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Nonsuicidal self-injury (NSSI) has been repeatedly associated with increased suicide risk. However, the transition from NSSI to suicidal thoughts and behaviors still remains as an enigma. One possible construct that may influence this relationship is cognitive flexibility, which refers to the ability to adapt responses/strategies based on environmental feedback. It may be that greater cognitive flexibility increases one's cognitive accessibility to suicide, making it a more viable option upon distress especially for those with a prior history of NSSI. Conversely, it may be that less cognitive flexibility creates a negative bias that exacerbates the effects of NSSI on suicide. Thus, in this study, we examined how NSSI characteristics (i.e., frequency and methods) interact with cognitive flexibility to predict lifetime suicide attempt (SA) history. Participants were 505 individuals with a lifetime history of NSSI who completed a survey assessing for their NSSI experiences, cognitive flexibility, and SA history. Moderation analyses were conducted while controlling for sexual orientation, which significantly predicted SA history. Results indicated a significant interaction between number of NSSI methods endorsed and cognitive flexibility. In particular, individuals were more likely to have had a history of SA if they scored higher on the alternative subscale of cognitive flexibility. The results suggest that the adaptive value of cognitive flexibility may be context dependent, and highlight the importance of personalized care among those who engage in self-harm.

People who identify as sexual minorities are at increased risk for suicide. Non-suicidal self-injury (NSSI) is also a risk factor for suicide and NSSI severity may contribute to development of capability for lethal self-injury. Further research is needed to understand how NSSI severity increases suicide risk, specifically in high-risk populations like sexual minorities. The current study seeks to examine whether sexual minority adults exhibit greater NSSI severity and suicide risk than heterosexuals, and if NSSI severity moderates the relationship between sexual orientation and suicide risk.Undergraduate students (N = 1,994) who reported five or more acts of NSSI in their lifetime completed online self-report questionnaires including sexual orientation, NSSI severity, and suicide risk.A factorial ANOVA demonstrated main effects of sexual orientation and NSSI severity on suicide risk.The lack of significant interaction effect indicates NSSI severity does not amplify the effect of on sexual orientation on suicide risk; rather, it predicts the same level of increased risk across orientations. Therefore, suicidality related to both sexual orientation and NSSI severity are equally important treatment targets.

Suicide is a considerable public health concern, particularly among U.S. veterans. Despite inpatient psychiatric hospitalization being a primary recommended treatment for acute suicidality, available inpatient group treatments remain limited. The current quality improvement project (QIP) aimed to examine the feasibility and acceptability of a newly developed single-session suicide-focused psychoeducation for veterans during psychiatric hospitalization. This project was conducted in two phases among veterans hospitalized for suicidal thoughts or behaviors. The first phase (

Background Both internet addiction (IA) and non-suicidal self-injury (NSSI) are major public health concerns among adolescents, however, the association between IA and NSSI was not well understood. We aimed to investigate the association between IA and NSSI within a cohort study, and explore the mediated effect of depressive symptoms and the moderating effect of social support in the association. Methods A total of 1530 adolescents aged 11–14 years who completed both the baseline (T1) and 14-month follow-up (T2) survey of the Chinese Adolescent Health Growth Cohort were included for the current analysis. IA, NSSI, depressive symptoms and social support were measured at T1; depressive symptoms and NSSI were measured again at T2. Structural equation models were employed to estimate the mediated effect of depressive symptoms and the moderating effect of social support in the association between IA and NSSI at T2. Results IA was independently associated with an increased risk of NSSI at T2, with the total effect of 0.113 (95%CI 0.055–0.174). Depressive symptoms mediated the association between IA and NSSI at T2, and social support moderated the indirect but not the direct effect of IA on NSSI at T2. Sex differences were found on the mediated effect of depressive symptoms and the moderated mediation effect of social support. Conclusions Interventions that target adolescents’ NSSI who also struggle with IA may need to focus on reducing depressive symptoms and elevating social support.

Despite its importance, limited work has investigated the nuances of suicidal thoughts and behavior self-disclosure. The present study aimed to examine potential differences in self-disclosure based on whether an individual has disclosed suicidal thinking versus behavior.Two hundred and four participants having disclosed their suicidal thoughts or behaviors completed a battery of online questionnaires assessing several key aspects of disclosure (i.e., disclosure recipient, perceived helpfulness of disclosure, impact on treatment seeking), as it pertained to both one's first and overall disclosure experiences.Individuals who disclosed a suicide attempt, versus ideation, were more likely to have disclosed to a formal support (i.e., health professional) and to seek professional help following disclosure. No significant group differences in perceived helpfulness of experiences were found.It may be beneficial to increase opportunities for disclosure of suicidal thinking. Overall, disclosures were perceived as helpful and may not impede future help-seeking behavior.

Abstract. Background: Challenges and inconsistencies in defining nonsuicidal self-injury (NSSI) have persisted for decades, which significantly impact NSSI conceptualization and assessment in clinical and research settings and impede the field's progress. Aims: The present study aimed to solicit opinions from individuals with NSSI expertise so as to improve the operational definition and conceptualization of NSSI. Method: We asked researchers, clinicians, and graduate students with varying NSSI expertise to provide opinions on six NSSI definitional components (e.g., whether pain should be a required outcome), as well as to review 118 behaviors and indicate whether each is NSSI. Results: Responses ( N = 159) revealed good agreement on specific NSSI definitional aspects and the classification of oft-cited NSSI behaviors. However, findings also demonstrated potential discrepancies in how clinicians and researchers define NSSI when compared with specific behaviors that might be classified as NSSI. Limitations: The opinions of the study's sample may not reflect the wider NSSI field. Conclusion: Findings suggest that there is an increased need for a clear and consistent definition of NSSI and specific NSSI behaviors. There is also a need to develop new assessment measures that capture the range of NSSI behaviors that received good-to-excellent agreement among self-injury experts.

