Current Thoughts Research Articles

Suicidal thoughts are associated with reduced source attribution of emotion.

Approximately 9% of people think about suicide during their lifetime. Suicidal thoughts are consistently associated with perceived failures in emotion regulation. However, factors contributing to these perceptions remain insufficiently clear. New evidence suggests that when people know little about the cause of their emotions (i.e., low source attribution of emotion), they perceive themselves as less successful in regulating them. Therefore, emotion regulation deficits in people with suicidal thoughts might be related to lower knowledge about sources of emotions. We examined this question in two ecological momentary assessment studies (N₁ = 396, N₂ = 195). We found that participants with current suicidal thoughts knew less about the sources of their emotions compared to participants with no suicidal thoughts history (Studies 1 and 2), and even when compared to controls with similar levels of psychiatric symptoms but no history of suicidal thoughts (Study 2). Using language processing, we found that written descriptions of the source of participants' emotions were less concrete among those with suicidal thoughts compared to participants with no suicidal thoughts history. Among suicidal participants, suicidal thoughts were more likely to be present in moments when participants knew less than usual about the source of their negative emotions (Study 2), and low knowledge of the source was associated with more frequent and prolonged suicidal thoughts (Studies 1 and 2). Finally, lower perceived success in emotion regulation mediated the association between source attribution of emotion and the occurrence of suicidal thoughts. Findings suggest that reduced knowledge about the source of negative emotions might increase the risk for suicidal thinking. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

MDES and Movie Watching: Examining Thought Patterns During Movie Watching Task

Multi dimensional experience sampling (MDES) occurs when questions are asked to participants while they are completing a certain task, and to assess and examine various facets and thought processes of participant’s experience while encountering that particular activity (Wallace et al., 2024). For instance, examining a participant's emotional state. This sampling method was applied to a movie watching study completed over the duration of May to August 2024. The study included 15 participants, who each observed a total of 15 film clips, in person in the lab located in Kingston, Ontario. The clips each ranged from one to three minutes, and comprised of various film genres. Participants would then complete an MDES questionnaire after observing each film clip. Once the data was obtained, a Principal Component Analysis (PCA) was completed. It was discovered that four components of thought were found including intrusive distraction, sensory engagement, episodic knowledge, and narrative comprehension of the clips. Episodic knowledge highlights the participant’s attention fixating on past events and their emotions and focuses less on current deliberate thoughts, and narrative comprehension concentrates on the participant’s problem-solving skills to understand the content occurring in the clips. Whereas, participant’s sensory engagement features their focus to sounds and images in the clips, and intrusive distraction aids in displaying that their focus is poor while viewing the clips, but their intrusive thoughts are high. Using the data it can be assumed that various thought processes can occur while an individual observes movies. It also aided in identifying any factors that could help or hinder participants' ability to focus on the movie clip task. The data can be beneficial in furthering our understanding of an individual's attentional abilities when viewing various genres and pieces of media. Works Cited Wallace, R. S., Mckeown, B., Goodall-Halliwell, I., Chitiz, L., Forest, P., Karapanagiotidis, T., Mulholland, B., Turnbull, A. G., Vanderwal, T., Hardikar, S., Alam, T. G., Bernhardt, B., Wang, H.-T., Strawson, W., Milham, M., Xu, T., Margulies, D., Poerio, G. L., Jefferies, E., … Smallwood, J. (2024). Mapping Patterns of Thought onto Brain Activity during Movie-Watching, 1–38. https://doi.org/10.1101/2024.01.31.578244

Prevalence of current suicidal thoughts and lifetime suicide attempts in individuals with cancer and other chronic diseases in Germany: Evidence for differential associations from a representative community cohort

