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

Objective: This randomized controlled trial of the online intervention, man therapy (MT), evaluated efficacy to reduce suicidal ideation (SI) and depression among working‐aged men. Method: Five‐hundred and fifty‐four men enrolled and 421 completed all surveys. Control Condition men explored the Healthy Men Michigan (HMM) website and Intervention Condition men explored HMM and MT. Hypotheses included men who used MT would report decreased SI and depression over time compared to Control Condition men. Results: Latent growth curve modeling revealed improvements in SI (slope = −0.23, p < 0.001, 95% CI: −0.29, −0.16) and depression (slope = −0.21, p < 0.001, 95% CI: −0.23, −0.18) over time for men in both groups; however, there was no difference in slope based on group assignment. Depression, lifetime suicide attempts, and interpersonal needs were associated with SI. Interpersonal needs and poor mental health were associated with depression. No group differences in change in risk and protective factors over time were observed. MT sub‐group analyses revealed significant improvements in risk and protective factors. Conclusion: While a direct effect of MT versus HMM on SI or depression was not observed, men in both groups improved. Results suggest online screening might play a role in reducing SI and depression among men and there are potential benefits to MT related to mental health, social support, and treatment motivation. [ABSTRACT FROM AUTHOR]

Stress and blunted reward processing are risk factors for Major Depressive Disorder (MDD). The experience of acute stress reduces fMRI correlates of reward-related neural activity; however, few studies have examined how acute stress impacts measures of reward derived from event-related potentials (ERPs). The current study examined the impact of an acute stressor on the Reward Positivity (RewP), an ERP that indexes reward sensitivity, in twenty-six college students. Participants completed a monetary reward task while they placed their left hand in cold water set at 13 °C (i.e. acute stress condition) and again while their hand was placed in room temperature water (i.e. control condition). These conditions were separated by one week and performed in a counter-balanced order across participants. The results revealed that the RewP amplitude was blunted in the acute stress condition compared to the control condition. Moreover, there was a trend toward this effect interacting with self-reported depressive symptoms: the RewP was reduced only among individuals who reported low depressive symptoms. The current study suggests that an acute stressor reduces the RewP, and that this effect might be moderated by current depressive symptoms. Future studies might examine the temporal association between reward processing and stress, and how they interact to predict depressive symptoms. The current study examined the impact of acute stress on the brain's reward system. The results indicated that acute stress reduced activity within the brain's reward system, particularly among individuals with low depressive symptoms. [ABSTRACT FROM AUTHOR]

Insomnia symptoms are common among individuals with psychiatric disorders, and associated with increased symptom severity. However, the Insomnia Severity Index (ISI) has rarely been psychometrically evaluated in a psychiatric sample. Furthermore, the latent structure of the ISI has not been evaluated using factor mixture modeling, which improves upon prior analytic techniques by integrating factor structure and including exogenous variables. Thus, the current study used factor mixture modeling to test the latent structure of the ISI among two samples of psychology clinic outpatients (Ns = 366 and 331). The ISI was best represented with a three-class structure representing "no or minimal," "moderate," and "severe" insomnia symptoms, with significantly escalating symptoms of depression, anxiety, and posttraumatic stress across these classes. Clinical cut-scores for the "severe" class were also derived using receiver operating curve analyses. Implications for theoretical conceptualization of insomnia among those with psychiatric disorders and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

We review the theoretical and empirical literature on the role of self-concept in suicidal behavior in the context of mood disorders (i.e., unipolar depression and bipolar spectrum disorders). The main themes emanating from this review are then juxtaposed against (a) the Interpersonal-Psychological Theory of Suicide and (b) biological research on the role of inflammatory processes in suicidality. Such a juxtaposition paves the way for a bio-cognitive-interpersonal hypothesis. Pathologies of the self-concept-primarily self-criticism-propel mood disorder sufferers to generate interpersonal stress that culminates in two proximal causes of suicidality: thwarted belongingness and perceived burdensomeness. In turn, these two interpersonal conditions set in motion systemic biosystemic inflammation, serving as a proximal cause for suicidality in mood disorders. We conclude by describing a research project aimed at testing this hypothesis, and by outlining pertinent implications for assessment, treatment, and prevention. [ABSTRACT FROM AUTHOR]

Recent standardized nomenclature has suggested distinctions among aborted, interrupted, and actual suicide attempts. This study examined differences in self-reported symptoms among individuals with a history of aborted, interrupted, and actual suicide attempts. 167 young adults with a history of suicidality completed self-report measures of suicide attempt history and current symptoms, a clinical interview assessing past suicidal behavior, and a pain tolerance task. Only 78.8% of participants who initially reported a suicide attempt history were classified as suicide attempters following the clinical interview. Individuals who reported only aborted attempts during the clinical interview reported less severe clinical symptoms than those reporting a history of at least one actual attempt. Individuals with a history of actual suicide attempts may represent a more clinically severe group than those with a history of aborted attempts only. [ABSTRACT FROM AUTHOR]

