Is Anhedonia a Mediating Factor between Depression and Suicidal and Self-Injury Ideation? Amber T. Pham, Jennifer C. Veilleux, Melissa J. Zielinski, Michael R. Nadorff, & E. Samuel Winer Department of Psychological Science, The University of Arkansas Anhedonia is defined as the loss of interest and pleasure in activities that were once experienced as enjoyable. Changes in anhedonia refer to the amount of pleasure lost or gained over time. 1 High levels of anhedonia are often associated with additional depressive symptoms, and depressed mood and/or anhedonia is required for a clinical diagnosis of Major Depressive Disorder. 2 Suicide attempts, ideation, and self-injury are behaviors often associated with depressive symptoms. 2 Research suggests that different components of depression may differentially influence outcomes. 3 Consistent with past research 3, we believed that anhedonia might account for the relation between depressive symptoms and suicide and self- injury outcomes. Therefore, we hypothesized that anhedonia may be a mediator in the relationship between depression and behaviors often associated with depression. Specifically, we investigated self-injury ideation and behaviors and suicide behaviors as outcome variables. Introduction Recruitment Strategy and Procedure Recruited through Amazon’s Mechanical Turk Pre-screened to select participants who endorsed either a previous suicide attempt or a previous instance of nonsuicidal self-injury (i.e., cutting, carving, burning, or punching oneself without the intent to die). Restricted to workers in the United States participants completed pre-screening surveys 369 were determined to be eligible for this study and were invited to participate. 219 participants (66.2% women) completed the second round of data collection and are included in the present analyses: M age = 32.33, SDage = 9.57, (Range = 18-64) 79% White, 5.9% African American, 5.9% Hispanic, 4.1% Asian American, 5% Others. 31.1% Employed, 41.6% Employed full time, 27.4% Employed part time. Measures Depression Anxiety Stress Scale (DASS) 4 Specific Loss of Interest and Pleasure Scale (SLIPS) 1 Suicide Behaviors Questionnaire-Revised (SBQ-R) 5 Ottawa Self-Injury Inventory-Clinical (OSI) 6 Analytic Strategy We ran four mediational analyses using PROCESS. 7 Depressive symptoms were the focal predictor, changes in anhedonia as the mediator, with self-injury and suicide variables as outcomes. Confidence intervals not including zero are considered statistically significant. Method Results 1.Winer, E. S., Veilleux, J. C., & Ginger, E. (2014) Development and validation of the Specific Loss of Interest and Pleasure Scale (SLIPS). Journal of Affective Disorders, 152, American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. Washington D, C.: APA. 3.Winer, E. S., Nadorff, M. R., Ellis, T. E., Allen, J. G., Herrera, S., & Salem, T. (in press). Anhedonia predicts suicidal ideation in a large psychiatric inpatient sample. Psychiatry Research. 4.Henry, J. D., & Crawford, J. R. (2005). The short ‐ form version of the Depression Anxiety Stress Scales (DASS ‐ 21): Construct validity and normative data in a large non ‐ clinical sample. British Journal of Clinical Psychology, 44(2), Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8(4), Martin, J., Cloutier, P. F., Levesque, C., Bureau, J.-F., Lafontaine, M.-F., & Nixon, M. K. (2013,May 6). Psychometric Properties of the Functions and Addictive Features Scales of the Ottawa Self-Injury Inventory: A Preliminary Investigation Using a University Sample. Psychological Assessment. Advance online publication. doi: /a Hayes, A. F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. New York, NY: Guilford 8.Laye-Gindhu, A., & Schonert-Reichl, K. A. (2005). Nonsuicidal self-harm among community adolescents: Understanding the “whats” and “whys” of self-harm. Journal of Youth and Adolescence, 34(5), References Discussion The analyses revealed that the effect of depression on self- injury ideation and self-injury behavior was not mediated by changes in anhedonia. Interestingly, anhedonia did mediate the relation between depression and the belief that self-injury is helpful, and partially mediated the relation between depression and suicidal ideation. Previous research has indicated that anhedonia accounted for significant variance in suicidal ideation even after accounting for other depressive symptoms in clinical samples. 3 mTurk was not a clinical sample, therefore the sample could be the factor that makes anhedonia not a full mediator for suicide risk. Changes in anhedonia may anger or upset individuals, leading them to have a need to release pain and anger, thus making them think self-injury is helpful. 8 Individuals who engage in nonsuicidal self-injury may do so for a “feeling.” Changes in anhedonia may cause individuals to lose feelings of positive emotions, so instead they prefer to feel anything, even pain, to simply feel something. 8 These results indicate a possible direction for treatment in individuals who engage in self-injury behavior. Future treatments could examine changes in anhedonia and way of thinking to prevent individuals from thinking self-harm is helpful. Through the use of treatment, individuals can find other ways to release pain and emotions and still decrease the amount of self-injury. Future studies could also examine anhedonia mediating depressive symptoms and suicide risk with at-risk samples (e.g., adolescents, inpatients at hospital release) to replicate and extend results found here. Depressive Symptoms AnhedoniaSelf-Injury Ideation Self-Injury Behaviors Depressive Symptoms -- Anhedonia.65**-- Self-Injury Ideation.45**.38**-- Self-Injury Behaviors.22**.19**.35**-- Suicide Ideation.52**.48**.54**.25** Table 5. Pearson Correlations for Study Variables Note: * Significant at the 0.05 level, ** Significant at the 0.01 level EffectSELLCIULCI Direct Effect Indirect Effect Self-Injury Ideation Figure 2. Mediated Model with Self-Injury Ideation as Outcome Anhedonia Self-Injury Behavior Depressive Symptoms X 2 (1, N = 218) = 49.00, Nagelkerke R 2 =.30 Table 2. Direct and Indirect Effects for Model 2 Anhedonia Depressive Symptoms.07(.02)**.57 (.06)**.03 (.01)*.01 (.01) Anhedonia Depressive Symptoms R 2 =.12, F(2, 194) = 12.93, p <.000 Self-Injury Helpfulness.59 (.05)**.03 (.02) EffectSELLCIULCI Direct Effect Indirect Effect (.05)**.08 (.02)**.11 (.02)** Table 1. Direct and Indirect Effects for Model 1 Anhedonia Depressive Symptoms R 2 =.31, F(2, 216) = 49.22, p <.001 Suicide Ideation Figure 1. Mediated Model with Suicide Ideation as Outcome.59 (.05)**. 02 (.02).05 (.02) Table 3. Direct and Indirect Effects for Model 3 Table 4. Direct and Indirect Effects for Model 4 EffectSELLCIULCI Direct Effect Indirect Effect EffectSELLCIULCI Direct Effect Indirect Effect X 2 (1, N = 218) = 11.27, Nagelkerke R 2 =.28 Figure 3. Mediated Model with Self-Injury Behavior as Outcome Figure 4. Mediated Model with Self-Injury Helpfulness as Outcome