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Our goal was to investigate the factor structure of a risk assessment tool utilized by suicide hotlines and to determine the predictive validity of the obtained factors in predicting subsequent suicidal behavior. We conducted an Exploratory Factor Analysis (EFA), an EFA in a Confirmatory Factor Analysis (EFA/CFA) framework, anda CFA on independent subsamples derived from a total sample of 1,085. Similar to previous studies, we found consistent evidence for a two-factor solution, with one factor representing a more pernicious form of suicide risk (i.e., Resolved Plans and Preparations; RPP) and one factor representing milder suicidal ideation (i.e., Suicidal Desire and Ideation; SDI). The RPP factor trended toward being more predictive of suicidal ideation at follow-up than the SDI factor. DOI: 10.1002/jclp.20717

We present data from two studies that aimed to investigate stigma against suicide. In Study 1, we employed Milgram et al.'s (1965) 'lost letter' technique. We predicted that fewer letters addressed to a fictitious organization with the word 'suicide' in its name would be returned than letters addressed to fictitious heart disease or diabetes organizations, presumably due to stigma. Contrary to expectation, there were no differences in the percentage of letters returned for each condition, despite power to detect small effects. In Study 2 we compared scores on the Suicide Opinion Questionnaire (SOQ; Domino, Gibson, Poling, & Westlake, 1980) from a study published in 1988 (Domino, MacGregor, & Hannah, 1988) to scores from a study conducted 19 years later. Results demonstrated reduced stigma toward suicide, with the belief that suicide is morally bad exhibiting the largest change. [c] 2010 Wiley Periodicals, Inc. J Clin Psychol: 66:611-626, 2010. Keywords: suicidal behavior; prevention DOI: 10.1002/jclp.20691

Suicidal behavior is a major problem worldwide and, at the same time, has received relatively little empirical attention. This relative lack of empirical attention may be due in part to a relative absence of theory development regarding suicidal behavior. The current article presents the interpersonal theory of suicidal behavior. We propose that the most dangerous form of suicidal desire is caused by the simultaneous presence of two interpersonal constructs--thwarted belongingness and perceived burdensomeness (and hopelessness about these states)--and further that the capability to engage in suicidal behavior is separate from the desire to engage in suicidal behavior. According to the theory, the capability for suicidal behavior emerges, via habituation and opponent processes, in response to repeated exposure to physically painful and/or fear-inducing experiences. In the current article, the theory's hypotheses ate more precisely delineated than in previous presentations (Joiner, 2005), with the aim of inviting scientific inquiry and potential falsification of the theory's hypotheses. Keywords: suicide, suicidal behavior, burdensomeness, belonging, opponent processes DOI: 10.1037/a0018697

The interpersonal-psychological theory of suicidal behavior (Joiner, 2005) holds that ah individual will die by suicide if he or she has both the desire for suicide and capability to act on that desire. According to the theory, suicidal desire results from the convergence of two interpersonal states: perceived burdensomeness and thwarted belongingness. However, desire alone is not sufficient to result in death by suicide--a third component must be present: the acquired capability for suicide, which develops from repeated exposure and habituation to painful and provocative events. The purpose of this article is to discuss four viable and timely directions for future research, given the current status of the theory. Keywords: interpersonal-psychological theory; suicide; suicidal capability; belongingness; burdensomeness DOI: 10.1002/jclp.20621

Although the significance of poor physical health for suicide risk is well established, the potential relevance of physical disability, as distinct from diseases and traumas that give rise to disability, has received little attention. Prior evidence suggests the possible utility of the stress process theoretical model for understanding variations in risk for suicide ideation and the contribution of physical disability to such risk. In this article, we examine the independent and joint explanatory significance of physical disability and components of the stress process model for risk of suicide ideation. Data from an ethnically diverse and representative sample of disabled and nondisabled adults (n = 1,768) reveal that physical disability is associated with a greater risk of lifetime suicidal ideation.

