of different types of treatment was partially supported for the depression character. When participants described the depression character as having a "psychological/mental health problem," they were more likely to perceive therapy/counseling as being helpful compared to medication. CONCLUSIONS: Participants recognized most of the psychiatric diagnoses as a mental health problem, acknowledged the seriousness of the presenting problems, and recommended effective help-seeking behavior. However, undergraduate U.S. students could benefit from increased MHL specifically related to AUD. [HLRP: Health Literacy Research and Practice. 2023;7(4):e207-e214.].

PLAIN LANGUAGE SUMMARY: This study sought to measure various components of MHL in a large sample of U.S. undergraduate students. Findings demonstrated that AUD remained largely misunderstood and stigmatized. Students would likely benefit from increased education related to factors that contribute to alcohol use disorder.

Suicidal Ideation and Risky Behavior are Related through Impulsivity and Low Wish to Live.

OBJECTIVE: Numerous studies have found support for the relationship between suicide and risky behavior. However, few studies have examined factors that may help explain the relationship between suicidal ideation (SI) and risky behavior. This preregistered study examined the relationship between SI and risky behavior and whether there is an indirect relationship through hopelessness, impulsivity, and low wish to live. These factors were selected due to their relationships with both SI and risky behavior. METHODS: Participants recruited from Amazon Mechanical Turk completed measures of SI, risky behavior, hopelessness, impulsivity, and wish to live. Consistent with our preregistered methods, we analyzed data from 180 participants with valid data. Indirect effects were evaluated via bootstrapping with 5000 resamples of the a path x b path product. RESULTS: Consistent with prior work, we found a significant positive association between SI and frequency of risky behavior (r = .49). We found significant indirect effects of SI on risky behavior through impulsivity and wish to live but not through hopelessness. CONCLUSION: SI and risky behavior are associated with each other through impulsivity and wish to live. Though future longitudinal research is needed to determine causality, this has important implications for models of suicidal thoughts and behaviors and their relationship with risky behavior. The potential of future orientation to explain the results is discussed.

Trait mindfulness and attention to emotional information: An eye tracking study.

Biased attention for emotional information is associated with the emotional disorders. Trait mindfulness is associated with lower depression and anxiety and with improved attentional control. Mindfulness is also related to lower levels of brooding rumination. The current study examined the association between trait mindfulness, brooding rumination, depressed and anxious state moods, and attention to emotional visual stimuli utilizing eye tracking methodology. Participants were 158 undergraduates. Trait mindfulness was negatively associated with attention to sad and threatening stimuli, but was not associated with attention to positive or neutral stimuli. There was an indirect effect of mindfulness on attention to sad stimuli through brooding rumination. Data are cross sectional but provide initial evidence that mindfulness may partially exert its effects on depression and anxiety by lessening attention to negatively-valenced stimuli.

Altering preferences for suicide crisis resources using the decoy nudge: Evidence of context-dependent effects in suicide prevention decision making.

OBJECTIVE: Suicide is the 10th leading cause of death in the United States. There are several important decisions that could confer later risk to a suicide attempt (e.g., how to store lethal means). Therefore, understanding how people make decisions that are relevant for suicide risk is an important area of study for suicidology. Human behavior diverges from perfectly rational economic decision making according to observable patterns based on predictable cognitive processes. Nudges attempt to diminish, leverage, or circumvent these deviations to increase the probability of a desired choice being selected or behavior being performed. One deviation from rationality is that human choice is context dependent. This deviation can be observed by introducing an objectively inferior alternative option (a decoy) into a choice array that alters an individual's preference. Using decoys could be one way to nudge people toward best practices in suicide prevention work. METHOD: This study examined if decoys could reliably alter participant preferences for suicide prevention resources using a hypothetical scenario in three separate online samples (i.e., general population, participants with recent suicidal thoughts, gun owners). RESULTS: Our results found that introducing a slightly (but objectively) worse version of an existing suicide prevention resource increased the preference toward the slightly better option. CONCLUSIONS: These findings indicate that using decoys could be an effective nudge for influencing people's preference toward best practices. Most important, these findings highlight the importance of context effects on choice preference in suicide research and prevention efforts, as well as suggest irrational decision-making processes in suicide-relevant decision making. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Implicit bias for suicide persists after ideation resolves.

