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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, ps ≥ 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., Competing Interests: Declaration of competing interest There are no competing interests to disclose., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Suicidal ideation (SI) disproportionately impacts individuals with minoritized race/ethnicity, gender, and sexual orientation. Minority stress - i.e., traumatic, insidious distress that results from acts of discrimination - may lead to the formation of posttraumatic cognitions that may generalize to suicidal ideation, elevating SI risk in minoritized populations. The current study aimed to test this potential relationship by examining whether minority stress and posttraumatic cognitions accounted for the association between discrimination and SI., Methods: Series of structural equation models, including multigroup confirmatory factor analyses conducted to test invariance of latent constructs, were estimated on cross-sectional data collected from minoritized young adults (n = 337)., Results: Results supported the hypothesized model: experience of discrimination indirectly associated with SI via correlations shared between minority stress and posttraumatic cognitions. Experiences of discrimination lacked a significant correlation with SI while accounting for minority stress and posttraumatic cognition variance. Invariance testing conducted to account for applicability of the model across race, ethnicity, sexual orientation, and plurality of minoritized identities all demonstrated that the model was applicable across these identity dimensions., Limitations: Granular inspection of identity dimensions was infeasible due to sample size and causal inferences cannot be drawn given cross-sectional nature of the data used., Conclusions: Posttraumatic cognitions within the context of discrimination may be effective treatment targets for minoritized individuals who present with minority stress and SI. Future studies should aim to replicate such findings longitudinally to infer temporality., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

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., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2023. Published by Elsevier B.V.)

Background: Individuals with eating disorders (EDs) often struggle with markedly low self- esteem and are at risk for suicidal behavior. Dissociation and perceived burdensomeness are often cited as facilitators of suicidal outcomes. Specifically, perceived burdensomeness is comprised of self-hate and liability on others, although it remains unclear which variables most heavily influence suicidal behavior in EDs., Methods: In a sample of 204 women with bulimia nervosa, the present study examined the potential impact of self-hate and dissociation on suicidal behavior. We hypothesized that suicidal behavior would be equally, and potentially more strongly, related to self-hate than dissociation. Regression analyses investigated the unique effects of these variables on suicidal behavior., Results: Consistent with our hypothesis, a significant relationship emerged between self-hate and suicidal behavior (B = 0.262, SE = 0.081, p < .001, CIs = 0.035-0.110, R-squared =0.07) but not between dissociation and suicidal behavior (B = 0.010, SE = 0.007, p = .165, CIs = -0.389-2.26, R-squared =0.010). Additionally, when controlling for one another, both self-hate (B = 0.889, SE = 0.246, p < .001, CIs = 0.403-1.37) and capability for suicide (B = 0.233, SE = 0.080, p = .004, CIs = 0.076-0.391) were uniquely and independently associated with suicidal behavior., Limitations: Future work should include longitudinal analyses to understand temporal relationships among study variables., Conclusions: In sum, when considering suicidal outcomes, these findings support a view that highlights personal loathing rooted in self-hate rather than de-personalizing aspects of dissociation. Accordingly, self-hate may emerge as a particularly valuable target for treatment and suicide prevention in EDs., Competing Interests: Declaration of competing interest The authors have no competing interests to disclose., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Suicide treatment research has placed major emphasis on preventing behavior, an observable phenomenon. Suicidal ideation (SI), however, is a distressing experience that annually impacts >15 million Americans; yet the construct validity of SI has not been well established, limiting empirical attention., Method: We compared the coherence of three SI items (diminished wish to live, urge to die/controllability, suicide intent/expectations) and four related items across three adult samples (N = 314) that differed based on current SI severity and assessment time-scales (retrospective versus momentary)., Results: A measurement model with scalar invariance had acceptable fit (CFI = 0.969, RMSEA = 0.076), indicating that the SI items consistently loaded onto one construct across samples. The structural model with metric invariance also had acceptable fit (CFI = 0.956, RMSEA = 0.063) and three of four related items (burdensome, hopelessness, and fatigue, but not agitation) were associated with SI across samples., Limitations: Use of existing data limited the items considered., Conclusions: Suicidal ideation is a coherent construct independent of the items used to assess it, the assessment's time-scale (retrospective versus momentary), or the severity of thoughts, and is worthy of greater empirical, clinical, and policy attention., Competing Interests: Conflict of interest DJ receives royalties from American Psychological Association Press and Guilford Press; he is also co-owner of CAMS-care, LLC (a professional training and consultation company). All other authors declare that they have no conflicts of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: Acute Suicidal Affective Disturbance (ASAD) has been proposed to address the need for a suicide-specific diagnostic entity that better accounts for the psychological symptoms that may emerge during an acute suicidal crisis and that may precede imminent suicidal behaviors. However, additional research is needed to establish ASAD's delimitation from preexisting psychological disorders, especially disorders that include suicidal thoughts and behaviors in their diagnostic criteria such as borderline personality disorder (BPD)., Methods: We estimated two Gaussian graphical models (GGMs), exploratory factor analysis (EFA) models, and confirmatory factor analysis models in a sample of psychiatric outpatients (N = 460) to examine the structure of ASAD and BPD symptoms., Results: Our estimated models showed while most ASAD and BPD symptoms largely shared associations with other symptoms belonging to their respective disorder construct, strong associations connected some ASAD symptoms with BPD symptoms, which, in a network model, emerged in the form of nonzero edges among those symptoms, and in EFA models, as factors that featured both ASAD and BPD symptoms as indicators., Conclusions: Our findings suggest the network structure of the proposed criteria of ASAD features symptoms that are largely distinct to ASAD but do include symptoms that share meaningful correlations with BPD symptoms that suggest ASAD and BPD are correlated constructs., Competing Interests: Conflict of interest This work was supported in part by the Military Suicide Research Consortium (MSRC), an effort supported by the Office of the Assistant Secretary of Defense for Health Affairs under Award Nos. (W81XWH-10-2-0181 and W81XWH-10-2-0178). Authors supported by the MSRC are Min Eun Jeon, Marielle A. Gomez, and Thomas E. Joiner. Opinions, interpretations, conclusions and recommendations are those of the authors and are not necessarily endorsed by the MSRC or the Department of Defense. Authors have no conflicts of interests to disclose., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Most DSM-5 eating disorder diagnoses are associated with elevated suicide risk; however, little is known about the relationship between Avoidant/Restrictive Food Intake Disorder (ARFID) and suicidal ideation. The aim of the current study was to examine suicidal ideation within an adult ARFID sample. Patients with eating disorders (N = 936), some of whom met criteria for a current DSM-5 diagnosis of ARFID (n = 79), completed the Beck Depression Inventory II Item 9, regarding suicidal ideation. The study was conducted within an eating disorder treatment facility that offers inpatient, residential, partial hospitalization program, and intensive outpatient levels of care. Findings suggest no significant pairwise differences in suicidal ideation prevalence between participants with ARFID and those with any other ED diagnosis. Thorough screening for suicidal thoughts and risk among those with ARFID is warranted at all levels of care. We suggest that future research expand upon this work in a larger adult ARFID sample., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Children and adolescents spend an increasing amount of time with screen media. Identifying correlates of youth mental disorders has become more urgent with rates of depression, self-harm, suicide attempts, and suicide deaths rising sharply among U.S. children and adolescents after 2012. This study examined the relationship between screen time and internalizing disorders in preadolescent children between the ages of 9 and 10., Methods: Participants were 9- and 10-year-old youth (n = 11,780) in the baseline of the multi-site Adolescent Brain and Cognitive Development Study (ABCD). Youth reported the number of hours a day they spent watching TV shows or movies, watching videos online, playing video games, texting, using social media, and video chatting. Youth responded to an abbreviated version of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-5), a semi-structured clinical interview measuring current and past symptoms of internalizing disorders using DSM-5 criteria., Results: Youth spending 2 or more hours (vs. less than 2) a day with screen media were more likely to fit criteria for depressive disorders, self-harm, and suicidal ideation or attempts, even after adjustment for demographic covariates. For anxiety disorders, associations with digital media use (social media, texting, gaming, and online videos) were stronger than with screen time generally., Limitations: This is a cross-sectional study utilizing retrospective screen time reports, which limits our ability to determine causality and the accuracy of the reports., Conclusions: Preadolescents who spend more time using screens, especially digital media, are more likely to fit DSM-5 criteria for internalizing disorders., (Copyright © 2022 Elsevier B.V. All rights reserved.)