The interpersonal--psychological theory of suicidal behavior (T. E. Joiner, 2005) makes 2 overarching predictions: (a) that perceptions of burdening others and of social alienation combine to instill the desire for death and (b) that individuals will not act on the desire for death unless they have developed the capability to do so. This capability develops through exposure and thus habituation to painful and/or fearsome experiences and is posited by the theory to be necessary for overcoming powerful self-preservation pressures. Two studies tested these predictions. In Study 1, the interaction of (low) family social support (cf. social alienation or low belonging) and feeling that one does not matter (cf. perceived burdensomeness) predicted current suicidal ideation, beyond depression indices. In Study 2, the 3-way interaction among a measure of low belonging, a measure of perceived burdensomeness, and lifetime number of suicide attempts (viewed as a strong predictor of the level of acquired capability for suicide) predicted current suicide attempt (vs. ideation) among a clinical sample of suicidal young adults, again beyond depression indices and other key covariates. Implications for the understanding, treatment, and prevention of suicidal behavior are discussed. Keywords: suicide, interpersonal--psychological theory, suicidal desire, suicidal capability, belongingnesss

The emotional cascade model proposes that the emotional and behavioral dysregulation of individuals with borderline personality disorder (BPD) may be fundamentally linked through emotional cascades, vicious cycles of intense rumination and negative affect that may induce aversive emotional states. In order to reduce this aversive emotion, dysregulated behaviors such as non-suicidal self-injury may then be used as distractions from intense rumination. This study explored emotional cascades in a sample enriched with participants meeting diagnostic criteria for BPD. The first part of the study explored a structural equation model that examined the mediational effects of emotional cascades on the relationship between BPD symptoms and dysregulated behavior and found evidence for full mediation, even after controlling for symptoms of depression and other Cluster B disorders. The second part of the study examined the effects of a rumination induction conducted with the intention of eliciting emotional cascades in those diagnosed with BPD. The results demonstrated that individuals with BPD experienced greater reactivity and intensity of negative affect, but not of positive affect, following the procedure--even when controlling for current depressive symptoms. Future directions and clinical implications for the emotional cascade model are discussed. Keywords: borderline personality disorder, emotion regulation, rumination, suicide attempts, binge eating

The current study examined the influence of a number of psychological factors on the effectiveness of an early intervention program targeting anxiety and depression in a non-clinical sample of college students. The early intervention program comprised elements of the cognitive-behavioral analysis system of psychotherapy (McCullough, 2000) delivered in a 2-hour computer-based educational program. Participants completed measures of depression, anxiety, and general distress prior to the intervention program and then again 8 weeks later. Additionally, participants were assessed for past major depression, sleep related difficulties, a number of anxiety disorders, and suicide ideation. Moderation of the effectiveness of the early intervention program by these factors depended on the dependent variable of interest, specifically: the effectiveness of the intervention program on symptoms of depression was moderated by insomnia; symptoms of anxiety by past post-traumatic stress disorder (PTSD) and specific phobia as well as sleep problems related to nightmares; and symptoms of general negative affect by social phobia and suicide ideation. Implications are discussed. Keywords: early intervention; anxiety; depression; moderators

The interpersonal-psychological theory of suicidal behavior (Joiner, 2005) proposes that the need to belong is fundamental; when met it can prevent suicide and when thwarted it can substantially increase the risk for suicide. We investigate one source of group-wide variation in belongingness among college students--changes in the social composition of college campuses across academic semesters-as an explanation for variation in suicidal ideation across the academic year. Our results indicate that in a sample of college students at a large southern state university (n = 309), suicidal ideation varied across academic semesters, with highest levels in summer compared to both spring and fall. Differences in suicidal ideation between summer and spring were, in large part, accounted for by belongingness. Theoretical, as well as practical, implications are discussed regarding mechanisms for seasonal variation in suicidal ideation.

Clinical work with suicidal patients has become increasingly challenging in recent years. It is argued that contemporary issues related to working with suicidal patients have come to pose a number of considerable professional and even ethical hazards for psychologists. Among various concerns, these challenges include providing sufficient informed consent, performing competent assessments of suicidal risk, using empirically supported treatments/interventions, and using suitable risk management techniques. In summary, there are many complicated clinical issues related to suicide (e.g., improvements in the standard of care, resistance to changing practices, alterations to models of health care delivery, the role of research, and issues of diversity). Three experts comment on these considerations, emphasizing acute versus chronic suicide risk, the integration of empirical findings, effective documentation, graduate training, maintaining professional competence, perceptions of medical versus mental health care, fears of dealing with suicide risk, suicide myths, and stigma/blame related to suicide. The authors' intention is to raise awareness about various suicide-related ethical concerns. By increasing this awareness, they hope to compel psychologists to improve their clinical practices with suicidal patients, thereby helping to save lives. Keywords: suicide, informed consent, risk assessment, treatment, risk management