Anxiety and depression diagnoses are associated with suicidal thoughts and behaviours. However, a categorical understanding of these associations limits insight into identifying dimensional mechanisms of suicide risk. This study investigated anxious and depressive features through a lens of suicide risk, independent of diagnosis. Latent class analysis of 97 depression, anxiety, and suicidality-related items among 616 psychiatric outpatients indicated a 3-class solution, specifically: (1) a higher suicide-risk class uniquely differentiated from both other classes by high reported levels of depression and anxious arousal; (2) a lower suicide-risk class that reported levels of anxiety sensitivity and generalised worry comparable to Class 1, but lower levels of depression and anxious arousal; and (3) a low to non-suicidal class that reported relatively low levels across all depression and anxiety measures. Discriminants of the higher suicide-risk class included borderline personality disorder; report of worthlessness, crying, and sadness; higher levels of anxious arousal and negative affect; and lower levels of positive affect. Depression and anxiety diagnoses were not discriminant between higher and lower suicide risk classes. This transdiagnostic and dimensional approach to understanding the suicidal spectrum contrasts with treating it as a depressive symptom, and illustrates the advantages of a tripartite model for conceptualising suicide risk. [ABSTRACT FROM AUTHOR]

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

Suicide has become an issue of great concern within the U.S. military in recent years, with recent reports indicating that suicide has surpassed combat related deaths as the leading cause of death. One concern regarding suicide risk in the military is that existing self-report measures allow service members to conceal or misrepresent current suicidal ideation or suicide plans and preparations. Implicit association tests (IATs) are computer-based, reaction time measures that have been shown to be resilient to such masking of symptoms. The death/suicide implicit association test (d/s-IAT) is an empirically supported IAT that is specific to death and suicide. The present study examined whether the performance of 1,548 U.S. military service members on the d/s-IAT significantly predicted lifetime suicidal ideation and depression. Zero-inflated negative binomial regression analyses were used to test these associations. Results indicated that the d/s-IAT was neither associated with history of suicidal ideation nor history of depression. [ABSTRACT FROM AUTHOR]

Depression and suicidal ideation are highly intertwined constructs. A common practice in suicide research is to control for depression when predicting suicidal ideation, yet implications of this practice have not been subjected to sufficient empirical scrutiny. We explore what, precisely, is represented in a suicidal ideation variable with depression covaried out. In an adult psychiatric outpatient sample (N = 354), we computed two variables—depression with suicidal ideation covaried out, and suicidal ideation with depression covaried out—and examined correlations between these residuals, three factors comprising a variegated collection of psychological correlates of suicidal ideation, psychiatric diagnoses, and past suicidal behavior. Findings indicated that suicidal ideation with depression covaried out appears to be characterized by fearlessness about death, self-sacrifice, and externalizing pathology. We propose that suicidal ideation may comprise two distinct components: desire for death (passive ideation and depressive cognitions) and will (self-sacrifice, fearlessness, externalizing behavior). Implications, limitations, and future directions are discussed. [ABSTRACT FROM AUTHOR]

The present study represents an early stage investigation into the phenomenon whereby those with bipolar disorder attempt suicide more frequently than those with unipolar depression, but do not tend to attempt suicide during mania. Data for this study were obtained from baseline measurements collected in a randomized treatment study at a major southwestern United States military medical center. We demonstrated the rarity of suicide attempts during mania, the higher frequency of suicide attempts in those with bipolar disorder compared to those with depression, and the persistence of effects after accounting for severity of illness. These results provide the impetus for the development and testing of theoretical explanations. [ABSTRACT FROM AUTHOR]

Insomnia symptoms are a known predictor of suicide; however, less is known about the relationship between hypersomnia and suicide, and how total sleep time may better account for suicidal ideation compared with subjective reports of insomnia symptoms. In the present secondary data analysis, a squared term confirmed the importance of both short and long total sleep time on suicidal behaviour. Total sleep time had a significant positive direct effect on suicidal behaviour ( b = 0.20, SE = 0.08, P < 0.05), significant negative direct effects on insomnia symptoms ( b = −1.67, SE = 0.13, P < 0.0001) and on depressive symptoms ( b = −1.76, SE = 0.29, P < 0.0001). Depression had a significant positive effect on suicidal behaviour ( b = 0.17, SE = 0.01, P < 0.0001), and significantly mediated the relationship between total sleep time and suicidal behaviour, but insomnia symptoms did not. Total sleep time squared had a significant positive relationship with suicidal behaviour ( b = 0.02, SE = 0.01, P < 0.05), significant negative direct effects on insomnia symptoms ( b = −0.12, SE = 0.01, P < 0.0001) and on depressive symptoms ( b = −0.12, SE = 0.02, P < 0.0001). Depression had a significant positive effect on suicidal behaviour ( b = 0.17, SE = 0.01, P < 0.0001), and significantly mediated the relationship between total sleep time and suicidal behaviour. These results suggest the importance of assessing for total sleep time in clinical settings with regard to suicide risk. [ABSTRACT FROM AUTHOR]

Italian-language versions of the Positive and Negative Affect Scale for Children (PANAS-C; Laurent et al. Psychological Assessment, 11, 326-338, 1999) and Physiological Hyperarousal Scale for Children (PH-C; Laurent et al. Psychological Assessment, 16, 373-380, 2004) were developed. Students ( N = 1026; M age = 12.05 years, SD = 1.49) from central Italy completed these scales. Measures were evaluated based on criteria from previous studies resulting in an 11-item PANAS-C PA scale (α = .88), a 13-item PANAS-C NA scale (α = .87), and a 14-item PH-C (α = .85). Confirmatory factor analyses resulted in best-fit indices that favored a 3-factor model consistent with the tripartite model of anxiety and depression. Similar to results reported with the original English-language and other translations of these measures, scores on the PA scale were lower and scores on the NA and PH scales were higher for older girls than older boys and younger boys and girls. Findings suggested that the psychometric properties of the Italian-language versions of the PANAS-C and PH-C were similar to the English-language versions and other translated versions of the measures. [ABSTRACT FROM AUTHOR]