Individuals with suicidal ideation (SI), demonstrate an association between suicide-related information and the self that is automatic and outside conscious control (i.e., implicit). However, it is unclear whether this implicit bias is a state-like processes that will resolve with the reduction of SI or whether it is more trait-like and enduring. Given that implicit bias has been proposed as an indirect measurement of SI, understanding its dynamic nature is important. To investigate this, we recruited 79 (22 with a history of, but no current, SI; 57 with no lifetime history of SI) young adults who completed a structured interview assessing current and past SI. Participants also completed the Suicide Affect Misattribution Procedure assessing implicit association with suicide-relevant, negative but not suicide relevant, positive, and neutral stimuli. Participants with a history of SI demonstrated greater implicit bias for suicide compared to participants with no lifetime history, but did not significantly differ in their responses to negative, positive, or neutral stimuli. This indicates that suicide-relevant implicit bias may be a trait-like process that endures after resolution of SI. This has important implications for the conceptualization of cognitive bias in suicide and the use of these biases as implicit markers of SI.

Social anxiety as a precursor for depression: Influence of interpersonal rejection and attention to emotional stimuli.

Social anxiety disorder (SAD) and major depressive disorder (MDD) are comorbid conditions, and SAD confers risk for MDD. Biased attention and interpersonal rejection are important for the development of SAD and MDD, but little research has examined how these processes may lead to MDD. We hypothesized that interpersonal rejection would result in SAD symptoms being associated with more "depression-like" attention biases. Participants (n = 164) completed a measure of SAD symptoms and an eye tracking task before and after a task in which they were randomized to be socially included or rejected. SAD symptoms, inclusion or rejection condition, and the interaction term were entered into separate hierarchical linear regressions predicting change in attention for five emotional faces. Rejection condition significantly moderated the effects of SAD on change in attention to sad, happy, and neutral faces. SAD predicted increased attention to sad faces and decreased attention to happy faces in the rejection condition, but not in the inclusion condition. SAD predicted increased attention to neutral faces in the inclusion condition, but not in the rejection condition. There were no significant effects for angry or disgust. Results suggest that SAD symptoms are associated with more depression-like attention biases in the context of interpersonal rejection.

The role of excessive reassurance seeking: An eye tracking study of the indirect effect of social anxiety symptoms on attention bias.

High social anxiety is associated with increased attentional bias, and difficulties disengaging from relevant threat information, though social anxiety may also be associated with avoidance of threat. Few mechanisms of this relationship have been empirically evaluated, whereas theories and treatment manuals implicate avoidance and/or safety behaviors as significant agents of negative reinforcement for anxiety symptoms and search for threat. The current study sought to investigate one safety behavior, excessive reassurance seeking, as a mediator of the relationship between social anxiety and attention bias to disgust facial stimuli. Support was found for our hypotheses, such that social anxiety symptoms had an indirect effect on attention bias to disgust faces through increased reassurance seeking. These results suggest that reassurance seeking may result in disengagement of attention to threat stimuli. Specifically, social anxiety may result in a decreased threshold for negative social cues and therefore seek out reassurance feedback and avoid threatening stimuli. Future studies should test these directly and utilize a prospective design. The current study suggests that reassurance seeking may be involved in the attention bias process, providing additional data for current cognitive theories of social anxiety and additional support for reinforcement patterns of anxiety symptoms.

Association between depressive symptom clusters and food attentional bias.

