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Background: Low self-esteem and self-burdensomeness have been proposed as risk factors for suicidal ideation. Yet, self-burdensomeness may be more relevant to suicidal ideation than low self-esteem. The purpose of the present study was to investigate the association between self-esteem, self-burdensomeness, and suicidal ideation in a sample of adult outpatients. Methods: Data from N = 202 patients (66.3% female; age: M[SD] = 39.87 [13.31], range: 19–73) who started therapy at an outpatient clinic were collected. A subsample of n = 111 patients (68.5% female; age: M[SD] = 38.50 [13.48], range: 20–73) also took part in a second assessment three-months later. Results: Self-burdensomeness was shown to predict suicidal ideation concurrently and prospectively – after controlling for age, gender, depression, and self-esteem. Furthermore, self-burdensomeness completely mediated the association between self-esteem and suicidal ideation. However, the reverse relationship, where the association between self-burdensomeness and suicidal ideation is mediated by self-esteem, was not supported. Conclusions: Self-burdensomeness might be understood as a driver of suicidal ideation. Findings point to the possibility that a focus on self-burdensomeness and/or low self-esteem might be relevant in the treatment of suicidal patients. [ABSTRACT FROM AUTHOR]

Previous suicide attempts, psychopathology symptoms, and pain significantly increase risk of suicide, a leading cause of death. It is possible that patients across these three groups exhibit key differences that could provide insights into unique interventions for suicide-related outcomes. Data were collected using a standardized form at 432 emergency departments (EDs; 14,018 participants [females, n = 8,042; 57.4%; males, n = 5,976; 42.6%]). We conducted a series of ANOVAs to investigate if patients presenting for (1) suicide attempts (n = 33; 0.2%), (2) psychopathology symptoms (n = 1,104; 7.9%), or (3) pain (n = 12,881; 91.9%) varied across a variety of healthcare-relevant variables. Findings indicated that patients presenting with suicide attempts were seen with more urgency (F[2,12054] = 66.41, p <.001) and were more likely to be admitted to hospitalization (F[2,14015] = 187.296, p <.001), observation unit overall (F[2,14015] = 78.572, p <.001), or transferred to another hospital (F[2,14015] = 406.568, p <.001); they also required longer visits (F [2, 12054] = 66.41, p <.001) as compared to patients with psychopathology symptoms or pain. Notably, potentially important similarities between groups emerged: groups did not differ across leaving without medical screening, leaving against medical advice, or contact with healthcare providers in the long-term (i.e., twelve months) or short-term (i.e., 72 hours) preceding ED admission. These findings in particular indicate that there could be ample time (1) prior to admission to intervene and (2) during care in EDs to connect patients to goal-oriented, time-limited evidence based psychotherapies at a time when they may be particularly willing to engage in care. [ABSTRACT FROM AUTHOR]

In this overview, I consider the gregariousness of human nature and use it as context for the five articles in this special issue on suicidality. I point out that these five papers represent the diversity in concepts and methods characteristic of a young science, decades away from maturity. Nevertheless, I contend that there are commonalities in suicidality specifically and human experience more generally, and that themes like human sociality may serve as a heuristic in understanding them and in preventing the deaths by suicide. [ABSTRACT FROM AUTHOR]

AbstractSuicide a leading cause of death among adolescents and is nearly always preceded by suicidal ideation (SI). Concerningly, SI during adolescence is not uncommon, as it is reported by as much as 20% of American youth. As such, SI in adolescence has been the subject of substantial research. Literature points to anger in adolescence as a relatively strong correlate of SI. However, work is limited, focusing on cross-sectional associations between anger in adolescence and SI and conceptualizing anger as a broad construct, failing to investigate the many narrow facets that comprise it. We address these gaps by investigating anger in adolescence as a (1) cross-sectional and (2) prospective correlate of SI and (3) investigating broad versus narrow conceptualizations of anger in adolescence as they relate to SI. Among two samples (Study 1, nationally representative community-based youth, n = 1,729; Study 2, high-risk juvenile justice involved youth, n = 1,406), anger in adolescence was cross-sectionally related to SI. However, when controlling for SI at baseline, anger in adolescence was not a prospective risk factor for SI at follow-up, nine years later. Finally, narrow facets of anger (e.g., argumentative, defiant, irritable, resentful, spiteful) were not more closely related than broad conceptualizations of anger to SI. These findings indicate that while anger in adolescence is cross-sectionally associated with SI, it should not necessarily be viewed as a valid risk factor for development of SI over the course of nearly a decade. Further, findings did not elucidate any narrow facets of anger that are particularly linked with SI. [ABSTRACT FROM AUTHOR]

The documentary film Robin's Wish aims to reclaim the media scrutiny around Robin Williams' death, fixating on causation being solely attributed to a postmortem diagnosis of which Williams was unaware—Lewy Body Dementia. The film and other sources as well defined and animated the view that Williams' death by suicide was fully a result of this medical condition, dismissing any possible role for mental disorders. The need to distance from mental disorders can have a palpable undercurrent of stigmatization of them; the documentary missed the opportunity to make its point and simultaneously build allyship with others who have lost someone to suicide who were clearly battling a mental disorder. In this context, we emphasize the importance of looking at causation mediationally (e.g., a neurological condition triggering a major depressive episode culminating, in turn, in death by suicide). Only through encompassing all elements and complexities of the human spirit and condition can we appropriately pay tribute to those we have lost to suicide and simultaneously de-stigmatize mental disorders. [ABSTRACT FROM AUTHOR]

Objective: Psychotherapy access, utilization, retention, and effectiveness require continued improvement, especially for groups for whom availability and outcomes may be currently suboptimal, including ethnoracial minorities. Further, ethnoracial status' intersectionality with other identity variables (e.g., gender) may relate to structural barriers to care and effectiveness of care, an area in need of further research. Method: The Florida State University Psychology Clinic, a low-cost population-facing treatment center, has routinely collected clinically relevant information on all consenting clients, including severity of clinical presentation at intake and over time, number of therapy sessions attended and of no-shows, premature termination, demographics, etc. A large sample of clients (N = 2,076; 57% women; 67.9% non-Hispanic White) on whom we collected and entered at least some data, though missing data were common, has accrued. We conducted chi-square tests to examine treatment utilization gaps, analysis of variance to measure differences in intake severity, and analysis of covariance to measure differences in treatment effectiveness. Results: Based on the percentages of ethnoracial minority groups with mental disorders in the broader local community, we are falling short in outreach to Black clients, and when we do engage them, we retain them suboptimally. Once well engaged, however, results across groups suggest few differences in outcomes by ethnoracial status, gender, or their intersection. Ethnoracial match was associated with more sessions attended in Black people. Conclusions: Psychotherapy effectiveness has the potential to be optimized for everyone, and a promising direction in this regard is the case conceptualization of a cultural formulation interview and cultural humility mindset. What is the public health significance of this article?: More than ever, in the wake of the COVID-19 pandemic, communities of color need both outreach and effective treatment. This study strongly suggests that once well engaged, psychotherapy effectiveness can be optimized for everyone, particularly in regard to ethnoracial and gender identity. This shows promise around the case conceptualization of a cultural formulation interview and cultural humility mindset. Through better understanding of how clients' various social and cultural identities impact treatment outcomes, these findings can continue to pave the way for more inclusive, culturally informed, and effective treatment for those who need it most. [ABSTRACT FROM AUTHOR]