Background: In chronic pain, patients’ coping affects their adaptation. In two studies, we examined the role of pain catastrophizing, a maladaptive coping strategy, in pain, distress, and disability. In Study 2 we compared catastrophizing to pain acceptance and to other coping strategies.Methods:Study 1. Chronic pain patients (N= 428) were assessed four times as to their pain, disability, catastrophizing, and distress (depression and anxiety).Study 2. Patients (N= 165) were assessed as to coping and pain acceptance, pain, related distress, depression, hope, suicidal ideations, perceived burdensomeness, and thwarted belongingness.Results:Study 1. A Structural Equation Modeling (SEM) analysis revealed that Time 1 Pain-based catastrophizing prospectively predicted pain (β =.36,p< .001). Distress prospectively predicted pain related disability (β = .34,p<.001).Study 2. Pain-based catastrophizing predicted sensory pain (β = .22,p= .018), depression (β = .43,p< .001), and suicidal ideation (O.R.= 1.88), which were also predicted by depression and perceived burdensomeness. Distraction predicted sensory pain (β = .21,p= .017, respectively). Activity engagement predicted low levels of depression (β = -.29,p< .001, respectively), and willingness to accept pain predicted low pain-related distress (β = -.16,p= .05).Conclusions: Pain catastro-phizing and pain acceptance constitute risk and resilience factors. Both should be assessed and targeted in pain management. [ABSTRACT FROM PUBLISHER]

Using longitudinal data spanning a 7-year period, we investigated the behavioral and psycho-social effects resulting from a parent’s death during early childhood or teenage years on adolescent and early adulthood functioning. Findings confirmed previous work demonstrating various behavioral problems and social-psychological adjustment deficits during adolescence. Results suggested that most detrimental adjustment behaviors among parentally bereaved youth fade as they entered into young adulthood. Yet, premature school withdrawals and diminished interests in college attendance at Wave 1 left many of these young adults with diminished academic accomplishments, lingering economic disadvantages and for females a hesitancy to marry as their lives progressed into adulthood. [ABSTRACT FROM AUTHOR]

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

Previous studies have supported the significant association between nightmares and suicidal ideation, but the underlying mechanisms are largely unknown. The purpose of the present study was to investigate perceived burdensomeness and thwarted belongingness as mediators in the relationship between nightmare distress and suicidal ideation. This sample consisted of 301 undergraduate students who endorsed experiencing nightmares (mean age 21.87 ± 2.17, 78.1% female). All participants completed questionnaires on nightmare distress (Nightmare Distress Questionnaire), unmet interpersonal needs (Interpersonal Needs Questionnaire), and suicidal ideation (Depressive Symptom Inventory - Suicidality Subscale). Analyses were performed using multiple mediation regression. Results indicated that nightmare distress was associated with perceived burdensomeness (r = 0.17, p < 0.001) and suicidal ideation (r = 0.24, p < 0.001), but was not related to thwarted belongingness (r = 0.10, p = 0.06). Multiple mediation analyses revealed that perceived burdensomeness partially mediated the relationship between nightmares and suicidal ideation, but thwarted belongingness did not. Additionally, this mediating relationship for perceived burdensomeness was moderated by gender, being significant only for females. These findings highlight the important role of interpersonal factors in the relationship between nightmares and suicidal ideation. [ABSTRACT FROM AUTHOR]

Individuals at risk for suicide experience periods of emotional, enduring, and vivid thoughts about their death by suicide and frequently report violent daydreams about death. Daydreaming is associated with forgetfulness and memory impairments. However, no studies have examined whether suicidal ideation is associated with deficits in everyday memory capabilities and whether violent daydreaming may influence these relationships. This study tested these hypotheses in a sample of 512 young adults. Self-report measures of subjective everyday memory capabilities, violent daydreaming, and suicidal ideation were administered. Results indicated that suicidal ideation and violent daydreaming were each significantly associated with greater impairments in everyday memory retrieval and everyday memory encoding (i.e., attentional tracking). Furthermore, violent daydreaming accounted for the relationship between suicidal ideation and impairments in everyday memory retrieval and memory encoding. Notably, findings remained after controlling for gender and depressive symptoms, a robust predictor of memory impairments. Implications and limitations are discussed. [ABSTRACT FROM AUTHOR]

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

Major depressive symptoms are associated with increased risk for suicidal ideation and behavior. Suicide is fearsome; as such, the interpersonal theory of suicide proposes that individuals who engage in suicidal behavior possess not only the desire to die, but also the acquired capability (AC) for suicide. This study examined whether major depressive episodes (MDEs) may be particularly relevant to suicidal behavior when considered in the context of AC. History of MDEs, AC, and suicide attempt history were examined in a large (n = 3377) sample of military members. Data were analyzed using hierarchical multiple regression. Results indicated that among individuals with high AC, the number of MDEs was significantly, positively associated with number of previous suicide attempts; MDEs were not significantly related to suicide attempt history among individuals with low AC. Findings held in the presence of robust covariates associated with suicidal behavior. Findings suggest that a history of MDEs alone may not indicate severe suicide risk-increased AC for suicide appears necessary for increased suicide risk. Implications for suicide treatment and prevention in military personnel are discussed. [ABSTRACT FROM AUTHOR]

