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Recent work has identified fearlessness about suicide , rather than fearlessness about death , as more theoretically relevant in the assessment of capability for suicide and thus a more appropriate construct of measurement. The aim of the current project was to develop and validate a scale specifically assessing fearlessness about suicide. Across two studies, support for a 7-item, single-factor structure of the Fearlessness About Suicide Scale (FSS) emerged. The FSS factor structure demonstrated a good fit in the first study and was replicated in the second study. Measurement invariance was examined across those identifying as men and women and found to be comparable. The FSS also demonstrated test-rest reliability and good convergent and divergent validity in community and undergraduate samples. Overall, findings indicate that the FSS has a replicable factor structure that generalizes across those identifying as men and women and may better assess components of capability for suicide than existing scales., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Disrupting the accessibility of the mental representation of suicide may be a possible pathway to a strategy for suicide prevention. Our study aims to theoretically evaluate this perspective by examining the impact of temporarily disrupting the concept of suicide on perceptions of suicide. Using a within-subject design, we tested the effects of semantic satiation targeting the word "suicide" on the perceptual judgment of suicide-relevant pictures in 104 young adults. On each trial, participants repeated aloud one of the three words (i.e., "accident," "murder," or "suicide") either three times (priming) or 30 times (satiation) and indicated whether a subsequent picture matched with the word. Results indicated that satiation of the word "suicide" slowed the accurate categorization of pictures related to all three words, and satiation of "murder" and "accident" delayed participants' judgment of suicide-relevant pictures. Our findings support that semantic satiation can render the suicide concept temporarily less accessible, thereby providing preliminary support for the strategy of concept disruption in suicide prevention., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

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., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Suicidality disproportionately affects Veterans, and in 2020 the Military Health and Well-Being Project was conducted in part to study the link between risk and protective constructs with suicidality among Veterans. In the present study, we investigate the relative contribution of risk (i.e., military self-stigma, daily stress, combat exposure, substance use, traumatic brain injury, and moral injury) and protective constructs (i.e., social integration, social contribution, public service motivation, purpose and meaning, and help-seeking) with suicidality. Using cross-sectional Pearson correlation and linear regression models, we studied the independent and relative contribution of risk and protective correlates in a sample of 1469 Veterans (male: n = 985, 67.1 %; female: n = 476, 32.4 %; transgender, non-binary, prefer not to say: n = 8, 0.5 %). When we investigated protective constructs individually as well as simultaneously, social contribution (β = -0.39, t = -15.59, p < 0.001) was the strongest protective construct against suicidality. Social integration (β = -0.13, t = -4.88, p < 0.001) additionally accounted for significant reduction in suicidality when all protective constructs were considered together. When we investigated the contribution of risk constructs towards suicidality, moral injury was most strongly associated with suicidality (r = 0.519, p < 0.001), yet when studied simultaneously for their relative contribution none of the constructs accounted for a significant amount of the variance in suicidality (|t|s ≤ 1.98, ps ≥ 0.07). These findings suggest that among Veterans it is possible that social contribution is protective against suicidality and could be a possible treatment target for the prevention or reduction of suicidality among Veterans., Competing Interests: Declaration of competing interest There are no competing interests to disclose., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: People with serious mental illness (SMI; schizophrenia, schizoaffective disorder, bipolar disorder) are at increased risk of suicidal ideation (SI). Over-attribution of social threat, or attributing threatening emotions to neutral faces, may contribute to social isolation through increased social avoidance and decreased social approach motivation. These factors are related to suicide, as well as perceived burdensomeness (PB) and thwarted belongingness (TB). This study examined how over-attribution of threat relates to PB, TB, and social motivations., Method: N = 273 participants with SMI were assessed for current SI and behavior, and were stratified into SI (N = 130) vs. non-SI (N = 143) groups. Participants completed smartphone surveys (via ecological momentary assessments [EMA]) 3×/day for 10 days. They also completed the Mobile Ecological Test of Emotion Recognition (METER) 1×/day. Linear mixed models and multi-level mediation tested the relationships between over-attribution of threat, METER performance, PB/TB, and social motivations., Results: Participants with and without SI did not significantly differ in over-attribution of threat or METER performance. In separate models, there was a relationship of over-attribution of threat with increased PB (B = 1.00, SE = 0.21, t = 4.72, p < .001), reduced social approach motivation (B = -0.74, SE = 0.22, t = -3.33, p < .001), and increased social avoidance (B = 0.90, SE = 0.24, t = 3.70, p < .001), all significant when adjusting for facial affect recognition ability. A model examining social motivations as a mediator between over-attribution of threat and PB/TB was not significant., Conclusion: These results suggest that over-attribution of threat relates to interpersonal constructs related to SI irrespective of facial affect abilities. This study may inform understanding of social cognitive processes related to suicide in SMI., Competing Interests: Declaration of competing interest Dr. Harvey has received consulting fees or travel reimbursements from Alkermes, Bio Excel, Boehringer Ingelheim, Karuna Pharma, Merck Pharma, Minerva Pharma, and Sunovion (DSP) Pharma in the past year. Dr. Harvey receives royalties from the Brief Assessment of Cognition in Schizophrenia (Owned by WCG Verasci, Inc. and contained in the MCCB). Dr. Harvey is chief scientific officer of i-Function, Inc. and Scientific Consultant to EMA Wellness, Inc. Dr. Depp has received consulting fees from WCG Clinical and Boehringer Ingelheim. Dr. Granholm has received consulting fees and travel reimbursements from Boehringer Ingelheim in the past year and is co-founder with equity interest in Granholm Consulting and BioSignal Solutions entities. Dr. Moore is a co-founder of KeyWise AI, Inc. and NeuroUX Inc. No other authors have conflicts of interest to report., (Copyright © 2024. Published by Elsevier B.V.)

