Category: Suicide and Self-Injury
Courtney Forbes, M.A., M.Ed.
Clinical Psychology Intern
Emory University School of Medicine
Atlanta, Georgia
Gabriela Khazanov, Ph.D.
Research Psychologist
Corporal Michael J Crescenz VA Medical Center
Philadelphia, Pennsylvania
Michelle Craske, Ph.D.
Professor of Psychology, Psychiatry and Biobehavioral Sciences
University of California Los Angeles
Los Angeles, California
Courtney Forbes, M.A., M.Ed.
Clinical Psychology Intern
Emory University School of Medicine
Atlanta, Georgia
Gabriela Khazanov, Ph.D.
Research Psychologist
Corporal Michael J Crescenz VA Medical Center
Philadelphia, Pennsylvania
Jeremy Stewart, Ph.D., Other
Queen’s University
Kingston, Ontario, Canada
Thomas Olino, Ph.D.
Professor
Temple University
Philadelphia, Pennsylvania
E. Samuel Winer, Ph.D.
Associate Professor
The New School for Social Research
New York, New York
As the 10th leading cause of death in the US, suicide is a public health emergency that is critical to address in the context of the COVID-19 pandemic. Although relationships between suicide risk and negative valence processes (e.g., negative affect, hopelessness) have been studied extensively, the relationships between suicide risk and positive valence processes, or responding to rewarding stimuli, are poorly understood. Investigating the nature of these relationships has the potential to improve suicidal outcomes, as abnormalities in reward response are a transdiagnostic feature of disorders like depression and PTSD that increase suicide risk. Furthermore, promising biomedical and psychotherapeutic treatments aiming to modify reward response and thereby improve clinical outcomes are currently being developed.
This symposium presents findings that clarify the associations between responsiveness to rewards and suicidal ideation and behavior across age groups (adolescents and adults), contexts (persons at risk for depression, Veterans with suicidal ideation, recently traumatized adults), and levels of analysis (self-report, behavioral, and neurobiological).
Paper 1 explores cross-sectional and longitudinal associations between neural reward response and suicidal ideation among adults with recent trauma exposure. Lower levels of activation in the insula and thalamus during an effort-based decision-making task were cross-sectionally associated with greater suicidal ideation.
Paper 2 examines the associations between anhedonia, suicidal outcomes, and symptoms of depression and PTSD in two samples with high levels of traumatic exposure. Anhedonia was associated with suicidal ideation and desire (perceived burdensomeness, thwarted belongingness), even when accounting for depression and PTSD severity, but not suicidal behavior or capability.
Paper 3 utilizes electroencephalography to probe neural responses to social reward among adolescents with suicidal ideation, suicide attempts, and nonclinical controls. Results indicate that (low) early attentional deployment toward positive social feedback differentiates adolescents with suicidal attempts from those with ideation and nonclinical controls.
Paper 4 analyzes reward response and impulsivity in relation to youth engagement in both nonsuicidal self-injury (NSSI) and suicidal thoughts and behaviors (STBs). Overall, NSSI and STBs demonstrated similar associations with self-report measures of reward sensitivity and impulsivity, suggesting the overlap of NSSI and STBs within a broader construct of self-harm.
Finally, Paper 5 uses network analysis to probe the relations among anhedonia, devaluation of reward, and self-injurious behaviors. Results suggest that self-blame may contribute to the development of anhedonia, or vice versa.
Taken together, these studies suggest that abnormalities in reward response are linked to suicidal ideation and behavior both cross-sectionally and longitudinally, and across stages of development, context, and levels of analysis. Results suggest that considering positive valence processes in addition to negative valence processes when treating suicidal ideation and behavior may improve clinical outcomes.
Presenter: Courtney Forbes, M.A., M.Ed. – Emory University School of Medicine
Co-author: Matthew Tull, PhD – University of Toledo
Co-author: Andrew Cotton, MD – University of Toledo Medical Center
Co-author: Xin Wang, MD, PhD – University of Toledo Medical Center
Presenter: Gabriela K. Khazanov, Ph.D. – Corporal Michael J Crescenz VA Medical Center
Co-author: Courtney Forbes, M.A., M.Ed. – Emory University School of Medicine
Co-author: Michelle Gordon, MPH – Penn Center for the Prevention of Suicide, University of Pennsylvania, Perelman School of Medicine
Co-author: Matthew Tull, PhD – University of Toledo
Co-author: Kim L. Gratz, Ph.D. – University of Toledo
Co-author: Michael Thase, MD – University of Pennsylvania, Perelman School of Medicine
Co-author: James McKay, PhD – University of Pennsylvania, Perelman School of Medicine
Co-author: Shari Jager-Hyman, Ph.D. – University of Pennsylvania
Presenter: Jeremy G. Stewart, Ph.D., Other – Queen’s University
Co-author: Emily Zhang, BA – Department of Psychiatry, Columbia University
Co-author: Alma Bitran, BS – Department of Psychiatry, Columbia University
Co-author: Gabrielle Craddock – Department of Psychology, Queen's University
Co-author: Natasha Drobotenko, MSc – Department of Psychology, Queen's University
Co-author: Randy Auerbach, PhD, ABPP – Department of Psychiatry, Columbia University
Presenter: Thomas Olino, Ph.D. – Temple University
Co-author: Julia Case, MA – University of Miami/Jackson Behavioral Health Hospital
Presenter: E. Samuel Winer, Ph.D. – The New School for Social Research
Co-author: Amanda Collins, MA – Mississippi State University
Co-author: Courtney Mason, MA – Mississippi State University
Co-author: Michael R. Gallagher, B.S. – Mississippi State University
Co-author: Matt Hanna, BA – The New School for Social Research
Co-author: Hilary DeShong, PhD – Mississippi State University