BACKGROUND: The mechanisms underlying the depression-obesity relationship are unclear. Food attentional bias (FAB) represents one candidate mechanism that has not been examined. We evaluated the hypothesis that greater depressive symptoms are associated with increased FAB. METHOD: Participants were 89 normal weight or overweight adults (mean age = 21.2 ±â€¯4.0 years, 53% female, 33% non-white, mean body mass index in kg/m2 = 21.9 ±â€¯1.8 for normal weight; 27.2 ±â€¯1.5 for overweight). Total, somatic, and cognitive-affective depressive symptom scores were computed from the Patient Health Questionnaire-8 (PHQ-8). FAB scores were calculated using reaction times (RT) and eye-tracking (ET) direction and duration measures for a food visual probe task. Age, gender, race/ethnicity, and body fat percent were covariates. RESULTS: Only PHQ-8 somatic symptoms were positively associated with RT-measured FAB (ß = 0.23, p = .04). The relationship between somatic symptoms and ET direction (ß = 0.18, p = .17) and duration (ß = 0.23, p = .08) FAB indices were of similar magnitude but were not significant. Somatic symptoms accounted for 5% of the variance in RT-measured FAB. PHQ-8 total and cognitive-affective symptoms were unrelated to all FAB indices (ps ≥ 0.09). CONCLUSIONS: Only greater somatic symptoms of depression were linked to food attentional bias as measured using reaction time. Well-powered prospective studies should examine whether this bias replicates, particularly for eye-tracking measures, and whether it partially mediates the depression-to-obesity relationship.

Implicit Association with Suicide as Measured by the Suicide Affect Misattribution Procedure (S-AMP) Predicts Suicide Ideation.

The identification of indirect markers of suicide that do not rely on explicit self-report of suicide ideation is vital, as research indicates that a significant number of individuals who die by suicide do not discuss or explicitly deny thoughts of suicide with a provider in their last health care interaction. The current study tests whether a new measure of implicit association with suicide, a modified version of the Affect Misattribution Procedure (AMP), predicts suicide ideation in participants oversampled for the experience of suicide ideation. Results indicated that implicit associations with suicide-related images were positively correlated with levels of suicide ideation and predicted suicide ideation when entered as a simultaneous predictor with symptoms of depression, thwarted belongingness, and perceived burdensomeness. Implicit associations with positive and negative images were unrelated to thoughts of suicide. The modified version of the AMP may be a particularly useful indirect measure of suicide ideation that can be easily included in suicide risk assessment paradigms in clinical practice and research studies.

Rejection sensitivity, interpersonal rejection, and attention for emotional facial expressions.

BACKGROUND AND OBJECTIVES: Rejection sensitivity (RS), attention for depression-relevant stimuli, and interpersonal rejection are established risk factors for depression. RS has previously been associated with increased attention for socially threatening faces, but has not been examined in the context of specifically depression-relevant stimuli. The current study examined whether RS influences attention for emotional facial expressions in the context of social rejection or inclusion. METHODS: Participants (n = 180) completed a self-report measure of RS and a free viewing eye tracking task before and after an experimental task (Cyberball) in which participants were randomized to be included or rejected. RESULTS: Hierarchical linear regressions predicting change in attention to emotional faces revealed significant effects only for sad faces. Higher RS was associated with increased attention for sad faces from pre- to post-Cyberball. Cyberball condition moderated the effect with participants in the rejection condition demonstrating increased attention for sad faces, but with no significant relationship in the inclusion condition. LIMITATIONS: Our sample had relatively low levels of RS and depression. CONCLUSIONS: Consistent with interpersonal and cognitive models of depression, we found that RS was associated with increased attention for sad faces when participants were interpersonally rejected. Results provide preliminary evidence that rejection sensitivity may contribute to depression vulnerability via increased attention to depression-relevant information in the context of interpersonal rejection. Further research including clinically depressed participants and using longitudinal approaches are necessary to confirm this potential relationship.

Rejection Sensitivity and Depression: Indirect Effects Through Problem Solving.

OBJECTIVE: Rejection sensitivity (RS) and deficits in social problem solving are risk factors for depression. Despite their relationship to depression and the potential connection between them, no studies have examined RS and social problem solving together in the context of depression. As such, we examined RS, five facets of social problem solving, and symptoms of depression in a young adult sample. METHOD: A total of 180 participants completed measures of RS, social problem solving, and depressive symptoms. We used bootstrapping to examine the indirect effect of RS on depressive symptoms through problem solving. RESULTS: RS was positively associated with depressive symptoms. A negative problem orientation, impulsive/careless style, and avoidance style of social problem solving were positively associated with depressive symptoms, and a positive problem orientation was negatively associated with depressive symptoms. RS demonstrated an indirect effect on depressive symptoms through two social problem-solving facets: the tendency to view problems as threats to one's well-being and an avoidance problem-solving style characterized by procrastination, passivity, or overdependence on others. CONCLUSIONS: These results are consistent with prior research that found a positive association between RS and depression symptoms, but this is the first study to implicate specific problem-solving deficits in the relationship between RS and depression. Our results suggest that depressive symptoms in high RS individuals may result from viewing problems as threats and taking an avoidant, rather than proactive, approach to dealing with problems. These findings may have implications for problem-solving interventions for rejection sensitive individuals.