Objectives:Older adults die by suicide at a higher rate than any other age group in nearly every country globally. Suicide among older adults has been an intractable clinical and epidemiological problem for decades, due in part to an incomplete understanding of the causes of suicide, as well as imprecision in the prediction and prevention of suicidal thoughts and behaviors in later life. Theory-driven investigations hold promise in addressing these gaps by systematically identifying testable, and thus falsifiable, mechanisms that may better explain this phenomenon and also point to specific interventions. Method:In this article, we comprehensively review key extant psychological and sociological theories of suicide and discuss each theory's applicability to the understanding and prevention of suicide among older adults. Results:Despite a modest number of theories of suicide, few have undergone extensive empirical investigation and scrutiny, and even fewer have been applied specifically to older adults. Conclusion:To advance the science and contribute findings with a measurable clinical and public health impact, future research in this area, from conceptual to applied, must draw from and integrate theory. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to identify personality traits and psychiatric comorbidities associated with a lifetime history of a suicide attempt in women with bulimia nervosa (BN). Method Data from two samples of women with BN ( n = 204 and n = 133) were examined. Participants in both samples completed the Dimensional Assessment of Personality Pathology-Basic Questionnaire and reported whether they had ever had a lifetime suicide attempt. Comorbid psychopathology was based on self-reported questionnaire and interview data. Univariate and multivariate logistic regression analyses were run, predicting a lifetime suicide attempt. Results Based on the Dimensional Assessment of Personality Pathology-Basic Questionnaire, identity problems were associated with a lifetime suicide attempt in both samples; cognitive dysregulation, anxiousness and insecure attachment were associated with a lifetime suicide attempt in one but not both samples. Lifetime anxiety disorder was associated with a lifetime suicide attempt in one sample, and depression was associated with a lifetime suicide attempt in both samples. Multivariate analyses revealed that only depression was uniquely associated with a lifetime suicide attempt in both samples. Discussion Although personality traits associated with aspects of emotion dysregulation were associated with a lifetime suicide attempt, depression was found to have the strongest association with a lifetime suicide attempt in two samples of women with BN. These findings suggest that depression severity may be the most important target of treatment and suicide prevention efforts in women with BN. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

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

Objective: The current study explored the clinical meaningfulness of distinguishing subjective (SBE) from objective binge eating (OBE) among individuals with threshold/subthreshold bulimia nervosa (BN). We examined relations between OBEs and SBEs and eating disorder symptoms, negative affect, and personality dimensions using both a group comparison and a continuous approach. Method: Participants were 204 adult females meeting criteria for threshold/subthreshold BN who completed questionnaires related to disordered eating, affect, and personality. Results: Group comparisons indicated that SBE and OBE groups did not significantly differ on eating disorder pathology or negative affect, but did differ on two personality dimensions (cognitive distortion and attentional impulsivity). Using the continuous approach, we found that frequencies of SBEs (not OBEs) accounted for unique variance in weight/shape concern, diuretic use frequency, depressive symptoms, anxiety, social avoidance, insecure attachment, and cognitive distortion. Discussion: SBEs in the context of BN may indicate broader areas of psychopathology. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2013) [ABSTRACT FROM AUTHOR]

Objectives: Studies suggest early-onset depression (EOD) is associated with a more severe course of the depressive disorder, while late-onset depression (LOD) is associated with more cognitive and neuroimaging changes. This study examined if older adults with EOD, compared with those with LOD, would exhibit more severe symptoms of depression and, consistent with the glucocorticoid cascade hypothesis, have more hippocampal volume loss. A second goal was to determine if LOD, compared with EOD, would demonstrate more cognitive and neuroimaging changes. Method: At regular intervals over a four-year period non-demented, older, depressed adults were assessed on the Mini-Mental Status Examination and the Montgomery–Asberg Depression Rating Scale. They were also assessed on magnetic resonance imaging. Results: Compared with LOD, EOD had more depressive symptoms, more suicidal thoughts, and less social support. Growth curve analyses indicated that EOD demonstrated higher levels of residual depressive symptoms over time. The LOD group exhibited a greater decrement in cognitive scores. Contrary to the glucocorticoid cascade hypothesis, participants with EOD lost right hippocampal volume at a slower rate than did participants with LOD. Right cerebrum gray matter was initially smaller among participants with LOD. Conclusions: EOD is associated with greater severity of depressive illness. LOD is associated with more severe cognitive and neurological changes. These differences are relevant to understanding cognitive impairment in geriatric depression. [ABSTRACT FROM PUBLISHER]