BackgroundResearch indicates an elevated risk for suicidal thoughts and behaviors (STBs) among individuals with cancer, but community-based studies on the prevalence of STBs in comparison to the general population and other chronic diseases are lacking. MethodsData was drawn from the representative population-based, prospective Gutenberg Health Study (GHS). Participants (N = 12,382; age: M = 59.5, SD = 10.8; 48.9 % women) completed highly standardized medical assessments and validated questionnaires such as the PHQ-9. In addition to prevalence estimates (stratified by STBs and gender), logistic regression models were calculated (controlling for confounders). ResultsThe sample included 1910 individuals with cancer, 8.2 % of whom reported current suicidal thoughts and 2.0 % reported lifetime suicide attempts. There was neither a significant association between a cancer diagnosis and suicidal thoughts (p = .077) nor suicide attempts (p = .17) in models adjusting for age, gender, and income. Other chronic diseases were linked to suicidal thoughts and attempts only in men. LimitationsAlthough the investigation of the two kinds of STB are a strength of the study, the items' different time frames complicate comparisons. In addition, the cross-sectional design limits the ability to understand observed relationships and to identify periods of risk. ConclusionThis study expands the evidence base regarding the vulnerability to STBs in individuals with cancer, including long-term survivors. It highlights their heterogeneity, differential risk factors underlying suicidal thoughts and attempts, and the relevance of other (contextual) factors shaping an individual's susceptibility to suicidal crises.

Suicidal thoughts and behaviors among untreated illicit substance users: a population-based study.

Research regarding the contribution of specific psychoactive substances to suicidality has yielded equivocal results. The present study examined the prevalence and factors associated with suicidal thoughts and behaviors among a population-based sample of untreated illicit substance users. A total of 616 illicit substance users who were recruited from high-risk areas of Shiraz using snowball sampling participated in the study. Eligible participants were individuals aged 18 years and older who regularly used one illicit psychoactive substance (e.g., opioids, heroin, cannabinoids, stimulants, hallucinogens) for at least one year and who had received no treatment for their drug use during the past year. Data were collected regarding socio-demographic characteristics, mental history, and substance use habits. Data regarding suicidal thoughts and behaviors were assessed using the Beck Suicidal Ideation Scale (BSIS) and self-reports of previous suicide attempts. Multiple logistic regression analysis was used to identify independent variables associated with suicidality. Among the participants, 23.6% reported having had suicidal thoughts during the past week and 6.7% reported having attempted suicide during the past year. Methamphetamine was reported as the primary substance of use among approximately half of the participants who attempted suicide during past year (49.2%). Multiple logistic regression analysis showed that current suicidal thoughts were independently associated with having no job, a history of mental health condition, previous suicidal attempts, concurrent use of more than one substance, and using methamphetamine and heroin as the primary substances. Suicidal thoughts were not associated with increased odds of regular opium and cannabis use. Both methamphetamine and heroin use are significantly associated with current suicidal thoughts. Evaluation of the risk of suicidality by physicians and mental health care professionals in both community and outpatient settings would be especially appropriate among those individuals using these psychoactive substances.

Recognition predictive modeling using electroencephalogram

A machine learning model that operates on raw electroencephalogram (EEG) signals is essential for accurately discerning the user’s current thoughts. Given the difficulty of categorizing EEG signals for use in brain-computer interface (BCI) programs, we adopted a systematic approach in this study to select an optimal predictive model. To enhance the effectiveness of our systematic approach, we extracted features such as band powers, averages, and root-mean-squared values. K-nearest neighbor (KNN), principal component analysis, and dual-layer neural networks were employed to evaluate and validate the effectiveness of the extracted features. The BCI IV competition-I dataset was utilized for analysis and validation. KNN achieved an average classification success rate of 98.02% compared to other methods. Furthermore, our research extends the application of this approach using it to create, test, and evaluate human driving behavior as a case study.

Abstract ED11-03: Approaches to radiation therapy for inflammatory breast cancer

Abstract Inflammatory breasst cancer ((BC) is an uncommon and highly agressive form of breast cancer, with a predilection for both distant metastases and local regional recurrence. In this talk we will review challenges in radiation therapy planning and execution unique to IBC. These include staging studies and photographs to define the full extent of disease prior to systemic therapy, as well as current thoughts on dose and fractionation. We will also discuss pros and cons of local therapy in patients with metastatic disease, as well as ongoing research studying ways to optimize local regional control with concurrent systemic therapy and radiation. Citation Format: J. Bellon. Approaches to radiation therapy for inflammatory breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr ED11-03.

