Search

In the frame of the interpersonal psychological theory of suicide (IPTS), Interpersonal Needs Questionnaire (INQ-15) assesses thwarted belongingness (TB) and perceived burdensomeness (PB), related to suicidal ideation (SI); Acquired Capability for Suicide Scale–Fearlessness About Death (ACSS-FAD) measures this component which contributes to lethal self-harm. The objective was to evaluate the psychometric properties of INQ-15 and ACSS-FAD in a population of Italian university students. Since the Italian INQ-15 was already validated, we translated ACSS-FAD through a multistage procedure and administered both to 1,665 Italian university students. Factor analysis confirmed a two-factor-related model of INQ-15, one factor of ACSS-FAD, and good reliability for both. We proved the association between INQ-15 and current SI and between ACSS-FAD and lifetime suicidal planning and/or suicide attempt. The convergent and discriminant validities were in line with those of previous studies. Both tools are valid and reliable to assess the constructs associated with suicide outcomes according to IPTS. [ABSTRACT FROM AUTHOR]

Objective: Suicidal ideation and suicidal behaviors are major public health concerns in the United States and are difficult to treat and predict. Risk factors that are incrementally informative are needed to improve prediction and inform prevention of suicidal thoughts and behaviors. Uncontrollability of suicidal ideation, one parameter of suicidal ideation, is one such candidate. Method: In the current study, we assessed the predictive power of uncontrollability of suicidal ideation, over and above overall suicidal ideation, for future suicidal ideation in a large sample of active‐duty service members. A total of 1044 suicidal military service members completed baseline assessments, of whom 664 (63.6%) completed 3‐month follow‐up assessments. Results: While baseline overall suicidal ideation itself was the strongest predictor of future suicidal ideation, uncontrollability of suicidal ideation added some incremental explanatory power. Conclusion: Further study of uncontrollability of suicidal thought is needed to elucidate its impact on suicidal outcomes. [ABSTRACT FROM AUTHOR]

This study employed network analysis to characterize central autism spectrum disorder (ASD) traits and suicide symptoms within an active duty military sample as well as to identify symptoms that may bridge between ASD traits and suicidality (i.e., suicidal ideation and behaviors). Participants were active duty U.S. military service members (N = 287). Autism spectrum traits, suicidality, depression, and suicide related constructs were assessed online via self-report. Within the combined ASD trait-suicidality network, suicide rumination, suicide behaviors, and depression had the highest strength centrality. The most central bridge symptoms between ASD and suicidality were thwarted belongingness, social skills deficits, and depressive symptoms. Social skills deficits and thwarted belongingness may function as a meaningful bridge between ASD symptoms and suicidality within active duty members. Individuals with ASD symptoms who additionally present with high levels of thwarted belongingness and/or considerable social skills deficits may be at increased risk for suicidality. Within an ASD-suicidality network, social skills deficits, low belonging, and depression had the greatest bridge strength. Although low belonging emerged as a bridge symptom, perceived burdensomeness did not. Suicide rumination, suicide behaviors, and depression were the most central symptom in an ASD-suicidality network. Symptoms related to social skills deficits may connect ASD traits and suicidality. [ABSTRACT FROM AUTHOR]

Introduction: Suicidal ideation (SI) represents one of the most prominent predictors of suicidal behavior (SB). The Interpersonal Needs Questionnaire (INQ) was developed from the Interpersonal Theory of Suicide (ITS) to assess the 2 core drivers of SI proposed by the theory. Despite the relevance of suicide-related ideations and ITS, there is a lack of psychometric measures validated in clinical Spanish population that adequately evaluate SI components of ITS. Thus, the main aim of the study was to validate INQ-10 in a Spanish clinical sample including the genuine cultural and linguistic characteristics of European Spanish. Methods: 315 participants were included in the analyses; 149 of them consulted mental health services for the presence of suicide-related behaviors. A series of exploratory and confirmatory factor analyses were carried out to identify the factor solution. Bivariate and multivariate analyses were used to analyze psychometric properties. Finally, sensitivity and specificity properties were explored through receiver-operating characteristic analyses which also provided the cut-off values of the questionnaire. Results: An 8-item version demonstrated a good fit to the 2-factor solution. Likewise, this 8-item version showed good psychometric properties. Sensitivity and specificity indices of the version validated as well as the calculated cut-off points were excellent. Conclusions: The current results demonstrate the utility of an 8-item INQ European Spanish version as a valid measure of the current SI in Spanish clinical population. In addition, the validated form reflects the theoretical framework on which it was built. [ABSTRACT FROM AUTHOR]

Suicidal thoughts and behaviors (STBs) are thought to result from, at least in part, abnormalities in various neural systems. Event‐related potentials (ERPs) are a useful method for studying neural activity and can be leveraged to study neural deficits related to STBs; however, it is unknown how effective ERPs are at differentiating various STB groups. The present meta‐analysis examined how well ERPs can differentiate (a) those with and without suicidal ideation, (b) those with and without suicide attempts, (c) those with different levels of suicide risk, and (d) differences between those with suicide attempts versus those with suicidal ideation only. This meta‐analysis included 208 effect sizes from 2,517 participants from 27 studies. We used a random‐effects meta‐analysis using a restricted maximum likelihood estimator with robust variance estimation. We meta‐analyzed ERP‐STB combinations that had at least three effect sizes across two or more studies. A qualitative review found that for each ERP and STB combination, the literature is highly mixed. Our meta‐analyses largely did not find significant relationships between STBs and ERPs. We also found that the literature is likely severely underpowered, with most studies only being sufficiently powered to detect unrealistically large effect sizes. Our results provided little‐to‐no support for a reliable relationship between the ERPs assessed and STBs. However, the current literature is severely underpowered, and there are many methodological weaknesses that must be resolved before making this determination. We recommend large‐scale collaboration and improvements in measurement practices to combat the issues in this literature. Our meta‐analysis is the first to synthesize the literature on the relationship between suicidal thoughts and behaviors (STB) and ERPs. This meta‐analysis provides evidence that ERPs may not be related to STBs. However, the study points toward reforms needed in this field before this conclusion can be drawn, including larger sample sizes, and better measures of STBs. [ABSTRACT FROM AUTHOR]