Background The current study aimed to examine the concurrent and prospective relationships between the three hypothesized components of behavioral approach system (BAS) sensitivity: drive, reflecting the motivation to pursue one's desired goals; reward responsiveness, reflecting sensitivity to reward or reinforcement; and fun-seeking, reflecting the motivation for pursuing novel rewards in a spontaneous manner, and NSSI urge severity. Methods A sample of 64 undergraduates with a history of repetitive NSSI completed an ecological momentary assessment protocol. During this period of time, participants reported on the BAS-constructs of drive, reward responsiveness, and fun-seeking, as well as NSSI urge severity on a momentary basis at three random intervals each day for a period of ten-days. Results Drive and reward responsiveness, but not fun-seeking, were concurrently positively associated with NSSI urge severity. However, no associations between BAS facets and prospective NSSI urges were found. Limitations This study was limited by its use of single items to assess the BAS-constructs of drive, reward responsiveness, and fun-seeking. Conclusions Our findings indicate that feeling strongly impacted by rewards and having a strong sense of drive toward goal attainment may represent cognitive risk states that are associated with increased within-person NSSI risk. However, their lack of prospective prediction may suggest that these cognitive states are associated only on a momentary basis with NSSI urges and may not confer risk.

Background The COVID‐19 pandemic has spurred the implementation of several public safety measures to contain virus spread, most notably socially distancing policies. Prior research has linked similar public safety measures (i.e., quarantine) with suicide risk, in addition to supporting the role of social connection in suicidal thoughts and behaviors; consequently, there is a need to better understand the relationship between widespread social distancing policies and suicide risk. The current study aimed to examine the prospective association between COVID‐19‐related social distancing practices and suicidal ideation. Methods Participants (N = 472) completed measures of suicidal ideation and impacts of social distancing practices at baseline and two weeks later. Results After controlling for general psychosocial distress (i.e., depression, social connectedness), cross‐lagged regression models identified prospective, bidirectional relationships between perceived impacts of social distancing on one's mental health and both passive and active suicidal ideation. The impact of social distancing on work/social routine was not associated with suicidal ideation. Conclusions Overall, findings suggest the importance of an individual's perception regarding the effect of social distancing on their mental health, rather than the disruption to work or social routine, in suicide risk. Findings highlight potential targets for suicide risk prevention and intervention.

Abstract. Background: Nonsuicidal self-injury (NSSI) is a strong predictor of suicide attempts (SA). Characteristics of NSSI have been shown to influence the NSSI–SA relationship; however, the temporal nature of this association is understudied. Aims: This study aimed to elucidate the NSSI-SA relationship by examining the association between NSSI characteristics and time lapsed from NSSI onset to first SA. Method: Participants were 111 individuals with a history of NSSI that preceded their first SA who completed a series of self-report measures. Results: NSSI methods of cutting and burning, and the anti-dissociation function, were associated with a shorter transition time from NSSI to SA. Earlier age of NSSI onset and the interpersonal boundaries function were related to a longer time to transition. Limitations: This sample size was limited, and data were collected cross-sectionally. Conclusion: Findings provide foundational knowledge regarding NSSI characteristics to inform theoretical models of the NSSI–SA association. This information can inform suicide risk assessments among those with a history of NSSI.

OBJECTIVE Text-based responses may provide significant contributions to suicide risk prediction, yet research including text data is limited. This may be due to a lack of exposure and familiarity with statistical analyses for this data structure. METHOD The current study provides an overview of data processing and statistical algorithms for text data, guided by an empirical example of 947 online participants who completed both open-ended items and traditional self-report measures. We give an introduction to a number of text-based statistical approaches, including dictionary-based methods, topic modeling, word embeddings, and deep learning. RESULTS We analyze responses from the open-ended question "How do you feel today?", detailing characteristics of the responses, as well as predicting past-year suicidal ideation. CONCLUSIONS We see the analysis of text from social media, open-ended questions, and other text sources (i.e., medical records) as an important form of complementary assessment to traditional scales, shedding insight on what we are missing in our current set of questionnaires, which may ultimately serve to improve both our understanding and prediction of suicide.

NSSI is a robust predictor of suicidal thoughts and behaviors. Despite this close link, there is a lack of information regarding specific behavioral and psychological features of NSSI that may influence, or serve as drivers, of these relationships. Consequently, the aim of the current study was to elucidate the specific NSSI-related mechanisms that may confer risk for suicide ideation and suicide attempts. Participants having a lifetime history of NSSI (N = 659) were included in the current study and completed a series of online questionnaires. Exploratory mediation analysis was utilized to simultaneously examine 28 behavioral and psychological NSSI features as potential mechanisms of the NSSI-suicide ideation and NSSI-suicide attempt relationships. Results identified 11 NSSI features as having non-zero specific indirect effects in the NSSI-suicide ideation relationship, with the antisuicide function of NSSI having the strongest influence. In examining the NSSI-suicide attempt relationship 12 NSSI features were identified as having non-zero specific indirect effects, with endorsement of swallowing dangerous substances as an NSSI method having the strongest influence. These findings suggest psychological and behavioral features of NSSI may differentially impact risk for suicide ideation and suicide attempts, respectively.

SummaryMedia coverage of non-suicidal self-injury (NSSI) ranges from providing helpful education to displaying graphic images. We offer the first research-informed, consensus-based guidelines for the responsible reporting and depicting of NSSI in the media, while also advising on ideas for dissemination and collaboration between media professionals and healthcare experts.