Measurement invariance across diverse groups, though crucial for determining the generalizability of a measure, has not yet been tested in many assessments of suicidal thoughts. The present study assessed the measurement invariance and psychometric properties of one such assessment, the Depressive Symptom Inventory-Suicidality Subscale, across multiple identity dimensions in a large data set ( n = 1,118) that combined three diverse samples. Findings supported measurement invariance of the scale by race, ethnicity, and sexual orientation when comparing those who were majority-aligning with their minoritized counterparts, as well as good internal consistency and expected convergent validity. The expected one-factor structure fit well for all three of the samples assessed. Overall, the results support measurement invariance and generalizability of the Depressive Symptom Inventory-Suicidality Subscale. Future studies should continue assessing measures of suicidal thoughts and behaviors through testing invariance across identities, especially as it pertains to specific identity subgroups and their intersections. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Suicide is a widespread public health concern, including among military Veterans. Traumatic brain injuries (TBIs) and lack of social integration have both been shown to increase risk for suicidality, an outcome that includes, among other suicide-related variables, suicidal ideation, suicide attempts, and suicide death. Interestingly, TBIs have also been identified as a risk factor for social integration problems. In this cross-sectional study we investigated associations between TBI, social integration, and suicidality. Additionally, mediation analysis was used to test whether social integration mediated the association between TBI and suicidality. A sample of 1469 military Veterans (male, n = 1004, 67.2 %; female, n = 457, 32.3 %; transgender/non-binary/prefer not to say, n = 8, 0.5 %) completed an online survey as part of the Military Health and Well-Being Project. TBI was negatively associated with social integration (r = -0.084, p < .001) and positively with suicidality (r = 0.205, p < .001). Social integration was negatively associated with suicidality (r = -0.161, p < .001). Finally, social integration partially mediated the relationship between TBI and social integration (B = 0.121, 95 % CI [0.031-0.23]). This work shows that in the context of TBI, lack of social integration may promote suicidality. It provides support for many theories of suicide which propose social problems as a risk factor of suicide-related outcomes. It further highlights social integration as potential fodder for novel interventions for suicidality, an approach that would have transtheoretical support., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2023. Published by Elsevier B.V.)

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

Anecdotal and theoretical work suggests blink rate as an indicator of imminent suicide risk. We sought to empirically examine whether suicide decedents displayed a reduced blink rate in goodbye videos filmed before death, compared to several control groups. Independent raters coded blink rates from videos of 34 suicide decedents and four comparison groups: "mundane" product review, non-suicidal arousal, non-suicidal depression, and non-imminent risk of suicidal ideation. Mean blink rate was lower in the suicide decedent group relative to all comparison groups ( p s < .001), except the depressed ( p = .976) and suicidal ideation ( p = .393) groups. Findings indicate blink rate may be reduced among individuals at imminent risk for suicide, exhibiting clinically-significant depressive symptoms, or experiencing suicidal ideation.