Briefing: Temporary works legacy archive: a pensieve to store memories

The recent release of the Temporary Works Forum’s (TWf) e-learning courses has revolutionised awareness. These courses have shown the importance of being reminded of the past, of lessons learned and other experiences, some of which would be lost without this initiative. The TWf legacy project is to make available an online searchable folder, or a ‘pensieve’. Primarily, this is focused on capturing TW memories, stories and events for archive, partially by retiring members who would like some of their career photos and experiences recorded. The project also aims to interview leading TW practitioners on their current thoughts on achieving best practice.

Mind-wandering contents and characteristics: an exploratory study comparing between work and non-work contexts

ABSTRACT Mind-wandering, where thoughts drift away from the immediate environment or task to self-generated thoughts, is a common human experience. Despite the growing research on its antecedents and consequences, the content and characteristics of mind-wandering across different contexts, such as work-related and non-work-related settings, remain poorly understood. This study, guided by the Context and Content Regulation Hypothesis, explores the nuances of mind-wandering by examining both its content and characteristics, such as deliberateness and temporal orientation. Over five working days, we prompted 131 workers three times daily to report the content and characteristics of their current thoughts. Our findings indicate that mind-wandering occurred less frequently during work but was predominantly populated with work-related content, regardless of the ongoing activity. Furthermore, while most mind-wandering events were future-oriented and spontaneous, those centred on work exhibited a more deliberate and pronounced future bias. Challenging the prevailing notion of mind-wandering as a mere distraction, our findings align with the Context and Content Regulation Hypothesis, emphasizing its strategic role in foreseeing and preparing for future work-related events.

Characteristics and Functions of Non-Suicidal Self-Injury That Inform Suicide Risk

Objective Although non-suicidal self-injury (i.e., NSSI) has been suggested as a robust risk factor of suicide, NSSI related information that is most related to suicide risk remains unclear. Commonly studied NSSI characteristics are its frequency and the number of methods endorsed. However, it may not be merely how frequent or how many different methods that matters, but “why,” which alludes to the importance of NSSI functions (or why individuals engage in NSSI). Thus, this study examined how the interactions between NSSI characteristics and functions are associated with suicide risk. Methods Undergraduate students (n = 820) with a lifetime history of NSSI, filled out self-report measures on NSSI and suicide risk. A hierarchical regression analysis was conducted to examine the moderation effects between four 2-way interactions (i.e., method X intrapersonal; method X interpersonal; frequency X intrapersonal; frequency X interpersonal) on suicide risk. Results Main effects of all four independent variables were statistically significant. In terms of interactions, the intrapersonal function moderated both the effects of NSSI frequency and methods on suicide risk, whereas the interpersonal function moderated the effects of NSSI frequency on suicide risk. Conclusion Our results highlight that some NSSI related information than others are more indicative of suicide risk. In particular, the combination of NSSI functions, along with its frequency and number of methods, holds promise when assessing for current and lifetime suicidal thoughts and behaviors.

Childhood Bullying as a Predictor of Suicidality in Young Adults in a Nationwide Population-Based Health Examination Study

Objective Having been bullied at school in childhood links to suicidality. We aimed at verifying earlier findings and delivering diverse data from a representative population-based sample of young adults to characterize the impacts beyond childhood. Method A random sample of adults, aged 18–28 years and representative of the general population living in Finland, participated in a nationwide health examination study. Adverse childhood experiences before the age of 16 years were analyzed for 779 participants in relation to lifetime suicidality (suicidal ideation, suicide attempts), current suicidal thoughts (HSCL-25), mental disorders (self-reports for lifetime, M-CIDI for DSM-IV during the past 12 months), current usage of mental health services, current usage of prescription medicines (ATC codes), current psychological distress (GHQ-12), and current work capacity and work ability. Results Having been bullied in childhood contributed to greater suicidality (p < 0.001), more frequent current usage of antipsychotics (p < 0.001) as well as antidepressants (p < 0.001), greater current psychological distress (p < 0.001), and poorer current work capacity (p < 0.001) as well as work ability (p < 0.001). Of the self-reported mental disorders on lifetime basis, psychosis had the strongest association (p = 0.03) with having been bullied, whereas the interview-based diagnosis of mental disorders during the past 12 months had no significant association. Conclusions Having been bullied at school before the age of 16 years was independently associated not only with suicidality, but also with the self-report of psychosis as well as a range of indicators of poorer mental health at the age of 18–28 years.

