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Introduction: Suicide is a leading cause of death. One challenge to prevention efforts is the wide phenomenological heterogeneity in suicidal urges, thoughts, and behaviors across individuals at risk. Despite this heterogeneity, most suicide research estimates group‐level effects by averaging across people as if they were the same, preventing detection of person‐specific factors that may modulate risk and be key to effective prevention. The goal of the present study is to illustrate the idiographic (i.e., person‐specific) approach and highlight its utility for suicide research. Methods: We implemented a case series approach using three cases from a subset of psychiatrically hospitalized adolescents who provided intensive longitudinal data on daily urges and coping behavior after discharge following a suicide attempt. For illustration, person‐specific, bidirectional links between suicidal urges and coping behavior were modeled across a series of cases using a vector autoregression approach. Results: The relationship between suicidal urges and coping differed across the three individuals, who were presented to exhibit the range of this variability in the presence/absence and magnitude of effects. Conclusions: Individuals who report similar suicidal risk levels likely respond in individualized ways to suicidal urges (e.g., use different coping strategies), necessitating personalized assessment and treatment. We discuss implications for future suicide research. [ABSTRACT FROM AUTHOR]

Objective: Sexual and gender minorities are at elevated risk for suicide, yet few studies have examined differences in risk within many sexual and gender minority subgroups. The purpose of this study was to examine differences in prevalence for suicide risk factors among a wide range of sexual orientations and gender identities.Method: Forty-one thousand four hundred and twelve college students (62% cis-female, 37% cis-male, 1% transgender/genderqueer) completed a wellness screen that included four suicide risk factors (depression, heavy alcohol use, suicide ideation, suicide attempt).Results: Gender minority students (i.e., transgender, genderqueer/non-binary) had significantly higher rates of depression, suicide ideation, and suicide attempts relative to cisgender peers, although there were no within-group differences among gender minority students. Adjusted odds ratios for endorsing two or more (2+) suicide risk factors were substantially higher for all sexual minority subgroups relative to heterosexuals. Among sexual minorities, those identifying as pansexual, bisexual, queer, or mostly gay/lesbian had greater odds of endorsing 2+ suicide risk factors relative to students identifying as mostly heterosexual, gay/lesbian, asexual, or 'other sexual minority'. Pansexual students had 33% greater odds of endorsing 2+ suicide risk factors relative to bisexual students.Conclusions: These findings highlight significant variation in suicide risk among sexual minority subgroups and the need for targeted interventions for subgroups at highest risk. [ABSTRACT FROM AUTHOR]

Objective: This study examines the feasibility of a risk-management protocol for adolescent research participants at risk for suicide that relies on engagement with telephone crisis counselors. The study also examines whether engagement is moderated by adolescent demographics and clinical characteristics.Method: Participants were 234 adolescents (83% female; 63% White) ages 12-18 (M = 15.3 years) drawn from the national study, Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) Study One sample of adolescents randomized for 3-month telephone follow-up (n = 2,850). This study's sample was comprised of adolescents who completed the follow-up (69% retention), met study risk criteria, and were transferred to a crisis hotline for risk management. Engagement with a counselor was assessed by successful call connection, call duration, and information sharing.Results: Ninety-four percent of calls resulted in a successful call transfer, and the majority of youth (84%) shared information with counselor about one or more coping strategies. Average call length was 12.6 min (SD = 9.9). Engagement did not vary by gender, race, age, ethnicity, or clinical characteristics.Conclusions: Adolescents' engagement with telephone risk-management services was strong, suggesting that this strategy can address safety. Further, findings suggest telephone risk-management services effectively engage youth across demographic and clinical subgroups. [ABSTRACT FROM AUTHOR]

Objective: Rumination is often cited as a risk factor for suicide, yet few studies of rumination have utilized clinical samples, and no studies have examined its prospective association with suicide attempts. The purpose of this study was to examine concurrent and prospective associations of brooding and reflection (the two components of rumination) with suicide ideation and suicide attempts among a high-risk clinical sample.Method: Participants were 286 adolescents and young adults (77% Caucasian, 59% female) aged 13-25 seeking psychiatric emergency services. A majority (71%) were presenting with a primary complaint of suicide ideation or recent suicide attempt. Participants completed a baseline assessment at the index visit; 226 participants (79%) completed a 4-month follow-up assessment of suicidal thoughts and behaviors.Results: Brooding was associated with lifetime history of one or more suicide attempts, but not concurrent suicide ideation. Reflection was not associated with lifetime suicide attempts or concurrent suicide ideation. Furthermore, prospective associations of brooding and reflection with suicide ideation and suicide attempts were weak-to-small in magnitude and statistically nonsignificant.Conclusions: Rumination appears to have a limited association with suicide-related outcomes within a high-risk clinical sample. Additional longitudinal studies utilizing clinical samples are critically needed to better understand these associations. [ABSTRACT FROM AUTHOR]

Gatekeeper training is a public health approach to suicide prevention that encourages community members to identify those at risk for suicide, respond appropriately, and refer for clinical services. Despite widespread use, few studies have examined whether training results in behavior change in participants. This study employed a naturalistic pre-post design to follow 434 participants in Applied Suicide Intervention Skills Training, finding small but significant increases in self-reported identification of at-risk youth, some helpful responses to youth, and numbers of youth referred to treatment from pre-test to 6- to 9-month follow-up. Changes in active listening and helping behaviors meant to support treatment referrals (such as convincing a youth to seek treatment) were not observed over time. Additional analyses explored predictors of self-reported skill utilization including identification as a "natural helper" and attitudes about suicide prevention. [ABSTRACT FROM AUTHOR]