Perceived burdensomeness (PB), defined by an intractable perception of burdening others, often reflects a false mental calculation that one's death is worth more than one's life and has been supported as a significant risk factor for suicide. Because PB often reflects a distorted cognition, it may serve as a corrective and promising target for the intervention of suicide. More work on PB is needed in clinically severe and in military populations. Sixty-nine (Study 1) and 181 (Study 2) military participants at high baseline suicide risk engaged in interventions targeting constructs relating to PB. Baseline and follow-up measures (at 1, 6, 12, 18, and 24 months) of suicidal ideation were administered, and various statistical approaches-including repeated-measures ANOVA, mediation analyses, and correlating standardized residuals-explored whether suicidal ideation decreased specifically by way of PB. In addition to utilizing a larger sample size, Study 2 included an active PB-intervention arm (N = 181) and a control arm (N = 121), who received robust care as usual. In both studies, participants improved considerably regarding baseline to follow-up suicidal ideation. The results of Study 2 mirrored those of Study 1, corroborating a potential mediational role for PB in treatment-related improvements in suicidal ideation in military participants. Effect sizes ranged from .07-.25. Interventions tailored at decreasing levels of perceived burdensomeness may be uniquely and significantly effective in reducing suicidal thoughts., (Copyright © 2023 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved.)

Two proposed suicide-specific diagnoses, with accumulating research support, characterize the phenomenology of acute suicidal crises: Suicide Crisis Syndrome (SCS) and Acute Suicidal Affective Disturbance (ASAD). Despite conceptual overlap and some similar criteria, the two syndromes have never been compared empirically. The present study addressed this gap by examining SCS and ASAD utilizing a network analysis approach. A sample of 1568 community-based adults (87.6% cisgender women, 90.7% White, M age  = 25.60 years, SD = 6.59) in the United States completed an online battery of self-report measures. SCS and ASAD were first examined in individual network models, followed by a combined network to determine changes in network structure, as well as identify bridge symptoms that connected SCS and ASAD. The proposed criteria of SCS and ASAD formed sparse network structures that were largely unaffected by the influence of the other syndrome in a combined network. Social disconnection/withdrawal and manifestations of overarousal-particularly agitation, insomnia, and irritability-emerged as bridge symptoms that may connect SCS and ASAD. Our findings indicate the network structures of SCS and ASAD exhibit patterns of independence, alongside interdependence between overlapping symptom domains (i.e., social withdrawal, overarousal). Future work should examine SCS and ASAD prospectively to better understand their temporal dynamics and predictive utility in relation to imminent suicide risk., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The documentary film Robin's Wish aims to reclaim the media scrutiny around Robin Williams' death, fixating on causation being solely attributed to a postmortem diagnosis of which Williams was unaware-Lewy Body Dementia. The film and other sources as well defined and animated the view that Williams' death by suicide was fully a result of this medical condition, dismissing any possible role for mental disorders. The need to distance from mental disorders can have a palpable undercurrent of stigmatization of them; the documentary missed the opportunity to make its point and simultaneously build allyship with others who have lost someone to suicide who were clearly battling a mental disorder. In this context, we emphasize the importance of looking at causation mediationally (e.g., a neurological condition triggering a major depressive episode culminating, in turn, in death by suicide). Only through encompassing all elements and complexities of the human spirit and condition can we appropriately pay tribute to those we have lost to suicide and simultaneously de-stigmatize mental disorders.

Objective: 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)., Method: 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., Results: 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., Conclusions: 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.HIGHLIGHTSWithin 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.