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

Background Anxiety along with anxiety-related risk factors has been increasingly implicated in suicidal ideation and suicide attempts. One such risk factor, anxiety sensitivity (AS), refers to fear of anxiety-related sensations. Subfactors of AS, notably physical and cognitive concerns, seem to be relevant to acquired capability, a risk factor for death by suicide from Joiner's (2005) Interpersonal-Psychological Theory of Suicide. Methods This study examined the effect of Anxiety Sensitivity Index (ASI) total score and subfactor scores on suicidal ideation and suicide attempt history in a very large, moderately severe outpatient sample (N = 1,378). Results Analyses were consistent with our a priori predictions about ASI cognitive concern and suicidal ideation. In contrast, ASI physical concerns did not predict previous suicide attempt as well as ASI cognitive or social concerns. However, ASI physical concerns did moderate the relationship between ASI social concerns and previous suicide attempt. Conclusions These findings suggest that suicide potential may be related to cognitive risk factors for anxiety. Depression and Anxiety 0:1-7, 2011. © 2011 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Suicide is a major public health concern and, as such, research that elucidates potential mechanisms contributing to suicide risk is highly important. Along these lines, prior research has linked high levels of distress tolerance with elevations in a specific component of suicide risk: the acquired capability for suicide. The following two studies aimed to examine whether sensation seeking-the tendency to seek out activities involving risk or thrill-moderates the previously established relationship between distress tolerance and the acquired capability, such that a heightened ability to tolerate emotional distress was more strongly related to the acquired capability amongst people with greater risk taking tendencies. Study 1 examined this possibility using self-report measures in an undergraduate population. Results indicated that individuals reporting high levels of both distress tolerance and sensation seeking exhibited the highest level of the acquired capability. In Study 2, using a separate undergraduate population, a behavioral measure of distress tolerance was utilized and the interaction of distress tolerance and sensation seeking yielded a similar pattern of results in the prediction of one component of the acquired capability: physiological pain tolerance. Results indicate that the degree to which individuals who do not experience negative affect as overwhelming may be at risk for elevations in the acquired capability is dependent upon their level of sensation seeking. [ABSTRACT FROM AUTHOR]

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

Consistent with the “scar hypothesis”, according to which mood depression might impact personality, we examined the effect of unipolar and hypomanic mood disturbances on cluster B (i.e., narcissistic, histrionic, and borderline) personality disorder features. Data from 113 suicidal young adults were utilized, and cross-lagged associations between unipolar and hypomanic mood disturbances and cluster B personality disorder features were examined using manifest-variable structural equation modeling (SEM). Hypomanic symptoms predicted an increase in narcissistic and histrionic personality disorder features over the Time 1–Time 2 period, as well as an increase in narcissistic personality disorder features over the Time 1–Time 3 period. Unipolar depressive symptoms and borderline features were reciprocally and longitudinally associated, albeit at different time periods. The sample distinct features restrict generalization of the findings. An exclusive use of self-report measures might have contributed to shared method variance. Results are consistent with the notion that hypomanic symptoms increase narcissistic personality disorder tendencies. Depression and Anxiety, 2008. © 2007 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Abstract: Based on clinical experience, anecdotal reports, and past empirical and conceptual work, we predicted that when people with narcissistic tendencies experience depressive symptoms, they are prone to develop paranoid attitudes. Moreover, we expected that this process was unidirectional, and that the combination of paranoid tendencies and depressive symptoms would not be associated with an increase in narcissistic symptoms. In both cases, results from our 6-month longitudinal study of 71 previously suicidal adults conformed to our expectations. [Copyright &y& Elsevier]

Abstract: At least five symptoms must occur for a DSM diagnosis of major depressive disorder (MDD), one of which must be sadness or anhedonia. The present study is the first known investigation of the implications of the presence or absence of these prioritized symptoms on symptom expression and clinical characteristics among 564 young adults with MDD. Differences in symptom expression and clinical characteristics occurred among MDD participants with sadness relative to those without sadness as well as among MDD participants with anhedonia relative to those without anhedonia. Differential symptom expression could have important implications for the etiology, prevention, and treatment of MDD. [Copyright &y& Elsevier]

The current study investigated the association between lifetime major depressive disorder (MDD) and self-reported memory and cognitive problems in a general population sample. The study was based on data from the National Comorbidity Survey-Replication (n = 5692). The relationship between lifetime MDD and self-reported memory and cognitive problems was examined while controlling for other 1-year and lifetime psychiatric disorders. We found a lifetime history of depression, but no other lifetime psychiatric disorder, to be associated with self-reported memory and cognitive problems. We review the results in relation to theories regarding the comorbidity of depression and cognitive problems. A history of depression increases the likelihood that individuals will make negative evaluations of their memory and cognitive functioning. Though depression is highly comorbid with other disorders, our results are unique in demonstrating the specificity of depression in its association with self-reported memory and cognitive problems. The observed association between depression and self-reported memory and cognitive problems may reflect that depression increases the risk for cognitive decline or may reflect that individuals with a history of depression tend to rate their memory as poor, or both. [ABSTRACT FROM AUTHOR]