Recent research suggests that many dysregulated behaviors, such as binge-eating and non-suicidal self-injury, often occur during times of emotional distress. These behaviors also appear to decrease negative affect. Why is it, however, that individuals engage in these behaviors to reduce emotional distress rather than taking a shower or talking to a friend? This study proposes the role of emotional cascades, an emotional phenomenon that occurs when an individual intensely ruminates on negative affect, thus increasing the magnitude of that negative affect to the point that an individual engages in a dysregulated behavior in order to distract from that rumination. The purpose of these studies was to examine the relationship between rumination and dysregulated behaviors, and in doing so determine if there is some support for the emotional cascade model of behavioral dysregulation. Using two different studies we were able to demonstrate that rumination is associated with some dysregulated behaviors, both cross-sectionally using structural equation modeling, and temporally using a two time-point method. Keywords: Rumination; Emotion regulation; Impulsivity; Binging: Purging; Reassurance seeking

A study to examine the association between childhood separation anxiety disorder (SAD) and the risk of developing of psychopathology during young adulthood is conducted. Results show that SAD contributed to the risk for the development of internalizing disorders, which are panic and depression, but decreased risk for externalizing disorders, which are alcoholism and substance abuse.

Past conceptual and empirical works have identified unique differences between multiple suicide attempters, single attempters, and zero attempters, but have overlooked two distinct subgroups of single attempters: true single attempters who will not attempt suicide again, and future multiple attempters who will. Consistent with fluid vulnerability theory, the authors hypothesized that subgroups should have differences in personality traits that can predict if a first-time attempter is likely to attempt suicide again. In a sample of 127 military members (81% male, 19% female) participating in a clinical intervention study for suicidal behaviors, hypomanic symptoms--not personality traits--predicted future multiple attempters, and future multiple attempters more frequently met criteria for a bipolar-spectrum disorder. Clinical implications and convergence of findings with fluid vulnerability theory and existing research are discussed. Keywords: suicide; multiple attempter; hypomanic symptoms; bipolar disorder

The interpersonal-psychological theory of suicidal behavior (T. E. Joiner, 2005) proposes that an individual will not die by suicide unless he or she has both the desire to die by suicide and the ability to do so. Three studies test the theory's hypotheses. In Study I, the interaction of thwarted belongingness and perceived burdensomeness predicted current suicidal ideation. In Study 2, greater levels of acquired capability were found among individuals with greater numbers of past attempts. Results also indicated that painful and provocative experiences significantly predicted acquired capability scores. In Study 3, the interaction of acquired capability and perceived burdensomeness predicted clinician-rated risk for suicidal behavior. Implications for the etiology, assessment, and treatment of suicidal behavior are discussed. Keywords: suicide, interpersonal psychological theory, belongingness, perceived burdensomeness

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2007.08.012 Byline: Michael D. Anestis, Edward A. Selby, Thomas E. Joiner Keywords: Impulsivity; Bulimia nervosa; Urgency Abstract: Prior work on maladaptive behaviors has cited impulsivity as a risk factor. The concept of impulsivity, however, fails to address the potential role of negative affect in such behaviors. The UPPS Impulsive Behavior Scale addresses this weakness by dividing impulsivity into four subscales: Urgency, Sensation Seeking, (lack of) Premeditation, and (lack of) Perseverance. We predicted that urgency, defined as the tendency, specifically in the face of negative affect, to act quickly and without planning, would predict elevations on three maladaptive behaviors -- excessive reassurance seeking, drinking to cope, and bulimic symptoms as measured by the Eating Disorder Inventory -- in both cross-sectional and longitudinal analyses in an undergraduate sample (N=70). Participants were assessed at two time points, 3-4 weeks apart. Urgency significantly predicted all three outcome variables cross-sectionally at both Time 1 and Time 2. Time 1 urgency significantly predicted Time 2 excessive reassurance seeking. Changes in urgency from Time 1 to Time 2 predicted changes in all three outcome variables. Results indicate a clear cross-sectional relationship between urgency and certain maladaptive behaviors. Additionally, some form of longitudinal relationship may exist between these variables, although the use of residual change scores precluded distinction between true change and change due to error. Author Affiliation: Department of Psychology, Florida State University, 1107W. Call Street, Tallahassee, FL 32306-4301, USA Article History: Received 22 May 2007; Revised 27 August 2007; Accepted 29 August 2007