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

Suicide risk screening depends heavily on accurate patient self-report. However, past negative experiences with mental health care may contribute to intentional nondisclosure of suicide risk during screening. This study investigated among 282 men older than age 50 whether likelihood for current explicit risk nondisclosure was associated with previous highest level of mental health care received. This sample was selected post hoc out of a larger sample of participants from higher risk and lower help-seeking populations (i.e., military service members and veterans, men older than age 50, and lesbian gay bisexual, transgender, and queer young adults), however, the other groups were underpowered for analysis. Among these men, history of psychiatric hospitalization was significantly associated with likelihood for explicit nondisclosure of current suicide risk, while history of receiving only outpatient therapy for suicidal thoughts or behaviors was significantly associated with likelihood for full reporting of suicide risk. Severity of suicidal ideation and internalized stigma against mental illness were significant indirect contributors to the effect. Although causality could not be determined, results suggest that a potential cost to consider for psychiatric hospitalization may be future nondisclosure of suicide risk. Conversely, outpatient interventions that appropriately manage suicidal thoughts or behaviors may encourage future full reporting of suicide risk and improve screening detection.

Suicide-specific rumination, a repetitive mental fixation on one's suicidal thoughts and intentions, may influence the transition from suicidal thoughts to behaviors. Research on suicide-specific rumination has been hindered by the lack of an independent measurement tool. This article presents the development and validation of a self-report measure of suicide-specific rumination across several samples with lifetime suicidal ideation (Sample 1: N = 494 students; Sample 2: N = 219 community members; Sample 3: N = 128 adults at high risk for suicide). The Suicide Rumination Scale (SRS) item pool was reduced from a pool of 41 items to 8 items that are highly discriminant and of varying levels of difficulty. The SRS demonstrated measurement invariance, convergent validity, and nonredundancy with related measures. Importantly, the SRS differentiated suicide attempters from ideators, suggesting its potential clinical relevance. Overall, these findings suggest that the SRS is a valid and incrementally useful measure of suicide-specific rumination.

Objective: Affective states and rumination have each been linked to suicidal ideation; however, to our knowledge, no studies have examined their interactive effect in predicting suicidal ideation in the short term. The present study examined the concurrent and short-term prospective relationships between affective states, rumination, and suicidal ideation using ecological momentary assessment (EMA)., Method: A sample of 237 community-based adults at high risk for suicide ( M age = 27.12 years, 61.6% cisgender women) responded to six EMA prompts each day for 2 weeks that assessed their momentary affective states (depression, anxiety, happiness, hopelessness, agitation, irritability), rumination, and suicidal ideation., Results: Rumination moderated the relationship between concurrent affective states and suicidal ideation, at both the within-person and between-person levels. Specifically, the relations between affective states and suicidal ideation were stronger at higher levels of rumination. These interaction effects were not found when examining short-term prospective associations., Conclusions: Affective states and rumination may each confer risk for suicidal ideation in the short term, and rumination may serve as a catalyst of the link between affective states and suicidal ideation when examined concurrently. Clinical implications, limitations, and future research directions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Dual-process models of cognition distinguish relatively automatic from relatively controlled processes in terms of their interactive impact on perception, judgment, and behavior. Such models have advanced explanation and prediction in a variety of domains across psychology but have yet to be comprehensively applied to the pressing societal and public health problem of suicide. We propose a model of suicide that integrates dual-process models of social cognition with ideation-to-action conceptualizations of suicide. The model specifies: (a) suicide-relevant automatic associations involving the self, others, the future, death, and bodily harm, (b) suicide-relevant motives involving the self, interpersonal relations, the future, and the desire to die, and (c) hypotheses regarding the conditions under which automatic associations and motives individually and interactively impact suicidal ideation and lethal action at various stages of an ideation-to-action framework. The model recasts a number of suicide-relevant variables in terms of the opportunity factor of dual-process theories of attitudes, which encompasses capacity-relevant variables (e.g., time, cognitive resources) that determine whether suicide-relevant judgments and behavior are the result of relatively automatic associations or more controlled, deliberative cognition. Accordingly, the model articulates a number of novel predictions regarding the sources of suicide-relevant automatic associations, motives, and opportunity factors, as well as their interactive influences on suicidal ideation and action. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