COVID-19 emerged in 2019 and has since killed more than two and a half million people worldwide. Several studies have investigated the role of COVID-19 on the prevalence of mental health outcomes, with general findings indicating elevated rates of mental health issues as compared to the pre-COVID-19 era. However, the effect of specific demographic features is less clear. As such, we investigated whether anxiety, depressive, and eating pathology symptoms varied by gender, age, status as a medical provider (compared to the general public), race, or region of origin. Forty-three effect sizes from 36 studies indicated that all three symptoms increased from pre- to peri‑COVID-19-eras across all regions. No symptom varied by age, status as a medical provider, or race, though females were significantly more likely to experience eating pathology than males. Findings from our study indicate that worldwide, regardless of age, status as a medical provider, race, or region of origin, respondents experienced significantly elevated rates of psychopathology symptoms during the onset of the COVID-19 pandemic., (Copyright © 2021. Published by Elsevier B.V.)

Background: Social support has been identified as a protective factor against suicidal thoughts and behaviors. Research has not conclusively identified the component of social support most implicated in suicidal thoughts and behaviors: (1) frequency of social contact or (2) closeness of relationships. This study examined the relationships between these facets of social support and suicidal thoughts and behaviors in two nationally representative samples, as well as subsamples with social anxiety disorder (SAD)., Methods: Study 1 variables for lifetime and past-year suicide ideation and attempt, social contact frequency, and closeness were calculated and examined within the National Comorbidity Survey-Replication (NCS-R). Study 2 examined the independent contributions of social contact frequency and closeness to only lifetime suicide attempt in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III)., Results: In the NCS-R, lower social closeness but not contact frequency was uniquely associated with suicidal ideation and attempt in the general sample and those with SAD. In the NESARC-III, both components of social support were associated with lifetime suicide attempt in the general sample, while only social closeness was uniquely associated with suicide attempt in the SAD subsample., Limitations: This study utilized cross-sectional data and was limited in the validity and specificity of the variables assessed., Discussion: Lower social closeness was more strongly associated with suicidality than social contact frequency and merits attention as a potential target for suicide-related interventions. Social closeness may be especially relevant in populations experiencing high rates of suicidal thoughts and behaviors and decreased social support., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Interoceptive dysfunction (ID) is associated with self-injurious behaviors, as disconnection from the body is thought to enable bodily harm. This study tested differences in ID among those with and without history of self-injurious behaviors, as well as the relationship between ID and lethality of past suicide attempts. Adults (N = 344; 61.3% female; mean age 27.68) seeking psychological treatment completed self-report measures and clinical interviews during intake at a community-based clinic. Overall symptom severity was substantial (e.g., approximately 40% reported current suicidal ideation and two-thirds met a clinical cut-off score of ≥ 16 on the Beck Depression Inventory). Orthogonal contrasts were used to test whether mean levels of ID differed across lifetime self-injurious behavior groups. Attempt lethality was regressed on interoceptive dysfunction, covarying depressive symptom severity, age, and gender. Participants with suicide attempt history demonstrated greater ID than those without. Participants who had engaged in non-suicidal self-injury demonstrated greater ID than those with no history of self-injurious behaviors. Greater ID was associated with higher lethality of past suicide attempt, above demographic and clinical covariates. ID may have transdiagnostic relevance for risk assessment and management of self-injurious behaviors., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: The present study explored group differences in suicide-related variables between those with and without psychosis within the context of a psychiatric inpatient sample that included a range of affective disorder diagnoses., Methods: 54 individuals with psychosis and 103 individuals without psychosis (but experiencing other severe and acute mental health issues) were compared, and analyses of indirect effects were conducted to test specificity of thwarted belongingness, perceived burdensomeness, capability for suicide, agitation, and insomnia as accounting for group differences in suicidal ideation., Results: Patients without psychosis experienced higher levels of suicidal ideation, perceived burdensomeness, thwarted belongingness, agitation, and insomnia than patients with psychosis. Additionally, perceived burdensomeness and agitation emerged as robust explanatory factors for the relationship between psychosis status and suicidal ideation., Limitations: Future work should include longitudinal analyses to understand temporal relationships between study variables. Additionally, stability of patients' psychotic symptoms was required and therefore may not reflect those at greatest acuity., Conclusions: Although several studies have investigated suicide-related variables among those with psychosis as compared to the general population, the present study is novel in that the severity of these symptoms in those with psychosis is compared to that of those in other acutely ill populations (e.g., major depression, substance use)., (Copyright © 2021. Published by Elsevier B.V.)

Background: Agitation is an important transdiagnostic factor for several mental health disorders and a significant risk factor for dangerous or maladaptive coping behaviors. How an individual responds to experiences of agitation itself may also play a crucial role in conferring risk towards maladaptive behaviors. Specifically, ruminating on high arousal emotions, such as anger, will also be more likely to initiate and maintain agitation, thereby increasing risk for impulsive and maladaptive behaviors., Methods: Undergraduate students (N=117) were randomly assigned to an emotion induction condition (i.e., control, sadness only, anger only, sadness and anger) followed by either a control condition or a rumination induction. They completed measures on subjective emotional state and agitation at baseline, after emotion induction, after rumination induction, and at the end of session., Results: Agitation was influenced by negative affect broadly with each experimental condition leading to agitation. Anger influenced momentary change in agitation and sustained agitation when combined with rumination., Limitations: The majority of participants in the current study were young, white females and the findings may not generalize to individuals of diverse genders and cultures who may have experience and cope with agitation differently., Conclusions: Recognizing and mitigating rumination during moments of anger may help decrease a clients' use of problematic coping behaviors., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Most suicide deaths in the United States are enacted with a firearm, and recent and first-time purchasers of firearms represent at-risk groups. This study aimed to examine differences in indicators of suicide risk among individuals who either (a) reported current firearm ownership/access or (b) denied current firearm ownership/access but reported an intention to obtain a firearm (i.e., prospective firearm owners). Participants were 96 young adults with a lifetime history of suicidal ideation and firearm ownership, access, or interest. We assessed recent suicidal ideation severity with the Depressive Symptom Index-Suicidality Subscale (DSI-SS) and sought to internally replicate findings with the Patient Health Questionnaire (PHQ-9) item 9. Fifty-two (54.2%) participants reported firearm ownership/access and 44 (45.8%) identified as prospective firearm owners. Prospective firearm owners had significantly greater DSI-SS suicidal ideation severity scores compared with those who already own/have access to a firearm, corresponding to a medium effect size; results were consistent with the PHQ-9 suicidal ideation item. Findings of this initial investigation suggest that the intention to commence firearm ownership might represent an at-risk period, especially for individuals with a history of suicidal thinking. Replication of findings in larger and more clinically severe samples is needed., (Copyright © 2020. Published by Elsevier B.V.)