Abstract. Background: Concerns exist regarding the perceived risks of conducting suicide-focused research among an acutely distressed population. Aims: The current study assessed changes in participant distress before and after participation in a suicide-focused research study conducted on a psychiatric inpatient unit. Method: Participants included 37 veterans who were receiving treatment on a psychiatric inpatient unit and completed a survey-based research study focused on suicide-related behaviors and experiences. Results: Participants reported no significant changes in self-reported distress. The majority of participants reported unchanged or decreased distress. Reviews of electronic medical records revealed no behavioral dysregulation and minimal use of as-needed medications or changes in mood following participation. Limitations: The study's small sample size and veteran population may limit generalizability. Conclusion: Findings add to research conducted across a variety of settings (i.e., outpatient, online, laboratory), indicating that participating in suicide-focused research is not significantly associated with increased distress or suicide risk.

Objective Despite nonsuicidal self-injury (NSSI) being a prevalent and problematic behavior, only approximately half of those who engage in NSSI disclose their behavior. Yet, limited research has explored the choice to disclose. This study sought to identify if NSSI characteristics, emotional distress, and perceived interpersonal obstacles discriminated between NSSI disclosure status. Exploratory aims also investigated reasons for one's disclosure decision and disclosure contextual factors. Method Participants included 977 undergraduate students (83% female) with a lifetime history of NSSI. Results Greater NSSI intrapersonal functions, suicide risk, and significant other support, and lower depression symptoms were associated with NSSI disclosure. Exploratory results highlight perceptions of one's NSSI severity and desire to receive support in disclosure choice; intrapersonal functions and peer support were associated with the timing of disclosure. Conclusions Findings underscore the potential importance of individual attitudes toward NSSI, in addition to traditionally measured risk factors, as potential drivers in NSSI disclosure.

Objective We sought to evaluate the influence of several well‐documented, readily available risk factors that may influence a psychiatric consultant's decision to admit an emergency department (ED) patient reporting suicidal ideation for psychiatric hospitalization. Methods We conducted a retrospective study of adult patients presenting to six affiliated EDs within Pennsylvania from January 2015 to June 2017. We identified 533 patients reporting current active suicidal ideation and receiving a complete psychiatric consultation. Socio‐demographic characteristics, psychiatric presentation and history, and disposition were collected. Decision tree analysis was conducted with disposition as the outcome. Results Four of 27 variables emerged as most influential to decisionmaking, including psychiatric consultant determination of current suicide risk, patient age, current depressive disorder diagnosis, and patient history of physical violence. Likelihood of admission versus discharge ranged from 97% to 58%, depending on the variables considered. Post hoc analysis indicated that current suicide plan, access to means, lack of social support, and suicide attempt history were significantly associated with psychiatric consultant determination of moderate‐to‐high suicide risk, with small‐to‐medium effect sizes emerging. Conclusions Only a handful of variables drive disposition decisions for ED patients reporting current active suicidal ideation, with both high and low fidelity decisions made. Patient suicide risk, determined by considering empirically supported risk factors for suicide attempt and death, contributes the greatest influence on a psychiatric consultant's decision to admit. In line with American College of Emergency Physicians (ACEP) recommendations, this study accentuates the importance of using clinical judgment and adjunct measures to determine patient disposition within this population.

Background The current study aimed to classify recent and lifetime suicide attempt history among youth presenting to medical settings using machine learning (ML) as applied to a behavioral health screen self-report survey. Methods In the current study, 13,325 (mean age = 17.06, SD = 2.61) pediatric primary care patients from rural, semi-urban, and urban areas of Pennsylvania and 12,001 (mean age = 15.79, SD = 1.40) pediatric patients from an urban children's hospital emergency department were included in the analyses. We used two methods of ML (decision trees, random forests) to (a) generate algorithms to classify suicide attempt history, and (b) validate generated algorithms within and across samples to assess model performance. We also employed ridge regression to evaluate performance of the ML approaches. Results Our findings demonstrate that ML approaches did not enhance our ability to classify lifetime or recent suicide attempt history among youth across medical care settings, suggesting that relationships may be mainly linear and non-interactive. In line with prior research, a history of suicide planning, active suicidal ideation, passive suicidal ideation, and nonsuicidal self-injury emerged as relatively important correlates of suicide attempt. Limitations The cross-sectional nature of the current study prevents us from determining the extent to which the important variables identified confer risk for future suicidal behavior. Conclusions The present study underscores the importance of suicide risk screenings that focus on the assessment of active and passive suicidal ideation and suicide planning, in addition to nonsuicidal self-injury, across pediatric medical settings.

Abstract. Background: Despite being a major public health concern, it is unclear how suicidal thoughts and behaviors differentially impact separate racial groups. Aims: The aim of the current study was to examine the occurrence of nonlethal suicide events, in addition to suicide attempt characteristics and factors contributing to suicide attempts. Method: A final sample of 7,094 undergraduates from a large northeastern university, identifying as members of three racial groups (White [67.30%], Black [17.30%], and Asian [15.40%]), completed online questionnaires. Results: White participants reported increased likelihood of endorsing lifetime suicidal ideation and plan, whereas Black participants reported decreased likelihood of these events; no differences were found in rates of lifetime suicide attempts. Black participants' suicidal behavior may involve greater ambivalence of intent. A higher proportion of Asian participants endorsed interpersonal factors as contributing to their suicide attempts, whereas a greater percentage of White participants reported internal contributing factors. Limitations: Findings are limited by the sample size and assessment of lifetime suicidal thoughts and behaviors. Conclusion: The findings present a more nuanced look at attitudes and actions related to suicidal thoughts and behaviors that may inform future research and risk assessment procedures.