There is mounting evidence that young children who express suicidal ideation (SI) have a different conceptualization of death than their peers. This study characterizes 3- to 6-year-olds' depictions of violence, death, and suicidal themes in a story completion task as a function of their history of SI. Participants were 228 children with depression (3.0-6.9 years) who completed a comprehensive psychiatric assessment and four story stem narratives. For each narrative, an interviewer began a story with a conflict that the child was encouraged to resolve. Children's resolutions were coded for standard themes and negative atypical themes including violence and homicide, accidental harm or death, and suicidal ideation/acts. Themes were examined as a function of children's SI status: active-SI (n = 25), passive-SI (n = 28), or no history of SI (n = 175). Across the narratives, 89 children described at least one negative atypical theme: violence or homicide (n = 78), accidental harm or death (n = 22), and suicide (n = 13). The responses of children with active-SI included significantly more violence or homicide than children without SI. Moreover, current active-SI predicted suicidal themes. There were no group differences in accidental harm or death, nor in common aggressive or punitive acts (e.g., hitting, yelling, spanking), indicating specificity between active-SI and more intense violence and death-related themes. In sum, young children with active SI are more likely than their depressed peers without SI to incorporate violence, homicide, and suicide into their narratives around conflict resolution. These themes appear more salient to depressed children with SI and pervasive in their thoughts and problem-solving strategies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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., (© 2021 S. Karger AG, Basel.)

Suicide is the second leading cause of death in adolescents; a frequent precursor of suicide is suicidal ideation (SI). Literature indicates that Post-Traumatic Stress Disorder (PTSD) and SI are robust cross-sectional correlates of one another, with PTSD often being conceptualized as a risk factor (i.e., conferring risk) for SI. Indeed, PTSD is a well-established risk factor for SI; however, SI is an understudied risk factor for PTSD. It is possible that, yet unknown if, PTSD and SI promote each other over time in a bidirectional fashion. We investigated the bidirectional longitudinal associations between PTSD and SI in a large, diverse sample, who at baseline were adolescents. Participants were interviewed between 1995 and 1998 and again between 2004 and 2008. We hypothesized that PTSD and SI would be cross-sectionally, longitudinally, and bidirectionally related and that the number of traumas endorsed at baseline would be positively associated with PTSD and SI at baseline and follow-up. Indeed, PTSD and SI were cross-sectionally correlated at baseline, but not follow-up. PTSD predicted SI over nine years; however, SI during adolescence did not predict PTSD in adulthood. Finally, poly-trauma endorsed at baseline was associated with increased risk of SI, but not PTSD, over nine years., (Published by Elsevier Ltd.)

Both a hypoactive reward system and maternal depression are associated with the onset of Major Depressive Disorder (MDD) in youth. Recent research indicates that blunted reward processing and maternal history of depression may interact to predict increases in depressive symptoms, however, the role of specific maternal depressive symptoms has not been examined. The current study investigated whether maternal depressive symptoms, history of MDD, and suicidal thoughts and/or behaviors (STBs) might lead to prospective increases in depressive symptoms one year later in the context of hypoactive reward processing. In a sample (N = 212) of 8 to 14-year-old girls, we assessed depressive symptoms in youth at baseline and follow up, while reward processing was measured using the Reward Positivity (RewP) event-related brain potential. Maternal STBs, current depressive symptoms, and history of maternal MDD were assessed at baseline. The results indicated that only girls with a blunted RewP and maternal STBs exhibited increased depressive symptoms one year later. These results were not evident when maternal depressive symptoms or maternal history of MDD was examined as the moderator. Overall, the current study provides evidence that maternal STBs uniquely impact youth with blunted reward processing., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Theory proposition, empirical evaluation, and resulting support or refutation are core pieces of the scientific process. These steps of theory-testing, however, can be complicated by relative rigidity and dogmatism, in combination with the logistical challenges inherent in conducting comprehensive, real-world tests of theories explicating complex scientific phenomena, especially rare ones. It may be argued that suicide is one such phenomenon, and one for which the field of psychology has struggled to develop satisfactory understanding. One leading theory of suicide, the Interpersonal Theory of Suicide, has garnered attention and, to a considerable degree, has weathered substantial scrutiny. Still, it is arguable that the theory has yet to be tested in full-that is, in accordance with all propositions originally put forth. In this effort, we sought to evaluate the current state of knowledge regarding the Interpersonal Theory of Suicide, as well as to suggest potential directions via which future work may proceed. We draw from the fields of philosophy, psychology, physics, and engineering in the hopes of engendering curiosity and critical thought about the assumptions researchers (ourselves included) bring to their work. We direct particular attention to the role of refutation in theory-testing; the supposed dichotomy of explanatory vs. algorithmic approaches; and the categorization of research programs as progressive vs. degenerative. In doing so, we hope not only to promote these ideas in the study of suicidal behavior but also to empiricists of all creeds and foci. We also include implications for suicide prevention efforts., (Copyright © 2021. Published by Elsevier Inc.)