Objective: Suicidality is known to be elevated among people with an eating disorder. The aim of the current study was to examine whether any of three specific behavioral facets of eating disorders (i.e., purging, binge eating, restricting) would be the strongest predictors of suicidal ideation, controlling for one another, in longitudinal analyses from admission to discharge. We hypothesized that purging, above and beyond restricting or binge eating, would be the most important predictor of suicidal ideation. Method: In the present study, patients with an eating disorder (N = 936), the majority of whom met criteria for a current DSM‐5 diagnosis of Anorexia Nervosa (n = 560), completed the Eating Pathology Symptoms Inventory (EPSI) and the Beck Depression Inventory II‐Item 9 suicidal ideation index, at admission and again at discharge. The settings were eating disorder treatment facilities offering inpatient, residential, partial hospitalization program (PHP), and intensive outpatient (IOP) levels of care. We pitted EPSI purging, EPSI restriction, and EPSI binge eating against one another in a regression framework predicting discharge suicidal ideation controlling for suicidal ideation at admission. Results: EPSI Purging significantly predicted both presence/absence of suicidal ideation (β =.22, t = 2.48, p =.01; OR = 1.25, 95% CI [1.05, 1.49]) and intensity of suicidal ideation (β =.04, t = 2.31, p =.02) at discharge, whereas neither EPSI Restricting nor EPSI Binge Eating did (p >.30). Discussion: Study results suggest that purging may have particular relevance in estimating suicide risk in patients with an eating disorder. [ABSTRACT FROM AUTHOR]

In the frame of the interpersonal psychological theory of suicide (IPTS), Interpersonal Needs Questionnaire (INQ-15) assesses thwarted belongingness (TB) and perceived burdensomeness (PB), related to suicidal ideation (SI); Acquired Capability for Suicide Scale–Fearlessness About Death (ACSS-FAD) measures this component which contributes to lethal self-harm. The objective was to evaluate the psychometric properties of INQ-15 and ACSS-FAD in a population of Italian university students. Since the Italian INQ-15 was already validated, we translated ACSS-FAD through a multistage procedure and administered both to 1,665 Italian university students. Factor analysis confirmed a two-factor-related model of INQ-15, one factor of ACSS-FAD, and good reliability for both. We proved the association between INQ-15 and current SI and between ACSS-FAD and lifetime suicidal planning and/or suicide attempt. The convergent and discriminant validities were in line with those of previous studies. Both tools are valid and reliable to assess the constructs associated with suicide outcomes according to IPTS. [ABSTRACT FROM AUTHOR]

Objective: Suicide attempts and self-injurious behaviors (SIBs) are known to be elevated among people with bulimia nervosa (BN). The aim of the current study was to examine the Interpersonal-Psychological Theory of Suicide (IPTS) as a framework for understanding, assessing, and mitigating suicidal behavior among women with BN. The IPTS suggests that for individuals to enact lethal suicide attempts, they must have both the desire to die (consisting of thwarted belongingness and perceived burdensomeness) as well as the capability to die (often acquired through repeated exposure to provocative or painful experiences). Method: Two-hundred and four women with eating disorders, the majority of whom met criteria for a current DSM-IV diagnosis of BN, completed measures from which proxies for IPTS variables were formed. Bivariate correlations and multiple regressions tested main effects and interactions of study variables. Tests of the difference between dependent correlations probed differential associations between study variables and suicidal ideation versus suicidal behavior. Results and Conclusions: Results yielded considerable but not unalloyed support for the theory, with desire to die variables (particularly perceived burdensomeness) more strongly associating with suicidal ideation than behavior, and the opposite holding true regarding capability. These findings suggest that the IPTS may provide a useful framework for understanding, assessing, and mitigating suicide risk among individuals with BN. [ABSTRACT FROM AUTHOR]

Suicide rates are elevated in individuals with chronic illness, yet few studies have examined risk factors for suicide in this population. Drawing from theoretical models and risk factors identified in the suicide literature more broadly, this article provides a conceptual overview of cognitive (e.g., pain catastrophizing, self-criticism), affective (e.g., emotion dysregulation), interpersonal (e.g., perceived burdensomeness, thwarted belongingness, critical expressed emotion), and behavioral factors that may contribute, at least in part, to the link between chronic illness, and illness-specific factors, and suicidal thoughts and behaviors. We also outline several avenues for future research in this area and provide specific considerations and recommendations for the screening, assessment, and initial intervention of suicide risk within individuals with chronic health conditions. [ABSTRACT FROM AUTHOR]

Older adults experience increased risk for suicide compared to the general population, and the circumstances surrounding the Coronavirus Disease 2019 (COVID-19) may potentiate this risk. We discuss how current COVID-19 pandemic-related policies are likely to harm older adults disproportionately. COVID-19 pandemic social distancing policies and ethical guidelines for COVID-19 treatment may exacerbate experiences of social isolation, perceived expendability, and exposure to suffering, which are related to the 3 main components of the Interpersonal Theory of Suicide (i.e. thwarted belongingness, perceived burdensomeness to society, and capability for suicide). The COVID-19 pandemic poses a drain on services and has drawn ethical debates about policies around treating younger adults first. These experiences may lead older adults to have reduced access to needed medical and psychiatric services and may convey damaging messages of expendability. Furthermore, the potential prolonged stress associated with the COVID-19 pandemic may affect neurological, immunological, and health functioning—exacerbating suicide risk. Potential venues to increase treatment options and decrease social isolation are discussed. We acknowledge optimistic effects as well, such as "pulling together" as a society and the many valuable ways older adults may contribute during this crisis. [ABSTRACT FROM AUTHOR]

