Research on suicidal ideation indicates the significant role of adverse childhood experiences (ACEs) and early parental attachment but fails to investigate risk potential in student populations....Show moreResearch on suicidal ideation indicates the significant role of adverse childhood experiences (ACEs) and early parental attachment but fails to investigate risk potential in student populations. This study aimed to research how adverse childhood experiences in a population of university students who report mood and stress problems are related to suicidal ideation and whether the relationship between adverse childhood experiences and suicidal ideation is moderated by attachment style. To target students at risk for suicidal ideation, purposive sampling was employed. An independent samples t-test with consecutive multiple regression (n= 234) showed that adverse childhood experiences, measured with the ACE questionnaire, predicted the presence and severity of suicidal ideation, measured by the BSSI. Consecutive ANCOVA showed that disorganized attachment to the mother and father, measured with the PBI, were found to predict suicidal ideation. Secure attachment was negatively associated with suicidal ideation, whereas for avoidant and anxious attachment there was no association found. A logistic regression analysis showed no moderation effect of insecure attachment styles in the relation between adverse childhood experiences and suicidal ideation. Gender, academic pressure, and nationality were controlled. Findings may be limited due to methodological and performance flaws. The results highlight the importance of early identification of adverse childhood experiences and disorganized attachment for intervention and prevention of later suicidal ideation amongst students.Show less
Victims who were involved in an accident are at risk of developing post-traumatic stress disorder (PTSD). Previous research showed that one-year PTSD, major depressive disorder (MDD), comorbid PTSD...Show moreVictims who were involved in an accident are at risk of developing post-traumatic stress disorder (PTSD). Previous research showed that one-year PTSD, major depressive disorder (MDD), comorbid PTSD-MDD symptom severity and new traumatic events are associated with long-term PTSD symptom severity. These different factors are often not included in research together and there are large differences in follow-up duration and study populations. The determination of predictors of PTSD is a prerequisite for efficient service delivery and prevention. Therefore, this study investigated the predictive value of 1-year PTSD, MDD, comorbid PTSD-MDD symptom severity and new traumatic events on 15-year PTSD symptom severity after traumatic injury. This study is a sub-project of Trauma TIPS, a prospective longitudinal cohort study. In this study n = 315 participants completed the online self-report questionnaires Impact of Event Scale - Revised (IES-R), Hospital Anxiety and Depression Scale (HADS) and Life Events Checklist for the DSM-5 (LEC-5). A multiple hierarchical regression analysis showed that higher 1-year PTSD, MDD and comorbid PTSD- MDD symptom severity significantly predicted higher 15-year PTSD symptom severity, unlike new traumatic events. These findings allow interventions to be developed to avert individual risk and may allow people with potential risk factors to be better monitored and treated in the future. This study partly replicated findings and revealed contradictions with previous research. Future research could focus on understanding the mechanism behind the association between 1-year PTSD, MDD and comorbid PTSD-MDD symptom severity and long-term PTSD symptom severity.Show less
Introduction. Longitudinal prospective studies are needed to identify risk factors for posttraumatic stress disorder (PTSD) symptoms 15 years after trauma, since cross-sectional findings do not...Show moreIntroduction. Longitudinal prospective studies are needed to identify risk factors for posttraumatic stress disorder (PTSD) symptoms 15 years after trauma, since cross-sectional findings do not inform how a possible pattern change as the clinical condition extends. Recently, thyroid hormones were in the top fifteen most relevant biochemical predictors for PTSD symptom trajectory within one year after trauma. Moreover, peritraumatic distress (PD) is highly associated with PTSD symptom severity. Nevertheless, most studies did not investigate the course of PTSD 15 years after a serious injury. This study hypothesized that higher thyroid functioning acutely after trauma, and higher PD predicted higher 15-year PTSD symptom severity, while the thyroid functioning mediated the relation between PD and 15-year PTSD symptom severity. Methods. This longitudinal prospective study examined 452 serious injury survivors. Blood samples were obtained acutely after trauma, and PD 23 days after trauma. PTSD symptom severity was assessed 15 years after trauma (M = 2.77, SD = 4.64), with the Clinician Administered PTSD Scale. Results. Multiple linear regression analyses showed that 15-year PTSD symptom severity was not predicted by the thyroid hormones and PD, and the thyroid hormones did not mediate the relation between PD and 15-year PTSD symptom severity. Discussion. Our study showed the importance of predicting 15-year PTSD symptoms, since understanding how and when these symptoms occur could be crucial for treatment and promising for risk identification at an early stage. More longitudinal studies are needed to understand why some people do, and others do not develop 15-year PTSD symptoms.Show less