The relationship between hopelessness and depression in predicting suicide-related outcomes varies based on the anticipation of positive versus negative events. In this prospective study of adolescents at elevated risk for suicide, we used two Beck Hopelessness Scale subscales to assess the impact of positive and negative expectations in predicting depression, suicidal ideation, and suicidal behavior over a 2- to 4-year period. In multivariate regressions controlling for depression, suicidal ideation, and negative-expectation hopelessness, positive-expectation hopelessness was the only significant predictor of depressive symptoms and suicidal behavior. Clinical interventions may benefit from bolstering positive expectations and building optimism. [ABSTRACT FROM AUTHOR]

The challenge of identifying suicide risk in adolescents, and particularly among high-risk subgroups such as adolescent inpatients, calls for further study of models of suicidal behavior that could meaningfully aid in the prediction of risk. This study examined how well the Interpersonal-Psychological Theory of Suicidal Behavior ( IPTS)-with its constructs of thwarted belongingness ( TB), perceived burdensomeness ( PB), and an acquired capability ( AC) for lethal self-injury-predicts suicide attempts among adolescents ( N = 376) 3 and 12 months after hospitalization. The three-way interaction between PB, TB, and AC, defined as a history of multiple suicide attempts, was not significant. However, there were significant 2-way interaction effects, which varied by sex: girls with low AC and increasing TB, and boys with high AC and increasing PB, were more likely to attempt suicide at 3 months. Only high AC predicted 12-month attempts. Results suggest gender-specific associations between theory components and attempts. The time-limited effects of these associations point to TB and PB being dynamic and modifiable in high-risk populations, whereas the effects of AC are more lasting. The study also fills an important gap in existing research by examining IPTS prospectively. [ABSTRACT FROM AUTHOR]

Individuals with substance use disorders (SUDs) are at high risk of suicidal behaviors, highlighting the need for an improved understanding of potentially influential factors. One such domain is self-efficacy to manage suicidal thoughts and impulses. Psychometric data about the Self-Efficacy to Avoid Suicidal Action (SEASA) Scale within a sample of adults seeking SUD treatment (N = 464) is provided. Exploratory factor analysis supported a single self-efficacy construct. Lower SEASA scores, or lower self-efficacy, were reported in those with more severe suicidal ideation and those with more suicide attempts, providing evidence for convergent validity. Implications of measuring self-efficacy in the context of suicide risk assessment are discussed. [ABSTRACT FROM AUTHOR]

Psychopathology, social support, and interpersonal orientation were studied in relation to suicide attempt status in acutely suicidal, psychiatrically hospitalized Black adolescents and a matched sample of White adolescents. In the total sample, multiple attempters were differentiated by lower perceived support. Within the Black youth subsample, social comparison and positive stimulation from others differentiated multiple attempters from single attempters/ideators. Only suicidal ideation predicted multiple attempts among White youth and only higher interpersonal orientation predicted multiple suicide attempts within Black adolescents. [ABSTRACT FROM AUTHOR]

Intervention research with youths at elevated risk for suicidal behavior and suicide--a vulnerable and high risk population--presents investigators with numerous ethical challenges. This report specifically addresses those challenges involving the informed consent and assent process with parents/guardians and youths. The challenges are delineated in the context of pertinent laws and regulatory requirements, and guidelines are suggested for their practical resolution. These are illustrated with case examples from NIMH-funded intervention trials. Through the sharing of such methodological information, intervention researchers can support each other in conducting ethical research in a manner that does not unduly compromise scientific rigor. [ABSTRACT FROM AUTHOR]

Illustrates the central implications that a developmental perspective has for suicide prevention, with emphasis on the need to consider multiple pathways to prevention. Developmental or life-span considerations of substantial importance to development of a strategic plan and identification of possible pathways to suicide prevention; Goal of suicide prevention strategies.

Summarizes findings from community-based studies that have explored suicide and risk factors among immigrant and Mexican-American groups. Reference to the increase in Mexican-American immigration since 1995; Information on suicidality within immigrant populations; Details on the existence of depression and psychiatric symptomatology among Mexican Americans.

Examines psychiatrically disturbed adolescents' history of exposures to suicide attempts and deaths in general. Identification of risk factors in the study of suicidal behavior; Effects of childhood experiences with suicide; Effects of exposures to death and suicidal behavior; Suicidality and attitudes toward death.

Presents a study on the identification of factors associated with adolescent suicidal behavior following psychiatric hospitalization. Facilitating effective aftercare interventions; Conducting of standardized baseline assessments and structured follow-up telephone interviews.

ABSTRACT: This study examined the extent to which adolescents' perceptions of their family environments were associated with suicidal behavior. Fifteen suicidal adolescents, 14 psychiatric controls, and 14 normal controls rated their families on cohesiveness, adaptability, parent-adolescent communication, parental caring, and parental over-protectiveness. Suicidal adolescents rated their families as the least cohesive and most rigid of the 3 groups, suggesting that adolescent suicidal behavior may occur when isolation is experienced within an inflexible family system. Suicidal and psychiatric control adolescents rated their families as similarly dysfunctional along the remaining variables, and as more dysfunctional than families of normal control adolescents. The implications of these findings are discussed, and it is suggested that several characteristics commonly attributed to families of suicidal adolescents may actually be general risk factors for adolescent psychopathology, rather than for suicidal behavior specifically. [ABSTRACT FROM AUTHOR]