To date, the field has been unable to provide a definitive answer on which suicide risk assessment measure or set of measures is most useful in applied clinical settings. This study pits several psychometrically sound suicide risk assessment measures against one another, to determine which tool optimally assesses the likelihood of future suicide-related outcomes over a 3-month period, in a large sample of military personnel seeking and/or referred to services due to suicide risk concerns. The risk assessment measures were (a) Columbia-Suicide Severity Rating Scale; (b) Self-Harm Behavior Questionnaire; (c) Suicidal Behaviors Questionnaire-Revised; and (d) Beck Scale for Suicide Ideation. A total of 1,044 suicidal military service members completed baseline assessments, of whom 758 (72.6%) completed 3-month follow-up assessments. The data indicate that there is no best measure for suicide risk assessment and clinicians are therefore encouraged to select the measure, from among the four studied, for use in regular practice that best suits the demands of their setting. (PsycInfo Database Record (c) 2021 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Objective: This study aims to document the impact of the COVID‐19 pandemic on mental health. Method: We compared a nationally representative online sample of 2,032 U.S. adults in late April 2020 to 19,330 U.S. adult internet users who participated in the 2018 National Health Interview Survey (NHIS) using the Kessler‐6 scale of mental distress in the last 30 days. Results: Compared to the 2018 NHIS sample, U.S. adults in April 2020 were eight times more likely to fit criteria for serious mental distress (27.7% vs. 3.4%) and three times more likely to fit criteria for moderate or serious mental distress (70.4% vs. 22.0%). Differences between the 2018 and 2020 samples appeared across all demographic groups, with larger differences among younger adults and those with children in the household. Conclusions: These considerable levels of mental distress may portend substantial increases in diagnosed mental disorders and in their associated morbidity and mortality. [ABSTRACT FROM AUTHOR]

Suicidality disproportionately affects Veterans, and in 2020 the Military Health and Well-Being Project was conducted in part to study the link between risk and protective constructs with suicidality among Veterans. In the present study, we investigate the relative contribution of risk (i.e., military self-stigma, daily stress, combat exposure, substance use, traumatic brain injury, and moral injury) and protective constructs (i.e., social integration, social contribution, public service motivation, purpose and meaning, and help-seeking) with suicidality. Using cross-sectional Pearson correlation and linear regression models, we studied the independent and relative contribution of risk and protective correlates in a sample of 1469 Veterans (male: n = 985, 67.1 %; female: n = 476, 32.4 %; transgender, non-binary, prefer not to say: n = 8, 0.5 %). When we investigated protective constructs individually as well as simultaneously, social contribution (β = −0.39, t = −15.59, p < 0.001) was the strongest protective construct against suicidality. Social integration (β = −0.13, t = −4.88, p < 0.001) additionally accounted for significant reduction in suicidality when all protective constructs were considered together. When we investigated the contribution of risk constructs towards suicidality, moral injury was most strongly associated with suicidality (r = 0.519, p < 0.001), yet when studied simultaneously for their relative contribution none of the constructs accounted for a significant amount of the variance in suicidality (| t |s ≤ 1.98, p s ≥ 0.07). These findings suggest that among Veterans it is possible that social contribution is protective against suicidality and could be a possible treatment target for the prevention or reduction of suicidality among Veterans. • Suicidality disproportionately affects Veterans. • We studied the risk and protective constructs for suicidality in Veterans. • Social contribution was associated with the lowest experience of suicidality. • Moral injury was associated with the greatest experience of suicidality. [ABSTRACT FROM AUTHOR]

Inaccurate disclosure of information is a significant limitation when relying on self-report for suicide risk screening. However, allowing for an explicit nondisclosure response option in screening items (e.g., "prefer not to disclose") may ultimately improve follow-up assessment validity. This study investigated explicit nondisclosure in suicide risk screening among military service members and veterans (n = 135), men older than 50 years, (n = 187), and LGBTQ (lesbian, gay, bisexual, transgender, or queer) young adults (n = 140); all higher risk and lower help-seeking populations. Results indicated that allowing for explicit nondisclosure minimally affected screening sensitivity and specificity. However, its selection was prevalent among higher risk participants, and was associated with experience of past unhelpful reactions and "avoidance of stigmatized consequences." Allowing for nondisclosure creates potential psychometric and classification advantages, and may be a safe and effective way to encourage discussion of barriers, build trust, maximize patient autonomy, and ultimately facilitate accurate risk disclosure to improve assessment validity. [ABSTRACT FROM AUTHOR]

Objective: The interpersonal theory of suicide has contributed to advances in the understanding and prevention of suicidal behavior, with over a decade of empirical examination. Few studies, however, have used a longitudinal design with repeated short-term follow-ups to examine the temporal trajectories of perceived burdensomeness, thwarted belongingness, and suicidal ideation, nor have any studies to our knowledge investigated the propositions of the interpersonal theory of suicide using a dynamic systems theory approach. The present study examined the temporal dynamics of perceived burdensomeness, thwarted belongingness, and suicidal ideation, as moderated by capability for suicide, using dynamic systems modeling analyses in a sample of 91 adults at high risk for suicide (Mage = 27.03 years, SD = 8.64; 53.8% female, 44.0% male, 1.1% nonbinary, 1.1% transgender female). Method: Participants completed brief online self-report measures at 6 timepoints, each 3 days apart. Results: Results were generally in support of the interpersonal theory of suicide: perceived burdensomeness, thwarted belongingness, and suicidal ideation exhibited patterns of temporal stability that were accentuated at high levels of capability for suicide; perceived burdensomeness and thwarted belongingness exhibited a reciprocal temporal pattern, as did perceived burdensomeness and suicidal ideation. However, thwarted belongingness did not have an incremental influence on suicidal ideation. Conclusions: Overall, these findings provide additional information about the nature of suicidal ideation and interpersonal risk factors over time and point to nonlinear dynamic systems modeling as an analytic technique that may prove useful in understanding trajectories of suicidal thoughts and behaviors. [ABSTRACT FROM AUTHOR]

Background: The disruptions to daily life caused by the coronavirus disease 2019 (COVID‐19) pandemic may have impacted mental health, particularly mood disorders. This study aimed to compare prevalence rates of anxiety disorder and depressive disorder in national samples in the U.S. before and during the pandemic. Methods: Participants (n = 336,525) were from U.S. Census Bureau‐administered nationally representative probability samples, one from the first half of 2019 and four during the pandemic in April and May 2020. All participants completed the Patient Health Questionnaire‐2 screening for depressive disorder and the Generalized Anxiety Disorder‐2 screening for anxiety disorders. Results: Compared to U.S. adults in 2019, U.S. adults in April and May 2020 were more than three times as likely to screen positive for depressive disorders, anxiety disorders, or one or both, with more than one out of three screening positive for one or both. The prevalence of anxiety decreased slightly between the April 23–May 4, 2020 and the May 21–26, 2020 administrations, while the prevalence of depression increased slightly. Conclusions: U.S. adults in 2020 are considerably more likely to screen positive for mood disorders than in 2019, with anxiety declining and depression increasing from April to May. [ABSTRACT FROM AUTHOR]