Relatively little research has been conducted on the relationship between alcohol misuse and suicidal behavior among the elderly. The current study's aim was to examine whether quantity and frequency of alcohol use and the interaction between these variables are related to current suicidal ideation, previous suicidal ideation/intent, and past suicide attempts in a community sample of 1,010 Australian adults over age 60. Results partially supported our hypotheses. The interaction between quantity and frequency of alcohol use was significant, suggesting that those who use alcohol less frequently but in greater quantities (i.e., binge drinking) are more likely to have a history of suicide attempts.

Prior work on maladaptive behaviors has cited impulsivity as a risk factor. The concept of impulsivity, however, fails to address the potential role of negative affect in such behaviors. The UPPS Impulsive Behavior Scale addresses this weakness by dividing impulsivity into four subscales: Urgency, Sensation Seeking, (lack of) Premeditation, and (lack of) Perseverance. We predicted that urgency, defined as the tendency, specifically in the face of negative affect, to act quickly and without planning, would predict elevations on three maladaptive behaviors-excessive reassurance seeking, drinking to cope, and bulimic symptoms as measured by the Eating Disorder Inventory in both cross-sectional and longitudinal analyses in an undergraduate sample (N = 70). Participants were assessed at two time points, 3-4 weeks apart. Urgency significantly predicted all three outcome variables cross-sectionally at both Time 1 and Time 2. Time 1 urgency significantly predicted Time 2 excessive reassurance seeking. Changes in urgency from Time 1 to Time 2 predicted changes in all three outcome variables. Results indicate a clear cross-sectional relationship between urgency and certain maladaptive behaviors. Additionally, some form of longitudinal relationship may exist between these variables, although the use of residual change scores precluded distinction between true change and change due to error. Keywords: Impulsivity; Bulimia nervosa; Urgency

The National Suicide Prevention Lifeline was launched in January 2005. Lifeline, supported by a federal grant from the Substance Abuse and Mental Health Services Administration, consists of a network of more than 120 crisis centers located in communities across the country that are committed to suicide prevention. Lifeline's Certification and Training Subcommittee conducted an extensive review of research and field practices that yielded the Lifeline's Suicide Risk Assessment Standards. The authors of the current paper provide the background on the need for these standards; describe the process that produced them; summarize the research and rationale supporting the standards; review how these standard assessment principles and their subcomponents can be weighted in relation to one another so as to effectively guide crisis hotline workers in their everyday assessments of callers to Lifeline; and discuss the implementation process that will be provided by Lifeline.

The factor structure and the internal consistency of the eating disorder examination-questionnaire (EDE-Q) are evaluated. The self evaluation and preoccupation with weight and shape item appear to be independent from the factor structure of other aspects weight and shape concerns.

The article describes a 20-year longitudinal study of body weight, dieting, and disordered eating in women and men. Body weight increased significantly over time in both women and men. However, women's weight perception and dieting frequency decreased over time, whereas men's weight perception and dieting frequency increased, and disordered eating declined more in women than in men from late adolescence to midlife. In both women and men, changes in weight perception and dieting frequency were associated with changes in disordered eating. In addition, adult roles such as marriage and parenthood were associated with significant decreases in disordered eating from late adolescence to midlife in women, whereas few associations were observed in men. Despite different developmental trajectories, women demonstrated more weight dissatisfaction, dieting, and disordered eating compared with men across the period of observation. Keywords: eating disorders, bulimia, longitudinal study, gender differences, dieting

