The Association between Anhedonia, Suicidal Ideation, and Suicide Attempts in a Large Student Sample

Winer, E. Samuel; Drapeau, Christopher W; Veilleux, Jennifer C.; Nadorff, Michael R.

doi:10.1080/13811118.2015.1025119

Cited by 70 publications

(72 citation statements)

References 27 publications

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“…A recent study by Winer and colleagues similarly found that anhedonia independently predicted suicidal ideation in an inpatient sample of adults even when controlling for cognitive and affective depressive symptoms (Winer et al, 2014); specifically, reductions in anhedonia symptoms were associated with fewer suicidal thoughts at discharge from the hospital setting, highlighting the potential role of anhedonia as a treatment target. Similar results were found in a sample of college students (Winer et al, 2016). However, additional controlled investigations exploring the relationship between suicide and anhedonia are needed, given that there is presently no rapid-acting treatment for either.…”

Section: Introductionsupporting

confidence: 88%

Anhedonia as a clinical correlate of suicidal thoughts in clinical ketamine trials

Ballard

Wills

Lally

et al. 2017

Journal of Affective Disorders

107

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Background Identifying clinical correlates associated with reduced suicidal ideation may highlight new avenues for the treatment of suicidal thoughts. Anhedonia occurs across psychiatric diagnoses and has been associated with specific neural circuits in response to rapid-acting treatments, such as ketamine. This analysis sought to evaluate whether reductions in suicidal ideation after ketamine administration were related to reduced levels of anhedonia, independent of depressive symptoms. Methods This post-hoc analysis included treatment-resistant patients with either major depressive disorder (MDD) or bipolar disorder (BD) from several clinical trials of ketamine. Anhedonia was assessed using a subscale of the Beck Depression Inventory (BDI) and the Snaith-Hamilton Pleasure Scale (SHAPS). The outcome of interest was suicidal ideation, as measured by a subscale of the Scale for Suicide Ideation (SSI5), one day post-ketamine administration. Results Anhedonia, as measured by the SHAPS, was associated with suicidal thoughts independent of depressive symptoms both before and after ketamine administration. One day post-ketamine administration, improvements on the SHAPS accounted for an additional 13% of the variance in suicidal thought reduction, beyond the influence of depressive symptoms. The BDI anhedonia subscale was not significantly associated with suicidal thoughts after adjusting for depressive symptoms. Limitations Data were limited to patients experiencing a major depressive episode and may not be generalizable to patients experiencing an active suicidal crisis. Conclusions Suicidal thoughts may be related to symptoms of anhedonia independent of other depressive symptoms. These results have implications for the potential mechanisms of action of ketamine on suicidal thoughts.

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Section: Introductionsupporting

confidence: 88%

Anhedonia as a clinical correlate of suicidal thoughts in clinical ketamine trials

Ballard

Wills

Lally

et al. 2017

Journal of Affective Disorders

107

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“…The heightened relationship between anhedonia and depression (and, to a lesser extent, anxiety) was elevated in part because we were assessing recent changes in anhedonia, which have previously been found to be associated with other virulent depressive symptoms (Joiner et al, 2003; Winer et al, 2016b; Winer et al, 2014a; Winer et al, 2014b). Increase in anhedonia is thus distinguishable from trait physical anhedonia (Shankman et al, 2010), and is likely more associated with anticipatory than consummatory disturbance (Thomsen, 2015; Winer et al, 2014b).…”

Section: Discussionmentioning

confidence: 99%

“…Participants ( N = 747) completed measures online as part of a larger study (Nadorff et al, 2014; Winer et al, 2016a; Winer et al, 2016c) in exchange for course credit. Participants who completed all questionnaires ( N =652) were included, and the sample consisted of 43% males and 57% females, ages 18–22 ( M = 18.9, SD = 1.43).…”

Section: Methodsmentioning

confidence: 99%

“…Anhedonia may be considered a stable personality trait or a change that indicates increased psychopathology (Loas, 2014; Thomsen, 2015; Winer et al, 2014b). Increases in anhedonia may be uniquely associated with other symptoms of depression, as they have been found to predict suicidality and severe depressive symptoms (Winer et al, 2016c; Winer et al, 2014a). Moreover, anhedonia could indicate the start of a process of reward devaluation (Winer and Salem, 2016); that is, a downward pattern of avoiding positivity associated with other depressogenic biases and poor outcomes (Bartoszek and Winer, 2015; Carvalho and Hopko, 2011; Winer et al, 2011).…”