Background: Suicide rates are elevated among United States (U.S.) military service members. Research has found that service members with autism spectrum disorder-related (ASD-related) traits are at increased risk for suicide. Complementary lines of inquiry have suggested that unit cohesion is a protective factor against developing suicidal ideation in military service members. However, given the social difficulties inherent in ASD, it is unclear whether unit cohesion might protect against suicide risk in this population., Method: Our sample consisted of 285 active duty U.S. military service members recruited online. We examined the interaction between ASD-related traits (as measured by the Autism Spectrum Quotient [AQ]), unit cohesion, and suicide risk (as measured by the Suicidal Behaviors Questionnaire-Revised [SBQ-R]). We also conducted exploratory analyses to examine whether unit cohesion attenuates the association between ASD-related traits and suicidal intent., Results: Elevated ASD-related traits were independently associated with higher levels of global suicide risk; however, unit cohesion was not independently associated with suicide risk. Unit cohesion did not significantly interact with ASD-related traits to predict suicide risk. Finally, we found that elevated ASD-related traits and unit cohesion have an independent effect on current suicidal intent., Discussion: Our findings suggest that unit cohesion might not buffer the effect of ASD-related traits on suicide risk. However, our results do show that greater unit cohesion may be independently associated with decreased suicidal intent. This study is limited by a cross-sectional design and use of self-report measures., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: High rates of suicidal ideation in those with social anxiety disorder (SAD) have been attributed to feelings of thwarted belongingness and perceived burdensomeness, but most work has been in non-clinical samples. We assessed the contributions of thwarted belongingness and perceived burdensomeness to suicidal ideation severity, over clinical covariates, in individuals diagnosed with SAD., Methods: Participants were 58 adult outpatients (mean age 25.62 years, 69% female) with SAD. Hierarchical linear regression assessed contributions of thwarted belongingness and perceived burdensomeness to suicidal ideation, before and after covarying other potential explanatory variables (depression, agitation, brooding rumination)., Results: Perceived burdensomeness was significantly positively related to suicidal ideation severity (p < .001) above thwarted belongingness, which was not incremental (p = .791). The same pattern was found after inclusion of additional covariates (perceived burdensomeness p = .006; thwarted belongingness p = .757). Greater agitation also uniquely accounted for more severe suicidal ideation (p = .001)., Limitations: This study was cross-sectional, did not assess all potential confounding variables, and utilized a treatment-seeking sample., Conclusions: Results suggest perceived burdensomeness is independently related to suicidal ideation severity in SAD, over thwarted belongingness and other clinical features. Future work should seek to replicate these findings and evaluate causal, longitudinal relationships among perceived burdensomeness, agitation, and severity of suicidal ideation in those with SAD in order to determine whether these may be clinically-relevant mechanisms., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to report., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Theories of suicide posit distinct etiological pathways for suicide attempts (SA) and suicidal ideation (SI) that are marked, in part, by disruptions in the ability to regulate reactions to threat/mutilation and interpersonally-relevant emotional stimuli. However, little research has specifically tested these associations. To address this gap, the present study extracted the Late Positive Potential (LPP) during an emotion regulation task to evaluate the independent associations that SA history and SI share with initial responsivity to, and regulation of, these distinct emotional contents., Methods: A clinical sample (N = 257) were recruited based on elevations in suicide risk factors. Participants completed a picture viewing and regulation task that included threat/mutilation, reward, and neutral images from the International Affective Picture System. Immediately prior to picture onset, participants were instructed to passively view the image, increase their emotional reaction to the image, or decrease their emotional reaction to the image., Results: Differential patterns of LPP amplitudes only emerged in the context of attempts to regulate emotional responses such that SA history predicted a superior ability to volitionally mitigate responses to threat/mutilation while SI was related to a worse ability to increase responses to reward. Effect sizes were in the small and small-to-medium range., Limitations: The present data were cross-sectional and included low trial counts., Conclusions: Taken together, these findings support existing theories of suicide suggesting that distinct mechanisms underlie suicidal thoughts and behaviors. Future research should seek to determine if these mechanisms may serve as a viable intervention targets., (Copyright © 2019. Published by Elsevier B.V.)

Background: A growing body of literature supports the potential existence of a new clinical entity, Acute suicidal affective disturbance (ASAD), which is characterized by rapid-onset, acute suicidality. This study aimed to evaluate whether current ASAD symptoms (i.e., suicidal intent, thwarted belongingness, perceived burdensomeness, disgust with others and oneself, agitation, irritability, insomnia, and nightmares) comprise a psychopathological network distinct from anxiety and depression symptoms., Methods: A sample of 167 psychiatric inpatients completed self-report measures of current ASAD, anxiety, and depression symptoms., Results: Network analyses revealed three distinct clusters of symptoms corresponding to ASAD, anxiety, and depression symptom self-report measure items. Namely, ASAD symptoms not only demonstrated strong associations with each other, but they also exhibited weak associations with symptoms of anxiety and depression., Limitations: This study utilized a cross-sectional design and distinct self-report measures to assess all constructs, which may have led to methodological confounds that influenced the observed network structure., Conclusions: Overall, our findings provide further evidence for ASAD as a syndrome with strongly interrelated symptoms. Furthermore, results indicate that ASAD may represent a construct distinct from anxiety and depression, underscoring its potential diagnostic value. Additional research is needed to replicate these findings across other high-risk populations, as well as to examine how ASAD symptoms may relate to other psychiatric symptoms., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Research suggests that insomnia is associated with elevated perceptions of loneliness and social disconnection; however, few quasi-experimental studies have tested the relationship between these constructs. This study examined whether insomnia symptom severity predicts changes in perceptions of interpersonal connectedness and desire for emotional support following in-laboratory participation in a social exclusion paradigm., Methods: Young adults (N = 70) completed self-report measures assessing constructs of interest before and after engaging in a social exclusion paradigm (Cyberball). Linear regression analyses were used to evaluate whether baseline insomnia symptom severity predicted perceived burdensomeness, desire for emotional support, and thwarted belongingness after playing Cyberball; analyses controlled for baseline perceived burdensomeness, desire for emotional support, and thwarted belongingness, respectively, as well as baseline social anxiety and depression symptoms., Results: Greater insomnia symptom severity significantly predicted greater feelings of perceived burdensomeness following Cyberball participation, beyond baseline perceived burdensomeness, social anxiety symptoms, and depression symptoms (β= .24, p = .001). More severe insomnia symptoms also significantly predicted lower desire for emotional support after playing Cyberball, beyond baseline desire for emotional support and social anxiety symptoms (β= -.14, p = .03) but not beyond baseline depression symptoms (β= -.16, p = .07). Insomnia symptoms were not significantly associated with thwarted belongingness after Cyberball (β= -.05-.08, p = .27-.57)., Limitations: Replication in larger samples and using other sleep disturbance indices is needed., Conclusions: Findings suggest that individuals with more severe insomnia symptoms in the past two weeks experience greater perceptions of being a burden on others and less desire for emotional support in response to social exclusion., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Suicidal ideation and depression alone are poor predictors of subsequent engagement in suicidal behavior. Evidence suggests, however, that the lethargy associated with depression may serve as a protective factor against suicide attempts. The purpose of this study was to examine whether suicidal ideation and depression symptoms interact in relation to lifetime