The effects of acetaminophen and a reading task on physical pain tolerance and fearlessness about death were tested in 106 undergraduate students. Participants were randomized into four groups, each receiving either acetaminophen or no medication, along with either a control or experimental reading task. It was predicted that acetaminophen would increase pain tolerance and fearlessness about death, that the experimental reading task would decrease both outcomes, and that the interventions would interact (i.e., acetaminophen would dampen the effects of the reading task). Multivariate analysis of variance was used to test hypotheses. No significant interaction was found (p = .17) and there was no effect for acetaminophen (p = .56), but individuals administered the experimental reading task demonstrated significantly higher physical pain tolerance (p < .05). [ABSTRACT FROM AUTHOR]

Background: Suicide-specific rumination, defined as rumination about one's suicidal thoughts, intentions, and plans, and Acute Suicidal Affective Disturbance (ASAD) have each been proposed as relevant and proximal predictors of suicidal behavior. The purpose of the current study was to examine relations between suicide-specific rumination, ASAD, and previous number of lifetime suicide attempts, particularly whether ASAD accounted for the association between suicide-specific rumination and previous lifetime suicide attempts.Methods: Undergraduate students with a past history of suicidality (N = 300) completed measures of their suicide-specific rumination, lifetime ASAD symptoms, and lifetime history of suicide attempts on an online questionnaire in exchange for course credit.Results: ASAD accounted for the association between suicide-specific rumination and lifetime number of past suicide attempts. This effect was particularly driven by suicidal intent aspect of ASAD, as opposed to the ASAD social alienation, self-alienation, and overarousal facets. An alternative model indicated that suicide-specific rumination did not account for the association between ASAD and lifetime past suicide attempts.Limitations: This study utilized exclusively self-report measures and a cross-sectional design, thereby precluding inferences of causality.Conclusions: These findings indicated that ASAD may explain the relationship between suicide-specific rumination and lifetime past suicide attempts. Future research using a prospective design is needed to elucidate these patterns and determine causal relationships. [ABSTRACT FROM AUTHOR]

We reflect on our 2002 article and the impact this research report has had both within and beyond psychological science. This article was both one of the first publications to provide empirical support for hypotheses based on the broaden-and-build theory of positive emotions and a product of the genesis of positive psychology. We highlight empirical and theoretical advancements in the scientific understanding of upward spiral dynamics associated with positive emotions, with particular focus on the new upward spiral theory of lifestyle change. We conclude by encouraging deeper and more rigorous tests of the prospective and reciprocal relations associated with positive emotions. Such progress is needed to better inform translations and applications to improve people’s health and well-being. [ABSTRACT FROM AUTHOR]

Objective: Numerous risk factors have been identified for suicidal ideation, including perceived burdensomeness, thwarted belongingness, agitation, insomnia, nightmares, cognitive anxiety sensitivity, and rumination. However, the complexity of these associations has not been well studied; the magnitude of these effects may vary at differing levels of suicidal ideation. The present study reexamined established risk factors for suicidal ideation using quantile regression, a statistical technique that calculates the effect at numerous quantiles of suicidal ideation, as opposed to the average effect across all quantiles. Method: A sample of 354 psychiatric outpatients (61.3% female, meanage = 27.01 years, standard deviation = 10.40) completed self‐report measures of their suicidal ideation and related risk factors prior to their initial intake appointments. Results: The relationship between each suicide risk factor and suicidal ideation was strongest at higher (.9 quantile), as opposed to nonexistent (.5 quantile) and low‐moderate (.7 quantile), levels of suicidal ideation. The interaction proposed by the interpersonal theory of suicide was significant at nonexistent and low‐moderate, but not high, levels of suicidal ideation. Conclusion: Our findings indicated that predictors of suicidal ideation differed in magnitude at varying levels of suicidal ideation. Implications, limitations, and future research directions are discussed. [ABSTRACT FROM AUTHOR]

Suicide-specific rumination, defined as a mental fixation on one's suicidal thoughts, intentions, and plans, may be an important predictor of suicidal behavior. To date, suicide-specific rumination has demonstrated convergence with, yet distinction from, a variety of suicide risk factors, and differentiated suicide attempters from ideators. However, no research has examined whether suicide-specific rumination is associated with lifetime suicide attempts above and beyond the presence of a host of other relevant suicide risk factors. The present study tested this hypothesis in samples of students ( N  = 300) and community members recruited via Amazon's MTurk ( N  = 209) who reported a lifetime history of suicidal ideation. Results indicated that suicide-specific rumination was associated with the presence of a lifetime suicide attempt, above and beyond a variety of other commonly-cited risk factors for suicidal thoughts and behaviors in both samples, including suicidal ideation, general rumination, interpersonal theory variables, emotion-relevant factors (dysregulation, experiential avoidance, distress tolerance, negative affect), symptoms of depression and anxiety, and overarousal. Overall, though limited by the use of non-clinical samples and a cross-sectional study design, that suicide-specific rumination outperformed all other suicide risk factors in predicting the presence of a lifetime suicide attempt suggests the potential potency of this relatively understudied risk factor in understanding transitions to suicidal behavior. [ABSTRACT FROM AUTHOR]

Background Psychological autopsy studies consistently report that the rate of detected mental disorders among suicide decedents is below 100%. This implies three possibilities: (a) a subset of suicide decedents did not have a mental disorder at the time of death; (b) all suicide decedents suffered from a mental disorder, but some were undetected due to methodological limitations; and/or (c) suicide decedents with an undetected mental disorder displayed significant and perhaps subclinical features of a mental disorder. Objective In this article, we examined these possibilities by evaluating the differences in symptoms and stressors between suicide decedents who were undiagnosed and those diagnosed with a mental disorder at the time of death. Method We reviewed 130 case studies of community-based suicide decedents originally described in Robins' (1981) psychological autopsy study. Results Without exception, suicide decedents in Robins' sample suffered either from a clearly diagnosable mental disorder or displayed features indicative of a significant, even if subclinical, presentation of a mental disorder. Undiagnosed and diagnosed suicide decedents did not significantly differ with regards to demographics, violence of suicide method, suicide attempt history, the number and intensity of stressful life events preceding death, and whether their death was a murder-suicide. Conclusion Although clearly not all who suffer from mental disorders will die by suicide, these findings imply that all who die by suicide appear to exhibit, at minimum, subclinical psychiatric symptoms with the great majority showing prominent clinical symptoms. We conclude with clinical implications and recommendations for future study. [ABSTRACT FROM AUTHOR]