Objective: Suicide attempts and self-injurious behaviors (SIBs) are known to be elevated among people with bulimia nervosa (BN). The aim of the current study was to examine the Interpersonal-Psychological Theory of Suicide (IPTS) as a framework for understanding, assessing, and mitigating suicidal behavior among women with BN. The IPTS suggests that for individuals to enact lethal suicide attempts, they must have both the desire to die (consisting of thwarted belongingness and perceived burdensomeness) as well as the capability to die (often acquired through repeated exposure to provocative or painful experiences). Method: Two-hundred and four women with eating disorders, the majority of whom met criteria for a current DSM-IV diagnosis of BN, completed measures from which proxies for IPTS variables were formed. Bivariate correlations and multiple regressions tested main effects and interactions of study variables. Tests of the difference between dependent correlations probed differential associations between study variables and suicidal ideation versus suicidal behavior. Results and Conclusions: Results yielded considerable but not unalloyed support for the theory, with desire to die variables (particularly perceived burdensomeness) more strongly associating with suicidal ideation than behavior, and the opposite holding true regarding capability. These findings suggest that the IPTS may provide a useful framework for understanding, assessing, and mitigating suicide risk among individuals with BN. [ABSTRACT FROM AUTHOR]

Objectives: There is a dearth of research on suicidal thoughts and behaviors among eating disorder patients diagnosed with binge eating disorder (BED) or other specified feeding or eating disorder (OSFED). This pilot study evaluated presence and severity of suicidal thoughts and behaviors by eating disorder diagnosis in a transdiagnostic clinical eating disorder sample. Methods: Participants were individuals (N = 257; 91.1% female; 94.6% Caucasian) currently receiving eating disorder treatment for anorexia nervosa (AN), bulimia nervosa (BN), BED, or OSFED. Participants completed online measures of variables. Results: Lifetime and current presence and severity of suicidal ideation and suicide attempts were statistically similar among diagnostic groups. Conclusion: Though largely overlooked, treatment‐utilizing individuals with BED and OSFED may experience elevated rates and severity of suicidal thoughts and behaviors, like those with AN and BN. Attention to suicide‐related risk assessment and management is needed when treating individuals with eating disorders, regardless of diagnosis. [ABSTRACT FROM AUTHOR]

To date, the field has been unable to provide a definitive answer on which suicide risk assessment measure or set of measures is most useful in applied clinical settings. This study pits several psychometrically sound suicide risk assessment measures against one another, to determine which tool optimally assesses the likelihood of future suicide-related outcomes over a 3-month period, in a large sample of military personnel seeking and/or referred to services due to suicide risk concerns. The risk assessment measures were (a) Columbia-Suicide Severity Rating Scale; (b) Self-Harm Behavior Questionnaire; (c) Suicidal Behaviors Questionnaire-Revised; and (d) Beck Scale for Suicide Ideation. A total of 1,044 suicidal military service members completed baseline assessments, of whom 758 (72.6%) completed 3-month follow-up assessments. The data indicate that there is no best measure for suicide risk assessment and clinicians are therefore encouraged to select the measure, from among the four studied, for use in regular practice that best suits the demands of their setting. (PsycInfo Database Record (c) 2021 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

The "Death/Life" Implicit Association Test (d-IAT) is a reaction-time task which has been associated with past and future suicidal behavior; in some work, the association has been incremental to explicit self-report of suicide risk. Proposed mechanisms for this association relate to one's unwillingness or inability to completely disclose or be introspectively aware of implicit risk. This study investigated moderators of implicit-explicit concordance as well as predictors of d-IAT score unexplained by self-reported suicidal thoughts and behaviors among an online sample of 382 adults with higher demographic suicide risk (i.e., military service members and veterans, men over age 50, and LGBTQ young adults). Before and after controlling for current explicit report, results replicated the finding of a significant relationship between d-IAT score and severity of past suicidal behavior, and additionally indicated that suicide attempt history and wish to live moderated the association between d-IAT score and explicit report. Furthermore, results suggest that poor introspective awareness, rather than deception, may account for differences between implicit and explicit risk assessment. Continuing investigation of moderators and mechanisms of the d-IAT is needed to improve the utility and validity of using implicit suicide risk assessment as a clinical tool. [ABSTRACT FROM AUTHOR]

Research has linked agitation and low body trust to suicidal thoughts and behaviors. We investigated a pathway with agitation accounting for the relationship between body trust and suicidality. 511 individuals recruited via MTurk (Study 1) and 167 undergraduate students (62.9% with suicide attempt history) (Study 2) completed measures of study variables. For ideation, the proposed pathway was significant across samples, as was a pathway with agitation predicting and body trust mediating. In Study 1, agitation explained the relationship between body trust and attempt history. In Study 2, neither independent variable was related to attempt history. Results suggest body trust is independently associated with suicidal ideation. Results were discrepant regarding suicide attempt history, necessitating future studies. [ABSTRACT FROM AUTHOR]