suicide attempts among a sample of psychiatric outpatients. A sample of 739 psychiatric outpatients (M age  = 27.26, 60.8% female, 73.3% White/European American) from a university-affiliated clinic completed a battery of self-report measures prior to their initial intake appointments. Consistent with hypotheses, a significant interaction emerged between suicidal ideation and depression symptoms in association with lifetime suicide attempts, such that the relationship between suicidal ideation and lifetime suicide attempts was strongest at low, as opposed to high, levels of depression. These findings align with previous research suggesting that lethargy may be a protective factor against suicide attempts, and conversely, that heightened arousal may serve as a suicide risk factor. Our results also point to a configuration of suicidal ideation and depression symptoms that might reflect higher suicide risk., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Firefighters are at increased risk for both problematic alcohol use and suicidality. Research has found that problematic alcohol use is related to suicidality among this population; however, limited data exist regarding what might account for this association. The present two-study investigation (1) examined the association between suicidality and problematic alcohol use among two large samples of firefighters and (2) tested whether interpersonal theory of suicide constructs-perceived burdensomeness (PB) and thwarted belongingness (TB)-serve as indirect indicators of this relationship., Methods: Participants in Study 1 were 944 U.S. firefighters (12.5% female); participants in Study 2 were 241 U.S. women firefighters. Participants completed the Interpersonal Needs Questionnaire, Alcohol Use Disorders Identification Test, and the Depressive Symptom Inventory-Suicidality Subscale (Study 1) or the Self-Injurious Thoughts and Behaviors Interview-Short Form (Study 2). Bias-corrected bootstrap indirect effects path analyses were utilized., Results: In Study 1, more problematic alcohol use was significantly associated with more severe career suicidal ideation via PB but not TB. In Study 2, problematic alcohol use was associated with career suicidal ideation via both PB and TB. PB seems to account for the relationship between problematic alcohol use and career suicidal ideation among male and female firefighters., Limitations: Limitations include use of a cross-sectional design, use of retrospective measures of suicidal ideation, and our findings derived from subsamples of two existing datasets., Conclusions: Findings suggest that PB and TB may explain the relationship between problematic alcohol use and suicidal ideation, but that this effect is discrepant based on gender., (Copyright © 2018. Published by Elsevier B.V.)

Recent research has indicated that firefighters are at elevated suicide risk. Fire service organizations have called for research to examine fire service subgroups that might be at relatively increased suicide risk. Although anecdotal reports suggest that wildland firefighters represent one such group, to our knowledge, no study has empirically examined this conjecture. Thus, the present investigation examined if wildland firefighters report greater levels of suicide risk than non-wildland firefighters. Moreover, we sought to determine if two constructs proposed by the interpersonal theory of suicide to comprise suicidal desire-thwarted belongingness and perceived burdensomeness-statistically explain the link between wildland firefighter status and suicide risk. Merged data from two nationwide investigations of firefighter mental health were utilized (N = 1,131; 68.2% male, 89.4% White). A total of 1.8% (n = 20) of the sample identified as wildland firefighters. Compared to non-wildland firefighters, wildland firefighters reported greater levels of suicide risk. Thwarted belongingness, but not perceived burdensomeness, statistically explained this link. Findings suggest that programs enhancing social connectedness within the fire service, particularly among wildland firefighters, might be one avenue for suicide prevention among firefighters. Results of this novel investigation should be interpreted in light of the relatively small subgroup of wildland firefighters., (Copyright © 2018 Elsevier B.V. All rights reserved.)

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., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Past research indicates that firefighters are at increased risk for suicide. Firefighter-specific occupational stress may contribute to elevated suicidality. Among a large sample of firefighters, this study examined if occupational stress is associated with multiple indicators of suicide risk, and whether distress tolerance, the perceived and/or actual ability to endure negative emotional or physical states, attenuates these associations. A total of 831 firefighters participated (mean [SD] age = 38.37y[8.53y]; 94.5% male; 75.2% White). The Sources of Occupational Stress-14 (SOOS-14), Distress Tolerance Scale (DTS), and Suicidal Behaviors Questionnaire-Revised (SBQ-R) were utilized to examine firefighter-specific occupational stress, distress tolerance, and suicidality, respectively. Consistent with predictions, occupational stress interacted with distress tolerance, such that the effects of occupational stress on suicide risk, broadly, as well as lifetime suicide threats and current suicidal intent, specifically, were attenuated at high levels of distress tolerance. Distress tolerance may buffer the effects of occupational stress on suicidality among firefighters. Pending replication, findings suggest that distress tolerance may be a viable target for suicide prevention initiatives within the fire service., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Research suggests that screening for suicidality does not have iatrogenic effects; however, less is known regarding the impact of repeatedly screening for suicidal ideation among individuals with varying levels of exposure to these screenings. This staggered sequential study evaluated whether suicidal ideation severity increases with repeated screening for suicidal ideation and depression symptoms., Methods: Undergraduates (N = 207) were recruited at one of four time points (baseline [n = 37], 1 month later [n = 61], 4 months later [n = 55], and 12 months later [n = 54]) to complete the self-report Beck Depression Inventory (BDI). Participants completed the BDI at the time point at which they were recruited and all subsequent study time points. Non-parametric tests were employed to compare suicidal ideation severity (BDI Item 9) and depression symptom severity (BDI total score): (1) within each group across time points and (2) within each time point across groups., Results: Suicidal ideation severity did not significantly differ within any group across time points, and for two groups, depression symptom severity decreased over time. For analyses between groups, suicidal ideation and depression symptom scores were, at times, significantly lower during subsequent BDI completion time points., Limitations: This study utilized a relatively small sample size and participants of low clinical severity., Conclusions: Findings align with prior research indicating that suicidality screening is not iatrogenic. This study also expanded upon previous studies by leveraging a staggered sequential design to compare suicidal ideation and depression symptom severity among individuals with varying exposure to suicidal ideation screenings., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The Interpersonal Theory of Suicide posits that hopelessness about thwarted belongingness and perceived burdensomeness is an important risk factor for the desire for suicide and suicide risk. Past research has indicated that general feelings of hopelessness interact with the constructs of thwarted belongingness and perceived burdensomeness to predict suicide ideation. However, no research has explicitly tested whether hopelessness specific to the interpersonal constructs of thwarted belongingness and perceived burdensomeness predicts suicide ideation and suicide risk. Participants in the current study (N = 173) were undergraduate students oversampled for history of suicide ideation, planning for suicide, and suicide attempt(s). Participants completed study measures online, including a new measure of hopelessness about thwarted belongingness and perceived burdensomeness. Results indicated that a three-way interaction of thwarted belongingness, perceived burdensomeness, and hopelessness about these interpersonal constructs, but not general hopelessness, predicted unique variance of suicide ideation and suicide risk. Results suggest that hopelessness about thwarted belongingness and perceived burdensomeness may be an important target for reducing suicidal desire., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Women protective service workers die by suicide at a higher rate than women workers in other occupational groups. However, no study has examined rates and correlates of suicidal thoughts and behaviors among women firefighters, despite the potential for these data to inform suicide screening, prevention, and intervention initiatives. The purpose of this study is to describe and compare pre-career and career rates of suicidal thoughts and behaviors and identify their sociodemographic and