Posttraumatic stress disorder (PTSD) is a frequent consequence of childhood abuse (CA) and is assumed to be more severe than PTSD from adult trauma. PTSD can be treated well with trauma-focused...Show morePosttraumatic stress disorder (PTSD) is a frequent consequence of childhood abuse (CA) and is assumed to be more severe than PTSD from adult trauma. PTSD can be treated well with trauma-focused treatment (TFT), but comorbidities such as suicidality and psychotic symptoms have been viewed as contraindications for using TFT. Aim: To identify the effects of TFT on suicidality in a population with CA-PTSD as well as the moderating effects of psychotic symptoms. Method: Baseline and post-treatment assessments of suicidality were investigated in 150 adult patients with CA-PTSD. Moderating effects of psychotic symptoms at baseline were investigated. Results: A reduction of suicidality was observed (z = -2.43, p = .015); for the majority of participants suicidality decreased (n = 47), while some participants experienced no change (n = 27) or an increase (n = 29) in suicidality. Only few participants (n = 21) showed comorbid psychotic symptoms at baseline. Psychotic symptoms at baseline were associated with higher suicidality (z = 2.391; p = .017), but after correction for multiple testing, not with PTSD symptoms (t(148) = -2.22, p = .028) at baseline. Psychotic symptoms did not modify PTSD or suicidality outcomes at post-treatment. Conclusion: A reduction of suicidality may be an overall trend in TFT, but no change or an increase in suicidality are also observed in participants. More research is needed on the role of psychotic symptoms. Suicidality should be closely monitored throughout treatment, and interventions to address immediate or extreme suicidality should be investigated further in future research.Show less
Background: Exposure to childhood maltreatment (CM) can induce hyperactive inflammatory responses, which can persist into adult life. Elevated levels of inflammation markers can impair brain...Show moreBackground: Exposure to childhood maltreatment (CM) can induce hyperactive inflammatory responses, which can persist into adult life. Elevated levels of inflammation markers can impair brain functioning and development, which can in turn increase the risk for psychopathology. Hence, inflammation might be one of the potential mechanisms explaining the link between CM and adult psychopathology. Objective: This study aimed to investigate whether inflammation might mediate the relationship between CM and internalizing psychopathology in adulthood. Additionally, the study aimed to determine whether this effect is specific to one or more subtypes of CM. Methods: A total of 116 adults participated in the study. CM was assessed using a combination of two questionnaires: the Parent-Child Conflict Tactics Scales (CTS-PC) and the Childhood Trauma Questionnaire (CTQ). Participants’ saliva samples were analysed for three pro-inflammatory cytokines (IL-6, IL-1β, TNF-α). The Internalizing Problems subscale from the Adult Self Report (ASR) questionnaire was used to determine internalizing psychopathology. Parallel mediation analyses were conducted to test the hypotheses. Results: Experienced childhood abuse and neglect both significantly predicted internalizing symptoms in adulthood. However, the associations were not mediated by pro-inflammatory cytokines. Conclusions: This study’s findings add to the extensive body of literature showing the longterm effects of CM on internalizing psychopathologies. Contrary to expectations, the mediation effect of inflammation in this relationship was not identified. As several methodological factors could have influenced the results, this outcome should not be considered as a firm disconfirmation of the mediation hypothesis. Further prospective studies addressing this question are warranted.Show less
Background: Suicidality is precipitated by a variety of mental vulnerabilities. There has been a dearth in knowledge about the interactions between psychological variables that can jeopardise...Show moreBackground: Suicidality is precipitated by a variety of mental vulnerabilities. There has been a dearth in knowledge about the interactions between psychological variables that can jeopardise university students into becoming suicidal. Aim: By exploring these interactions cross-sectionally using network analysis, this study sought to deduce risk profiles for student suicidality from 464 university students with self-reported mood and stress problems. Methods: Suicidality and clinical risk factors such as depression, anxiety, and posttraumatic stress were assessed using 13 self-report questionnaires. Interactions between those variables were analysed via connectivity and centrality indices in 114 and 74 participants identified at high risk for suicidal thoughts and suicidal attempts, respectively. Results: Symptoms of depression, posttraumatic stress, and anxiety displayed large interconnections in either centre. Perceived burdensomeness connected heavily with suicide thoughts and subjective symptoms of depression. Study-related stressors demonstrated centrality only at risk for suicide attempts. Conclusions: Suicide prevention programs for university students may benefit from targeting critical interactions between mental vulnerabilities for suicidality. Suicidal thoughts may be influenced especially by affecting perceived burdensomeness. Changes in depression may be crucial for achieving effects on perceived burdensomeness, posttraumatic stress, and anxiety.Show less