Importance: Brief cognitive behavioral therapy (BCBT) is a clinically effective intervention for reducing risk of suicide attempts among suicidal US Army soldiers. However, because specialized treatments can be resource intensive, more information is needed on costs and benefits of BCBT compared with existing treatments.Objective: To evaluate the cost-effectiveness of BCBT compared with treatment as usual for suicidal soldiers in the US Army.Design, Setting, and Participants: A decision analytic model compared effects and costs of BCBT vs treatment as usual from a US Department of Defense (DoD) perspective. Model input data were drawn from epidemiologic data sets and a clinical trial among suicidal soldiers conducted from January 31, 2011, to April 3, 2014. Data were analyzed from July 3, 2018, to March 25, 2019.Interventions: The strategies compared were treatment as usual alone vs treatment as usual plus 12 individual BCBT sessions. Treatment as usual could include a range of pharmacologic and psychological treatment options.Main Outcomes and Measures: Costs in 2017 US dollars, suicide attempts averted (self-directed behavior with intent to die, but with nonfatal outcome), suicide deaths averted, and incremental cost-effectiveness ratios, assuming a 2-year time horizon for treatment differences but including lifetime costs.Results: In the base-case analysis, BCBT was expected to avert approximately 23 to 25 more suicide attempts and 1 to 3 more suicide deaths per 100 patients treated than treatment as usual. Sensitivity analyses assuming a range of treatment effects showed BCBT to be cost saving in most scenarios. Using the federal discount rate, the DoD was estimated to save from $15 000 to $16 630 per patient with BCBT vs treatment as usual. In a worst-case scenario (ie, assuming the weakest plausible BCBT effect sizes), BCBT cost an additional $1910 to $2250 per patient compared with treatment as usual.Conclusions and Relevance: Results suggest BCBT may be a cost-saving intervention for suicidal active-duty soldiers. The costs of ensuring treatment fidelity would also need to be considered when assessing the implications of disseminating BCBT across the entire DoD. [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]

Objectives: Suicide attempts (SAs), by definition, represent a risk for serious injury or death; thus, one's SA may contribute to the development of posttraumatic stress disorder (PTSD). Yet, empirical data on this topic are lacking. This study aimed to characterize the phenomenology, rate, and associated features of PTSD following one's SA. Method: A total of 386 adult SA survivors recruited from web‐based sources participated. Results: Overall, 27.5% (95% confidence interval = 23.1–31.9%) of SA survivors screened positive for a probable SA‐related PTSD diagnosis. Individuals with a probable SA‐related PTSD diagnosis reported greater current suicidal intent than those without this probable diagnosis; this association was significant at low, but not high, levels of depression symptoms. Conclusions: A substantial proportion of SA survivors may experience SA‐related PTSD. SA‐related PTSD may be a viable assessment and intervention target to improve the quality of life and to reduce future suicide risk among SA survivors. [ABSTRACT FROM AUTHOR]

Background: Research is needed to identify the factors that explain the link between prior and future suicidality. This study evaluated possible mediators of the relationship between: (1) the severity of prior suicidality and (2) suicidal ideation severity at 3-month follow-up among a sample of high-risk military personnel. Methods: US military service members referred to or seeking care for suicide risk (N = 624) completed self-report psychiatric domain measures and a clinician interview assessing prior suicidality severity at baseline. Three months later, participants completed a self-report measure of suicidal ideation severity. Three separate percentile bootstrap mediation models were used to examine psychiatric factors (i.e. alcohol abuse, anxiety sensitivity, hopelessness, insomnia, posttraumatic stress symptoms, suicidal ideation, and thwarted belongingness) as parallel mediators of the relationship between prior suicidality severity (specifically, suicidal ideation, suicide attempt, and overall suicidality – i.e. ideation/attempt severity combined) at baseline and suicidal ideation severity at follow-up. Results: Hopelessness, specifically, and the total effect of all mediators, each significantly accounted for the relationship between prior suicidality severity and subsequent ideation severity across models. In the models with attempt severity and overall suicidality severity as predictors, thwarted belongingness was also a significant mediator. Conclusions: Hopelessness, thwarted belongingness, and overall severity of psychiatric indices may explain the relationship between prior suicidality severity and future suicidal ideation severity among service members at elevated suicide risk. Research is needed to replicate these findings and examine other possible mediators. [ABSTRACT FROM AUTHOR]

Myths about suicide abound in the therapeutic setting. They often inhibit the ability of clinicians (and families) to assess the severity and magnitude of a patient's suicide risk. This special [...]