Background: No valid and reliable instrument exists to assess knowledge, skills, experience and attitudes pertaining to suicide prevention (SP) among healthcare professionals (HCPs) in training....Show moreBackground: No valid and reliable instrument exists to assess knowledge, skills, experience and attitudes pertaining to suicide prevention (SP) among healthcare professionals (HCPs) in training. Aim: This study intended to develop and test the psychometric properties of the Suicide Prevention Skills Inventory (SPSI). Methods: A literature review identified seven subscales and 76 items for the SPSI. Using a cross-sectional design, data was collected in a sample of Dutch undergraduate, graduate and postgraduate healthcare students (N = 439), partaking in the online survey. An Exploratory Factor Analysis was performed on the continuous scales; inter-item, item-total and Pearson correlations were calculated for the binary scales. Cronbach’s alphas were calculated for all subscales and the overall instrument. Results: A four subscale solution (Provider Competencies, Moral Attitude, Experience Making Contact and Personal Interest in SP Skills Training) with 35 items showed the most optimal fit, with items loading >.40 on factors and good inter-item and item-total correlations. Reliability for the individual subscales and total scale ranges from good to excellent (α = .72-.90). Due to poor reliability the subscale Factual Knowledge was excluded. Discussion: The four subscale SPSI shows a stable latent structure and good reliability. However, validity of the instrument is only confirmed once results have been replicated in a new and representative sample. Future applications of the SPSI include the assessment of learning effects among HCPs in training and provide insight into the level of SP expertise of graduated HCPs starting their career in the clinical fieldShow less
Background: A common consequence after a traumatic injury is the development of a depressive disorder and one of the known risk and protective factors are the coping styles used to control the...Show moreBackground: A common consequence after a traumatic injury is the development of a depressive disorder and one of the known risk and protective factors are the coping styles used to control the distress. Objective: The aim of this study was to examine the predictive value of the use of passive and active coping styles on the development of depressive symptoms within the first year after trauma. It also aimed to assess potential gender differences within this association. Methods: 556 traumatic injury patients participated in the study. They were recruited from two academic hospitals in NL completed the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) and the Utrechtse Coping Lijst (UCL) questionnaire at T2. The UCL contained the active coping styles Active Approach, Social Support, Emotional Expression and Reassuring Thoughts and the passive coping styles Palliative Reaction, Avoidance Behaviour and Passive Reaction Pattern. Linear Mixed Models were used to analyse the data. Results: Greater use of Emotional Expression style predicted higher overall depressive symptoms. Greater use of Avoidance Behaviour and Passive Reaction Pattern predicted higher overall depressive symptoms and Palliative Reaction predicted lower depressive symptoms over time. A higher score on Active Approach significantly predicted lower depressive symptoms specifically for men. Conclusions: Different effects have been found in men and women for active coping styles. Most passive coping styles create a risk factor for depressive symptom severity regardless of gender. Implications entail risk monitoring and possible training interventions. Inconsistent results make implementation of intervention strategies difficult.Show less
Introduction: harm expectancy violation is a strategy that enhances exposure therapy for PTSD patients. Before exposed to trauma reminders, patients formulate anticipatory harm expectancies...Show moreIntroduction: harm expectancy violation is a strategy that enhances exposure therapy for PTSD patients. Before exposed to trauma reminders, patients formulate anticipatory harm expectancies regarding the occurrence of aversive events. Exposure is maintained until this expectancy is violated, creating crucial learning effects. However, harm expectancies are under investigated. Our goal is to gain more insight into harm expectancies prior to treatment and to investigate other related variables. Methods: this study is part of the overarching IMPACT-study of Oprel et al. (2018). CA-PTSD patients (N = 150) from PsyQ Psychotrauma departments filled in one standardized and one idiosyncratic harm expectancy prior to the first exposure session. PTSD symptom severity (CAPS-5), posttraumatic cognitions (PTCI) an emotion dysregulation (DERS) were measured at baseline. Relationships were examined using Spearman correlation analyses. The relationship between harm expectancy and PTSD severity, possibly mediated by posttraumatic cognitions and emotion dysregulation, was examined using PROCESS. Results: small significant positive correlations were found between the standardized harm expectancy and other variables. The idiosyncratic harm expectancy only correlated with the standardized harm expectancy. A small proportion of harm expectancy variance was explained by predictors in the mediation. Posttraumatic cognitions and emotion dysregulation were no significant mediators. Discussion: results indicate that the harm expectancy instrument is not a good measure and that there might be no relation between harm expectancy levels and PTSD-pathology related instruments. Secondly, harm expectancies might not be traced accurately with existing explicit techniques, since these cognitions might operate on a more implicit level. Measurement improvements were discussed.Show less