Decisions about the classification of eating disorders have significant scientific and clinical implications. The eating disorder diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) reflect the collective wisdom of experts in the field but are frequently not supported in empirical studies and do not capture the disorders of eating experienced by most people with an eating disorder. Statistical approaches to classification such as latent class analysis and taxometrics can help to create a classification system with greater scientific validity and clinical utility. The field would benefit from direct empirical comparisons of different classification schemes with various clinical and scientific validators. Such studies would enable the creators of the next DSM eating disorder classification to increase understanding of the advantages and disadvantages associated with choosing various diagnostic criteria sets for the eating disorders. Keywords: eating disorders, classification, diagnosis, DSM-IV

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2006.04.007 Byline: Thomas E. Joiner, Natalie J. Sachs-Ericsson, LaRicka R. Wingate, Jessica S. Brown, Michael D. Anestis, Edward A. Selby Keywords: Physical abuse; Sexual abuse; Suicide; Family history Abstract: Research to date has indicated that childhood abuse is associated with suicide, though little research has examined the unique contribution of specific types of abuse to suicidal behavior. We predict that childhood physical and violent sexual abuse will have a greater effect on suicide attempts than molestation and verbal abuse. Author Affiliation: Department of Psychology, Florida State University, Tallahassee, FL 32306-1270, USA Article History: Received 16 November 2005; Revised 11 April 2006; Accepted 26 April 2006

Background: Research to date has indicated that childhood abuse is associated with suicide, though little research has examined the unique contribution of specific types of abuse to suicidal behavior. We predict that childhood physical and violent sexual abuse will have a greater effect on suicide attempts than molestation and verbal abuse. Methods: The National Comorbidity Survey data were used to test these predictions while controlling for a number of psychiatric and psychosocial variables. Results: As expected, childhood physical and violent sexual abuse showed similar effects on lifetime suicide attempts, which were stronger than the effects of molestation and verbal abuse. Limitations: This was a cross-sectional, retrospective study, so true causality cannot be shown. Some measurement limitations exist. Additionally, effect sizes were small but still significant. Conclusions: While all forms of childhood abuse are troubling and create risk for future psychopathology and suicidality, the present study indicates that childhood physical and violent sexual abuse should be seen as greater risk factors for future suicide attempts than molestation and verbal abuse. Keywords: Physical abuse; Sexual abuse; Suicide; Family history

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.beth.2005.12.002 Byline: Kathryn H. Gordon, Marissa M. Brattole, LaRicka R. Wingate, Thomas E. Joiner Abstract: Eating disorders are thought to occur less among African-American women than among women of other ethnic groups. Ninety-one clinicians read 1 of 3 passages (differing only with regards to the girl's race: African-American, Caucasian, or Hispanic) describing disturbed eating patterns of a fictional character named Mary. Participants were then asked to indicate if they thought Mary had a problem and to rate her anxiety, depression, and eating disorder symptoms based upon the passage they had read. The results suggest that clinicians may have race-based stereotypes about eating disorders that could impede their detection of symptoms in African-American girls. Author Affiliation: Florida State University Article History: Received 26 May 2005; Accepted 13 December 2005

Eating disorders are thought to occur less among African-American women than among women of other ethnic groups. Ninety-one clinicians read 1 of 3 passages (differing only with regards to the girl's race: African-American, Caucasian, or Hispanic) describing disturbed eating patterns of a fictional character named Mary. Participants were then asked to indicate if they thought Mary had a problem and to rate her anxiety, depression, and eating disorder symptoms based upon the passage they had read. The results suggest that clinicians may have race-based stereotypes about eating disorders that could impede their detection of symptoms in African-American girls.

The study is conducted to determine whether a distinction exists between bulimia nervosa (BN) and eating disorder not otherwise specified, BN type (EDNOS-BN) in terms of eating and general psychopathology. The clinical implication of BN partial syndrome and prompt reevaluation of existing BN diagnostic boundaries is highlighted by the findings of the study and the post hoc analyses emphasizes the need for greater differentiation within EDNOS.