Suicide is the second leading cause of death among university students. Insomnia symptoms have been established as a risk factor for suicidal ideation and feelings of thwarted belongingness have...Show moreSuicide is the second leading cause of death among university students. Insomnia symptoms have been established as a risk factor for suicidal ideation and feelings of thwarted belongingness have been proposed to explain the link between insomnia symptoms and suicidal ideation. The purpose of this study was to investigate the association between insomnia symptoms and suicidal ideation, with thwarted belongingness mediating the relationship, in a sample of Dutch university students. The study assessed participants crosssectionally (n = 218) and after six months (n = 83). Participants completed the Insomnia Severity Index, Beck Scale for Suicide Ideation, the Interpersonal Needs Questionnaire, Beck Depression Inventory, and the Beck Anxiety Inventory. Logistic regression and mediation analyses were conducted. Symptoms of depression and anxiety were controlled for. Crosssectionally, insomnia symptoms were significantly associated with suicidal ideation. When adjusting for symptoms of depression and anxiety, the association became nonsignificant and only symptoms of depression emerged as an independent predictor. Thwarted belongingness mediated the relationship between insomnia symptoms and suicidal ideation cross-sectionally. When depressive symptoms were controlled for, the mediation model became nonsignificant. Longitudinally, results suggested no predictive effect of insomnia symptoms on suicidal ideation and no mediation effect of thwarted belongingness on the relationship. The results did not support insomnia symptoms as an independent risk factor for suicidal ideation in university students, which underscores the need for more rigorous research to clarify this relationship for the future.Show less
Background: Despite increasing evidence for the effectiveness of Serious Games (SG), research and the implementation of such digital measures in mental health care lags behind. Insights into...Show moreBackground: Despite increasing evidence for the effectiveness of Serious Games (SG), research and the implementation of such digital measures in mental health care lags behind. Insights into attitudes and their influencing factors for professionals and clients of mental health care are assumed to facilitate the implementation and development of SG. Objective: This study aimed to gain a greater understanding of the attitudes of professionals and clients of mental health care towards SG and factors that influence (media usage, gaming experience) and moderate that relationship (age, gender). Method: A cross-sectional online survey with a quantitative study design was conducted with professionals (N = 166) and (former) clients of mental health care (N = 154). Two independent samples t-tests were conducted to study the influence of media usage and gaming experience on attitude towards SG, whereas four ANCOVAs were applied to examine the moderating effects of age and gender. Results: Media usage and gaming experience did not significantly influence the attitude towards SG in both samples. Also, age and gender did not significantly moderate the studied relationship. Conclusion: The factors media usage and gaming experience and the moderators age and gender do not contribute to a greater understanding of the attitude towards SG. Following these variables cannot facilitate the implementation and development of SG in mental health care. Based on the chosen sampling and measurement methods, the collected data was not considered representative of the studied population and statistical analysis were conducted with reduced power.Show less
Background: Serious games for mental health purposes is a young but rapidly growing concept, however, implementation in clinical practice lags behind. Knowing the characteristics and attitudes of...Show moreBackground: Serious games for mental health purposes is a young but rapidly growing concept, however, implementation in clinical practice lags behind. Knowing the characteristics and attitudes of the users, mental health professionals, will aid in seeking the optimal design and more efficient implementation. Objective: We wanted to gain more insight on what professionals want from the games, and if knowledge about games or practicing different therapeutic modalities is related to attitude on serious games. Method: We surveyed 123 MPHs via a cross-sectional online survey about technology usage, gaming knowledge, and attitudes towards serious games. Data were analysed using a t-test, chi-square test, exploratory factor analysis, and an ANOVA. Results: The results showed that overall interest to implement serious games with their own clients was high (75.6%), and perceived benefits outweighed perceived disadvantages, but current implementation rate was very low (.8%). The biggest reason for not wanting to use serious games was lack of knowledge (14.6%). Knowledge about gaming was significantly positively correlated to overall attitude, and with willingness to implement. There was no significant relationship between any specific therapeutic modality and the overall attitude towards serious games, which contradicts results from previous studies. Conclusion: Knowledge about games increases the attitude and willingness to try serious games with clients. Most mental health professionals reported to have beginner knowledge, thus educating them about (serious) gaming could help with implementation and adherence. More research is needed to map out why the professionals who are interested have not yet tried serious games. User-centred design (UCD) should be widely implemented when developing serious games for mental health purposes.Show less