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

Detection of underreporting in suicide risk assessment remains a significant concern in clinical practice. The aim of this research is to examine whether underreporting based on elevated Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) K-r and L-r scale scores may aid in identifying patients with suppressed scores on the Suicide/Death Ideation scale (SUI) and extra-test measures of suicide risk. We anticipated that, in voluntarily admitted psychiatric inpatients (N = 1,011) and individuals receiving outpatient services in a university-affiliated psychology clinic (N = 521), those indicated as underreporting would produce lower mean scores across SUI and extra-test measures of suicide risk, and that the magnitudes of the associations between SUI and extra-test scores would be strongest for those underreporting. A series of t tests and correlational analyses were conducted in both samples. Although those classified as underreporting consistently produced lower mean scores for SUI and extra-test measures of suicide risk, the magnitudes of the associations were consistently significant and stronger only in outpatients without K-r or L-r scale elevations. Clinical implications for this research include examining K-r elevations when assessing suicide risk and incorporating a therapeutic assessment approach to suicide risk assessment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Suicide rates within the U.S. military are elevated. The interpersonal theory of suicide, supported within military samples, suggests that social disconnectedness confers risk for suicide. Autism spectrum disorder (ASD) is characterized by symptoms-difficulties in social communication/interaction (SCI) and restricted and repetitive behaviors (RRBs)-that contribute to social disconnectedness. To our knowledge, no study has examined ASD-related traits and suicide risk among active duty U.S. military service members. Participants included 292 active duty U.S. military service members ( M [SD] age = 28.67 [7.40] years, 68.5% male, 78.1% White). The Autism Spectrum Quotient, Repetitive Behaviours Questionnaire-2 for Adults, Self-Injurious Thoughts and Behaviors Interview-Short Form, and Interpersonal Needs Questionnaire assessed for SCI difficulties, RRBs, suicidal symptoms, and interpersonal theory of suicide constructs (i.e., perceived burdensomeness, thwarted belongingness), respectively. Elevated levels of SCI difficulties and RRBs were associated with increased odds of reporting suicidal thoughts and behaviors occurring since joining the military, controlling for the number of years of service and suicidal symptoms occurring prior to joining the military. Perceived burdensomeness and thwarted belongingness statistically accounted for the relationship between ASD-related traits and suicidal ideation occurring since joining the military; a rival mediator, emotion dysregulation, was not a significant mediator. Among active duty U.S. military service members, greater ASD-related traits were associated with an increased likelihood of reporting suicidal thoughts and behaviors occurring since joining the military. Clinical efforts targeting perceived burdensomeness and thwarted belongingness might reduce suicide risk among military service members with elevated ASD-related traits. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background: People with psychotic disorders are at an increased risk of suicide, but there is little understanding of suicidal ideation (SI) in this population. The Interpersonal Psychological Theory of Suicide posits that perceived burdensomeness (PB) and thwarted belonginess (TB) contribute to SI. To our knowledge there are no studies using ecological momentary assessment (EMA) to assess these interpersonal risk factors in a sample of individuals with psychotic disorders. This study investigated the validity and variability of PB and TB, and whether SI, EMA-measured psychotic symptoms, mood, and social context relate to PB and TB., Method: Ninety-six participants with a psychotic disorder, including mood disorders with psychosis completed in-lab assessments of current SI, and then EMA surveys on a smartphone 3×/day for 10 days, answering questions about burdensomeness, belongingness, symptoms (i.e., hearing voices, experiencing suspiciousness), mood (i.e., happy, sad), and social context., Results: Burdensomeness varied within-participants less than belongingness (t (95) = -3.74, p=< .001). Participants with SI had higher mean burdensomeness ratings (t (94) = -2.70, p < .01) and lower mean belongingness ratings (t (94) = 3.68, p < .001) than did participants without SI. Being with others, greater psychotic experiences, less happiness, and greater sadness related to greater burdensomeness. SI status, being alone, greater psychotic experiences, less happiness, and greater sadness related to less belongingness., Conclusions: This study examined the real-time influences of SI and psychotic symptoms on burdensomeness and belongingness. Hearing voices, suspiciousness, mood, and SI are related to interpersonal suicide-related risk factors. In this sample, social context had a differential effect on burdensomeness and belongingness., (Copyright © 2021. Published by Elsevier Ltd.)

