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Poor sleep quality is a known contributor to suicidal thoughts and behaviors. This study examines whether sleep quality modulates the effect of an individual's stress response and risk/reward-based decision making on suicide risk. Participants were 160 adults at a residential substance use treatment facility with lifetime exposure to trauma who completed a clinician-administered measure of suicide risk, the Iowa Gambling Task (IGT), and a self-report measure of sleep. Cortisol reactivity (i.e., changes in cortisol before and after a personalized trauma script) was used to measure stress response. We used quantile regression to examine the effects of sleep, cortisol, and risk/reward decision-making on suicide risk. We found poor sleep quality to be increasingly salient in individuals at greater risk for suicide than those at lower risk for suicide. Furthermore, individuals with moderate to moderate-high levels of suicide risk seem to have greater cortisol reactivity. In the low-moderate quantile, we found suicide risk to be associated with both high stress reactivity and low-risk, high-reward decision-making, as well as low stress reactivity and high-risk/low-reward decision-making. These findings should be interpreted considering several methodological constraints, such as the use of a pre-determined sample and instruments not tailored for our hypotheses, the MINI 'Suicide' Module's limited differentiation between suicidal ideation and behavior, and variably timed cortisol sampling. Despite these limitations, the findings from this study support the use of evidence-based interventions focused on improving sleep quality and managing emotional reactivity to decrease suicide risk. • Poor sleep intensifies suicide risk in trauma-exposed, substance-use patients. • Quantile regressions examine how risk factors impact various suicide risk levels. • Cortisol reactivity is related to moderate to moderate-high suicide risk. • Low-moderate suicide risk has two stress reactivity and decision-making profiles. • Improving sleep and emotional reactivity may help reduce suicide risk. [ABSTRACT FROM AUTHOR]

Existing literature suggests that psychological and functional impairment, independent of head injury severity, can increase suicide risk. This study explores the impacts of self-perceived dysfunction within four neurobehavioral symptom clusters—vestibular (e.g., dizziness, balance), somatosensory (e.g., headaches, nausea, vision), affective (e.g., anxious, irritable mood), and cognitive (e.g., concentration, memory, indecision)—on current suicidal ideation and the perceived likelihood of future suicidal ideation and attempts. Community participants (n = 309; M age = 36.88; 51.6% female; 79.6% White) completed the Neurobehavioral Symptom Inventory (NSI) and the Self-Injurious Thoughts and Behaviors-Short Form (SITBI-SF). Quantile regression analysis was used to explore the effects of the four neurobehavioral symptom clusters at different levels of suicidal ideation intensity, perceived likelihood of future suicidal ideation, and self-perceived likelihood of future suicide attempt. Controlling for past head injuries and suicide attempts, affective symptoms were significantly associated with a moderate and high average intensity of current suicidal ideation. Somatosensory symptoms were significantly associated with a moderate perceived likelihood of future suicidal ideation. Finally, vestibular symptoms were significantly associated with a moderate perceived likelihood of a future suicide attempt. These findings highlight the critical need to consider a broader spectrum of symptoms, including chronic physical symptoms, when assessing suicide risk. Furthermore, they underscore the need to expand beyond affective symptoms as an explanation for increased suicidality and examine additional mechanisms through which chronic physical symptoms can increase suicide risk. [ABSTRACT FROM AUTHOR]

The American 911 emergency call system fulfills a unique role in preventing suicide and is universally available to all residents suffering a mental health crisis. Previous studies have found disparities between socioeconomic and racial groups in mental health treatment and in help-seeking behaviors. However, very few studies have analyzed disparities in the use of the 911 system for mental health or suicidal crises. The present study conducted negative binomial regression analyses to determine if an increase in suicide-related 911 call rate is associated with race and socioeconomic characteristics in Western King County, Washington. We used the geographic locations of 4823 suicide-related calls from January 2019 to June 2020 to contrast against 2019 demographic data from the Census Bureau. We found increased percentage of Black, Indigenous and People of Color (BIPOC), residents relying on private health insurance, and lower education levels were associated with a decreased suicide-related 911 call rate. We found residents relying on public health insurance to be associated with an increased suicide-related 911 call rate. Future research should explore how residents use 911 in mental health crises to further improve public suicide prevention efforts. Our findings demonstrate how areas with poor health care options may rely more on the 911 system amidst a suicidal crisis. • Explores associations between socioeconomic and race factors and suicide-related 911 call rate. • Increased call rate associated with use of public health insurance. • Mixed results but suggests BIPOC individuals use 911 less for suicidal crisis. [ABSTRACT FROM AUTHOR]