Pathways of depressive symptoms to self-harm and suicide warning signs during COVID-19 pandemic: The role of anxiety and related distress, dysfunction and somatization

BackgroundEarly in the COVID-19 pandemic, concern about widespread waves of depression and suicide emerged worldwide. Clarity on the relationship between mental health symptoms and warning signs of current self-harm or suicide thoughts and behaviors (ShSTB) in Mexican adults could be useful for designing effective public health policies and preventive strategies during health emergencies. ObjectiveThe present study uses a path model to explore the relationship between depressive symptoms, anxiety, and related distress, dysfunction, and somatization with ShSTB warning signs in Mexican adults during the COVID-19 pandemic. The study also describes the relative risks of these mental health variables for men and women, and for those who were seeking psychological care versus those who were not. MethodThe study was conducted with 18,449 Mexicans (M = 33 years, SD = 11.00, range = 18–59), including 12,188 women (66.10 %) and 2706 (14.67 %) who were seeking psychological care. A web-based application included two multidimensional screening scales to evaluate depression, anxiety and somatic symptoms and related distress/dysfunction, as well as past and current ShSTB. Based on the participants' sex, the entire sample was randomly divided into two sub-samples to compare and replicate the Confirmatory Factor Analysis (CFA) results, getting evidence of the multidimensionality of the scales. With the two sub-samples, we also tested the nested models from a structural equation model (SEM) to suggest a relationship between mental health and self-harm/suicide variables. FindingsOur findings suggest that 31 % of participants were at risk for depression, 42.30 % for anxiety, 38.30 % for Marked Distress, Dysfunction and Somatization (MDDS), 33.30 % for at least one ShSTB, and 4.20 % for Previous Self Harm Thoughts and Behaviors (PShTB) during the COVID-19 pandemic. A greater percentage of women and participants seeking psychological care showed high levels of mental health symptoms, PShTB, MDDS, and ShSTB. The path model suggested a direct influence of PShTB and MDDS on ShSTB. Depression symptoms lead to ShSTB in three possible ways: through PShTB, PShTB affecting MDDS, and generalized anxiety affecting MDDS. Discussion and outlookThe pandemic was accompanied by a high prevalence of depression-anxiety, marked distress, dysfunction and somatization and self-harm/suicide thoughts and behaviors. The findings of this study suggest evidence over the well-known association between depression and anxiety, and between depression, previous self-harm thoughts and behaviors, and self-harm/suicide. The evidence suggests to distinguish when participants were suffering from MDDS and anxious depression from those only suffering from depression. The methodological conditions of the study suggest a comprehensive model of ShSTB prevention. Findings also suggest the need to care for Mexicans with depressive symptoms and PShTB as well as those suffering from anxious depression with MDDS to prevent suicide, by implementing effective public health policies and preventive strategies to reduce the mental health gap during health emergencies. LimitationsThis research was a cross-sectional study, suggesting that future analyses should focus on the evaluation of its consistency with confirmed diagnoses of mental health disorders, self-harm/suicide risks, and the effect of remote psychological help to address these problems.

Psychotropic Medications Promote Time-Dependent Reduction of Suicidal Ideation in Mood Disorder: A Prospective Cohort Study.

Despite a plethora of research on the topic, there is still no solid evidence that pharmacological treatment actually reduces the risk of suicide in patients with mental illness. In this study, we aimed to assess the effect of psychotropic medications on suicidal ideation in patients with major depressive disorder (MDD) and bipolar disorder (BPD) in two age groups: less than 25 years and 25 years and older. We analyzed 312 patients with mood disorders with current suicidal thoughts or recent suicide attempts. We followed the participants from baseline for 6 months and assessed changes in suicidal ideation with Columbia-Suicide Severity Rating Scale (C-SSRS). The effect of psychotropic drug administration on suicidal ideation over time was analyzed using a linear mixed model. In patients aged 25 years and older with mood disorders, suicidal ideation was more severe when using psychotropic drugs than when not using them. However, suicidal ideation decreased rapidly over time. The time-dependent reduction in suicidal ideation was accelerated when using antidepressants and sedatives/hypnotics in adult MDD, and when using mood stabilizers in adult BPD. However, this effect was not observed in participants aged less than 25 years. Adequate psychotropic medication may reduce suicidal ideation in patients with mood disorders aged 25 years and older. Additional research on psychotropic drugs is needed to effectively reduce the risk of suicide among children and adolescents with mood disorders.