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confidence: 99%

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Mapping the relationship between anxiety, anhedonia, and depression

Winer

Bryant

Bartoszek

et al. 2017

Journal of Affective Disorders

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Introduction Anxiety and depression are often comorbid conditions, but there is uncertainty as to how this comorbidity develops. Thus, in three studies, we attempted to discern whether anhedonia may be a key linking factor between anxiety and depression. Methods Three studies asked participants about their symptoms of anxiety and depression: in Study 1, 109 participants completed measures of anxiety, depression, activity avoidance, and perceived enjoyability and importance of avoided activities; in Study 2, 747 participants completed measures of anhedonia, anxiety, depression, and defensiveness; in Study 3, 216 participants completed measures assessing the same constructs as in Study 2 at four time-points (ranging 11 months in span). Results In Study 1, symptoms of anxiety and depression were only positively related in individuals who relinquished potential enjoyment due to their anxiety-related avoidance; in Study 2, the indirect effect of anhedonia helped explained how anxiety symptoms imparted risk onto depressive symptoms; and in Study 3, anxiety led to anhedonia and then depression over time and anhedonia led to anxiety and then depression at both 5 and 11 months. Limitations The manuscript is limited by the use of a student sample in study 2, cross-sectional methods in studies 1 and 2, and reliance on self-ratings in studies 2 and 3. Conclusions Anxiety may devolve into depression through anhedonia, such that anxious individuals begin to lose pleasure in anxiety-provoking activities, which results in the development of other depressive symptoms.

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“…Individuals experiencing anhedonia can have difficulty motivating themselves to pursue rewarding stimuli, thus causing dysfunction. Recent changes in anhedonia—that is, the loss of interest or pleasure—may be especially associated with depression [6–8]. This is because a loss signals that a person previously enjoyed and/or had interest in certain activities or social settings (i.e., had a functioning reward system), but that he or she is now getting less reward from those experiences [9,10].…”

Section: Introductionmentioning

confidence: 99%

Struggling toward reward: Recent experience of anhedonia interacts with motivation to predict reward pursuit in the face of a stressful manipulation

et al. 2017

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Anhedonia, or the loss of interest and/or pleasure, is a core symptom of depression. Individuals experiencing anhedonia have difficulty motivating themselves to pursue rewarding stimuli, which can result in dysfunction. Action orientation is a motivational factor that might interact with anhedonia to potentially buffer against this dysfunction, as action-oriented individuals upregulate positive affect to quickly motivate themselves to complete goals in the face of stress. The Effort-Expenditure for Rewards Task (EEfRT) is a promising new method for examining differences in motivation in individuals experiencing anhedonia. In the EEfRT, participants choose either easier tasks associated with smaller monetary rewards or harder tasks associated with larger monetary rewards. We examined the relationship between action orientation and EEfRT performance following a negative mood induction in a sample with varying levels of anhedonia. There were two competing hypotheses: (1) action orientation would act as a buffer against anhedonia such that action-oriented individuals, regardless of anhedonic symptoms, would be motivated to pursue greater rewards despite stress, or (2) anhedonia would act as a debilitating factor such that individuals with elevated anhedonic symptoms, regardless of action orientation, would not pursue greater rewards. We examined these hypotheses via Generalized Estimating Equations and found an interaction between anhedonia and action orientation. At low levels of anhedonia, action orientation was associated with effort for reward, but this relationship was not present at high levels of anhedonia. Thus, at low levels of anhedonia, action orientation acted as a buffer against stress, but at high levels, anhedonia debilitated action orientation so that it was no longer a promotive factor.

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The Association between Anhedonia, Suicidal Ideation, and Suicide Attempts in a Large Student Sample

Cited by 70 publications

References 27 publications

Anhedonia as a clinical correlate of suicidal thoughts in clinical ketamine trials

Anhedonia as a clinical correlate of suicidal thoughts in clinical ketamine trials

Mapping the relationship between anxiety, anhedonia, and depression

Struggling toward reward: Recent experience of anhedonia interacts with motivation to predict reward pursuit in the face of a stressful manipulation

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