Objective: Utilizing a sample of military service members at risk of suicide, this study aimed to: (a) identify patterns of suicide attempt (SA) history reporting across five measures and (b) evaluate whether consistent SA reporters (i.e., individuals who consistently report an SA history across measures) differ from inconsistent SA reporters on other clinical severity indices. Method: Participants (N = 984) completed five validated SA history measures and self‐report psychiatric symptom measures. Results: Of the sample, 35.4% inconsistently responded to SA history measures. Inconsistent reporters disclosed more severe suicide threat histories than consistent reporters. On all other clinical severity indices, inconsistent reporters evinced either less severe or comparable symptom levels. Conclusions: A nontrivial portion of service members may respond inconsistently to different assessments of SA history. Research is needed to identify factors that account for inconsistent SA history reporting and to improve the accuracy of SA history assessments among military personnel. [ABSTRACT FROM AUTHOR]

Objective: Here we argue for the necessity, validity, and clinical utility of a new diagnostic entity, acute suicidal affective disturbance (ASAD). Method: We expand on the conceptual, clinical, and practical rationale for ASAD, propose its defining features, describe research results to date, and suggest avenues for future research. Results: There is accruing evidence for the existence of a previously unclassified, rapid‐onset mood disturbance that geometrically escalates and regularly results in life‐threatening behavior. Conclusions: ASAD research may not only improve the field's understanding of suicidal behavior but also enhance clinical effectiveness and save lives. [ABSTRACT FROM AUTHOR]

Previous evidence suggests an association between negative cognitive styles and suicide-related outcomes. Recently, Acute Suicidal Affective Disturbance (ASAD) was proposed to characterize the phenomenology of acute suicidal crises, with key features being the rapid onset of suicidal intent, social- or self-alienation, perceptions of intractability, and overarousal. ASAD may account for the association between negative cognitive styles and suicide-related outcomes. Students (N = 177) selectively recruited based on their history of suicidality completed self-report measures. ASAD symptoms explained the association between rumination subtypes (brooding and reflection), as well as anxiety sensitivity cognitive concerns, and lifetime number of suicide attempts. Further, ASAD symptoms significantly accounted for the relationship between a latent negative cognitive styles variable and lifetime number of suicide attempts. Together, these findings are consistent with theoretical conceptions of negative cognitive styles being an associated feature of ASAD, and that ASAD symptoms may account for the relationship between negative cognitive styles and suicidal behavior. [ABSTRACT FROM AUTHOR]

Objective: A suicide attempt is at least somewhat life-threatening by definition and is, for some, traumatic. Thus, it is possible that some individuals may develop posttraumatic stress disorder (PTSD) from a suicide attempt. Method: In this article, we consider whether one's suicide attempt could fulfill Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for a PTSD Criterion A event and contribute to the development of attendant PTSD symptoms (e.g., flashbacks, avoidance, shame/guilt, nightmares); discuss theoretical models of PTSD as they relate to suicide attempts; reflect on factors that might influence rates of suicide attempt–related PTSD; highlight methodological limitations that have hampered our understanding of suicide attempt–related PTSD; and posit areas for future scientific and clinical inquiry. Results: Strikingly, the degree to which a suicide attempt leads to PTSD is unknown. Conclusions: We conclude with a call for research to systematically assess for suicide attempts alongside other potentially traumatic experiences (e.g., combat exposure, rape) that are included in standardized PTSD assessments. [ABSTRACT FROM AUTHOR]

Objective: Exercise dependence has been linked to capability for suicide and suicidal behavior; however, less understood are which facets of exercise dependence confer risk for suicidal behavior and the potential mechanisms of this association. This study examined relationships between exercise dependence, capability for suicide, and past suicidal behavior. Methods: A sample of 540 individuals recruited via MTurk completed online measures of their exercise dependence, capability for suicide, and history of suicidal behavior. Results: Suicide attempters reported higher levels of continuance in exercise despite physical or psychological consequences, lack of control over exercise, and reductions in other activities due to exercise than nonattempters. Capability for suicide accounted for the relationship between continuance in exercise despite adverse consequences and lifetime number of suicide attempts. Conclusions: When exercise becomes pathological in the form of exercise dependence, steps should be taken to reduce such engagement due to its observed association with suicidal behavior. [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]

The effects of acetaminophen and a reading task on physical pain tolerance and fearlessness about death were tested in 106 undergraduate students. Participants were randomized into four groups, each receiving either acetaminophen or no medication, along with either a control or experimental reading task. It was predicted that acetaminophen would increase pain tolerance and fearlessness about death, that the experimental reading task would decrease both outcomes, and that the interventions would interact (i.e., acetaminophen would dampen the effects of the reading task). Multivariate analysis of variance was used to test hypotheses. No significant interaction was found (p = .17) and there was no effect for acetaminophen (p = .56), but individuals administered the experimental reading task demonstrated significantly higher physical pain tolerance (p < .05). [ABSTRACT FROM AUTHOR]

