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Fox, Kathryn

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Fox

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Kathryn

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Fox, Kathryn
Author's Publications: search.filters.isAuthorOfPublication.96e02093-c067-4c4a-bad6-fb42efbcb6ae

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Now showing 1 - 4 of 4
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    Examining the role of sex in self-injurious thoughts and behaviors
    (Elsevier BV, 2017) Fox, Kathryn; Millner, Alexander; Mukerji, Cora; Nock, Matthew
    Self-injurious thoughts and behaviors (SITBs), including nonsuicidal self-injury, suicidal thoughts, suicide attempts, and suicide death exhibit substantial sex differences. Across most countries, men die by suicide more frequently than women; yet, women think about and attempt suicide more frequently than men. Research on sex differences in nonsuicidal self-injury is less developed; however, nonsuicidal self-injury is historically understood as a primarily female phenomenon. This review describes current research on sex differences across SITBs with a focus on factors that moderate these effects, such as age, race, geographic region, and time. Additionally, this review describes factors that may help to explain why sex differences across SITBs exist, including differences in culture, access to lethal suicide methods, rates of mental illness, and utilization of health care. The role of gender, and particularly non-binary gender, is also discussed. Current understanding of these sex differences is described with an eye toward future research on this topic.
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    Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: A meta-analytic review
    (Elsevier BV, 2016) Bentley, Kate H.; Franklin, Joseph C.; Ribeiro, Jessica D.; Kleiman, Evan; Fox, Kathryn; Nock, Matthew
    Suicidal thoughts and behaviors are highly prevalent public health problems with devastating consequences. There is an urgent need to improve our understanding of risk factors for suicide to identify effective intervention targets. The aim of this meta-analysis was to examine the magnitude and clinical utility of anxiety and its disorders as risk factors for suicide ideation, attempts, and deaths. We conducted a literature search through December 2014; of the 65 articles meeting our inclusion criteria, we extracted 180 cases in which an anxiety-specific variable was used to longitudinally predict a suicide-related outcome. Results indicated that anxiety is a statistically significant, yet weak, predictor of suicide ideation (OR=1.49, 95% CI: 1.18, 1.88) and attempts (OR=1.64, 95% CI: 1.47, 1.83), but not deaths (OR=1.01, 95% CI: 0.87, 1.18). The strongest associations were observed for PTSD. Estimates were reduced after accounting for publication bias, and diagnostic accuracy analyses indicated acceptable specificity but poor sensitivity. Overall, the extant literature suggests that anxiety and its disorders, at least when these constructs are measured in isolation and as trait-like constructs, are relatively weak predictors of suicidal thoughts and behaviors over long follow-up periods. Implications for future research priorities are discussed.
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    Meta-analysis of risk factors for nonsuicidal self-injury
    (Elsevier BV, 2015) Fox, Kathryn; Franklin, Joseph C.; Ribeiro, Jessica D.; Kleiman, Evan; Bentley, Kate H.; Nock, Matthew
    Nonsuicidal self-injury (NSSI) is a prevalent and dangerous phenomenon associated with many negative outcomes, including future suicidal behaviors. Research on these behaviors has primarily focused on correlates; however, an emerging body of research has focused on NSSI risk factors. To provide a summary of current knowledge about NSSI risk factors, we conducted a meta-analysis of published, prospective studies longitudinally predicting NSSI. This included 20 published reports across 5078 unique participants. Results from a random-effects model demonstrated significant, albeit weak, overall prediction of NSSI (OR = 1.59; 95% CI: 1.50 to 1.69). Among specific NSSI risk factors, prior history of NSSI, cluster b, and hopelessness yielded the strongest effects (ORs > 3.0); all remaining risk factor categories produced ORs near or below 2.0. NSSI measurement, sample type, sample age, and prediction case measurement type (i.e., binary versus continuous) moderated these effects. Additionally, results highlighted several limitations of the existing literature, including idiosyncratic NSSI measurement and few studies among samples with NSSI histories. These findings indicate that few strong NSSI risk factors have been identified, and suggest a need for examination of novel risk factors, standardized NSSI measure ment, and study samples with a history of NSSI.
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    Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies
    (Cambridge University Press (CUP), 2015) Ribeiro, J. D.; Franklin, J. C.; Fox, Kathryn; Bentley, K. H.; Kleiman, Evan; Chang, B. P.; Nock, Matthew
    Background A history of self-injurious thoughts and behaviors (SITBs) is consistently cited as one of the strongest predictors of future suicidal behavior. However, stark discrepancies in the literature raise questions about the true magnitude of these associations. The objective of this study is to examine the magnitude and clinical utility of the associations between SITBs and subsequent suicide ideation, attempts, and death. Method We searched PubMed, PsycInfo, and Google Scholar for papers published through December 2014. Inclusion required that studies include at least one longitudinal analysis predicting suicide ideation, attempts, or death using any SITB variable. We identified 2179 longitudinal studies; 172 met inclusion criteria. Results The most common outcome was suicide attempt (47.80%), followed by death (40.50%) and ideation (11.60%). Median follow-up was 52 months (mean = 82.52, s.d. = 102.29). Overall prediction was weak, with weighted mean odds ratios (ORs) of 2.07 [95% confidence interval (CI) 1.76–2.43] for ideation, 2.14 (95% CI 2.00–2.30) for attempts, and 1.54 (95% CI 1.39–1.71) for death. Adjusting for publication bias further reduced estimates. Diagnostic accuracy analyses indicated acceptable specificity (86–87%) and poor sensitivity (10–26%), with areas under the curve marginally above chance (0.60–0.62). Most risk factors generated OR estimates of <2.0 and no risk factor exceeded 4.5. Effects were consistent regardless of sample severity, sample age groups, or follow-up length. Conclusions Prior SITBs confer risk for later suicidal thoughts and behaviors. However, they only provide a marginal improvement in diagnostic accuracy above chance. Addressing gaps in study design, assessment, and underlying mechanisms may prove useful in improving prediction and prevention of suicidal thoughts and behaviors.