Borderline personality disorder (BPD) symptoms and suicidal behaviors are prevalent among undergraduate students. Although rumination contributes to self-destructive behaviors in BPD, less research examines the role of rumination in distinct suicidal outcomes among individuals with BPD features instead focusing more on self-destructive behaviors as a latent variable. The present study examined the main and interactive effects of BPD features and two forms of rumination (brooding and anger) in the prediction of suicide-related outcomes (ideation and attempts) among college students. Participants (

Objective Veterans die by suicide at a higher rate than the U.S. population, and veterans more frequently use a firearm as the suicide method. Consequently, firearm accessibility and storage represent important prevention considerations. This project aimed to explore the implementation of suicide prevention efforts among veterans who went on to die by suicide, with and without the use of a firearm, and to identify factors that differentiated veteran suicide decedents to help inform suicide prevention efforts. Methods Data from the Veteran Health Administration Behavior Health Autopsy Program was analyzed for 97 veteran suicide decedents. Results Results demonstrated that veterans who used a firearm for suicide were less likely to have engaged in suicide prevention efforts overall and were less likely to have received lethal means safety counseling / safety planning. Veterans who died by firearm had lower levels of notable risk factors (e.g., prior suicide attempt, no-shows for appointments), however were more likely to have a documented unsecured firearm in their home. Conclusion These findings support the benefit of broadening the reach of suicide prevention efforts, especially for high-risk veterans with access to firearms.

Non-suicidal self-injury (NSSI) co-occurs with both other maladaptive behaviors (e.g., aggression) and emotion dysregulation. However, the extent to which these maladaptive behaviors are linked to NSSI independent of emotion dysregulation is unclear. The present study examined relationships between NSSI and six other maladaptive behaviors among university undergraduates. When controlling for demographic variables, emotion dysregulation, and other maladaptive behaviors, binge eating, purging, illicit drug use, and physical aggression were each related to lifetime NSSI history and/or severity. No maladaptive behaviors were significantly related to the presence of current diagnostic-level NSSI in these multivariate analyses. Results suggest that some maladaptive behaviors may relate uniquely to NSSI risk independent of emotion dysregulation, highlighting the importance of considering such behaviors in self-injury assessment and treatment.

Nonsuicidal self-injury (NSSI) is one of the strongest predictors of suicidal behavior. Despite this, the field still has a limited understanding of the mechanisms by which this relationship is conferred. As there has been a proliferation of research in this area over the past decade, an updated systematic review of the empirical research examining potential factors driving the relationship between NSSI and suicide-related outcomes is needed to move the field forward. We identified only 18 studies examining moderators or mediators of the relationship. Research to date does little to improve our understanding of the robust, prospective relationship between NSSI and suicide outcomes, highlighting a foundational gap in both the empirical and theoretical literature. Thus, we propose the Nonsuicidal to Suicidal Self-Injury Pathway Model, an expanded theoretical model of this relationship drawing on extant theory and empirical research, as well as discuss future directions for work in this area.

Key Points Question Is the labor migration of parents in China associated with nonsuicidal self-injury (NSSI) or suicidality among children, adolescents, and young adults who were left behind, and are there sex differences in any association? Findings In this cross-sectional study in China of 15 312 participants, labor migration of the father or of both parents was associated with 1 to 4 (but not ≥5) episodes of NSSI in 1 year and with suicidality among offspring, whereas differential associations by sex were minimal. In addition, higher odds of experiencing 1 to 4 episodes of NSSI were found for offspring who were initially separated from 1 or both parents at preschool age. Meaning These findings suggest that interventions to address NSSI should consider potential associations with parental migration., Importance The labor migration of parents in China often leaves children behind, which may be adversely associated with children’s health. However, few studies have assessed the association of parental migration with nonsuicidal self-injury (NSSI) or with suicidality among their offspring. Objective To examine the associations of parental labor migration with NSSI and with suicidality as well as potential differential associations by sex among offspring left behind. Design, Setting, and Participants This nationwide cross-sectional study was conducted from February to October 2015 among individuals aged 11 to 20 years from 45 public middle and high schools across 5 provinces of China. Data analysis was performed from November 1, 2020, to March 1, 2021. Exposures Parental labor migration, including parental migration status (yes vs no), migration pattern (father, mother, or both), and the child’s age at the initial parent-child separation. Main Outcomes and Measures Less frequent (1-4 episodes) NSSI, more frequent (≥5 episodes) NSSI, suicidal ideation, and suicide attempt in the past year were measured using validated questionnaires. Multinomial or binomial logistic regression analyses were used separately to estimate adjusted odds ratios (aORs) and 95% CIs of the associations between parental migration and NSSI, suicidal ideation, or suicide attempt. Potential covariates (demographic, family-level, and psychological characteristics) were adjusted for in 3 sequential models. Results A total of 15 312 participants (7904 male [51.6%] and 7408 female [48.4%]) aged 11 to 20 years (mean [SD] age, 15.1 [1.8] years) were included. Of those participants, 5963 (23.3%) experienced parental migration. The 12-month prevalence of less frequent NSSI was 17.2% (2635 of 15 312), the 12-month prevalence of more frequent NSSI was 11.6% (1783 of 15 312), the 12-month prevalence of suicidal ideation was 15.2% (2335 of 15 312), and the 12-month prevalence of suicide attempt was 3.5% (535 of 15 312). Parental migration was associated with less frequent NSSI (adjusted odds ratio [aOR], 1.13; 95% CI, 1.03-1.24); no significant association of parental migration with more frequent NSSI (aOR, 1.01; 95% CI, 0.90-1.13), suicidal ideation (aOR, 1.00; 95% CI, 0.90-1.10), or suicide attempt (aOR, 1.09; 95% CI, 0.90-1.33) was identified. Compared with children whose parents did not migrate, the aOR for less frequent NSSI for participants whose father migrated was 1.18 (95% CI, 1.06-1.31), and the aOR for less frequent NSSI for participants having both parents migrate was 1.12 (95% CI, 1.01-1.28). Compared with children whose parents did not migrate, participants who experienced initial separation from 1 or both parents at preschool age had an aOR for less frequent NSSI of 1.16 (95% CI, 1.03-1.31). No sex disparities were found in these associations except for participants who experienced initial separation from 1 or both migrant parents at preschool age, for which the aOR for more frequent NSSI was higher among male (aOR, 1.27; 95% CI, 1.04-1.55) than female (aOR, 0.96; 95% CI, 0.77-1.19) participants. Conclusions and Relevance This cross-sectional study found that parental migration, mainly of the father or of both parents, or an initial separation of children at preschool age from 1 or both parents who migrated was associated with higher odds of experiencing 1 to 4 NSSI episodes in 1 year among offspring. Overall, the associations of parental migration with NSSI and suicidality were similar between male and female participants., This cross-sectional study examines whether migration of 1 or both parents is associated with risk of nonsuicidal self-injury or suicidality and whether the risk differs by sex among the children, adolescents, and young adult offspring left behind in China.