Background: Suicide-specific rumination, defined as rumination about one's suicidal thoughts, intentions, and plans, and Acute Suicidal Affective Disturbance (ASAD) have each been proposed as relevant and proximal predictors of suicidal behavior. The purpose of the current study was to examine relations between suicide-specific rumination, ASAD, and previous number of lifetime suicide attempts, particularly whether ASAD accounted for the association between suicide-specific rumination and previous lifetime suicide attempts.Methods: Undergraduate students with a past history of suicidality (N = 300) completed measures of their suicide-specific rumination, lifetime ASAD symptoms, and lifetime history of suicide attempts on an online questionnaire in exchange for course credit.Results: ASAD accounted for the association between suicide-specific rumination and lifetime number of past suicide attempts. This effect was particularly driven by suicidal intent aspect of ASAD, as opposed to the ASAD social alienation, self-alienation, and overarousal facets. An alternative model indicated that suicide-specific rumination did not account for the association between ASAD and lifetime past suicide attempts.Limitations: This study utilized exclusively self-report measures and a cross-sectional design, thereby precluding inferences of causality.Conclusions: These findings indicated that ASAD may explain the relationship between suicide-specific rumination and lifetime past suicide attempts. Future research using a prospective design is needed to elucidate these patterns and determine causal relationships. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Interoception deficits have been associated with various points on the suicidality continuum. Most research, however, has focused on general, rather than specific facets of, interoception. This study compared individuals with lifetime suicidal ideation, plans, and attempts using a multidimensional assessment of interoception. Method: A total of 537 adults completed measures of their interoception and lifetime suicide histories. Results: Individuals with lifetime suicidal ideation reported more worry about their bodily sensations. Those with lifetime suicide attempts reported a greater tendency to distract themselves from bodily sensations and less self‐regulation using bodily sensations. Individuals at all points of the suicidality continuum reported less trust of their bodily sensations. Conclusion: These findings suggest that interoception may be impaired in those with a history of suicidal thoughts and behaviors. Longitudinal designs are needed to parse apart the interplay of these variables and directionality of these relationships. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the characteristics of suicide risk assessments completed using the Decision Tree framework both in and between psychotherapy sessions, clinical features of patients for whom between‐session assessments are indicated, and data collected across assessments. Method: Data were collected from 1,358 suicide risk assessments conducted with psychiatric outpatients (N = 41) at elevated suicide risk engaged in care at a psychology training clinic. Results: Participants completed an average of 4.75 (standard deviation = 4.95) suicide risk assessments (2.81 ± 4.43 between‐session assessments) per each month in treatment. Assessment frequency and patient ratings of suicidal desire and intent were each significantly associated with therapist risk level categorizations. Conclusion: The Decision Tree framework's in‐ and between‐session assessments have the potential to be implemented in a routinized format among psychiatric outpatients at elevated suicide risk. Additional research is needed to establish the feasibility and clinical utility of this framework across samples and providers. [ABSTRACT FROM AUTHOR]

Objective: Numerous risk factors have been identified for suicidal ideation, including perceived burdensomeness, thwarted belongingness, agitation, insomnia, nightmares, cognitive anxiety sensitivity, and rumination. However, the complexity of these associations has not been well studied; the magnitude of these effects may vary at differing levels of suicidal ideation. The present study reexamined established risk factors for suicidal ideation using quantile regression, a statistical technique that calculates the effect at numerous quantiles of suicidal ideation, as opposed to the average effect across all quantiles. Method: A sample of 354 psychiatric outpatients (61.3% female, meanage = 27.01 years, standard deviation = 10.40) completed self‐report measures of their suicidal ideation and related risk factors prior to their initial intake appointments. Results: The relationship between each suicide risk factor and suicidal ideation was strongest at higher (.9 quantile), as opposed to nonexistent (.5 quantile) and low‐moderate (.7 quantile), levels of suicidal ideation. The interaction proposed by the interpersonal theory of suicide was significant at nonexistent and low‐moderate, but not high, levels of suicidal ideation. Conclusion: Our findings indicated that predictors of suicidal ideation differed in magnitude at varying levels of suicidal ideation. Implications, limitations, and future research directions are discussed. [ABSTRACT FROM AUTHOR]

Suicide-specific rumination, defined as a mental fixation on one's suicidal thoughts, intentions, and plans, may be an important predictor of suicidal behavior. To date, suicide-specific rumination has demonstrated convergence with, yet distinction from, a variety of suicide risk factors, and differentiated suicide attempters from ideators. However, no research has examined whether suicide-specific rumination is associated with lifetime suicide attempts above and beyond the presence of a host of other relevant suicide risk factors. The present study tested this hypothesis in samples of students ( N  = 300) and community members recruited via Amazon's MTurk ( N  = 209) who reported a lifetime history of suicidal ideation. Results indicated that suicide-specific rumination was associated with the presence of a lifetime suicide attempt, above and beyond a variety of other commonly-cited risk factors for suicidal thoughts and behaviors in both samples, including suicidal ideation, general rumination, interpersonal theory variables, emotion-relevant factors (dysregulation, experiential avoidance, distress tolerance, negative affect), symptoms of depression and anxiety, and overarousal. Overall, though limited by the use of non-clinical samples and a cross-sectional study design, that suicide-specific rumination outperformed all other suicide risk factors in predicting the presence of a lifetime suicide attempt suggests the potential potency of this relatively understudied risk factor in understanding transitions to suicidal behavior. [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]

The interpersonal theory of suicide posits that individuals who simultaneously experience high levels of thwarted belongingness, perceived burdensomeness, and acquired capability for suicide are at high risk for a lethal or near-lethal suicide attempt. Although supported by self-report studies, no study has examined facets of the theory experimentally. The present study aimed to examine the belongingness and capability components of the theory by testing whether experimentally manipulated social exclusion interacts with self-reported acquired capability to predict higher self-administered shock levels on a self-aggression paradigm. A sample of 253 students completed self-report measures and were then randomly assigned to a social exclusion manipulation condition (future alone, future belonging, no feedback). Participants then participated in the self-aggression paradigm. The positive association between acquired capability and self-aggression was strongest among participants in the future alone social exclusion condition. In those assigned to the future belonging or no feedback conditions, the association between acquired capability and self-aggression was non-significant. These findings provide modest experimental support for the interpersonal theory of suicide and highlight a potential mechanism through which social exclusion may impact suicide risk. Limitations and future research directions are discussed. [ABSTRACT FROM AUTHOR]