Anxiety is commonly associated with insomnia. Given that social anxiety disorder is one of the most prevalent anxiety disorders, socially anxious individuals may be particularly vulnerable to insomnia. However, there is currently very little empirical work on this relationship. This study used bivariate correlations to examine whether social anxiety was related to insomnia in an undergraduate sample (n=176) using the Social Interaction Anxiety Scale and the Insomnia Severity Index. Further, we utilized responses from the Beck Depression Inventory to investigate the role of depressive symptoms in the association between social anxiety and insomnia. Hierarchical linear regressions were used to examine the moderational and mediational role of depressive symptoms in the link between social anxiety and insomnia. To increase generalizability to clinical samples, analyses were repeated on a subset of the sample with clinically significant social anxiety symptoms (n=23) compared to a matched control group (n=23). Consistent with expectation, social anxiety was associated with increased insomnia symptoms. Specifically, social anxiety was correlated with sleep dissatisfaction, sleep-related functional impairment, perception of a sleep problem to others, and distress about sleep problems. Importantly, depressive symptoms mediated the relationship between social anxiety and insomnia, thereby at least partially accounting for insomnia among socially anxious individuals. Our data support the contention that social anxiety is associated with insomnia and suggest that depression may play a vital role in this co-occurrence. Depression and Anxiety 0:1–7, 2007. © 2007 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Abstract: Background: There is a paucity of research on the distinguishing features of double depression, particularly in older adults. Preliminary studies have revealed that individuals with double depression diagnoses tend to have more severe depression than individuals with major depression or dysthymia alone, but few other distinctions between the diagnostic categories have been found. Method: We examined the possibility that hopelessness particularly characterizes double depression, by comparing older adults with double depression, dysthymia alone, or major depression alone, on hopelessness, as well as on internal and external locus of control. The sample included 54 older psychiatric outpatients who completed a battery of cognitive and symptom measures, and underwent structured clinical interviews. Results: Double depressed patients showed high levels of hopelessness, whereas patients with either major depression or dysthymia alone showed more moderate levels of hopelessness. Low internal locus of control characterized both groups with a dysthymia diagnosis (dysthymia alone and double depression), and differentiated them from the group with major depression alone. Limitations: The sample size was modest, and the results may not generalize to older adults with different demographic characteristics. Conclusions: Hopelessness may be important in understanding the phenomenology of double depression in older adults, and may inform diagnostics and psychotherapeutics as well. [Copyright &y& Elsevier]

The relationship between childhood diagnosis, personality psychopathology and suicidal behavior in young adulthood was explored in a sample of 327 suicide ideators, single attempters, and multiple attempters. Of the total sample, 174 received at least one childhood diagnosis; the 153 without a diagnosis provided a comparison group. Results suggest that a childhood history of an anxiety disorder or major depression predispose a person to both later multiple suicide attempts and personality psychopathology. Gender was found to play a significant role, with females being predisposed to multiple attempts in young adulthood but only as a function of childhood anxiety, not major depression. Additionally, childhood anxiety disorders were found to predispose to multiple attempts as a function of personality psychopathology, with distinctly different paths for males and females. Implications are discussed in terms of etiology, prevention, and treatment. [ABSTRACT FROM AUTHOR]

The tripartite model of depression and anxiety suggests that anhedonia represents a relatively specific marker of depression. A strong version of this view is that anhedonic symptoms would particularly characterize depressed patients, even when compared to another diagnostic group—schizophrenic patients—for whom anhedonic symptoms represent a well-studied feature. This prediction was tested among 102 VA psychiatric inpatients (95 men), ages 21–72 (M=43.56; S.D.=8.47), all of whom received diagnoses of either major depression (n=50) or schizophrenia (n=52) based on structured diagnostic interviews. As predicted, patients with major depression scored significantly higher on the anhedonic symptoms scale of the Beck Depression Inventory (BDI) than did patients with schizophrenia. However, there was no difference between the two groups on the BDI total score or the BDI non-anhedonic symptoms score. Consistent with the tripartite model, anhedonic symptoms were more related to depressive vs. schizophrenic diagnostic status, whereas non-anhedonic depressive symptoms were not. Within the study''s limitations, results were interpreted as relatively strong support for the validity and extension of the tripartite model. [Copyright &y& Elsevier]

Coyne's (1976b) interpersonal theory of depression asserts that devaluation and rejection by relationship partners may exacerbate depressive symptoms. We tested this assertion empirically and investigated two theoretically based moderators of this effect: reassurance-seeking and self-esteem level. Dating women ( N= 134) completed measures of depression, reassurance-seeking, and self-esteem at Time 1 and a measure of depression at Time 2 six weeks later. Male partners completed a measure of devaluation of the women. Partner devaluation was not associated with increased emotional distress for women across the entire sample. However, significant moderating effects of both reassurance-seeking and self-esteem level were found. Partner devaluation predicted increased emotional distress among women who reported high levels of reassurance-seeking and among women who reported low levels of self-esteem. Results are discussed in terms of convergence with Coyne's theory. [ABSTRACT FROM AUTHOR]

Focuses on the possible relationship between shyness and depression. Suggestion that shyness becomes a vulnerable factor for depression only in the absence of social support; Identification of the participants and the methods used in the study; Support of the premise by the study's results.

Focuses on a study in which the attributional style and depressive symptoms in pregnant teenagers was investigated. Evaluation on whether pregnancy is a stressful life event for teenagers and if this is associated with depression; Examination of whether teenagers with a pessimistic attributional style will be more depressed after childbirth than optimistic teenagers; Number of teenagers involved in the study; Results of the study.