The Interpersonal-Psychological Theory of Suicidal Behavior (IPTS) posits that suicide stems from a motivation to die by suicide, emanating from perceived-burdensomeness and failed belongingness, and a capacity to kill oneself. We propose a bridge between IPTS and dissociation theory/research via a recent reformulation of Melanie Klein's notion of the depressive position, as comprised of three elements: Demeaning affect, compensatory affect-regulatory maneuvers, and mental representation of self-as-deficient and others as judgmental/punitive and at times seductive. This position is formed in childhood, proceeds to adulthood, and is projected into the future with the hope of finding respite from criticism. This hope is then thwarted by the sufferer's interpersonal action leading to interpersonal strife. We posit that, in the Basic Level, a trauma-based, dissociative structure is formed, whereby the reformulated depressive position disengages from benign and benevolent mental processes, in turn creating interpersonal havoc. In the Advanced Level, dissociative mechanisms are utilized to assist the now depressed-suicidal position to succeed in its mission: Killing the self. A chilling case illustration of this pattern is presented and discussed. Clinically, we recommend a routine measurement of both dissociation and suicide risk, and appraisal of the psychodynamic connecting dissociation and suicidality. [ABSTRACT FROM AUTHOR]

Suicide is a widespread public health concern, including among military Veterans. Traumatic brain injuries (TBIs) and lack of social integration have both been shown to increase risk for suicidality, an outcome that includes, among other suicide-related variables, suicidal ideation, suicide attempts, and suicide death. Interestingly, TBIs have also been identified as a risk factor for social integration problems. In this cross-sectional study we investigated associations between TBI, social integration, and suicidality. Additionally, mediation analysis was used to test whether social integration mediated the association between TBI and suicidality. A sample of 1469 military Veterans (male, n = 1004, 67.2 %; female, n = 457, 32.3 %; transgender/non-binary/prefer not to say, n = 8, 0.5 %) completed an online survey as part of the Military Health and Well-Being Project. TBI was negatively associated with social integration (r = −0.084, p <.001) and positively with suicidality (r = 0.205, p <.001). Social integration was negatively associated with suicidality (r = −0.161, p <.001). Finally, social integration partially mediated the relationship between TBI and social integration (B = 0.121, 95 % CI [0.031–0.23]). This work shows that in the context of TBI, lack of social integration may promote suicidality. It provides support for many theories of suicide which propose social problems as a risk factor of suicide-related outcomes. It further highlights social integration as potential fodder for novel interventions for suicidality, an approach that would have transtheoretical support. • Suicide is a leading cause of death in military Veterans. • Social integration and traumatic brain injuries both confer risk for suicidality. • Social integration partially mediates the link between traumatic brain injuries and suicidality. • Social integration could be a point of treatment for Veterans presenting with comorbid TBI and suicidality. [ABSTRACT FROM AUTHOR]

The effect of perceived criticism from others is one potentially important risk factor for suicide that has received scant attention, despite decades of research on the role of criticism in the treatment and course of mental illnesses such as schizophrenia and mood disorders. This study analyzed the effect of perceived criticism's association with suicidal ideation and attempts as well as its connection with the suicide related constructs thwarted belongingness and perceived burdensomeness as described in the Interpersonal Theory of Suicide. Fifty participants (66% female, MAge = 18.7), 18 of whom had previously made one or more suicide attempts, completed a battery of self-report assessments as well as two in-person, structured clinical interviews. Analyses demonstrated that perceived parental criticism is a significant indicator of suicide ideation (β = .297, p = .003) and attempts (β = .373, p < .001) and that perceived criticism from close friends is a significant indicator of suicide attempts (β = .297, p = .006). Perceived criticism has a strong indirect effect on suicide ideation and attempts through its effect on thwarted belongingness, but not perceived burdensomeness, while controlling for mental illnesses. Some limitations of this study include the cross-sectional design and the use of a relatively small, restricted age sample. Treatment designed to mitigate perceived criticism and thwarted belongingness may be an important component in combatting suicidal ideation and attempts, particularly among young adults. [ABSTRACT FROM PUBLISHER]

Rumination has been implicated as a risk factor for suicidal ideation and attempts, yet the literature to date has not been synthesized. We conducted a meta-analysis of the association between rumination and both suicidal ideation and attempts to consolidate the existing literature (k = 29). Results indicated that the relationships between global rumination (k = 13; Hedge's g = .74, p < .001, 95% CI [.45, 1.04]), brooding (k = 12; Hedge's g = .63, p < .001, 95% CI [.35, .90]), and reflection (k = 12; Hedge's g = .38, p = .002, 95% CI [.10, .65]) with suicidal ideation were significant. Associations between global rumination (k = 3; Hedge's g = .26, p < .001, 95% CI [.08, .44]) and brooding (k = 4; Hedge's g = .47, p = .004, 95% CI [.02, .91]) and suicide attempts were significant, but reflection (k = 4; Hedge's g = .09, p = .646, 95% CI [-.54, .72]) was unrelated. However, given the limited studies included in suicide attempt analyses--and the exclusive use of cross-sectional designs and heterogeneity with regard to samples and measures--these parameters should be taken with caution. Generally, age, gender, race/ethnicity, and year of publication were not moderators, and there was little evidence for publication bias across effects, with the exception of the effect of global rumination on suicidal ideation. Several future research directions are discussed. [ABSTRACT FROM AUTHOR]

Objective To identify demographic, diagnostic, and personality factors that predict treatment dropout in a sample of outpatients with clinically significant suicidal ideation. Method A total of 287 adult outpatients at elevated risk for suicide completed self-report measures of demographics, suicidal and depression symptoms, and personality characteristics at treatment intake. Clinician-assessed psychiatric diagnoses and ratings of overall functioning also were collected. Results Lower overall functioning (odds ratio [OR] = .947; 95% confidence interval [CI] [.909, .987]) and the presence of a substance use disorder (OR = 4.543; 95% CI [1.058, 19.499]) were the most robust predictors of attrition. Dropouts also were more likely to have a depressive disorder, more comorbid diagnoses, and more severe depression and suicidal symptoms. Conclusions Findings suggest that clinician-assessed poorer overall functioning and a substance use disorder diagnosis are risk factors for attrition among suicidal individuals, above and beyond other symptom measures. Further research is warranted to investigate attrition in additional outpatient samples. [ABSTRACT FROM AUTHOR]