Illness perception, self-esteem and self-care management of patients on continuous ambulatory peritoneal dialysis: A cross-sectional study from a Tertiary Care Hospital in South India

Background: Chronic diseases are those conditions that last for more than a year requiring ongoing medical attention and crippling the activities of daily living. End-stage kidney disease invites significant psychosocial stressors and demands routine adaptation. It cha­llenges the patient with a constant fear of death, draining them physically and mentally, making them depen­dent on the healthcare team and having to follow complicated pharmacological regimes with dietary limitations. Objective: The study was intended to assess illness perception, self-esteem, and self-care management of patients on continuous ambulatory peritoneal dialysis. Methodology: Using quantitative approach, a descriptive study was undertaken for a period of six weeks in Peritoneal Dialysis unit of the Artificial Kidney Lab (AK Lab) of Christian Medical College, Vellore. A total of 63 patients were selected using total enumeration sampling technique. Data was collected using self-administered questionnaires namely Brief Illness Perception Questionnaire (B–IPQ), Current thoughts scale and Questionnaire on self-care management. Results: Most of the subject’s illness perception were moderately (42.86%) and severely affected (41.27%). On the whole, the subjects had higher self-esteem (mean = 71.49); however, the appearance self-esteem was rather low (19.67). All subjects had adequate self-care management. Conclusion: Patients undergoing CAPD perceive their illness as a threat and they have low appearance self-esteem. On the basis of this finding, formulation of guidelines for psychological management of these patients would help them to develop coping skills.

ALONE WITH MY THOUGHTS: USING NATURAL LANGUAGE PROCESSING TO DISTINGUISH LONELY FROM CALM ALONENESS

Abstract Time spent alone is common in daily life, and particularly in old age; it may at times be experienced as lonely, and at times as calming (positive solitude). The use of machine learning to interpret human language (e.g., natural language processing or NLP) has been growing in psychology, and NLP has been used to distinguish experiences of loneliness from positive solitude in social media data (e.g., tweets). How effective might such NLP techniques be for classifying naturally-occurring aloneness experiences in older adults’ everyday lives? The present study uses 1,546 thought samples collected from 133 adults aged 18-85 (M = 49.6 years; 73% female) at moments when they were alone over a 1-3 week period; participants reported their current thoughts (open-ended) and affective states (lonely, calm) at each assessment. Support vector machines were then used to classify moments of aloneness as being lonely (vs. not lonely) and calm (vs. not calm) based on the words participants used when describing their thoughts. When compared against participants’ actual reported affective states, these classifications achieved up to 67% accuracy for “lonely” and 79% accuracy for “calm”. “Lonely” thought reports included the word “work” more frequently, whereas “calm” thought reports more frequently included the words “reading” and “think/thought”, suggesting individuals engage in quiet or contemplative activities during positive solitude. Age differences therein are also examined. Findings suggest that NLP may be a useful tool for identifying older adults at risk of loneliness (and its negative health implications) by using brief reports of their everyday thoughts.

