am i really here?

4/14/2021

1

am i really here?Dissociation in Daily Life and Adolescent Suicide Risk

Vera Vine, Sarah E. Victor, Harmony Mohr, Amy L. Byrd & Stephanie Stepp

University of Pittsburgh

NASSPD 2021

• 2nd leading cause of death

• 3/4 of adolescents’ suicide ideation may go undisclosed

• Prevention requires understanding related, more readily reportable experiences

Suicide in Adolescence

Curtin & Heron, 2019; Heron, 2016; Pisani et al., 2012

1

2

4/14/2021

2

Dissociation• “disruptions and/or discontinuities in the

normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior”

• Subjective experience can include• Derealization

• Depersonalization, incl. numbness

APA, 2013

Dissociation• Most well characterized in adults

• Mostly via questionnaire (c.f., Greene, 2018)

• Normative and pathological

• Inconsistent factor structure

• Unclear phenomenological boundaries:• Boredom?

• Emptiness?

Holtgraves & Stockdale, 1997; Lyssenko et al., 2018; Ruiz et al., 2008; van Isjendoorn &

Scheungel, 1996; Xavier et al., 2018; Keisel & Lyons, 2001; Tolmunen et al., 2007

3

4

4/14/2021

3

Dissociation• Formerly: the unconscious enactment of suicide

• Today: • Response to acute stress

• Part of acute suicidal state

• Possible motivator of self-harm

• Associated with higher lethality suicidal behavior

Blasco-Fontecilla et al., 2015; Calati et al., 2017; Frankl, 1969; Galynker, 2016; Janet,

1889; Oberndorf, 1950; Sar, 2014; Sar et al., 2011; Walzer, 1968

Suicide & Dissociation in a Transdiagnostic Landscape• Suicide is associated with psychopathology pervasively, but…

• Psychopathology is a poor predictor of suicide

• Suicide-specific processes are hard to distinguish

• Dissociation confounded with other feeling states?

Nock et al., 2019

5

6

4/14/2021

4

Research Questions

1. Can we capture adolescents’ dissociation in daily life with EMA?

2. Does dissociation in a daily life context characterize adolescents with elevated suicide risk?

3. Is dissociation in daily life associated with adolescent suicide risk independently of:• Psychopathology?

• Related affective states?

• Exploratory: contextual effects of demographic characteristics

Adolescent Participants (N = 162)

• Aged 11 – 13

• 47% Female

• 41% African American, 16% Biracial, 4% Hispanic

• 80% (n = 129) on public assistance

• Clinically referred & oversampled for emotion dysregulation

7

8

4/14/2021

5

Elevated Suicide Risk

• A history of suicidal or self-harming thoughts or behaviors

• As indicated in any assessment method (interview, questionnaire, EMA)

• As reported by any informant (adolescent, primary caregiver)

EMA Protocol

• 10 Prompts total

• 4 consecutive days (2 weekend days)• Mon & Fri 4pm, 8pm

• Sat & Sun 12pm, 4pm, 8pm

• Avg compliance: 90.2% of prompts

9

10

4/14/2021

6

*Originally coded 0 = not at all, 4 = a lot

Measuring Dissociation in Daily Life ITEM RATING FREQUENCY

(n of adolescents)

1. Since [last prompt], have you felt spaced out or numb?

0 = no, 1 = yes 43 (26.5%)

2. During the past 15 minutes, how much have you felt empty?

0 = no, 1-4 = yes* 59 (36.4%)

3. Since [last prompt], have you felt as though you were in a dream?

0 = no, 1 = yes 39 (24.1%)

4. Since [last prompt], have you had thoughts about whether or not you even existed?

0 = no, 1 = yes 27 (16.7%)

Measuring Dissociation in Daily Life

Discarded item: During the past 15 minutes, how much have you felt bored?

0 = no, 1-4 = yes* 147 (90.7%)

*Originally coded 0 = not at all, 4 = a lot

11

12

4/14/2021

7

χ2(2)=2.34, p=.310 RMSEA=.03, 90% CI [.00, .16] CFI=1.00, TLI=0.99

x

Coefficients are standardized.

Modeling Dissociation in Daily Life


Female gender

Public assistance

Modeling Approach

SUICIDE RISK

NONREDUNDANT BPD SEVERITY

DAILY NA

DAILY PA

13

14

4/14/2021

8

Daily Life Dissociation and Elevated Suicide Risk

1



Female gender

Public assistance

Main Results


x

Results – Additional Psychopathology Covariate


DAILY NA

DAILY PA

DAILY LIFE DISSOCIATION

SUICIDE RISK

4-DAY RISK (EMA)

15

16

4/14/2021

9

Results – 4-Day Suicide Risk (EMA Items Only)

4-DAY RISK (EMA)


DAILY NA

DAILY PA


Results – BOYS ONLY


DAILY NA

DAILY PA


SUICIDE RISK

17

18

4/14/2021

10

Results – GIRLS ONLY


DAILY NA

DAILY PA


SUICIDE RISK

Summary

• We can capture individual differences in adolescents’ dissociation using EMA in daily life• Trait-like, significant variance was between subjects

• Not informed by ratings of boredom

19

20

4/14/2021

11

Summary

• Dissociation in daily life was associated with elevated suicide risk (i.e., history of suicide/self-harm thoughts and behaviors)oCompared to their also clinically referred peers

oRobust against effects of daily affect

o Especially in girls

o “Emptiness” as a relatively unique, suicide-relevant indicator?

Future Directions

• Multilevel structure of dissociation experiences

• Dissociation as a _____ of suicide risk? • Precursor?

• Causal factor?

• Useful marker?

→ Temporal ordering & proximity experiences in time?

• Psychophysiology of dissociation

21

22

4/14/2021

12

Thank you [email protected]

• Chair & Discussant, Drs. Lori Scott and Tina Goldstein

• National Institute of Mental Health (MH101088, PI: Stephanie Stepp;MH018951, PI: David Brent)

• Emotion & Personality Development Group, University of Pittsburgh

23

Documents

am i really here?