The authors discuss the active engagement of suicidally depressed individuals in several interpersonal processes that elicit the rejection of others and withdrawal of interpersonal support. In addition, such processes may increase future risk for suicidal behavior. These processes include ways in which suicidal individuals group themselves (e.g., assortative relationship formation) and relate to others (e.g., help negation, negative feedback seeking, excessive reassurance seeking). Implications of these behaviors for the therapeutic setting are discussed, as well as potential ways to respond to and treat them. Keywords: suicide; depression; treatment

Are depressive symptoms in middle childhood associated with more or less realistic social self-perceptions? At the beginning and end of the school year, children in grades 3 through 5 (n = 667) rated how much they liked their classmates, predicted the acceptance ratings they would receive from each of their classmates, and completed self-report measures of perceived acceptance and depressive symptoms. Accuracy of perceived acceptance was indexed by the mean difference between pairs of predicted and received ratings (absolute values). Standardized residual scores created by regressing self-reported perceived acceptance (either predicted ratings or children's responses to a questionnaire measure of perceived peer acceptance) onto peer acceptance ratings formed two measures of bias. Bi-directional associations were found for accuracy of perceived acceptance and depressive symptoms; inaccurate perceptions predicted increases in depressive symptoms and depressive symptoms predicted decreased accuracy. Neither measure of bias predicted changes in depressive symptoms. Depressive symptoms predicted increases in negatively biased perceptions as assessed via questionnaire. KEY WORDS: self-perceptions; perceptual accuracy; bias; depressive symptoms.

In light of concerns about potential iatrogenic effects of information about suicide, in the current study we examined the emotional impact of reading a list of warning signs for suicide in comparison to comparable lists for heart attacks and diabetes. All participants read two sets of warning signs, with the experimental group reading the suicide warning signs. Results confirm no difference in emotional impact across groups, along with providing evidence that warning signs for suicide are as easy to recall after exposure as warning signs for heart attack. Implications for pubic health campaigns are discussed.

The issue of suicide warning signs on the Internet is considered. In addition to reviewing some of the relevant conceptual issues about warning signs, a random sample of Internet sites was selected and reviewed. Warning signs were grouped and agreement across sites was examined, with results confirming broad disparity in what is presented to the public. The implications of a lack of consensus on warning signs for suicide are discussed.

The current article addresses the issue of warning signs for suicide, attempting to differentiate the construct from risk factors. In accordance with the characteristic features discussed, a consensus set of warning signs identified by the American Association of Suicidology working group are presented, along with a discussion of relevant clinical and research applications.

In this study we examined the effect that reading a list of warning signs for suicide has on beliefs about suicide, including the belief that one can recognize a suicidal crisis. All participants read two sets of warning signs (with only the experimental group reading the suicide warning signs) and then answered questions concerning beliefs related to three health problems. Results indicate that participants who read the suicide warning signs reported greater abilities to recognize if someone is suicidal but did not report stronger beliefs that suicidal individuals are partly to blame, nor did they report lower likelihoods of befriending suicidal individuals. Results suggest that reading the list of warning signs may be effective in increasing the public's ability to recognize suicidal crises without creating or magnifying stigmatizing beliefs about suicidal individuals.

In this study we analyzed the socioeconomic differences in mortality from suicide in the economically active male population aged 25-64 years in Spain and France in 1980-1982 and 1988-1990; in the case of Spain the data came from the Eight Provinces Study (Regidor, Gutierrez-Fisac, & Rodriguez, 1995). Individuals were grouped into four categories: professional/managerial, clerical/sales/service, agricultural, and manual workers. For 1980-1982, among those aged 2544, professionals and managers had the lowest risk of mortality in Spain, and clerical/sales/service workers in France. These socioeconomic differences in mortality increased in 1988-1990. In 1980-1982, among those aged 45-64, clerical/sales/service workers had the lowest risk of mortality from suicide relative to the other occupational groups in both countries, but this difference was not maintained in 1988-1990. Thus, differences in suicide mortality for men by occupational status depended in the present study upon both the nation studied and the time period chosen for study.