Background: The lockdown that ensued the COVID-19 pandemic severely impacted people’s mental health, the extent of which still needs to be further investigated. Young people and students are...Show moreBackground: The lockdown that ensued the COVID-19 pandemic severely impacted people’s mental health, the extent of which still needs to be further investigated. Young people and students are generally more susceptive and vulnerable to developing depression and suicide ideation. This study focused on the specific sample of university students. The student’s living situation (living alone vs. living with other people) and their perceived loneliness was assessed to determine the lockdown’s impact on their mental health, specifically on depressive symptoms and suicide ideation. Methods: A survey including Beck’s Depression Inventory (BDI), Beck’s Scale for Suicide Ideation (BSS) and the De Jong-Gierveld Loneliness Scale (DJGLS) was sent out to students of Leiden University at two different time points in March 2020 (N=216) and during a follow-up in April and May 2021 (N=49).The data of 49 participants was analysed using paired samples t-tests and multiple linear regression analyses. Results: there was a significant increase in mean BSS scores (p = 0.020, M2020: 0.7 and mean2021:1.8), but not in mean BDI scores (p = 0.454, M2020:10.3 and M2021: 10.9). Adding living alone vs. living with people as another predictor in a regression analysis yielded non-significant results (BDI: p = 0.842; BSS: p = 0.716). The interaction between living alone and the scores on the DJGLS were also not significant (BDI: change in R2 =0.008 & p = 0.541; BSS: change in R2 = 0.045 & p = 0.089). Discussion: The results suggest that over the period of the lockdown the student’s mental health problems, specifically suicide ideation, increased. However, loneliness and the living situation did not impact the difference in scores. Both the universities and the appropriate governmental authorities should take action to support this vulnerable population. What specific aspect of the lockdown influenced the results needs further studies. Future research should additionally aim to severely increase the sample size as well as studying the long-term effects of this pandemic on students mental health.Show less
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: Early studies show promising evidence for the feasibility and effectiveness of intensive Trauma-Focused Therapy (TFT) programs for patients with Posttraumatic Stress Disorder (PTSD)....Show moreBackground: Early studies show promising evidence for the feasibility and effectiveness of intensive Trauma-Focused Therapy (TFT) programs for patients with Posttraumatic Stress Disorder (PTSD). Little is known about the most effective treatment formats with regard to the therapy dose and frequency. The current study examines the effects of the High Intensive Trauma-focused Therapy (HITT) on the feasibility, tolerability, safety, and symptom outcomes. Methods: A Pragmatic Clinical Trial (PCT) was conducted with 16 treatment-resistant patients with PTSD who failed to respond sufficiently to previous treatment. The HITT treatment consisted of two five-day inpatient programs with Eye Movement Desensitization and Reprocessing, exposure, and trauma-sensitive yoga. Primary outcome was measured with the PCL-5 at the beginning and end of both HITT-weeks (T1 to T4). Clinically Significant Changes (CSC) and Reliable Change Indexes (RCI) were calculated. Results: No patients dropped out of treatment and no symptom exacerbations or adverse effects occurred. RCI and CSC from T1 to T4 showed that four patients recovered, two patients improved, and ten patients remained unchanged after treatment. The corresponding effect size on the PCL-5 between T1 and T4 was large (Cohen’s d = 0.88). Conclusions: Results demonstrated that the HITT-program was feasible, tolerable, and safe for all treatment-resistant patients and beneficial for six of these patients. Randomized controlled trials are needed to replicate these results and study the effectiveness of this treatment to further improve TFT formats. Also, future research is necessary to early select treatment-resistant patients who benefit from treatment to develop more cost- and time-effective treatments.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
BACKGROUND: Child maltreatment is a global health problem affecting children across the globe, that can result in serious impairments in later life, taking the form of serious psychological...Show moreBACKGROUND: Child maltreatment is a global health problem affecting children across the globe, that can result in serious impairments in later life, taking the form of serious psychological disorders or impoverished social skills. Empathy belongs to one of these fundamental skills. The current study aims to replicate previous findings that childhood maltreatment history is associated with lower empathy levels. Generally, research distinguishes between affective and cognitive empathy. Hence, this study explores possible differences in impact of child maltreatment history on cognitive versus affective empathy. METHOD: This cross-sectional design involved 218 healthy participants between 18 and 79 years of age. To assess child maltreatment, the Dutch version of the Childhood Trauma Questionnaire (CTQ) was used. The Interpersonal Reactivity Index (IRI) and the Multifaceted Empathy Test (MET) were used to assess both cognitive and affective empathy. The sample was divided into maltreated and non-maltreated participants, by applying cut-off scores, and where compared with multivariate ANOVAs on MET mean arousal level, MET total accuracy, perspective taking (PT), empathic concern (EC), fantasy (FS) and personal distress (PD). RESULTS: The present study failed to replicate previous findings of associations between child maltreatment and lowered empathy. Furthermore, a difference in impact on the two forms of empathy was not identified. However, after the exclusion of outliers, an indication was found for impaired cognitive empathy in individuals with maltreatment history. DISCUSSION: The present study shows that possible selective effects of child maltreatment on either cognitive or affective empathy may exist. Knowing how maltreatment differentially affects individuals in later adulthood, can help to optimize both prevention measures as well as treatments dealing with the consequence of child maltreatment, e.g. individual training focusing on either type of empathy. Limitations of the present study are discussed.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