Research has demonstrated a robust link between traumatic brain injuries (TBIs) and suicide risk. Yet, few studies have investigated factors that account for this link. Utilizing a clinical sample of deployed military personnel, this study aimed to examine a serial meditation model of anger and depression in the association of mild TBI and suicide risk. A total of 149 military service members referred for evaluation/treatment of a suspected head injury at a military hospital participated in the present study (92.6% male; M age = 27.9y). Self-report measures included the Suicidal Behaviors Questionnaire—Revised (SBQ-R), Automated Neuropsychological Assessment Metrics (ANAM) anger and depression subscales, and Behavioral Health Measure-20 depression subscale. A current mild TBI diagnosis was confirmed by a licensed clinical psychologist/physician. Overall, 84.6% (126/149) of participants met diagnostic criteria for a current mild TBI. Bootstrapped serial mediation analyses indicated that the association of mild TBI and suicide risk is serially mediated by anger and depression symptoms (bias-corrected 95% confidence interval [CI] for the indirect effect = 0.044, 0.576). An alternate serial mediation model in which depression symptoms precede anger was not statistically significant (bias-corrected 95% CI for the indirect effect = −0.405, 0.050). Among a clinical sample of military personnel, increased anger and depression statistically mediated the association of mild TBI and suicide risk, and anger appears to precede depression in this pathway. Findings suggest that therapeutically targeting anger may serve to thwart the trajectory to suicide risk among military personnel who experience a mild TBI. Future research should investigate this conjecture within a prospective design to establish temporality. [ABSTRACT FROM AUTHOR]

Borderline personality disorder diagnostic criteria, particularly affective dysregulation and behavioral dysregulation, are avenues through which suicide risk is conferred, though pathways are not well understood. The interpersonal theory of suicide may help elucidate these associations. The current study examined indirect relationships between affective and behavioral dysregulation and suicidal ideation through perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide. 169 outpatients completed measures prior to their intake assessment. Perceived burdensomeness accounted for the relationship between affective dysregulation and suicidal ideation. The acquired capability did not explain the association between behavioral dysregulation and suicide attempt history. Affective and behavioral dysregulation may be key targets in treatment for reducing suicide risk. [ABSTRACT FROM PUBLISHER]

An introduction to articles published within the issue is presented, including one on the applications of machine learning in suicide research and clinical practice, another on the near-term risk factors for suicide and the phenomenology of an acute suicidal crisis, and another on an examination of an instrument designed to measure the severity of suicidal behavior via self-poisoning.

Unlabelled: Utilizing Add Health longitudinal data, we compared 21 male suicide casualties to 10,101 living respondents identifying suicide correlates.Method: 21 suicide decedents completed surveys in 1994/1995 (Wave 1) and 11 completed at Wave 3; responses were compared with Chi-square and oneway ANOVA tests.Results: Suicide decedents were prone to higher delinquency and fighting at Wave 1, but not at Wave 3. At Wave 1 suicide decedents remained undistinguished from living respondents in depression, self-esteem, and drug uses. Yet, after Wave 3, the 11 respondents dying by suicide showed significantly higher depression, drug use and lower self-esteem.Conclusion: Delinquency trends can readily understood, but more complex causes are needed to account for unexpected changes in self-esteem, depression and drug uses. [ABSTRACT FROM AUTHOR]

When perceiving a dangerous predation threat, mammalian and other species activate antipredator defensive reactions. These include the seemingly paradoxical—but compatible—activation of overarousal (e.g., agitation, insomnia) and "shutdown" (e.g., mutism, withdrawal) states. Acute suicidal crises, too, are characterized by the co-occurrence of overarousal and shutdown behaviors. In the minutes, hours, and days prior to one's death by suicide, it is not uncommon for one to be simultaneously agitated and socially withdrawn, states that resemble antipredator defensive reactions. In this article, we present empirical, clinical, and philosophical grist for our conjecture that antipredator defensive reactions may serve as a useful way to understand the phenomenology of a serious suicidal crisis, and we reflect on the implications that soon-to-be suicide decedents are simultaneously killer and victim. [ABSTRACT FROM AUTHOR]

This study was based on a sample of male high school students who completed National Longitudinal Adolescent Health Surveys in 1994, 1995, and 2001. We studied these students prospectively, comparing those who later died by suicide (n = 21) with those who were still living (n = 10,101). We employed chi-square and analysis of variance tests for statistical significance between suicide decedents and living respondents. Results showed suicide decedents were more likely to have experienced the suicide loss of another family member, to have been expelled from school, to have engaged in more delinquent actions including fighting, and to have greater involvement with the criminal justice system. Although one might have expected suicide casualties to have exhibited a greater amount of suicidal thoughts, attempts, and higher incidences of suicidality among their friends, our analyses did not find that these factors were associated with actual suicides. Should these findings be replicated, this would point to a need to refine youth suicide risk assessments. Collecting life histories, as well as identifying patterns of delinquency and fighting, may serve as more potentially fruitful means for assessing genuine suicide risk than some traditional risk assessment methods.z. [ABSTRACT FROM AUTHOR]

Building upon the idea that humans may be a eusocial species (i.e., rely on multigenerational and cooperative care of young, utilize division of labor for successful survival), we conjecture that suicide among humans represents a derangement of the self-sacrificial aspect of eusociality. In this article, we outline the characteristics of eusociality, particularly the self-sacrificial behavior seen among other eusocial species (e.g., insects, shrimp, mole rats). We then discuss parallels between eusocial selfsacrificial behavior in nonhumans and suicide in humans, particularly with regard to overarousal states, withdrawal phenomena, and perceptions of burdensomeness. In so doing, we make the argument that death by suicide among humans is an exemplar of psychopathology and is due to a derangement of the self-sacrificial behavioral suite found among eusocial species. Implications and future directions for research are also presented. [ABSTRACT FROM AUTHOR]