Background Psychological autopsy studies consistently report that the rate of detected mental disorders among suicide decedents is below 100%. This implies three possibilities: (a) a subset of suicide decedents did not have a mental disorder at the time of death; (b) all suicide decedents suffered from a mental disorder, but some were undetected due to methodological limitations; and/or (c) suicide decedents with an undetected mental disorder displayed significant and perhaps subclinical features of a mental disorder. Objective In this article, we examined these possibilities by evaluating the differences in symptoms and stressors between suicide decedents who were undiagnosed and those diagnosed with a mental disorder at the time of death. Method We reviewed 130 case studies of community-based suicide decedents originally described in Robins' (1981) psychological autopsy study. Results Without exception, suicide decedents in Robins' sample suffered either from a clearly diagnosable mental disorder or displayed features indicative of a significant, even if subclinical, presentation of a mental disorder. Undiagnosed and diagnosed suicide decedents did not significantly differ with regards to demographics, violence of suicide method, suicide attempt history, the number and intensity of stressful life events preceding death, and whether their death was a murder-suicide. Conclusion Although clearly not all who suffer from mental disorders will die by suicide, these findings imply that all who die by suicide appear to exhibit, at minimum, subclinical psychiatric symptoms with the great majority showing prominent clinical symptoms. We conclude with clinical implications and recommendations for future study. [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]

Objective To characterize individuals' prior experiences with being asked whether they are having thoughts of suicide and to understand factors that affected their response accuracy. Method Undergraduates ( N = 306) reporting a lifetime history of suicidal ideation completed a web-based survey about their experiences being probed about suicidal thoughts. Results Nearly two-thirds of participants (63.1%) reported having been previously asked whether they were having thoughts of suicide, with health care providers comprising the plurality of probers. Individuals reported the greatest accuracy of ideation disclosure to mental health professionals. Stigma-related concerns were the most common barriers to accurate disclosure of ideation, whereas wanting emotional support and the prober to understand them were cited as facilitators for accurately responding. Conclusion A number of factors influence the accurate and inaccurate disclosure of suicidal ideation. Further research is needed to understand how to facilitate accurate disclosure of suicidal ideation across settings and populations. [ABSTRACT FROM AUTHOR]

Current psychological diagnostic classification systems do not fully capture the scope of suicidality, leading to recent advocacy for the inclusion of a suicidespecific diagnosable condition. We contend that a suicide-specific diagnosable condition should parsimoniously reflect acuity and characterize not only if, but also when, a person will engage in suicidal behavior. Two potential solutions to this diagnostic void have been proposed: (1) acute suicidal affective disturbance (ASAD) and (2) suicide crisis syndrome (SCS). This article provides an overview of the phenomenology and existing empirical evidence for ASAD and SCS, as well as a comparison between the two conditions. It also outlines a number of future research directions, including the need to examine both conditions prospectively in heterogeneous samples of people across the lifespan, as well as the necessity of comparing the reliability, validity, and clinical utility of these two syndromes directly within single studies. [ABSTRACT FROM AUTHOR]

The effect of perceived criticism from others is one potentially important risk factor for suicide that has received scant attention, despite decades of research on the role of criticism in the treatment and course of mental illnesses such as schizophrenia and mood disorders. This study analyzed the effect of perceived criticism's association with suicidal ideation and attempts as well as its connection with the suicide related constructs thwarted belongingness and perceived burdensomeness as described in the Interpersonal Theory of Suicide. Fifty participants (66% female, MAge = 18.7), 18 of whom had previously made one or more suicide attempts, completed a battery of self-report assessments as well as two in-person, structured clinical interviews. Analyses demonstrated that perceived parental criticism is a significant indicator of suicide ideation (β = .297, p = .003) and attempts (β = .373, p < .001) and that perceived criticism from close friends is a significant indicator of suicide attempts (β = .297, p = .006). Perceived criticism has a strong indirect effect on suicide ideation and attempts through its effect on thwarted belongingness, but not perceived burdensomeness, while controlling for mental illnesses. Some limitations of this study include the cross-sectional design and the use of a relatively small, restricted age sample. Treatment designed to mitigate perceived criticism and thwarted belongingness may be an important component in combatting suicidal ideation and attempts, particularly among young adults. [ABSTRACT FROM PUBLISHER]

A new suicide-specific diagnostic entity, acute suicidal affective disturbance (ASAD), was recently proposed to fill a void in the nomenclature. Although several studies have examined the reliability, validity, and potential clinical utility of ASAD, no studies have examined personality indicators of ASAD. This study sought to examine the association between personality and psychopathology factors, as assessed by the Minnesota Multiphasic Personality Inventory–2–Revised Form (MMPI–2–RF), and constructs that comprise ASAD in a sample of 554 psychiatric outpatients who completed all measures prior to their intake appointments. A smaller subset of patients (N= 58) also completed a measure designed to assess lifetime ASAD symptoms. Results indicated that ASAD symptoms were associated with traits characterized by emotional turmoil and atypical cognitive processes. Further, suicide-related criteria that comprise ASAD were related to low positive emotionality and hopelessness, whereas the overarousal criteria were associated with somatic symptoms and an inability to tolerate frustration and stress. These findings expand on previous research that examines the convergent and discriminant validity of ASAD and could inform clinical treatment by providing insight into personality traits that might be associated with acute suicide risk. [ABSTRACT FROM PUBLISHER]