Introduction There has been an increased emphasis on understanding suicidal thoughts and behaviors as they occur in real-time, resulting in a proliferation of studies utilizing intensive time sampling methods. Given the continued growth in this area, there is a need to synthesize the feasibility of these methods in capturing suicidal ideation at the daily level, in addition to an examination of study factors that may impact suicidal ideation detection, to guide future research. Method Online databases (i.e., PsychINFO, ERIC, PubMed, MEDLINE) were systematically searched for articles published through December 2020 that assessed suicidal ideation at the daily level. Results Twenty-six articles presenting data from sixteen independent datasets met inclusion criteria. Across included articles, suicidal ideation detection ranged from approximately 1-92% of participant-completed surveys, with 18-100% of unique study participants reporting suicidal ideation during the study period. Assessment-based factors (i.e., number of daily assessments, duration of daily assessment period) did not appear to be meaningfully associated with suicidal ideation detection rates. Rather, participant characteristics (i.e., baseline suicide risk history, inclusion criteria) were better indicators of a study's ability to capture suicidal ideation at the daily level. Conclusions Findings highlights the impact of targeting participants with elevated suicide risk at study enrollment.

Abstract. Background: Interpersonal problem-solving difficulties constitute a suicide risk factor that may be particularly relevant among college students. Most studies have examined general interpersonal problem-solving; however, context-specific abilities may have greater clinical implications. Aim: This study examined whether individuals with and without a history of suicidal thoughts and behaviors differed in context-specific interpersonal problem-solving. Method: Undergraduate students ( n = 112) completed a brief interview and interpersonal problem-solving tasks with positive (e.g., initiating romantic relationship) and negative (i.e., physical revenge) resolutions. Results: Individuals with a history of suicide ideation generated more effective solutions and more alternatives in the negative-resolution scenario; no significant differences were identified for the positive-resolution scenarios. No group differences were found based on suicide attempt status. Limitations: Our results do not account for the mechanisms that influence problem-solving abilities in negative-resolution scenarios. Conclusion: Clinical efforts may benefit from targeting the translation of interpersonal problem-solving abilities to situations with positive resolutions.

Concerns of measurement error often motivate researchers to aggregate item information, using simple heuristics (e.g., sum scores) or latent variable methods, to mitigate unwanted effects such as parameter bias and attenuation. These approaches are often invoked without acknowledging that many scales in practice likely fail to possess the necessary properties for these models to be sufficient (i.e., positive conditional association and vanishing conditional dependence). We argue that measures which are not psychometrically homogeneous likely contain item specific effects particularly when examined in conjunction with external variables. We demonstrate this using a clinical empirical example assessing risk factors for suicidal ideation and show that measures constructed in alignment with principles of psychometric homogeneity are most appropriately modeled at the scale (or subscale) level while other measures should be considered at the item level. As a result, latent variable applications to such instruments are susceptible to interpretational confounding. The effects of interpretational confounding on R2, root mean square error, and model parameters are evaluated in a small simulation study. We conclude that item specific effects are not uncommon in practice and impact both explanatory and predictive research. Our findings suggest that classical approaches to addressing measurement error are insufficient to fully capture the breadth of instruments implemented in practice. Careful consideration of both the scale construction process and roles of scale items in the broader psychological theory are necessary prior to the application of traditional measurement methods.

This study examined the presence and correlates of COVID-specific suicidal thoughts and behaviors (i.e., thoughts of or engaging in intentional COVID-19 exposure with associated suicidal intent) among psychiatrically hospitalized adolescents. Adolescents (N = 143) completed study measures as part of the standard intake process between March 13th and August 14th, 2020. Participants answered questionnaires assessing COVID-specific passive and active suicidal ideation (SI) and suicidal behavior, as well as COVID-related stressors and emotions, and public health guidance compliance. Findings highlights that COVID-specific SI is common in high-risk youth. COVID-specific SI was associated with COVID-19-related negative emotions, elevated stress, and decreased public health guidance compliance. Results suggest that COVID-specific suicidal thoughts and behaviors, and risk correlates, should be assessed within high-risk populations to facilitate prevention of risky behavior associated with intentional COVID-19 exposure. Supplementary Information The online version contains supplementary material available at 10.1007/s10578-021-01225-3.