occupational correlates among women firefighters., Methods: Data were obtained from 313 current U.S. women firefighters who completed a web-based survey (mean age = 37.30y, SD = 9.70y, 92.7% White)., Results: Pre-career rates of suicide ideation, plans, attempts, and non-suicidal self-injury (NSSI) were found to be 28.4%, 10.2%, 5.8%, and 11.2%, respectively. Career rates of suicide ideation, plans, attempts, and NSSI were found to be 37.7%, 10.9%, 3.5%, and 9.3%, respectively. Pre-career rates of suicide ideation (OR = 4.760, 95% CI = 2.820-8.034, p < 0.001), plans (OR = 4.867, 95% CI = 2.067-11.463, p < 0.001), attempts (OR = 7.175, 95% CI = 1.726-29.828, p = 0.007), and NSSI (OR = 9.676, 95% CI = 4.130-22.670, p < 0.001) were significantly associated with career suicidality. With few exceptions, neither sociodemographic characteristics nor firefighter experiences were associated with career suicidal symptoms., Limitations: Study limitations include a cross-sectional design and convenience sample recruitment strategy., Conclusions: Women firefighters report elevated rates of suicidal thoughts and behaviors. Suicidal symptoms occurring prior to one's tenure as a firefighter-and not solely an aspect of firefighter career experiences-should be considered in suicide risk screening, prevention, and intervention initiatives. Studies examining modifiable suicide risk factors and correlates (e.g., psychiatric symptoms, workplace harassment) are needed., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Stressful life events (SLEs) are associated with increased risk for suicidal behavior. Less is known regarding the intensity of SLEs and how this may vary as a function of suicide attempt history. As a large percentage of suicide decedents do not have a history of suicidal behavior, SLEs precipitating suicide may help characterize suicidality in this understudied population. This paper examines the intensity, number, and accumulation of SLEs preceding death by suicide among decedents with varying suicide attempt histories. Suicide attempts, SLEs, and suicide methods were examined in two samples: 62 prison-based and 117 community-based suicide decedents. Regression was used to compare the level of stressor precipitating death by suicide in decedents who died on a first attempt versus multiple previous attempts. A non-significant trend was observed in the prison population which was supported by significant findings in the community-based sample. Decedents who died on a first attempt experienced a stressor of a lower magnitude when compared to decedents with multiple previous suicide attempts. We discuss the implications of these findings in relation to the stress-diathesis model for suicide., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Loneliness has been repeatedly associated with sleep problems; however, there is a dearth of research examining the prospective relationship between insomnia and loneliness, as well as this association controlling for other psychiatric symptoms. This study evaluated the cross-sectional and prospective relationship between insomnia and loneliness using six samples: 666 undergraduates; 2785 Army recruiters; 208 adults with a history of suicidality and/or depression; 343 adult psychiatric outpatients; 326 young adults at elevated suicide risk; and 183 undergraduates. A meta-analysis also was conducted to examine the magnitude of the relationship between insomnia and loneliness across the six studies. More severe insomnia symptoms were significantly associated with greater feelings of loneliness while accounting for some (e.g., anxiety, nightmares) but not all (i.e., depression) psychiatric covariates. Findings underscore the strength of the association between insomnia and loneliness and suggest that depression may account for this relationship. Additional studies are needed to further establish the temporal relationship between these variables, delineate the role of depression in the association between insomnia and loneliness, and test whether insomnia may confer unique risk for subsequent loneliness., (Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.)

Background: The RDoC matrix framework calls for investigation of mental health problems through analysis of core biobehavioral processes quantified and studied across multiple domains of measurement. Critics have raised concerns about RDoC, including overemphasis on biological concepts/measures and disregard for the principle of multifinality, which holds that identical biological predispositions can give rise to differing behavioral outcomes. The current work illustrates an ontogenetic process approach to addressing these concerns, focusing on biobehavioral traits corresponding to RDoC constructs as predictors, and suicidal behavior as the outcome variable., Method: Data were collected from a young adult sample (N=105), preselected to enhance rates of suicidality. Participants completed self-report measures of traits (threat sensitivity, response inhibition) and suicide-specific processes., Results: We show that previously reported associations for traits of threat sensitivity and weak inhibitory control with suicidal behavior are mediated by more specific suicide-promoting processes-namely, thwarted belongingness, perceived burdensomeness, and capability for suicide., Limitations: The sample was relatively small and the data were cross-sectional, limiting conclusions that can be drawn from the mediation analyses., Conclusions: Given prior research documenting neurophysiological as well as psychological bases to these trait dispositions, the current work sets the stage for an intensive RDoC-oriented investigation of suicidal tendencies in which both traits and suicide-promoting processes are quantified using indicators from different domains of measurement. More broadly, this work illustrates how an RDoC research approach can contribute to a nuanced understanding of specific clinical problems, through consideration of how general biobehavioral liabilities interface with distinct problem-promoting processes., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: Childhood abuse is linked to suicide. Potential pathways include the increased risk for the development of psychiatric disorders and the contribution of abuse to suicide capability. The current study compared the effects of childhood non-violent and violent abuse in the prediction of suicide attempts, and examined the potential mediated effects of psychiatric disorders., Methods: Data from the National Comorbidity Surveys were obtained. At baseline, assessments of childhood non-violent abuse (e.g., parental verbal abuse) and violent abuse (e.g., parental physical abuse, relative rape) were obtained. We also assessed for other adverse childhood experiences, baseline suicidal behaviors, and psychiatric disorders. At the ten-year follow-up, we assessed for psychiatric disorders and suicide attempts that had occurred over time., Results: Both non-violent and violent abuse predicted attempts, though participants experiencing violent abuse had significantly higher rates. Bootstrapped mediation analyses determined that the influence of non-violent abuse on suicide attempts was indirect, and exerted its influence through the psychiatric disorders that occurred during the ten-year follow-up., Limitations: The study relied on retrospective reports of childhood abuse. Further, we could not clearly determine the temporal order of the psychiatric disorders and suicide attempts occurring over follow-up., Conclusion: Different mechanisms may underlie the pathway between violent and non-violent abuse and suicide attempts. Verbal abuse may lead to negative cognitive styles and psychiatric disorders associated with suicidality; violent abuse may contribute to the capacity for suicide. Interventions may need to be specifically tailored to meet the distinct needs of individuals who have experienced past childhood abuse., (Copyright © 2017 Elsevier B.V. All rights reserved.)

This study investigated the cross-cultural relevance and validity of the Interpersonal Theory of Suicide (ITS) utilizing young adult samples from South Korea (n =554) and the United States (U.S.; n =390). To examine the ITS, all participants completed self-report questionnaires measuring Thwarted Belongingness, Perceived Burdensomeness, and Capability for Suicide. We examined whether each construct significantly predicted the severity of suicidal risk in both samples. We also determined whether the strength of the effects of Thwarted Belongingness and Perceived Burdensomeness on suicidal ideation differed between the two samples due to the greater degree of importance placed on interpersonal relationships in collectivistic cultures such as South Korea. Structural equation modeling was used to examine these hypotheses. Thwarted Belongingness, Perceived Burdensomeness, and Capability for Suicide significantly predicted elevated suicidal risk. However, there were no significant differences in the paths from Thwarted Belongingness or Perceived Burdensomeness to suicide risk between the South Korean and U.S., Samples: These findings support the cross-cultural relevance and applicability of the ITS, whereby Thwarted Belongingness and Perceived Burdensomeness serve as indicators of suicide risk in both Western (U.S.) and East Asian (Korean) samples., (Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.)