Background Research regarding suicide mortality among firefighters within the U.S. has been sparse and has yielded inconsistent findings. This study aimed to: (i) describe suicide rates within a large, urban fire department; and (ii) compare firefighter suicide rates with demographically adjusted general population suicide rates. Methods Rosters were obtained from the Philadelphia Fire Department (PFD) for all members employed by or separated from the department between 1993 and 2014 (N = 4,395). Vital statistics for each member were obtained from the CDC's National Death Index. Results Overall, 272 deaths were recorded; 11 (4.0%) were certified as suicides. The overall suicide rate among firefighter affiliates of the PFD between 1993 and 2014 was 11.61 per 100,000 person-years. Conclusions The suicide rate among firefighters appears comparable to, and perhaps lower than, demographically adjusted general population estimates. Infrastructure to triangulate and monitor suicide rates from multiple departments, both career and volunteer, is needed to derive a more representative and informative estimate of firefighter suicide rates. Am. J. Ind. Med. 59:942-947, 2016. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

With the increasing utilization of Web-based surveys for suicide and suicide-related research, it is critical to understand factors that affect participants' decision to request study compensation (and thus potentially reveal their identity) or remain anonymous. This study evaluated differences in demographics, suicidal symptoms, and suicide-related constructs between participants electing and declining to provide identifying information to receive study compensation. A sample of 931 firefighters (91.5% male) participated in a Web-based mental health survey; on survey completion, individuals had the option to provide contact information to receive a $10 gift card. Logistic regression analyses were employed to investigate differences between those who did and did not provide this information. Overall, 82.8% provided identifying information, with younger individuals significantly more likely to do so. Participants reporting more severe suicidal symptoms and greater levels of suicide-related constructs appeared equally, and in some cases, significantly more, willing to provide identifying information. Findings indicate that individuals reporting more sensitive or stigmatizing experiences might not systematically opt out of receiving study compensation to remain anonymous on Web-based surveys. Additional research is warranted to replicate these findings in more representative samples and further delineate personality and other factors influencing the disclosure of contact information to receive study compensation. [ABSTRACT FROM PUBLISHER]

Borderline personality disorder diagnostic criteria, particularly affective dysregulation and behavioral dysregulation, are avenues through which suicide risk is conferred, though pathways are not well understood. The interpersonal theory of suicide may help elucidate these associations. The current study examined indirect relationships between affective and behavioral dysregulation and suicidal ideation through perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide. 169 outpatients completed measures prior to their intake assessment. Perceived burdensomeness accounted for the relationship between affective dysregulation and suicidal ideation. The acquired capability did not explain the association between behavioral dysregulation and suicide attempt history. Affective and behavioral dysregulation may be key targets in treatment for reducing suicide risk. [ABSTRACT FROM PUBLISHER]

The interpersonal theory of suicide posits that individuals who experience suicide ideation will only develop suicidal intent, and subsequently engage in suicidal behavior when they have concomitant fearlessness about death and tolerance for physical pain (i.e., the capability for suicide). The current studies examined the hypothesis that one aspect of the capability for suicide—fearlessness of the pain involved in dying—would amplify the positive association between current suicide ideation and a previous suicide attempt in two samples at high risk for experiencing suicide ideation and suicide attempts. Study 1 examined this relation using self-report methods in a sample of adults entering treatment in a mental health outpatient clinic. Study 2 utilized similar methods in a sample of adults admitted to inpatient psychiatry. Both studies indicated that those individuals who reported suicide ideation were more likely than non-ideators to report having attempted suicide only if they also reported greater fearlessness of the pain involved in dying. The current findings support the theorized role of the capability for suicide in the transition from ideation to attempt and also support assessing the capability for suicide in risk assessment. [ABSTRACT FROM PUBLISHER]

Objective: The interpersonal-psychological theory of suicide posits that perceived burdensomeness (PB; i.e., the belief that others would be better off if one were dead) and thwarted belongingness (TB; i.e., the belief that one lacks meaningful social connections) are both necessary risk factors for the development of suicidal ideation. To test these relations, measures are needed that are well validated, especially in samples of at-risk adults. Method: The current study was designed to examine the factor structure of an eight-item version of the Interpersonal Needs Questionnaire (INQ) in a sample of 405 U.S. past and current military personnel (Mage = 31.57 years, SD = 7.28; 90.4% male) who endorsed either current suicidal ideation and/or a past suicide attempt. Analyses were conducted using confirmatory factor analysis (CFA). Results: A bifactor model comprising a general factor, labeled interpersonal needs, and two specific factors, labeled PB and TB, fit the data best. The general factor captured a high proportion of overall variance (81.9%). In contrast, the TB factor captured only a modest amount of variance in items meant to capture this factor (59.1%) and the PB factor captured very little variance in items meant to capture this factor (13.5%). Further, only the interpersonal needs factor was associated with lifetime and past-week suicidal ideation as well as suicidal ideation frequency and duration. Conclusions: The current findings indicate that, for the INQ-8 in high-risk military personnel, a general interpersonal needs factor accounted for the relations PB and TB share with suicidal ideation. [ABSTRACT FROM AUTHOR]