Background: Leading theoretical explanations for suicide state that for suicide death to occur, a person must have sufficient capability to enact an attempt. Exposure to painful and provocative events is hypothesized to play an important role in acquiring the capability for suicide over a lifetime. Unfortunately, assessment tools for painful and provocative events have focused solely on the frequency of events, neglecting the potential contributions of perceived impact. Further, past measurements have used predetermined items for painful and provocative events thereby neglecting other relevant events. The current study uses visual analog scales (VAS) to assess both the frequency and impact of painful and provocative events and how these contribute to the capability for suicide., Method: Data were collected from 787 adults via Amazon's online platform., Results: Findings indicated that the frequency VAS and impact VAS both had a moderate correlation with the original Painful and Provocative Events Scale. Greater scores on the frequency VAS were associated with increased capability, whereas lower scores on the subjective impact VAS were associated with increased capability scores. Both VAS independently predicted capability above and beyond the PPES., Limitations: Temporal or causal associations are unable to be drawn due to cross-sectional data. In addition, the sample was largely homogenous (White = 72%, female = 63.5%), limiting generalizability., Conclusions: These initial findings demonstrate individuals who perceive painful and provocative events as being less impactful may have increased capability, and that VAS may be appropriate to approximate the impact and frequency of painful and provocative events.

Suicide-specific rumination, characterized by perseveration on and difficulties disengaging from suicidal thoughts and ideas, has been linked to increased suicide risk; however, previous studies were limited by the use of a cross-sectional design and relatively lower risk samples. This study aimed to replicate and extend previous findings by examining the short-term longitudinal association between suicide-specific rumination and suicidal intent, controlling for numerous robust covariates, in a sample of community-based adults at high risk for suicide, who were recruited from suicide-related forums online. Ninety-one adults with significant suicidal ideation (M age  = 27.03, SD = 8.64; 53.8% female, 44.0% male, 1.1% non-binary, 1.1% transgender female) completed brief online self-report measures at six time-points, each three days apart. Multilevel modeling analyses indicated that suicide-specific rumination was associated with suicidal intent, above and beyond suicidal ideation, perceived burdensomeness, thwarted belongingness, agitation, insomnia, nightmares, and sociodemographic characteristics. Further, a lagged model demonstrated that suicide-specific rumination predicted subsequent time-point suicidal intent, controlling for current suicidal intent and all other covariates. Overall, these findings suggest that perseverating on one's suicidal thoughts may serve as a proximal factor that increases suicide risk. Future investigations should explore potential mechanisms of this association, as well as interventions that may reduce suicide-specific rumination., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Capability for suicide is frequently assessed using the Acquired Capability for Suicide Scale (ACSS) or the Acquired Capability for Suicide Scale-Fearlessness About Death (ACSS-FAD); however, the measurement invariance of these self-report measures across relevant demographic groups has not been tested. The current study aimed to examine the measurement invariance of the ACSS and ACSS-FAD across (a) gender; (b) suicide attempt status; and (c) military deployment history in a sample of 2,551 participants ( M = 28.92, SD = 10.73; 56.7% male, 68.5% White) who participated in one of several studies funded by the Military Suicide Research Consortium. Results indicated that the ACSS exhibited poor model fit; thus, further investigation of measurement invariance was not conducted. Furthermore, although partial measurement invariance of the ACSS-FAD was met for gender, scalar invariance was not supported across military deployment history, and no form of measurement invariance was met across suicide attempt status. Overall, given the lack of strong model fit and measurement invariance in the ACSS and ACSS-FAD across several demographic groups, new or modified self-report measures for capability for suicide may be warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Older adults experience increased risk for suicide compared to the general population, and the circumstances surrounding the Coronavirus Disease 2019 (COVID-19) may potentiate this risk. We discuss how current COVID-19 pandemic-related policies are likely to harm older adults disproportionately. COVID-19 pandemic social distancing policies and ethical guidelines for COVID-19 treatment may exacerbate experiences of social isolation, perceived expendability, and exposure to suffering, which are related to the 3 main components of the Interpersonal Theory of Suicide (i.e., thwarted belongingness, perceived burdensomeness to society, and capability for suicide). The COVID-19 pandemic poses a drain on services and has drawn ethical debates about policies around treating younger adults first. These experiences may lead older adults to have reduced access to needed medical and psychiatric services and may convey damaging messages of expendability. Furthermore, the potential prolonged stress associated with the COVID-19 pandemic may affect neurological, immunological, and health functioning-exacerbating suicide risk. Potential venues to increase treatment options and decrease social isolation are discussed. We acknowledge optimistic effects as well, such as "pulling together" as a society and the many valuable ways older adults may contribute during this crisis., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: The Suicide Risk Assessment and Management Decision Tree (DT) is a clinician-administered assessment that leads to risk categorizations that correspond with actionable strata. This study investigated the construct validity and test-retest reliability of the DT risk categories across two time points., Method: Outpatients (N = 731) completed a battery of self-report measures. Spearman's correlations were used to examine the relationships between DT suicide risk level and suicidal symptoms, theory-based risk factors, psychiatric correlates, and DT suicide risk level at Timepoint 2. Correlations were analyzed for significant differences to examine the divergent validity of the DT., Results: Results, overall, were in line with hypotheses, with the exception of depression and thwarted belongingness., Conclusions: Findings provide evidence for the reliability, convergent validity, and discriminant validity of the DT. This clinician-administered suicide risk assessment may be useful for standardization of the assessment and management of suicide risk in outpatient clinical settings., (© 2020 Wiley Periodicals LLC.)