The Caring Contacts suicide prevention intervention has been promoted by the Joint Commission, given its effectiveness, high reach, and cost effectiveness. Despite its increased application, no study has examined whether patient characteristics influence perceptions of the intervention, which may inform implementation efforts and ultimately impact effectiveness. One hundred fifty-four veterans were recruited from a Veterans Affairs psychiatric inpatient unit. Participants completed a survey to provide feedback on preferences, including the message correspondent, format (e.g., postcard, email), the importance of handwriting (vs. typed), visual presentation, and schedule for mailings. Results demonstrated that Caring Contacts preferences did not differ by most variables, including military rank, combat deployment history, or most personal technology use characteristics. Some demographic differences were identified, especially by age. More older veterans preferred messages to be sent in a physical letter compared to younger veterans, but if messages were sent via postal mail, younger veterans had a stronger preference for messages to be handwritten and sent using real stamps and colorful envelopes. Overall, findings suggest that few Caring Contacts adaptations are needed based on patient characteristics. Programs targeting older cohorts should consider postal mail formats for Caring Contacts.

OBJECTIVE: Despite increased use of behavioral analogues to identify casual mechanisms of self-injurious behavior (e.g. suicide attempts; non-suicidal self-injury), little is known about the impact on participants. The current study examined the impact of a specific behavior analogue, Self-Aggressive Paradigm (SAP), on participant affect. METHODS: Community participants (n = 507) reported several affective ratings before and after completing SAP task procedures. RESULTS: Following the SAP, participants reported reductions in nervousness and fear and increases in calmness and anger (d = .21). Participants with a current anxiety disorder reported greater increases in happiness; those with a suicide attempt history reported greater increases in sadness. RESULTS: Findings demonstrate the SAP has no adverse mood effects, supporting its use in experimental research.

OBJECTIVE As recent advances in suicide research have underscored the importance of studying distinct suicide outcomes (i.e., suicidal thinking vs. behavior), there is a need to consider the theoretical meaningfulness of our statistical approach(es). As an alternative to more popular statistical methods, we introduce ordinal regression, detailing specific forms that are well-aligned to examine outcomes specific to suicide research. METHOD Ordinal regression models allow for assessment of the influences of covariates on the experience of lower (i.e., suicidal ideation) to higher (i.e., suicidal planning) suicide risk outcomes. RESULTS As an empirical application, we fit a sequential ordinal regression model with 17 theoretically selected covariates and modeled category specific effects for each covariate. CONCLUSIONS Results detailed from depression and presence of nonsuicidal self-injury demonstrate the utility of ordinal regression in consideration of transitions across suicide outcomes. Ordinal regression models may be particularly informative in identifying risk factors unique to each suicide outcome, which has the potential to meaningfully inform theoretical models of suicide and suicide risk prediction.

Text is a burgeoning data source for psychological researchers, but little methodological research has focused on adapting popular modeling approaches for text to the context of psychological research. One popular measurement model for text, topic modeling, uses a latent mixture model to represent topics underlying a body of documents. Recently, psychologists have studied relationships between these topics and other psychological measures by using estimates of the topics as regression predictors along with other manifest variables. While similar two-stage approaches involving estimated latent variables are known to yield biased estimates and incorrect standard errors, two-stage topic modeling approaches have received limited statistical study and, as we show, are subject to the same problems. To address these problems, we proposed a novel statistical model-supervised latent Dirichlet allocation with covariates (SLDAX)-that jointly incorporates a latent variable measurement model of text and a structural regression model to allow the latent topics and other manifest variables to serve as predictors of an outcome. Using a simulation study with data characteristics consistent with psychological text data, we found that SLDAX estimates were generally more accurate and more efficient. To illustrate the application of SLDAX and a two-stage approach, we provide an empirical clinical application to compare the application of both the two-stage and SLDAX approaches. Finally, we implemented the SLDAX model in an open-source R package to facilitate its use and further study. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Nonsuicidal self-injury (NSSI) typically occurs in the presence of negative emotions. Prior research has emphasized interpersonal stress as a specific context that may elevate negative emotions in this population and even increase the likelihood of NSSI behavior. However, the factors that contribute to the relationship between interpersonal stress and NSSI have received relatively limited attention. The current pilot study aimed to experimentally examine interpersonal problem-solving as a potential moderator of the interpersonal stress – NSSI risk relationship among those with a NSSI history. Eighty-six participants (52.3% with NSSI history) were randomly assigned to one of three mood induction conditions (interpersonal negative, general negative, interpersonal neutral), after which they completed an interpersonal problem-solving task and a laboratory analogue of self-injurious behavior. Results indicated that NSSI history was associated with poorer interpersonal effectiveness. Further, individuals with a history of NSSI who experienced an interpersonally-focused negative mood and produced less effective interpersonal solutions were more self-harming on a laboratory analogue of self-injurious behavior. While the present findings are preliminary in nature, they offer guidance for research moving forward and, if replicated, suggest interpersonal problem-solving as a potential treatment target among individuals engaging in NSSI.

Abstract. Background: Patient disclosure of prior suicidal behaviors is critical for effectively managing suicide risk; however, many attempts go undisclosed. Aims: The current study explored how responses following a suicide attempt disclosure may relate to help-seeking outcomes. Method: Participants included 37 veterans with a previous suicide attempt receiving inpatient psychiatric treatment. Veterans reported on their most and least helpful experiences disclosing their suicide attempt to others. Results: Veterans disclosed their suicide attempt to approximately eight individuals. Mental health professionals were the most cited recipient of their most helpful disclosure; romantic partners were the most common recipient of their least helpful disclosures. Positive reactions within the context of the least helpful disclosure experience were positively associated with a sense of connection with the disclosure recipient. Positive reactions within the most helpful disclosure experience were positively associated with the likelihood of future disclosure. No reactions were associated with having sought professional care or likelihood of seeking professional care. Limitations: The results are considered preliminary due to the small sample size. Conclusion: Findings suggest that while positive reactions may influence suicide attempt disclosure experiences broadly, additional research is needed to clarify factors that drive the decision to disclose a suicide attempt to a professional.