Rumination's effect on suicide ideation through grit and gratitude: A path analysis study.

The current study documents the relationship between suicide ideation, grit and gratitude, and rumination subtypes of brooding and reflection. The relationship between rumination and suicide ideation has been well documented and previous research has demonstrated that grit and gratitude are protective factors against suicide. We hypothesized that both subtypes of rumination would have an indirect effect on suicide ideation through levels of grit and gratitude. Results of a conditional indirect effects path analysis indicated that brooding was indirectly related to suicide ideation through gratitude. Brooding interacted with grit such that it only predicted suicide ideation at low levels of grit. Reflection interacted with gratitude to predict levels of grit. Results suggest that brooding may impact suicide risk and resilience through its effect on gratitude, indicating important cognitive-behavioral targets for suicide prevention strategies. These results extend the literature about the relationship between well known risk factors for suicide and protective factors.

Sex differences in attention to disgust facial expressions.

Research demonstrates that women experience disgust more readily and with more intensity than men. The experience of disgust is associated with increased attention to disgust-related stimuli, but no prior study has examined sex differences in attention to disgust facial expressions. We hypothesised that women, compared to men, would demonstrate increased attention to disgust facial expressions. Participants (n = 172) completed an eye tracking task to measure visual attention to emotional facial expressions. Results indicated that women spent more time attending to disgust facial expressions compared to men. Unexpectedly, we found that men spent significantly more time attending to neutral faces compared to women. The findings indicate that women's increased experience of emotional disgust also extends to attention to disgust facial stimuli. These findings may help to explain sex differences in the experience of disgust and in diagnoses of anxiety disorders in which disgust plays an important role.

Randomized controlled trial of attention bias modification in a racially diverse, socially anxious, alcohol dependent sample.

OBJECTIVE: Attention biases may be an important treatment target for both alcohol dependence and social anxiety. This is the first ABM trial to investigate two (vs. one) targets of attention bias within a sample with co-occurring symptoms of social anxiety and alcohol dependence. Additionally, we used trial-level bias scores (TL-BS) to capture the phenomena of attention bias in a more ecologically valid, dynamic way compared to traditional attention bias scores. METHOD: Adult participants (N = 86; 41% Female; 52% African American; 40% White) with elevated social anxiety symptoms and alcohol dependence were randomly assigned to an 8-session training condition in this 2 (Social Anxiety ABM vs. Social Anxiety Control) by 2 (Alcohol ABM vs. Alcohol Control) design. Symptoms of social anxiety, alcohol dependence, and attention bias were assessed across time. RESULTS: Multilevel models estimated the trajectories for each measure within individuals, and tested whether these trajectories differed according to the randomized training conditions. Across time, there were significant or trending decreases in all attention TL-BS parameters (but not traditional attention bias scores) and most symptom measures. However, there were not significant differences in the trajectories of change between any ABM and control conditions for any symptom measures. CONCLUSIONS: These findings add to previous evidence questioning the robustness of ABM and point to the need to extend the effects of ABM to samples that are racially diverse and/or have co-occurring psychopathology. The results also illustrate the potential importance of calculating trial-level attention bias scores rather than only including traditional bias scores.

Inhibition of Attention for Affective Material: Contributions by HOMER1 Gene Variation.