Purpose of the Study: Combat is a risk factor for posttraumatic stress disorder (PTSD); however, less is known about how exposure to combat in early adulthood may contribute to the development of PTSD as the individual ages. Prior exposure to trauma may "sensitize" people to respond more intensely to subsequent stressors. Further, aging initiates new challenges that may undermine previous coping strategies. Over the life course combat veterans may be more reactive to new stressors and thus be more vulnerable to PTSD. Design and Methods: This study draws on the two waves of the National Comorbidity Survey (NCS-1) and NCS-2 (10-year follow-up). Participants were male (noncombat N = 620 and combat N = 107) and 50-65 years of age at Wave-2. At baseline, participants were assessed for exposure to wartime combat, number of Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses in the past year, and life-time PTSD. At follow-up, PTSD occurring between waves was determined. A measure of recent life stressors was also obtained. Results: Using logistic regression analyses, combat predicted PTSD at follow-up (controlling for baseline demographics, number of DSM diagnoses in the past year, life-time PTSD). Recent life stressors were also associated with PTSD. Importantly, the effect of combat on PTSD was significant at high levels, but not low levels, of recent life stress. Implications: Veterans who have experienced combat may be more reactive to new stressors, and in turn be more vulnerable to PTSD. Combat veterans should be regularly assessed for current stressors and PTSD. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the association of the serotonin transporter gene to family history of suicidality. Forty-seven volunteers responded to questionnaires about family history of suicide, and provided buccal swabs for analysis of the polymorphism. Allelic homozygocity (the short variant) was associated with family history of suicidality. These data, to be interpreted with the study's limitations in mind, suggest a link between the serotonin transporter gene polymorphism and suicide-related variables, which should be the focus of future research. [ABSTRACT FROM AUTHOR]

We addressed several questions regarding the relation of anxiety sensitivity to anxious symptoms among 47 youth psychiatric inpatients (18 boys, 29 girls), ages 9-17 (M = 14.23, SD = 1.89). Participants completed measures of anxiety sensitivity, anxious and depressive symptoms, trait anxiety, and positive and negative affect; chart diagnoses were available. Consistent with hypotheses, we found that (a) anxiety sensitivity was associated with anxious symptoms, even controlling for trait anxiety and depressive symptoms; and (b) anxiety sensitivity displayed symptom specificity to anxious versus depressive symptoms (i.e., was associated with anxiety controlling for depression but not with depression controlling for anxiety). Furthermore, regarding factors of anxiety sensitivity, we obtained mixed support for our prediction that phrenophobia would be associated with both depression and anxiety, whereas fear of physical arousal would be associated with anxiety but not depression. Implications for the construct validity of anxiety sensitivity were discussed. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To determine if females with anorexia nervosa (AN) associate emaciation with beauty by examining implicit attitudes toward emaciated bodies relative to thin bodies. Method Thirty women with AN and 29 healthy control women were primed by viewing images of either emaciated or thin women. Participants then completed a lexical decision task (LDT), wherein they distinguished words from nonwords as quickly and accurately as possible. Response times were measured. Real words consisted of beautiful, ugly, neutral, and positive words. Body mass index (BMI) was measured and several clinical interviews were completed, including the Eating Disorders Examination Questionnaire 4 (EDEQ-4). Results There was a significant effect of group in the emaciated condition; participants with AN responded faster to both beautiful and ugly words than control women did. Eating disorder symptom severity (as measured by the EDEQ-4 subscales) predicted the strength of the association between emaciation and beauty. Discussion At an implicit, automatic level, women with AN in this study had stronger associations between emaciation and both beauty and ugliness than control women did, suggesting that women with AN may have atypical beliefs about beauty. Thin ideal internalization is an important factor in the development and maintenance of eating disorders; the type of thin ideal being internalized may be important to consider, particularly given the extent to which pro-eating disorder websites promote idealization of emaciation. The associations found by using the LDT highlight the utility of implicit measures, particularly when conducting assessments involving sensitive or atypical beliefs. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:138-147) [ABSTRACT FROM AUTHOR]

Abstract: Background: Eating disorders are serious psychiatric illnesses with high levels of suicidality and high comorbidity. However, no study has established the extent to which suicidality is uniquely associated with eating disorders rather than attributable to comorbid mood, anxiety, or substance use disorders. The current study examined whether unique associations between eating disorders and suicidality exist and whether potential associations differ by eating disorder diagnosis. Methods: Participants were women (n = 364) from the second stage of a large epidemiological study examining eating and health related attitudes and behaviors. The Structured Clinical Interview for Axis I diagnoses (SCID-I) was used to determine lifetime psychiatric diagnoses and lifetime suicidality. Results: A multiple regression model including eating and comorbid disorders indicated that bulimia nervosa (BN) was significantly associated with suicidality above and beyond risk predicted by comorbid disorders. No unique association was found for anorexia nervosa (AN) or eating disorder not otherwise specified while controlling for comorbidity. Conclusions: BN is independently associated with suicidality, and findings emphasize the need to incorporate suicide risk assessment in standardized assessments of eating disorders. [Copyright &y& Elsevier]

Suicidal and nonsuicidal self-injurious behaviors represent perplexing yet highly prevalent public health problems. Though the behaviors are differentiable, they frequently co-occur. The nature of the association between them, however, remains poorly understood. The interpersonal theory of suicide (Joiner, 2005; Van Orden et al., 2010) offers one viable framework for enhancing our understanding in this domain. In this review, we provide an overview of the literature on nonsuicidal self-injury, its relation to suicidal behavior, and how the interpersonal theory of suicide conceptualizes this relationship. Alternative perspectives and future directions are also discussed. [ABSTRACT FROM PUBLISHER]

The self-help literature promotes the use of positive self-statements (e.g., I'm a lovable person) to boost self-esteem and mood; however, research provides evidence that positive self-statements may be harmful to people with low self-esteem. Prior research has only tested the efficacy of one type of positive self-statement (stable/global), but research on attitude change and self-verification motives suggests that people with low self-esteem may benefit more from using unstable/specific positive self-statements. To test the effect of each type of positive self-statement on self-esteem and mood, a quasi-experiment was conducted in which participants with high and low self-esteem were randomly assigned to either write about a stable/global positive self-statement, unstable specific positive self-statement, or their favorite activity following a laboratory stressor. Results provided evidence that participants with low self-esteem experienced the largest decrease in negative affect if they were assigned to write about their favorite activity, whereas participants with high self-esteem experienced the largest increase in state self-esteem and disguised mood if they were assigned to write about a stable/global positive self-statement following a stressor. These results suggest that factors that confer resilience to individuals with low self-esteem may differ from the factors that confer resilience to individuals with high self-esteem. [ABSTRACT FROM AUTHOR]

Abstract: Research indicates that distress tolerance exhibits a complicated relationship with risk factors for suicidal behavior. Specifically, low self-reported distress tolerance has been linked to perceived burdensomeness and thwarted belongingness. Contrastingly, high self-reported distress tolerance has been linked to the acquired capability for suicide. Given the frequently discrepant findings between self-report and behavioral indices of distress tolerance, we sought to expand upon prior findings by testing these relationships utilizing a behavioral measure of distress tolerance. Additionally, in an effort to further clarify the role of distress tolerance relative to painful and/or provocative experiences in the acquired capability, we examined whether distress tolerance serves as a moderator. Results revealed no significant associations between distress tolerance and burdensomeness or belongingness; however, distress tolerance was positively associated with the acquired capability. Furthermore, the interaction of distress tolerance and painful and/or provocative experiences significantly predicted the acquired capability, with the strength of the association increasing at higher levels of distress tolerance. Results highlight the potential importance of perceived versus actual ability to tolerate distress with respect to suicidal desire. In contrast, the results reflect the importance of actual persistence in the acquired capability. [Copyright &y& Elsevier]