There is significant debate about the feasibility of using predictive models for suicide prevention. Although statistical considerations have received careful attention, patient perspectives have not been examined. This study collected feedback from high-risk veterans about the U.S. Department of Veterans Affairs (VA) prevention program called Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment (REACH VET).Anonymous questionnaires were obtained from veterans during their stay at a psychiatric inpatient unit (N=102). The questionnaire included three vignettes (the standard VA script, a more statistical vignette, and a more collaborative vignette) that described a conversation a clinician might initiate to introduce REACH VET. Patients rated each vignette on several factors, selected their favorite vignette, and provided qualitative feedback, including recommendations for clinicians.All three vignettes were rated as neutral to very caring by more than 80% of respondents (at least 69% of respondents rated all vignettes as somewhat caring to very caring). Similar positive feedback was obtained for several ratings (e.g., helpful vs. unhelpful, informative vs. uninformative, encouraging vs. discouraging). There were few differences in the ratings of the three vignettes, and each of the three scripts was preferred as the "favorite" by at least 28% of the sample. Few patients endorsed concerns that the discussion would increase their hopelessness, and privacy concerns were rare. Most of the advice for clinicians emphasized the importance of a patient-centered approach.The results provide preliminary support for the acceptability of predictive models to identify patients at risk for suicide, but more stakeholder research is needed.

Widespread attempts to implement suicide prevention efforts may be hindered by stigma regarding suicidal thoughts and behaviors (STBs). Despite extensive literature linking general mental health stigma to numerous negative outcomes (i.e., reduced help-seeking), limited research has extended findings to STB-specific stigma. Thus, the present study aimed to examine the association between three types of STB stigma (public, self, and anticipated) and self-disclosure, a specific form of help-seeking for some individuals, among civilians and a population at heightened suicide risk, U.S. veterans. Participants (n = 500) reported a lifetime history of suicidal ideation (n = 253 identified as a U.S. veteran; n = 132 reported being enrolled in Veteran Health Administration [VHA] care) who completed self-report measures about their STB experiences, including stigma and self-disclosure. Results highlighted a significant association between greater self-stigma, as well as greater anticipated stigma, and a reduced likelihood of STB disclosure, among veterans but not civilians. No significant associations as a result of VHA care status were found. Together, findings suggest that individuals' concerns related to STBs and STB disclosure may be grounded in past experiences in the military, and thus highlight the need for prevention efforts that protect against negative consequences related to STB disclosure.

The present study aimed to extend prior literature on single-item assessment by examining response consistency (1) between several commonly used single-item assessments of suicidal ideation, planning, and attempts, and (2) across three timeframes (past month, past year, and lifetime) commonly employed in the literature. Participants (N = 613) were recruited from an online community, Amazon Mechanical Turk (mTurk). Participants were administered three sets of four distinct single-items assessing suicidal ideation, suicidal planning, and suicide attempt history, respecitvely. Items were drawn from well-known large-scale studies (e.g., National Comorbidity Survey; World Health Organization Mental Health Survey Initiative, Youth Risk Behavior Survey) and commonly used suicide risk assessments (i.e., Self-Injurious Thoughts and Behaviors Interview). Through examinations of intraclass correlations and confirmatory factor analyses, findings suggested mixed response agreement across most outcomes and timeframes. Response inconsistency among items assessing suicidal ideation and among items assessing suicidal planning were partly attributed to minor, yet important, language differences. Given findings that even minor language changes in suicidal ideation and planning items may inflate or restrict prevalence estimates in a meaningful way, it will be important for researchers and clinicians alike to pay close attention to the wording of single items in designing research studies, interpreting findings, and assessing patient risk.

Objectives Though nonsuicidal self-injury (NSSI) is generally considered to be a private act, 21%-52% of individuals who engage in NSSI do so around others. Those who engage in NSSI alone often demonstrate severe behavior. However, little is known about the distinction between those who only sometimes versus always engage in NSSI when they are around others. Three groups of individuals who engage in NSSI were examined: Always, sometimes, and never alone. Method Participants (N = 861; 84.2% female; M age = 20.06) were undergraduates who answered online questionnaires. Severity of NSSI, suicide risk, and social risk factors were used to predict group membership. Results Engaging in NSSI around others aligned with less severe NSSI behavior, lower suicide risk, and fewer interpersonal difficulties versus those who engage in NSSI alone. Conclusions NSSI's social context may indicate clinical severity. This information is useful for clinicians who work with individuals with a history of NSSI.

Suicide is a serious public health problem; however, suicides are preventable with timely, evidence-based interventions. Social media platforms have been serving users who are experiencing real-time suicidal crises with hopes of receiving peer support. To better understand the helpfulness of peer support occurring online, this study characterizes the content of both a user’s post and corresponding peer comments occurring on a social media platform and present an empirical example for comparison. It introduces an approach that uses pairwise topic models to transform large corpora of discussion into associated topics of user and peer posts. The key advantages of this approach include: (i) modeling both the generative process of each type of the corpora (i.e., user posts and peer comments) and the associations between them, and (ii) using phrases, which are more informative and less ambiguous than words, in addition to words, to represent social media posts and topics. The study evaluated the method using data from Reddit r/SuicideWatch. It examined how the topics of user and peer posts were associated and how this information influenced the peer perceived helpfulness of the peer support. Then, this study applied structural topic modeling to data collected from individuals with a history of suicidal crisis as a means to validate findings. The observations suggest that effective modeling of the association between the two lines of topics can uncover helpful peer responses to online suicidal crises, notably providing the suggestion of professional help. The proposed technology can be applied to “paired” corpora in many applications, such as technical support forums, question-answering sites, and online medical services.