Канонічна педагогіка у метафізичному праві

Views on upbringing, learning, education, development are always relevant, because different ideas of the influence of some people on others are the subject of research in many sciences. Earthly life, the spiritual environment requires every time to withdraw the mind from earthly, sensual concerns, and turn to spiritual supersensual, inaccessible mental problems that affect the ontological life activity of a person, which is regulated by the relevant norms. By and large, we are talking about general pedagogy in positive law, about vital pedagogical knowledge, which is recognized as profound - soulful, spiritual. But this is not enough. This knowledge is fully justified by God's providence and is highlighted in theological literature. It follows that there are such types of pedagogy as ordological (bodily), existential (spiritual) and transcendental (spiritual). I believe that it is appropriate (in this case) to combine them into the concept of canonical pedagogy. Metaphysical law is a natural-supernatural secret writing, imbued with the spirit of wisdom, a cryptological method designed for the action of human supersensible principles. A special coded ontological code was created by divine eternity in order to obtain naturally permissible life innovations for the creative cognitive process of life. The metaphysical law, created by supernatural man on the basis of knowledge of natural and supernatural laws, natural phenomena, natural laws, contains theological motives of life, the meaning of the natural existence of the inner man and his salvation from evil. It is clear that metaphysical law works with positive law, natural law, canon law, ecclesiastical law, philosophy of law and pedagogy through spiritual unity and synergy. Let's resort to the following research algorithm: metaphysical law-canonical pedagogy - pedagogy in metaphysical law - canonical-law laboratory. Metaphysical man needs metaphysical law and metaphysical pedagogy, despite the fact that man is currently most concerned with physical, bodily issues. Solving earthly concerns does not at all free a person from future heavenly cares. The current restless thoughts have reason to exist. Bodily ordological restlessness must be satisfied by the settlement of the future unearthly with the help of earthly means. Metaphysical law is such a tool.

Supervision of the mental health lived experience workforce in Australia: A scoping review.

The mental health Lived Experience workforce (also referred to as peer workforce) is growing rapidly internationally and within Australia. Peer workers are increasingly employed within multi- and inter-disciplinary teams, often directly supervised by mental health professionals such as nurses. Professional supervision has been identified as fundamental for implementing a sustainable peer workforce, but significant gaps in the literature remain, in particular, an understanding of appropriate supervision practices. This scoping review synthesized academic and grey literature on Lived Experience supervision in Australia, exploring current thoughts on best practices. Four electronic databases were searched, and grey literature was located via Google Advanced searches, contacting Lived Experience experts and conducting web-based desktop searches of key mental health organization websites. Thematic analysis identified and described key characteristics in relation to how supervision is conceptualized and operationalized. Eight peer-reviewed and 46 grey literature documents describing supervision and supervisory practices were analysed. Of these studies, 26 were Lived Experience-led. Analysis revealed four key themes: (i) defining peer supervision, (ii) variability in understanding the purpose of supervision, (iii) approaches to supervision and the need for choice and flexibility, and (iv) qualities and skills of the supervisor. Additionally, the establishment of a national professional organization for peer workers was highlighted to protect the authenticity of Lived Experience roles and develop an effective workforce. Clearly, a sustainable Lived Experience workforce cannot develop in isolation, and mental health nurses, as important allies in mental healthcare, need to work alongside, plan and advocate for appropriate supervision practices for this emerging workforce.

Cynical hostility increases whereas sense of coherence decreases the odds for current suicidal thoughts: A cross-sectional study of the general adult population sample.

Earlier, somatic diseases and mental disorders have been associated with cynical hostility as well as sense of coherence, but there is a gap of knowledge, whether they contribute to suicidality at population level. A random sample of adults, representative of the general population living in Finland, participated in a nationwide health examination study. For 4387 participants aged 18-97 years, we analyzed, after controlling for confounding factors, whether cynical hostility, as assessed with the 8-item Cook-Medley Hostility Scale, or sense of coherence, as assessed with the 13-item Sense of Coherence Scale, contributed to current suicidal thoughts during the past 7 days as scored on the 25-item Hopkins Symptom Checklist. Suicidal thoughts (current thoughts of ending one's life) were associated significantly with cynical hostility (p < 0.001) as well as with sense of coherence (p < 0.001). Of the specific items of cynical hostility, the item "I am sure that most people do not have problems with lying for their own good" was associated most strongly with current suicidal thoughts (p < 0.001). Cynical hostility predicted current suicidal thoughts in a population-based sample of adults aged 18-97 years. Sense of coherence protected from current suicidal thoughts.

Testing the interpersonal theory of suicide in adolescents: A multi-wave longitudinal study.