Objective: Using a longitudinal design, the authors of this study examined the relationship between externalizing problems and impulsivity in early childhood and symptoms of disordered eating in late adolescence. Method: Participants were urban, African American first-grade girls (N = 119) and their parents who were participating in a longitudinal study examining the prevention of disruptive behaviors. Impulsivity, conduct problems, and oppositional defiant behavior were assessed by parent report via structured interview questions. At 9-year follow-up, bulimic symptoms were measured by the Eating Disorder Inventory. A hierarchical regression analysis was conducted to determine the longitudinal association among impulsivity, conduct problems, and oppositional defiant behavior and bulimic symptoms. Results: Parental report of impulsivity in first-grade girls, but not conduct problems or oppositional defiant behavior, was associated with self-reported bulimic symptoms in the girls in late adolescence (p < .04). Conclusions: These results extend previous findings of a concurrent relationship between impulsivity and dysfunctional eating behaviors to a minority sample and further indicate that behavioral impulsivity in early childhood may be used to identify children for targeted prevention of disordered eating. [ABSTRACT FROM AUTHOR]

Despite a clear relationship between marijuana use and suicidality, little is known about psychological vulnerability factors that may interact with marijuana use to increase suicidality among this high-risk group. The present study examined the moderational impact of social anxiety on the relationship between marijuana use status (current users vs abstainers) and suicidality among 343 community adults. We also examined whether social anxiety moderated the relation between more frequent use (daily vs less frequent) among the 134 current marijuana users. Although social anxiety did not moderate the relation between use status and suicidality, it did moderate the relation between daily use status and suicidality after controlling for a wide range of relevant variables (e.g., demographics, depression, negative affect, and other types of anxiety). The overall model accounted for 59% of the variance in suicidality such that daily marijuana users with elevated social anxiety reported the highest suicidality. Findings highlight the importance of considering social anxiety in efforts to understand and prevent suicidality among this high-risk population. [Copyright &y& Elsevier]

Abstract: Joiner''s (2005) interpersonal–psychological theory of suicidal behavior posits that an individual must exhibit elevations on three variables – perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide – in order to enact lethal self-harm. Thus far, however, no research has examined the role of emotion in this process or whether the interaction of these three variables is more problematic for certain populations than for others. We sought to address these voids by examining the role of negative urgency as an amplifier of the relationship between the components of the theory and lifetime number of suicide attempts. Results indicated that the four-way interaction of negative urgency and the three components of the theory predicted lifetime number of suicide attempts, controlling for depression symptoms and sex. Additionally, the three-way interaction of the theory components significantly predicted lifetime number of suicide attempts in the full sample. Furthermore, for individuals with negative urgency scores at or above the median, the three-way interaction of the theory components significantly predicted lifetime number of suicide attempts whereas, for individuals with negative urgency scores below the median, the interaction was non-significant. These findings indicate that, although elevations on the three components of the theory may be dangerous for anyone, this is particularly true for individuals exhibiting high levels of negative urgency, as they might be more likely to quickly develop suicidal ideation and resort to painful self-harming behaviors while experiencing negative affective states. [Copyright &y& Elsevier]

The interpersonal-psychological theory of suicidal behavior (Joiner, 2005) holds that an individual will die by suicide if he or she has both the desire for suicide and capability to act on that desire. According to the theory, suicidal desire results from the convergence of two interpersonal states: perceived burdensomeness and thwarted belongingness. However, desire alone is not sufficient to result in death by suicide—a third component must be present: the acquired capability for suicide, which develops from repeated exposure and habituation to painful and provocative events. The purpose of this article is to discuss four viable and timely directions for future research, given the current status of the theory. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65:1–9, 2009. [ABSTRACT FROM AUTHOR]

Abstract: The goal of this study was to examine differences in the factor structure of borderline personality disorder symptoms among different ethnic groups. The authors obtained information regarding ethnic identity and endorsement of borderline personality disorder criteria for an ethnically diverse community sample of 1140 young adult subjects from south Florida. Using this information the authors conducted an exploratory factor analysis examining differences between Caucasian, Hispanic and African American groups. A principal-components factor analysis (PCA) with Varimax rotation for each ethnic group revealed a reasonably generalizable four-factor structure: affective dysregulation, cognitive disturbance, disturbed relatedness and behavioral dysregulation. The emergence of a four-factor structure across three separate, relatively large samples suggests that the factors obtained have merit. However, the loadings of some BPD symptoms, such as impulsivity, varied for each ethnic group. The results of this study indicate that ethnic variations in borderline personality disorder should be considered during assessment and treatment of this disorder. Also, future research should examine if this same factor structure holds for ethnic minorities with BPD diagnoses, examine ethnic differences in the etiology and maintenance of BPD symptomatology, and explore the effects that these differences might have in treatment settings. [Copyright &y& Elsevier]

Theory proposition, empirical evaluation, and resulting support or refutation are core pieces of the scientific process. These steps of theory-testing, however, can be complicated by relative rigidity and dogmatism, in combination with the logistical challenges inherent in conducting comprehensive, real-world tests of theories explicating complex scientific phenomena, especially rare ones. It may be argued that suicide is one such phenomenon, and one for which the field of psychology has struggled to develop satisfactory understanding. One leading theory of suicide, the Interpersonal Theory of Suicide, has garnered attention and, to a considerable degree, has weathered substantial scrutiny. Still, it is arguable that the theory has yet to be tested in full-that is, in accordance with all propositions originally put forth. In this effort, we sought to evaluate the current state of knowledge regarding the Interpersonal Theory of Suicide, as well as to suggest potential directions via which future work may proceed. We draw from the fields of philosophy, psychology, physics, and engineering in the hopes of engendering curiosity and critical thought about the assumptions researchers (ourselves included) bring to their work. We direct particular attention to the role of refutation in theory-testing; the supposed dichotomy of explanatory vs. algorithmic approaches; and the categorization of research programs as progressive vs. degenerative. In doing so, we hope not only to promote these ideas in the study of suicidal behavior but also to empiricists of all creeds and foci. We also include implications for suicide prevention efforts. [ABSTRACT FROM AUTHOR]