Failure to inhibit attention to irrelevant affective information has been linked to depression and rumination. However, few studies have investigated the biological bases of this process. Variation in the HOMER1 gene was identified in a genome-wide association study as associated with major depressive disorder and is associated with executive functioning inefficiency. Several studies have linked variation in the BDNF gene with emotional and cognitive processes such as rumination. The current study examined the association between these two auspicious genetic variants and inhibition of attention for affective information. In Study 1, 60 psychiatrically healthy community participants completed a negative affective priming task with positive and negative words. HOMER1 variation, but not BDNF variation, was associated with difficulty inhibiting irrelevant negative information. These results were replicated in a second study utilizing a sample of 97 psychiatrically healthy young adults. Implications for the current literature and future directions are discussed.

5-HTTLPR, HTR1A, and HTR2A cumulative genetic score interacts with mood reactivity to predict mood-congruent gaze bias.

Genetic variation within the serotonin system has been associated with biased attention for affective stimuli and, less consistently, with vulnerability for major depressive disorder. In particular, 5-HTTLPR, HTR1A (rs6295), and HTR2A (rs6311) polymorphisms have been linked with biased cognition. The present study developed a serotonergic cumulative genetic score (CGS) that quantified the number of risk alleles associated with these candidate polymorphisms to yield a single CGS. The CGS was then used to model genetic influence on the relationship between reactivity to a negative mood induction and negatively biased cognition. A passive-viewing eye-tracking task was administered to 170 healthy volunteers to assess sustained attention for positive, dysphoric, neutral, and threatening scenes. Participants were then induced into a sad mood and readministered the passive-viewing task. Change in gaze bias, as a function of reactivity to mood induction, was the primary measure of cognitive vulnerability. Results suggest that, although none of the individual genes interacted with mood reactivity to predict change in gaze bias, individuals with higher serotonin CGS were significantly more likely to look toward dysphoric images and away from positive images as mood reactivity increased. These findings suggest that a CGS approach may better capture genetic influences on cognitive vulnerability and reaffirm the need to examine multilocus approaches in genomic research.

Effect of antidepressant medication use on emotional information processing in major depression.

OBJECTIVE: Acute administration of antidepressant medication increases emotional information processing for positive information in both depressed and healthy persons. This effect is likely relevant to the therapeutic actions of these medications, but it has not been studied in patients with major depressive disorder taking antidepressants as typically prescribed in the community. METHOD: The authors used eye tracking to examine the effects of antidepressant medication on selective attention for emotional stimuli in a sample of 47 patients with major depressive disorder (21 medicated and 26 unmedicated) and 47 matched comparison subjects without depression. Participants completed a passive-viewing eye-tracking task assessing selective attention for positive, dysphoric, threatening, and neutral stimuli in addition to providing medication information and self-report measures of depression and anxiety severity. RESULTS: Depressed participants currently taking antidepressants and nondepressed comparison subjects demonstrated greater total gaze duration and more fixations for positive stimuli compared with unmedicated depressed participants. Depressed participants on medication also had fewer fixations for dysphoric stimuli compared with depressed participants not on medication. CONCLUSIONS: Antidepressants, as prescribed in the community to patients with depression, appear to modify emotional information processing in the absence of differences in depression severity. These results are consistent with previous work and indicate a robust effect for antidepressants on positive information processing. They also provide further evidence for modification of information processing as a potential mechanism of action for antidepressant medication.

Childhood abuse and vulnerability to depression: cognitive scars in otherwise healthy young adults.

Models of depression vulnerability posit that negative early experiences, such as exposure to childhood abuse (CA), increase vulnerability to depression later in life. Though most victims of CA do not go on to develop depression, the question remains as to whether these individuals retain cognitive 'scars' that may contribute to depression vulnerability. The present study examined the relationship between self-reported, retrospective CA and cognitive vulnerability to depression in a carefully selected sample of young adults without current or past psychopathology. We measured cognitive vulnerability with both a self-report questionnaire, the Dysfunctional Attitudes Scale (DAS), and a measure of information processing bias, the Scrambled Sentences Test (SST). Self-reported severity of CA was associated with increased cognitive vulnerability to depression on both the DAS and SST. Vulnerability to depression as measured by the SST, but not by the DAS, prospectively predicted increases in depressive symptoms over a 6-month period. Scores on the SST also interacted with CA to predict increases in depressive symptoms. These findings demonstrate the pernicious effects of CA even in those without current or past psychopathology.