Background: A new clinical entity, Acute Suicidal Affective Disturbance (ASAD), was recently proposed to characterize rapid-onset, acute suicidality including the cardinal symptom of behavioral intent. This study examines the proposed ASAD criteria factor-analytically and in relation to correlates of suicidal behavior and existing psychiatric disorders in samples of psychiatric outpatients and inpatients., Methods: Two samples of psychiatric outpatients (N=343, aged 18-71 years, 60.6% female, 74.9% White) and inpatients (N=7,698, aged 15-99 years, 57.2% female, 87.8% White) completed measures of their ASAD symptoms and psychological functioning., Results: Across both samples, results of a confirmatory factor analysis supported the unidimensional nature of the ASAD construct. Additionally, results provided evidence for the convergent and discriminant validity of ASAD, demonstrating its relation to, yet distinction from, other psychiatric disorders and correlates of suicide in expected ways. Importantly, ASAD symptoms differentiated multiple attempters, single attempters, and non-attempters, as well as attempters, ideators, and non-suicidal patients, and was an indicator of past suicide attempts above and beyond symptoms of depression and other psychiatric disorders., Limitations: This study utilized cross-sectional data and did not use a standardized measure of ASAD., Conclusions: ASAD criteria formed a unidimensional construct that was associated with suicide-related variables and other psychiatric disorders in expected ways. If supported by future research, ASAD may fill a gap in the current diagnostic classification system (DSM-5) by characterizing and predicting acute suicide risk., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Although insomnia has been identified as a robust predictor of suicidal ideation and behaviors, little is known about the mechanisms by which sleep disturbances confer risk for suicide. We investigated thwarted belongingness as an explanatory link between insomnia symptoms and suicidal ideation across three military service member and veteran samples., Methods: Data were collected among United States military service members and veterans (N 1 =937, N 2 =3,386, N 3 =417) who completed self-report measures of insomnia symptoms, thwarted belongingness, suicidal ideation, and related psychiatric symptoms (e.g., anxiety, hopelessness). Bias-corrected bootstrap mediation analyses were utilized to examine the indirect effects of insomnia symptoms on suicidal ideation through thwarted belongingness, controlling for related psychiatric symptoms., Results: Consistent with study hypotheses, thwarted belongingness significantly accounted for the relationship between insomnia and suicidal ideation across all three samples; however, insomnia symptoms did not significantly account for the relationship between thwarted belongingness and suicidal ideation, highlighting the specificity of our findings., Limitations: This study utilized cross-sectional self-report data., Conclusions: Insomnia may confer suicide risk for military service members and veterans, in part, through the pathway of thwarted belongingness. Additional prospective studies are warranted to further delineate this model of risk. Our results offer a potential therapeutic target for the prevention of suicide, via the promotion of belongingness, among service members and veterans experiencing insomnia symptoms., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: Suicide rates among veterans are disproportionately high compared to rates among the general population. Veterans may experience a number of negative emotions (e.g., anger, self-directed hostility, shame, guilt) during periods of postwar adjustment and reintegration into civilian life that may uniquely confer risk for suicide. Mechanisms of these associations, however, are less well studied. The purpose of the present study was to examine the relationship between negative emotions and suicide risk in veterans through the theoretical framework of the interpersonal theory of suicide., Methods: A large sample of veterans (N = 541) completed measures assessing their negative emotions, perceived burdensomeness, thwarted belongingness, and suicide risk., Results: Self-directed hostility and shame related indirectly to suicide risk through both perceived burdensomeness and thwarted belongingness. Thwarted belongingness accounted for the association between anger and suicide risk, whereas perceived burdensomeness accounted for the relationship between guilt and suicide risk., Limitations: This study had a cross-sectional design and relied solely on self-report measures., Conclusions: These findings provide evidence for the role of negative emotions in conferring risk for suicide in veterans. Clinical implications, limitations, and future research directions are discussed., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: Insomnia is a robust correlate of suicidal ideation and behavior. Preliminary research has identified thwarted belongingness (c.f. social disconnection) as an explanatory link between insomnia and suicidal ideation., Objectives: This study replicates and extends previous findings using both cross-sectional and longitudinal designs in four demographically diverse samples. Additionally, the specificity of thwarted belongingness was evaluated by testing anxiety as a rival mediator., Method: Self-report measures of insomnia symptoms, thwarted belongingness, suicidal ideation and behavior, and anxiety were administered in four adult samples: 469 undergraduate students, 352 psychiatric outpatients, 858 firefighters, and 217 primary care patients., Results: More severe insomnia was associated with more severe thwarted belongingness and suicidality. Thwarted belongingness significantly accounted for the association between insomnia and suicidality, cross-sectionally and longitudinally, beyond anxiety. Notably, findings supported the specificity of thwarted belongingness: anxiety did not significantly mediate the association between insomnia and suicidality, and insomnia did not mediate the relation between thwarted belongingness and suicidality., Limitations: This study relied solely on self-report measures. Future studies incorporating objective sleep measurements are needed., Conclusion: Findings underscore the utility of assessing and addressing sleep disturbances and social disconnection to reduce suicide risk., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Firefighters are at increased risk for mental health problems. However, little is known about differences in psychiatric symptoms between volunteer and career firefighters. This study aimed to (1) describe differences in psychiatric symptoms and barriers to mental health care between U.S. firefighters in volunteer-only and career-only departments; and (2) determine if greater self-reported structural barriers to mental health care (e.g., cost, availability of resources) explain the differences in psychiatric symptom levels. Overall, 525 current U.S. firefighters participated. Analyses of covariance and logistic regression analyses were used to evaluate group differences between volunteer (n=204) and career (n=321) firefighters, adjusting for demographic and occupational characteristics. Volunteer firefighters reported significantly elevated levels of depression, posttraumatic stress, and suicidal symptoms compared to career firefighters. Career firefighters reported relatively elevated levels of problematic alcohol use. Volunteer firefighters additionally reported greater structural barriers to mental health care (e.g., cost, availability of resources), and these barriers accounted for the differences in mental health variables between volunteer and career firefighters. Findings suggest that volunteer firefighters report elevated psychiatric symptoms compared to career firefighters and greater structural barriers to mental health treatment may explain this link. Increased efforts are needed to develop firefighter-specific interventions and bolster mental health service utilization., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Past research suggests that suicide has a profound impact on surviving family members and friends; yet, little is known about experiences with suicide bereavement among military populations. This study aimed to characterize experiences with suicide exposure and their associations with lifetime and current psychiatric symptoms among military service members and veterans., Methods: A sample of 1753 United States military service members and veterans completed self-report questionnaires assessing experiences with suicide exposure, lifetime history of suicidal thoughts and behaviors, current suicidal symptoms, and perceived likelihood of making a future suicide attempt., Results: The majority of participants (57.3%) reported knowing someone who had died by suicide, and of these individuals, most (53.1%) reported having lost a friend to suicide. Chi-square tests, one-way ANOVAs, and logistic regression analyses revealed that those who reported knowing a suicide decedent were more likely to report more severe current suicidal symptoms and a history of suicidal thoughts and behaviors compared to those who did not know a suicide decedent. Hierarchical linear regression analyses indicated that greater self-reported interpersonal closeness to a suicide decedent predicted greater self-reported likelihood of a future suicide attempt, even after controlling for current suicidal symptoms and prior suicidal thoughts and behaviors., Limitations: This study utilized cross-sectional data, and information regarding degree of exposure to suicide was not collected., Conclusions: Military personnel and veterans who have been bereaved by suicide may themselves be at elevated risk for suicidal thoughts and behaviors. Additional