The COVID-19 pandemic caused concern regarding suicide risk mitigation while requiring many clinicians to transition to telehealth. We hypothesized that this transition would increase suicide intent, suicide desire, and depressive symptom ratings from pre-COVID-19 to peri-COVID-19. Patients at a southeastern US outpatient psychotherapy training clinic reported on suicide risk and depressive symptoms before and after the transition to telehealth treatment. Additionally, the effect of continuation of treatment on suicide risk was also analyzed. Suicide risk levels (n=39) and depressive symptoms (n=25) did not increase following the transition to telehealth. Self-reported suicide desire ratings significantly decreased from pre- to peri-pandemic assessments. Findings suggest that telehealth, among other sociocultural factors, became somewhat of a "port in a storm," such that it may have provided protections from exacerbations of mental health concerns and further vulnerabilities towards increased suicide risk. This paper concludes with relevant implications and suggestions for community health clinics. [ABSTRACT FROM AUTHOR]

Measurement invariance across diverse groups, though crucial for determining the generalizability of a measure, has not yet been tested in many assessments of suicidal thoughts. The present study assessed the measurement invariance and psychometric properties of one such assessment, the Depressive Symptom Inventory–Suicidality Subscale, across multiple identity dimensions in a large data set (n = 1,118) that combined three diverse samples. Findings supported measurement invariance of the scale by race, ethnicity, and sexual orientation when comparing those who were majority-aligning with their minoritized counterparts, as well as good internal consistency and expected convergent validity. The expected one-factor structure fit well for all three of the samples assessed. Overall, the results support measurement invariance and generalizability of the Depressive Symptom Inventory–Suicidality Subscale. Future studies should continue assessing measures of suicidal thoughts and behaviors through testing invariance across identities, especially as it pertains to specific identity subgroups and their intersections. Public Significance Statement: We examined whether the Depressive Symptom Inventory–Suicidality Subscale (DSI-SS) measured intensity of suicidal thinking similarly across race, ethnicity, and sexual orientation to determine the measure's usability across diverse groups; results showed that such was the case. The DSI-SS also shared significant relationships with other measures of suicidal thinking and psychopathology. Overall, findings support the DSI-SS as a reliable and valid measure of suicidal thinking. [ABSTRACT FROM AUTHOR]

Suicide is a serious public health threat in the U.S. as evidenced by increases in suicide rates between 1999 and 2018 and between 2020 and 2022. Opiate use has been implicated as a contributor of such trends in suicide rates by directly influencing overdose deaths and indirectly by exacerbating mental health and life circumstances. A moderated network model was estimated on a subset of the National Violent Death Reporting System Data (n = 78,089) to examine the partial correlation structure of suicidal thoughts and behaviors, opiate use at the time of death, stressful life circumstances, experience of depression, alcohol abuse, and substance abuse. Moderation effects of year of death and opiate use at the time of death were independently tested to compare network structures across suicide decedent cohorts/years and opiate use at the time of death. Results showed that overall network structures appeared to be very stable over years/cohorts. Opiate use at the time of death, stressful life circumstances, experience of depression, alcohol abuse, and substance abuse explained limited variance of suicidal thoughts and behaviors. Simultaneously, connections between suicidal thoughts and behaviors, as well as depressed mood, increasingly strengthened over years/cohorts. Alcohol and substance abuse were also increasingly co-occurring over years/cohorts, although they were less co-occurring in decedents who had used opiates at the time of death. Future studies should aim to examine if partial correlation structures identified in the current study generalize in non-decedents and in those with marginalized identities. [ABSTRACT FROM AUTHOR]