A number of studies have reported a bifurcated relationship between psychopathy and suicidality, such that suicidality is positively related to Factor 2 (impulsive-antisocial lifestyle) of psychopathy but negatively related or unrelated to Factor 1 (affective-interpersonal deficits). The present study aims to expand these findings by investigating this relationship through the lens of the interpersonal-psychological theory of suicidal behavior across both undergraduate and forensic samples. We hypothesized that, although both Factors 1 and 2 would be associated with the acquired capability for suicide, Factor 2 would exhibit a unique relationship with suicidal desire (perceived burdensomeness and thwarted belongingness). Results were largely supportive of these hypotheses, although differences were noted across samples and measures. Findings highlight the importance of precision in the assessment of antisociality and suggest potential differences in the construct of psychopathy between non-criminal and criminal samples. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to characterize rates and correlates of mental health service use, as well as barriers to care, among a sample of firefighters reporting a history of suicide ideation, plans, or attempts during their firefighting careers.Methods: Participants (N=483) completed a Web-based survey assessing history of suicidal thoughts and behaviors, prior mental health service utilization, and barriers to treatment.Results: Overall, 77% of participants reported receipt of mental health services during their firefighting careers (attempt history, 93%; plan but no attempt, 77%; and ideation only 68%). Firefighters with fewer years of service were less likely than those with more years to have accessed treatment. Service nonusers were more likely than service users to report concerns regarding reputation and embarrassment as barriers to care.Conclusions: Findings from this preliminary investigation suggest that the majority of firefighters with a history of elevated suicide risk have received mental health services. [ABSTRACT FROM AUTHOR]

This study was based on a sample of male high school students who completed National Longitudinal Adolescent Health Surveys in 1994, 1995, and 2001. We studied these students prospectively, comparing those who later died by suicide (n = 21) with those who were still living (n = 10,101). We employed chi-square and analysis of variance tests for statistical significance between suicide decedents and living respondents. Results showed suicide decedents were more likely to have experienced the suicide loss of another family member, to have been expelled from school, to have engaged in more delinquent actions including fighting, and to have greater involvement with the criminal justice system. Although one might have expected suicide casualties to have exhibited a greater amount of suicidal thoughts, attempts, and higher incidences of suicidality among their friends, our analyses did not find that these factors were associated with actual suicides. Should these findings be replicated, this would point to a need to refine youth suicide risk assessments. Collecting life histories, as well as identifying patterns of delinquency and fighting, may serve as more potentially fruitful means for assessing genuine suicide risk than some traditional risk assessment methods.z. [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]

Objective: Empirically informed suicide risk assessment frameworks are useful in guiding the evaluation and treatment of individuals presenting with suicidal symptoms. Joiner et al. (1999) formulated one such framework, which has provided a concise heuristic for the assessment of suicide risk. The purpose of this review is to ensure compatibility of this suicide risk assessment framework with the growing literature on suicide-related behaviors. Methods: This review integrates recent literature on suicide risk factors and clinical applications into the existing model. Further, we present a review of risk factors not previously included in the Joiner et al. (1999) framework, such as the interpersonal theory of suicide variables of perceived burdensomeness, thwarted belongingness, and capability for suicide (Joiner, 2005; Van Orden et al., 2010) and acute symptoms of suicidality (i.e., agitation, irritability, weight loss, sleep disturbances, severe affective states, and social withdrawal). Results: These additional indicators of suicide risk further facilitate the classification of patients into standardized categories of suicide risk severity and the critical clinical decision making needed for the management of such risk. Conclusions: To increase the accessibility of empirically informed risk assessment protocols for suicide prevention and treatment, an updated suicide risk assessment form and decision tree are provided. [ABSTRACT FROM AUTHOR]

Objective: Despite the existence of efficacious interventions that reduce suicide risk, connecting high-risk individuals with care remains a problem. Little is known about factors that may be associated with service use and nonuse among suicidal adults. This study aimed to identify correlates of mental health service use among adults reporting past-year ideation, plans, or attempts.Methods: Data from the 2013 National Survey on Drug Use and Health (NSDUH) were analyzed to identify correlates of mental health service use among a nationally representative sample of adults reporting past-year suicide ideation (N=2,126), plans (N=690), or attempts (N=345). Findings were compared with results for individuals reporting no past-year suicidality (N=35,106).Results: Approximately 50% of adults with past-year ideation, plans, or attempts reported contact with any type of mental health services in the past year. Individuals who were more likely to have connected with services in the past year included females, non-Hispanic whites, those in worse general medical health, and those with a more severe clinical picture (that is, presence of serious psychological distress or a past-year diagnosis of a major depressive episode). Among the groups with suicide ideation, plans, or attempts, no significant differences in service use emerged between veterans and nonveterans or between married and nonmarried individuals.Conclusions: Findings underscore the low rates of service use among adults at elevated risk of suicide and reveal possible avenues by which to increase treatment engagement in this population. Additional research is warranted to examine correlates of service use within a prospective design. [ABSTRACT FROM AUTHOR]

Memories recalled from the field, or first person, perspective tend to be specific, more detail-oriented, and emotional. In contrast, memories from the observer, or third person, perspective, tend to be more general, less detail-oriented and emotional. Research suggests that individuals with a history of suicidality exhibit over-general autobiographical memories (i.e., lacking in detail). We propose that individuals with a history of suicidality may encode and recall memories more from the observer perspective, which is associated with recalling fewer details about events. This hypothesis was tested by examining the memory perspectives of 107 young adults with and without symptoms of suicidality during task and event recall. Compared to controls, suicide attempters recalled tasks and neutral events significantly less from the observer perspective and more from the field perspective; suicide ideators and controls were not significantly different on recall perspectives. No significant differences in negative event and suicide attempt recall were found across groups. Results indicated that suicide attempters exhibited a recall bias towards first person, internally focused memories. Limitations and future directions are discussed. [ABSTRACT FROM AUTHOR]