work is needed to delineate the relationship between these experiences., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Non-suicidal self-injury (NSSI) is a strong predictor of suicidal ideation and attempts. Consistent with the interpersonal theory of suicide, preliminary evidence suggests that NSSI is associated with higher levels of perceived burdensomeness (PB) and thwarted belongingness (TB). However, no study to date has examined the cross-sectional and prospective relationships between NSSI, TB, PB, and suicidal ideation (SI). To fill this gap, this study examined the mediating role of TB and PB in the relationship between NSSI and SI at baseline and follow-up. Young adults (N=49) with and without histories of NSSI completed self-report measures of TB, PB, and SI at three time points over two months. NSSI history was associated with higher levels of PB, TB, and SI at all time points. TB and PB significantly accounted for the relationship between NSSI history and SI at baseline. However, the relationship between NSSI history and SI at follow-up was mediated by PB, not TB. Findings provide evidence for the roles of TB and PB in the relationship between NSSI and SI, and partial support for the interpersonal theory of suicide. Future research and clinical implications are discussed., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Recent research suggests that firefighters experience elevated rates of suicidal ideation and behaviors. The interpersonal theory of suicide may shed light on this finding. This theory postulates that suicidal desire is strongest among individuals experiencing perceived burdensomeness and thwarted belongingness, and that the combination of suicide desire and acquired capability for suicide is necessary for the development of suicidal behaviors. We tested the propositions of the interpersonal theory in a large sample of current United States firefighters (N=863). Participants completed self-report measures of perceived burdensomeness, thwarted belongingness, fearlessness about death (FAD; a component of acquired capability), and career suicidal ideation and suicide attempt history. Regression models were used to examine the association between interpersonal theory constructs, career suicidal ideation severity, and the presence of career suicide attempts. In line with theory predictions, the three-way interaction between perceived burdensomeness, thwarted belongingness, and FAD was significantly associated with career suicide attempts, beyond participant sex. However, findings were no longer significant after accounting for years of firefighter service or age. Contrary to predictions, the two-way interaction between perceived burdensomeness and thwarted belongingness was not significantly related to career suicidal ideation severity. Applications of the theory to firefighters and future research are discussed., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Recent evidence suggests an association between cognitive anxiety sensitivity and suicidal ideation. Cognitive anxiety sensitivity has also been implicated as a precursor to various forms of overarousal. These manifestations of overarousal (i.e., agitation, insomnia, nightmares, and anger) may account for the association between cognitive anxiety sensitivity and suicidal ideation., Methods: In Study 1, undergraduate students selectively sampled for recent suicidal ideation completed all measures online. In Study 2, clinical outpatients completed all measures prior to their initial intake appointments at a psychology clinic., Results: Study 1 demonstrated that agitation and insomnia individually and jointly accounted for the association between cognitive anxiety sensitivity and suicidal ideation, controlling for general anxiety and demographic variables. Study 2 replicated and extended these findings, such that, controlling for demographics, general anxiety, and physical and social anxiety sensitivity, agitation and anger each independently and together accounted for the association between cognitive anxiety sensitivity and suicidal ideation, whereas insomnia and nightmares did not., Limitations: This study utilized a cross-sectional design and self-report measures in both samples as well as a sample of undergraduate students in Study 1., Conclusions: Together, these findings suggest that agitation and anger may explain the previously established relationship between cognitive anxiety sensitivity and suicidal ideation. Targeting cognitive anxiety sensitivity in treatment may in turn reduce these forms of overarousal and thereby suicide risk., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: The current study presents initial support for the construct validity of Acute Suicidal Affective Disturbance (ASAD), a clinical entity consisting of acute suicide risk and several related features., Methods: Participants (N=195) were university students who were recruited for a history of suicide attempt(s), history of suicidal ideation, or no history of suicide attempts or suicidal ideation. Participants completed study measures online., Results: Factor analytic results indicated a one factor solution for a lifetime measure of ASAD symptoms. The measure demonstrated strong convergent and divergent validity with common correlates of suicide-related outcomes and incremental predictive validity, as lifetime occurrence of ASAD symptoms predicted number of past suicide attempts above and beyond a host of suicide risk factors. Lifetime ASAD symptoms differed between those with multiple suicide attempts, those with a single attempt, and participants without a history of attempts, as well as between participants with a history of both suicidal ideation and attempts and those with a history of suicidal ideation but not suicide attempts., Limitations: The cross-sectional research design limits the ability to infer causation between ASAD symptoms and suicidal behavior. Only past ASAD symptoms (not current symptoms) were measured., Conclusions: ASAD appears to be a unified clinical entity that characterizes acute suicide risk which may assist clinicians in determining a client's potential for death by suicide., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: States of heightened arousal (e.g., agitation, sleep disturbance) have been repeatedly linked to suicidal thoughts and behaviors, including attempts and death. Studies have further indicated that these states may be particularly pernicious among individuals who evidence high suicidal capability. The objective of this study was to examine the interactive effects of heightened arousal and the capability for suicide in the prospective prediction of death by suicide. We examine this relation beyond the effects of robust predictors of suicide, namely depression and hopelessness., Methods: Participants were drawn from a larger study of undergraduates who completed baseline assessments during their freshman year and were then followed to time of death. The sample in this study only included individuals who had died by suicide (n=96) or other causes (n=542). Proxy measures to assess predictor variables were constructed using items from the MMPI, which was administered at baseline. An independent sample of clinical outpatients (n=was used to evaluate the construct validity of the proxy measures)., Results: Results were in line with expectation: heightened arousal interacted with capability for suicide to prospectively predict death by suicide, such that, as severity of heightened arousal symptoms increased, the likelihood of death by suicide increased among individuals high but not low on capability for suicide., Limitations: Limitations include the use of proxy measures, the extended length of follow-up, and the homogeneity of the sample (i.e., primarily White males)., Conclusion: These findings add to an emerging literature that supports the moderating influence of capability for suicide on the relationship between states of heightened arousal on the likelihood of death by suicide., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: Firefighters experience high-risk occupational hazards that may confer increased risk for suicide; however, prevalence rates of suicidal thoughts and behaviors among firefighters are unknown. The purpose of this study is to describe the career prevalence of suicide ideation, plans, attempts, and non-suicidal self-injury among firefighters, in addition to sociodemographic, physical health, and occupational correlates., Methods: Data were obtained from a cross-sectional convenience sample of 1027 current and retired firefighters who completed a nationwide web-based survey on mental health (mean age=38.49, SD=11.70; 91.2% male; 87.3% White). Sociodemographic, physical health, and occupational correlates were assessed via a structured questionnaire. Suicidal thoughts and behaviors were assessed using a modified version of the Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF)., Results: The career prevalence estimates of suicide ideation, plans, attempts, and non-suicidal self-injury were found to be 46.8%, 19.2%, 15.5%, and 16.4%, respectively. Key factors associated with increased risk for reporting suicidal thoughts and behaviors included lower firefighter rank, fewer years of firefighter service, membership in an all-volunteer department, a history of professionally responding to a suicide attempt or death, and active duty military status., Limitations: The current study utilized a cross-sectional convenience sample of firefighters., Conclusions: Firefighters report an alarmingly high career prevalence of suicidal thoughts and behaviors. Our preliminary data are compelling, indicating the need for additional research as well as increased prevention and treatment efforts among firefighters to decrease suicide risk., (Copyright © 2015. Published by Elsevier B.V.)