This article reviews the literature on the use of 'no-suicide contracts' in clinical practice, including conceptual discussions, patient and clinician surveys, and a few empirical studies on clinical utility. Our primary conclusion is that no-suicide contracts suffer from a broad range of conceptual, practical, and empirical problems. Most significantly, they have no empirical support for their effectiveness in the clinical environment. The authors provide and illustrate the commitment to treatment statement as a practice alternative to the no-suicide contract. Keywords: suicide; no-suicide contracts crisis response plan; crisis management

This article reviews the interpersonal-psychological theory of attempted and completed suicide and describes its applications in suicide risk assessment, crisis intervention, and skills-based psychotherapies. Three components are necessary, but not sufficient, for an individual to die by suicide: (1) the acquired capability to enact lethal self-injury, (2) a sense that one is a burden on others, and (3) the sense that one does not belong to a valued social group. We suggest that therapeutic interventions should focus on ascertaining the presence of these components and work to amend the cognitive distortions, negative interpersonal response styles, and ineffective coping behaviors that serve to maintain suicidal urges. Keywords: suicide; multiple attempters; risk assessment; treatment

The rise in suicide by African Americans in the United States is directly attributable to the dramatic, nearly three-fold increase in suicide rates of African American males. Gibbs (1997) hypothesized high social support, religiosity, and southern residence are protective factors against suicidality for Black people. This hypothesis was tested among 5,125 participants from the National Comorbidity Survey; 299 were African American males. In this study we hypothesized that there would be significantly lower suicidality in the South, and social support and religiosity would mediate this relationship. Our results indicate that Southern region is indeed a significant predictor of suicidal symptoms in African American men, such that suicidal symptoms were lower in the South, but religiosity and social support did not account for this effect. Other potential mediators were also examined.

A comprehensive multifactorial instrument was created to measure problematic eating behaviors in young children. Quality of mother-child interactons during feeding was one of the factors that clinicians should take into consideration.

The relationship between impulsivity and compulsivity in patients with bulimia nervosa (BN) is investigated. Impulsivity and compulsivity can coexist in BN patients and that both traits may provide useful information about comorbid problems in women with BN.

The parental perception of offspring body shape, differential reporting of offspring eating behaviors by mothers and fathers and gender-specific patterns of offspring feeding habits are examined. Results indicated that mothers and fathers perceived their child's weight status similarly, but differed when giving reports of their child's eating habits.

An interactive model of bulimic symptom development, first suggested by Vohs et al. (1999), was tested in adult women (mean age = 45.19). The following hypothesis was examined in a longitudinal design over 2.5 years: Women high in perfectionism, low in self-esteem, and who perceive themselves as overweight would be the most likely to experience an increase in bulimic symptoms. Results supported the model with regard to maintenance and exacerbation, but not onset, of bulimic symptoms. Furthermore, the interactive model was tested to see if it showed specificity to bulimic, versus depressive or anxious, symptoms. Some support for the model's specificity to bulimic symptoms was observed; however, the increase of anxious symptoms was also observed. Clinical and theoretical implications are discussed.

The current study examined compensation and capitalization treatment models with specific reference to problem-solving appraisal and problem-solving treatment of suicidal behavior (M. D. Rudd, T. Joiner, & M. H. Rajab, 2000). A sample of 98 young adults (mean age = 22), who had recently attempted suicide or ideated about suicide to the degree that they came to clinical attention, were randomly assigned to either problem-solving or control treatment. Participants with poorer problem-solving appraisal at baseline responded better than did participants with greater problem-solving appraisal to problem-solving treatment at 6-month follow-up, as would be predicted by the compensation model. Results suggest that treatment of suicidality for individuals with problem-solving skill deficits may be most effective by targeting these deficits rather than capitalizing on strengths. Keywords: suicide, compensation, capitalization, problem solving, strengths

Research has established the existence of mood induction in conditions of moderate to intense affective displays. Findings are less consistent with regard to for whom and under what circumstances mood induction occurs. The present study expands upon past work by examining the unique and interactive effects of target mood state ('depressed' vs. 'depressed-anxious') and participant gender on mood induction and interpersonal rejection. Participants viewed a video of either a pure depressed or concurrently depressed and anxious female target, then completed measures of mood symptoms, regard for the target, and willingness to interact with the target. Women reported similar mood symptoms in response to both videos, but men reported elevated depressed and anxious mood following the depressed-anxious video. Men were also more likely to hold the depressed-anxious target in lower regard, but no gender differences were found in willingness to interact with the target. The present findings suggest that women's displays of concurrent depressed and anxious mood, as compared to depressed mood alone, have particularly negative effects upon men's mood.