Introduction: Each year, a substantial proportion of trainees who enter the U.S. Air Force (USAF) Basic Military Training (BMT) are unable to complete training. Reentry to civilian life poses significant challenges, including finding employment, establishing a new career path, and paying for education. To our knowledge, no study has examined the association of discharge from USAF BMT and mental health symptoms. Utilizing a sample of 85 individuals discharged from USAF BMT for reasons other than mental health concerns, the present study aimed to: (1) characterize the severity of current depression and anxiety symptoms; (2) examine the relationship between the severity of current depression and anxiety symptoms and sociodemographic variables; and (3) determine whether or not a trainee agreed with the decision to be discharged from BMT is associated with differing severities of depression or anxiety symptoms.Materials and Methods: Participants were individuals who were prematurely discharged from USAF BMT for reasons other than mental health issues. Premature discharge is defined as any trainee who was unable to complete BMT in the USAF and was subsequently sent home. Participants were recruited from online Facebook groups for individuals who were prematurely discharged from USAF BMT. Participants were administered a battery of self-report questionnaires through a web-based survey platform. A structured demographic overview was administered to all participants to assess for age, gender, reason for discharge, amount of time spent in BMT, amount of time spent in medical hold, and whether or not the trainee agreed with the decision to be discharged. The Patient Health Questionnaire-9 (PHQ-9) was used to assess current symptoms consistent with depression. The Generalized Anxiety Disorder-7 (GAD-7) was used to assess current symptoms consistent with anxiety. Descriptive statistics were used to assess overall depression and anxiety rates, and analyses of covariance (ANCOVAs) were used to analyze group differences. This study was approved by the Institutional Review Board (IRB) at Florida State University (FSU).Results: In total, 85 participants (42.4% = female) were accounted for in these data. Regarding depression symptom severity, 58.8% of participants (n = 50) indicated moderate or higher levels of depression symptoms. Regarding anxiety symptoms, 45.9% of participants (n = 39) indicated moderate or higher levels of anxiety symptoms. There were no significant differences reported regarding depression or anxiety symptoms across gender, age, amount of time spent in BMT, and amount of time spent in medical hold. Significant differences were found between depression and anxiety symptoms and whether or not a trainee agreed with the decision to be discharged from the USAF, such that trainees who did not agree with this decision reported higher levels of depression and anxiety symptoms.Conclusions: The findings of this study indicate that this population of trainees who were prematurely discharged from USAF BMT for reasons other than mental health concerns has high levels of depression and anxiety symptoms. Discharge from BMT may be associated with substantial distress when the individual disagrees with the reason for discharge. Enhanced procedures and continued research regarding their postdischarge well-being seem warranted. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Drawing from the National Survey on Drug Use and Health (NSDUH; N = 611,880), a nationally representative survey of U.S. adolescents and adults, we assess age, period, and cohort trends in mood disorders and suicide-related outcomes since the mid-2000s. Rates of major depressive episode in the last year increased 52% 2005-2017 (from 8.7% to 13.2%) among adolescents aged 12 to 17 and 63% 2009-2017 (from 8.1% to 13.2%) among young adults 18-25. Serious psychological distress in the last month and suicide-related outcomes (suicidal ideation, plans, attempts, and deaths by suicide) in the last year also increased among young adults 18-25 from 2008-2017 (with a 71% increase in serious psychological distress), with less consistent and weaker increases among adults ages 26 and over. Hierarchical linear modeling analyses separating the effects of age, period, and birth cohort suggest the trends among adults are primarily due to cohort, with a steady rise in mood disorder and suicide-related outcomes between cohorts born from the early 1980s (Millennials) to the late 1990s (iGen). Cultural trends contributing to an increase in mood disorders and suicidal thoughts and behaviors since the mid-2000s, including the rise of electronic communication and digital media and declines in sleep duration, may have had a larger impact on younger people, creating a cohort effect. (PsycINFO Database Record (c) 2019 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Abstract Background Pathological worry is defined as worry that is excessive, pervasive, and uncontrollable. Although pathological worry is related to depression, anxiety, and suicidal ideation, less is understood about what specific features of worry confer risk for these mental health conditions. The current study examined associations between four characteristics of worry—frequency, duration, controllability, and content—and self-reported symptoms of depression, anxiety, suicidal ideation, and lifetime suicide attempts. Methods A sample of 548 community participants (53.6% female, 45.4% male, 0.5% transgender male, 0.2% transgender female, and 0.2% gender non-binary), aged 19–98 years (M = 36.54, SD = 12.33), was recruited via Amazon's MTurk and completed a battery of self-report questionnaires online. Results Results indicated that controllability of worry was uniquely associated with depression, anxiety, and suicidal ideation above and beyond other characteristics of worry, demographic variables, negative affect, and future-oriented repetitive thinking. Lifetime suicide attempts were found non-significant to these mental health outcomes. Frequency of worry was also positively related to depression. Limitations This study utilized a cross-sectional design with exclusive self-report measures. Conclusions Overall, these findings suggest that controllability of one's thoughts may be a key transdiagnostic factor that confers risk for a variety of psychopathology-related concerns. Clinical relevance includes identifying potential risk factors for varying psychopathology. Future research should examine relationships between worry controllability and anxiety, depression, suicidal ideation, and attempts, within clinical samples and utilizing a variety of methodologies. Highlights • Worry features are examined with depression, anxiety, and suicide. • 548 community participants completed a battery of online surveys. • Controllability of worry was most strongly related to all psychopathology except suicide attempts. • Frequency of worry was positively related to depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: Given the negative consequences of excess weight, a large portion of the US population is seeking to obtain and maintain weight loss. Weight Suppression (WS) represents the difference between previous highest adult weight and current weight and may have negative psychological consequences. The current study examined the link between WS and lifetime non-suicidal self-injurious (NSSI) behavior and explored indirect effects in this link using survey data in two large samples.Methods: Sample 1 included 1011 college students (67% female, mean age = 19 years); Sample 2 included 2461 participants from an epidemiological study (68% female, mean age = 34 years). Models of direct and indirect effects were tested in MPlus using bootstrapping.Results: As hypothesized, greater WS was associated with increased likelihood of lifetime NSSI in both samples (OR = 1.05 and 1.02). In both samples, significant indirect effects of drive for thinness (Total R2 = 0.06 and 0.09) and depressive symptoms (Total R2 = 0.13 and 0.29) accounted for this association. Alternative models in which the indirect effect of WS was tested in associations between drive for thinness or depressive symptoms and NSSI were not supported.Conclusion: Results suggest that the link between WS and lifetime NSSI may be accounted for by eating or mood-related pathology. Future research should test whether addressing associated eating and mood problems would eliminate the link between WS and NSSI as a means for reducing suicide risk. [ABSTRACT FROM AUTHOR]

Agitation has been implicated as an acute risk factor for suicidal behavior, yet the literature to date has not been consolidated to better understand this relationship. We conducted a meta-analysis of the association between agitation and suicidal behavior to synthesize the existing literature (k = 13 studies) and point out future directions for research. Results indicated that the association between agitation and suicidal behavior is moderate (Hedge's g = 0.40, p = 0.007, 95% CI [0.08, 0.72]). Follow-up meta-regressions revealed that age, gender, and year of publication were not significant moderators of the magnitude of this relationship. However, there was evidence of publication bias, as shown by a funnel plot and Egger's test. These findings suggest the importance of future research that examines the nature of the association between agitation and suicidal behavior longitudinally and with novel research designs, as implications for clinical practice and suicide risk assessment may be substantial. [ABSTRACT FROM AUTHOR]