The Interpersonal-Psychological Theory of Suicide (IPTS) proposes that suicide ideation is caused by the interaction of perceived burdensomeness and thwarted belongingness, in which each predictor amplifies the harm of the other. Though several studies support this synergy hypothesis, research has not considered potential quadratic effects of perceived burdensomeness and thwarted belongingness, which can distort the sign, size, and significance of interactions, if mistakenly neglected in a model. This investigation examined the synergy hypothesis in samples of university undergraduates and psychiatric inpatients, this time controlling for quadratic effects. Despite adequate power, results showed no interaction between perceived burdensomeness and thwarted belongingness in either sample, regardless of the presence of quadratic effects. Additionally, no quadratic effects were observed. The lower-order, linear perceived burdensomeness term was positively associated with suicide ideation in both samples, but the thwarted belongingness term was not associated with suicide ideation in either sample. The discussion considers implications of current findings for the IPTS, highlighting a need to formally test the impact of sample characteristics on the estimation of theory parameters. Recommendations for systematic evaluation of such sample and theory parameters are offered and their clinical implications are discussed., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Biobehavioral dispositions can serve as valuable referents for biologically oriented research on core processes with relevance to many psychiatric conditions. The present study examined two such dispositional variables-weak response inhibition (or disinhibition; INH-) and threat sensitivity (or fearfulness; THT+)-as predictors of the serious transdiagnostic problem of suicide risk in two samples: male and female outpatients from a U.S. clinic (N=1078), and a population-based male military cohort from Finland (N=3855). INH- and THT+ were operationalized through scores on scale measures of disinhibition and fear/fearlessness, known to be related to DSM-defined clinical conditions and brain biomarkers. Suicide risk was assessed by clinician ratings (clinic sample) and questionnaires (both samples). Across samples and alternative suicide indices, INH- and THT+ each contributed uniquely to prediction of suicide risk-beyond internalizing and externalizing problems in the case of the clinic sample where diagnostic data were available. Further, in both samples, INH- and THT+ interactively predicted suicide risk, with individuals scoring concurrently high on both dispositions exhibiting markedly augmented risk. Findings demonstrate that dispositional constructs of INH- and THT+ are predictive of suicide risk, and hold potential as referents for biological research on suicidal behavior., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Nearly all mental disorders increase suicide risk; however, some better predict ideation versus attempts. The interpersonal theory of suicide provides a framework to understand these relationships, via the constructs of thwarted belongingness, perceived burdensomeness, and acquired capability. The current study examined the relationships between various mental disorders and theory constructs among 997 adult outpatients, controlling for sex and age. Disorders generally symptomatically associated with social withdrawal or potential liability to others (i.e., depressive and bipolar disorders, social phobia, borderline personality disorder, schizophrenia and other psychotic disorders, certain drug dependence) were uniquely positively associated with thwarted belongingness and perceived burdensomeness. Disorders associated with potential exposure to painful and provocative events (i.e., posttraumatic stress disorder, schizophrenia and other psychotic disorders, certain drug use) were associated with increased acquired capability. Notably, alcohol use disorders, attention-deficit/hyperactivity disorder subtypes, and panic/agoraphobia were negatively associated with thwarted belongingness or perceived burdensomeness; avoidant personality disorder, and certain anxiety disorders and drug use disorders, were associated with decreased acquired capability. Importantly, disorders associated with both thwarted belongingness and perceived burdensomeness may place individuals at greatest risk for suicide if acquired capability develops. Implications for comorbidity and suicide risk assessment and treatment are discussed., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Converging evidence suggests that acute states of overarousal are common prior to suicidal behavior. Yet, there has been very little theory-driven research of these phenomena. We consider two competing theoretical perspectives. The first is consistent with the interpersonal theory of suicide, which suggests that the prospect of engaging in lethal suicidal behavior should elicit some degree of arousal; however, the effect of arousal will be particularly relevant when considered in the context of an individual׳s capability for suicide. The second perspective draws from escape-based models, which would suggest that arousal alone should result in increased suicide risk, given the distress associated with high arousal states. Results indicated that the interaction of overarousal and capability for suicide was associated with suicidal symptoms. As overarousal increased, suicidal symptoms increased among high capability individuals and decreased among low capability individuals. These effects were observed beyond the effects of depression, anxiety, age, gender, and marital status. There was no significant main effect of overarousal. Results support a perspective in line with the interpersonal theory, suggesting that overarousal states may be particularly dangerous for individuals who have developed the capability for suicide., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: The current study examined the effects of online social evaluations and comparisons on body dissatisfaction and bulimic symptoms., Methods: We tested the effects of maladaptive Facebook usage (defined as the tendency to seek negative social evaluations and/or engage in social comparisons via Facebook) on body dissatisfaction and bulimic symptoms in a sample of 232 college females followed for approximately 4 weeks., Results: Results provided evidence that maladaptive Facebook usage significantly predicted increases in bulimic symptoms and episodes of over-eating approximately four weeks later. Body dissatisfaction was found to fully mediate the relationship between maladaptive Facebook usage and increases in over-eating episodes, whereas body dissatisfaction partially mediated the relationship between maladaptive Facebook usage and increases in bulimic symptoms more broadly., Limitations: Limitations include the use of a novel measure of maladaptive Facebook usage due to the absence of an existing measure and a non-clinical sample., Conclusions: The results of this study suggest that reducing maladaptive Facebook usage may be a fruitful target for interventions aimed at reducing body dissatisfaction and symptoms of eating pathology., (Copyright © 2013 Elsevier B.V. All rights reserved.)

We conducted four studies to examine the relationship between over-exercise and suicidality. Study 1 investigated whether over-exercise predicted suicidal behavior after controlling for other eating disorder behaviors in a patient sample of 204 women (144 with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) Bulimia Nervosa [BN]). Study 2 tested the prospective association between over-exercise and acquired capability for suicide (ACS) in a sample of 171 college students followed for 3-4 weeks. Study 3 investigated whether pain insensitivity accounted for the relationship between over-exercise and ACS in a new sample of 467 college students. Study 4 tested whether ACS accounted for the relationship between over-exercise and suicidal behavior in a sample of 512 college students. In Study 1, after controlling for key covariates, over-exercise was the only disordered eating variable that maintained a significant relationship with suicidal behavior. In Study 2, Time 1 over-exercise was the only disordered eating behavior that was associated with Time 2 ACS. In Study 3, pain insensitivity accounted for the relationship between over-exercise and ACS. In Study 4, ACS accounted for the relationship between over-exercise and suicidal behavior. Over-exercise appears to be associated with suicidal behavior, an association accounted for by pain insensitivity and the acquired capability for suicide; notably, this association was found across a series of four studies with different populations., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)