Despite the high prevalence of nonsuicidal self-injury (NSSI) and resultant physical scarring, few studies have explored the occurrence and psychological implications of concealing NSSI scars. This study examines NSSI scar concealment from the self and others, as well as the cognitive, affective, and self-injury-related correlates of these concealment practices. This study aimed to characterize the extent to which individuals who engage in concealment practices have a history of, or desire to engage in, treatment for NSSI specifically geared towards NSSI scarring. Adults with at least one NSSI scar (N = 278) completed online questionnaires measuring NSSI engagement and scarring, scar concealment behaviors, scar-related cognitions, as well as symptoms of anxiety and depression, and recent suicidal ideation and NSSI urges. Results indicate that the degree of scar concealment from the self and from others is associated with greater experiences of negative scar-related cognitions, higher levels of anxiety and depressive symptomatology, and higher severity of NSSI urges. These correlations persisted after accounting for NSSI severity indices, including extent of NSSI scarring, suggesting that scar concealment practices may be important clinical indicators of current distress and potential future self-injury. Future research should explore the extent to which scar concealment practices are longitudinally associated with distress and risk for NSSI maintenance.

Identifying those who engage in non-suicidal self-injury (NSSI) rely heavily on self-disclosure. However, less than half of those who engage in NSSI disclose their self-injurious behavior often due to the fear of negative reaction. This study examined how perceived reactions to NSSI disclosure (i.e., 'negative reactions', 'tangible aid,' and 'emotional support') may be associated with suicide risk through depression. Participants were 385 undergraduate students who had a lifetime history of engaging in and disclosing at least one of their NSSI acts. Perceived reactions to NSSI disclosure were assessed through the Self-injury Social Reactions Questionnaire; suicide risk was assessed through the Suicidal Behavior Questionnaire Revised; depression was assessed through the Beck Depression Inventory-II. Path analyses were conducted to examine the indirect effects of perceived reactions to NSSI disclosure on suicide risk through depression. Exploratory analyses of independent models examining each reaction separately were conducted as well. In the full model, negative reactions and emotional support were indirectly associated with suicide risk through depression. In the independent models, all three reaction types were associated with suicide risk through depression. The current study elucidates a potential mechanism in which specific perceived reactions to NSSI disclosure may influence one's suicide risk.

Evidence suggests that the negative consequences of COVID-19 may extend far beyond its considerable death toll, having a significant impact on psychological well-being. Despite work highlighting the link between previous epidemics and elevated suicide rates, there is limited research on the relationship between the COVID-19 pandemic and suicidal thoughts and behaviors. Utilizing an online survey, the current study aimed to better understand the presence, and extent, of the association between COVID-19-related experiences and past-month suicidal thoughts and behaviors among adults in the United States recruited via Amazon Mechanical Turk (n = 907). Results support an association between several COVID-19-related experiences (i.e., general distress, fear of physical harm, effects of social distancing policies) and past-month suicidal ideation and suicide attempts. Further, a significant proportion of those with recent suicidal ideation explicitly link their suicidal thoughts to COVID-19. Exploratory analyses highlight a potential additional link between COVID-19 and suicidal behavior, suggesting that a portion of individuals may be intentionally exposing themselves to the virus with intent to kill themselves. These findings underscore the need for suicide risk screening and access to mental health services during the current pandemic. Particular attention should be paid to employing public health campaigns to disseminate information on such services to reduce the enormity of distress and emotional impairment associated with COVID-19 in the United States.

Only approximately half of individuals engaging in nonsuicidal self-injury (NSSI) ever disclose their behavior. Yet there is a dearth of research aimed at understanding NSSI disclosure and the outcomes of choosing to disclose, such as social reactions to NSSI disclosure. The current study aimed to develop and validate a measure of perceived social reactions to the disclosure of NSSI, the Self-Injury Social Reactions Questionnaire (SI-SRQ). Results supported a three-factor structure of the SI-SRQ assessing positive (tangible aid, emotional support) and negative social reactions in undergraduate ( n = 269), community ( n = 217), and recent NSSI ( n = 129) samples. The internal consistencies of the resultant subscales, in addition to the convergent validity, were also supported. The development of the SI-SRQ provides an avenue to enhance our knowledge of the relationship between social reactions to NSSI disclosure and disclosure outcomes, which may help inform educational efforts about responding to NSSI disclosures more effectively.

Deployment to a combat zone is a fundamental mission for most military forces, but prior research suggests that there is a complex and nuanced association between deployment and related risk factors for suicide. Deployment and combat experiences vary greatly among military personnel and can affect a variety of protective and risk factors for suicide. This article offers a critical examination of the association among modern U.S. military deployments, suicide attempts, and death while considering the context of a prominent theory of suicide. Although previous work has demonstrated that deployment is not associated with suicide overall in this population, there is growing evidence that risk may be elevated shortly after deployment, and for some subgroups. Specific aspects of combat exposure, including the experience of killing or witnessing death in combat, may be important contributing factors. An analysis of the literature illustrates that deployment-related risk factors for suicide are complex. The limitations of the literature are discussed, and future directions are suggested.

Introduction Suicide is a major public health concern. One consistently cited risk factor for suicide is childhood maltreatment, which also may play a role in the transition from suicidal ideation to suicidal behavior. Method The current study aimed to examine the relationship between childhood maltreatment and suicide attempts during adolescence (N = 4834; 52.1% female; 67.5% Caucasian). Data from the U.S. National Longitudinal Study of Adolescent Health were utilized. Forty-six theoretically-relevant risk factors were explored as potential mediators of this relationship using an exploratory mediation data analytic method. Results Results demonstrated a significant childhood maltreatment - suicide attempt relationship only among females. After considering demographics and suicidal ideation, having received counseling in the previous 12 months was the most influential mediator, followed by having a friend attempt suicide in the previous 12 months. Conclusions These findings highlight potential gender differences in the relationship between childhood maltreatment and later suicide attempts, and, moreover, the importance of assessing for recent exposure to peer suicidal behavior in suicide risk assessments.