There has been an increase in recent years in the use of empirically supported treatments (ESTs) for a variety of mental disorders. This study was an investigation of the impact of standardized use of ESTs in an outpatient community clinic. Clients treated prior to and those treated alter the implementation of this policy were compared. The results indicate significant group differences, with the improvement ratings of the group receiving ESTs surpassing those of the group receiving unsupported treatment. Support for the use of ESTs indicates that patients may be best served if therapists rely primarily on these treatments. Keywords: empirically validated treatments, empirically supported treatments, treatment outcome, graduate training

T. E. Joiner's (2004, in press) theory of suicidal behavior suggests that past suicidal behavior plays an important role in future suicidality. However, the mechanism by which this risk is transferred and the causal implications have not been well studied. The current study provides evaluation of the nature and limits of this relationship across 4 populations, with varying degrees of suicidal behavior. Across settings, age groups, and impairment levels, the association between past suicidal behavior and current suicidal symptoms held, even when controlling for strong covariates like hopelessness and symptoms of various Axis I and II syndromes. Results provide additional support for the importance of past suicidality as a substantive risk factor for later suicidal behavior. Keywords: Joiner's theory, past, future, suicidal behavior

In recent years, numerous studies have demonstrated a link between positive and negative feedback seeking by depressed individuals, interpersonal rejection, and depression chronicity. Nonetheless, many of the specific interpersonal patterns underlying these links have yet to be clearly specified. One important lingering question concerns how depressed individuals respond to negative evaluation or feedback from others, because continued negative feedback seeking could place depressed people at risk for further rejection and continuation/exacerbation of depressive symptoms. Two studies were conducted to investigate the influence of negative feedback provisions from others on the feedback seeking behaviors of individuals with depressive symptoms. The results from Study 1 indicated an increased tendency to seek negative feedback among depressive individuals in association with an independent negative evaluation by their college roommates. Using a sample of newlywed couples, Study 2 extended this finding by demonstrating that, when directly provided with negative feedback from their spouses, individuals with depressive symptomatology actively sought further negative feedback, while those without such symptoms did not. Together, the results from these studies suggest that depressed individuals are likely to respond to negative evaluation and feedback from others with behaviors that could place them at risk for further rejection and continuing, if not worsening problems with depression. Keywords: Depressive symptoms; Interpersonal processes

Previous research in undergraduate women has demonstrated that an individual's level of self-competence was a stronger predictor of bulimic symptom change than their level of self-liking (Bardone, Perez, Abramson, & Joiner, 2003). The authors examined whether self-competence would similarly predict bulimic symptom change in a sample of older women. In April 2000, a large group of adults attending mood disorder conferences completed questionnaires about eating disorder symptoms and self-esteem. Approximately 2.5 years later, 150 women, 45 years of age and older, were contacted for a follow-up study. Eighty-eight women completed follow-up eating disorder and self-esteem measures. Consistent with prior research, self-competence emerged as a stronger predictor of bulimic symptom change than self-liking, such that lower self-competence was associated with an increase in bulimic symptoms. The results indicate that self-competence may serve as a useful prognostic indicator and therapeutic target for older women seeking treatment for eating disorders.

In this study, the authors examined the validity of the tripartite model of anxiety and depression (L. A. Clark & D. Watson, 1991) in a community epidemiotogical sample of 467 urban African American youth. Participants completed the Baltimore How I Feel (N. S. Ialongo, S. G. Kellam, & J. Poduska, 1999), a measure of anxiety and depressive symptoms, in Grades 6 and 9. Confirmatory factor analyses indicated that a 3-factor model representing the tripartite model fit the data well and better than competing models. Longitudinal confirmatory factor analysis revealed configural invariance of the tripartite factor structure. However, a predicted divergence among dimensions over time was not evidenced. High correlations among the tripartite dimensions suggest that anxiety and mood symptoms may not differentiate in urban youth. Results are discussed in terms of the ethnicity and urban context of this community sample.

An assessment was made to determine whether major depression or dysthymia was associated more strongly with the onset of bulimia. It was revealed that dysthymia was a stronger correlate with bulimia than major depression, and that the presence of dysthymia in adolescence might be a possible risk factor for the development of bulimia nervosa.

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.