Suicide is a major public health crisis among youth. Several prominent theories, including the Interpersonal Theory of Suicide (IPTS), aim to characterize the factors leading from suicide ideation to action. These theories are largely based on findings in adults and require testing and elaboration in adolescents. Data were examined from high-risk 13-18-year-old adolescents (N = 167) participating in a multi-wave, longitudinal study; 63% of the sample exhibited current suicidal thoughts or recent behaviors (n = 105). The study included a 6-month follow-up period with clinical interviews and self-report measures at each of the four assessments as well as weekly smartphone-based assessments of suicidal thoughts and behaviors. Regression and structural equation models were used to probe hypotheses related to the core tenets of the IPTS. Feelings of perceived burdensomeness were associated with more severe self-reported suicidal ideation (b = 0.58, t(158) = 7.64, p < .001). Similarly, burdensomeness was associated with more frequent ideation based on weekly smartphone ratings (b = 0.11, t(1460) = 3.41, p < .001). Contrary to IPTS hypotheses, neither feelings of thwarted belongingness, nor interactions between burdensomeness and thwarted belongingness were significantly associated with ideation (ps > .05). Only elevated depression severity was associated with greater odds of suicide events (i.e., suicide attempts, psychiatric hospitalizations, and/or emergency department visits for suicide concerns) during the follow-up period (OR = 1.83, t(158) = 2.44, p = .01). No effect of acquired capability was found. Perceptions of burdensomeness to others reflect a critical risk factor for suicidal ideation among high-risk adolescents. Null findings with other IPTS constructs may suggest a need to adopt more developmentally sensitive models or measures of interpersonal and acquired capability risk factors for youth. Refining methods and theoretical models of suicide risk may help improve the identification of high-risk cases and inform clinical intervention.

Implementing diagnostic stewardship to improve diagnosis of urinary tract infections across three medical centers: A qualitative assessment.

Urine-culture diagnostic stewardship aims to decrease misdiagnosis of urinary tract infections (UTIs); however, these interventions are not widely adopted. We examined UTI diagnosis and management practices to identify barriers to and facilitators of diagnostic stewardship implementation. Using a qualitative descriptive design, we conducted semistructured interviews at 3 Veterans' Affairs medical centers. Interviews were conducted between November 2021 and May 2022 via Zoom videoconferencing using an interview guide and visual prototypes of proposed interventions. Interviewees were asked about current practices and thoughts on proposed interventions for urine-culture ordering, processing, and reporting. We used a rapid analysis matrix approach to summarize key interview findings and compare practices and perceptions across sites. We interviewed 31 stakeholders and end users. All sites had an antimicrobial stewardship program but limited initiatives targeting appropriate diagnosis and management of UTIs. The majority of those interviewed identified the importance of diagnostic stewardship. Perceptions of specific interventions ranged widely by site. For urine-culture ordering, all 3 sites agreed that documentation of symptomology would improve culturing practices but did not want it to interrupt workflow. Representatives at 2 sites expressed interest in conditional urine-culture processing and 1 was opposed. All sites had similar mechanisms to report culture results but varied in perceptions of the proposed interventions. Feedback from end users was used to develop a general diagnostic stewardship implementation checklist. Interviewees thought diagnostic stewardship was important. Qualitative assessment involving key stakeholders in the UTI diagnostic process improved understanding of site-specific beliefs and practices to better implement interventions for urine-culture ordering, processing, and reporting.

Assessing the performance of QSP models: biology as the driver for validation.

Validation of a quantitative model is a critical step in establishing confidence in the model's suitability for whatever analysis it was designed. While processes for validation are well-established in the statistical sciences, the field of quantitative systems pharmacology (QSP) has taken a more piecemeal approach to defining and demonstrating validation. Although classical statistical methods can be used in a QSP context, proper validation of a mechanistic systems model requires a more nuanced approach to what precisely is being validated, and what role said validation plays in the larger context of the analysis. In this review, we summarize current thoughts of QSP validation in the scientific community, contrast the aims of statistical validation from several contexts (including inference, pharmacometrics analysis, and machine learning) with the challenges faced in QSP analysis, and use examples from published QSP models to define different stages or levels of validation, any of which may be sufficient depending on the context at hand.