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

Inaccurate disclosure of information is a significant limitation when relying on self-report for suicide risk screening. However, allowing for an explicit nondisclosure response option in screening items (e.g., "prefer not to disclose") may ultimately improve follow-up assessment validity. This study investigated explicit nondisclosure in suicide risk screening among military service members and veterans ( n = 135), men older than 50 years, ( n = 187), and LGBTQ (lesbian, gay, bisexual, transgender, or queer) young adults ( n = 140); all higher risk and lower help-seeking populations. Results indicated that allowing for explicit nondisclosure minimally affected screening sensitivity and specificity. However, its selection was prevalent among higher risk participants, and was associated with experience of past unhelpful reactions and "avoidance of stigmatized consequences." Allowing for nondisclosure creates potential psychometric and classification advantages, and may be a safe and effective way to encourage discussion of barriers, build trust, maximize patient autonomy, and ultimately facilitate accurate risk disclosure to improve assessment validity.

Nonalcohol substance use is a robust correlate of suicide risk. However, few data exist regarding the degree to which nonalcohol substance use, as measured by objective indicators (e.g., urinalysis toxicology screen), is related to suicide risk. This study examined the associations of a multimodal assessment of nonalcohol substance use and multiple indicators of suicide risk. Overall, 168 acute care psychiatric inpatients participated and provided data spanning urinalysis toxicology screen and self-report instruments. Substance use per urinalysis toxicology screen and self-report was not related to current suicidal ideation severity. However, substance use per urinalysis toxicology screen was significantly associated with a suicide attempt history and suicidality as a primary reason for admission. Substance use is an important variable to consider in suicide risk conceptualization. Findings underscore the importance of leveraging, when possible, objective indicators of substance use (e.g., urinalysis toxicology screen) in suicide risk formulations.

Background: Interoceptive deficits (ID) have been associated with non-suicidal self-injury (NSSI) and suicidal behavior in multiple studies. Many of these studies are limited in scope, and have not fully examined possible mechanisms explaining how ID affect suicidal behavior., Methods: This study assesses how self-reported ID relate to suicide ideation and attempts in six distinct and geographically diverse samples of adults (n = 2706) and one sample of adolescents (n = 436). Participants responded to a variety of self-report questionnaires and interviews., Results: Contrary to our hypothesis, self-reported ID were only associated with suicidal ideation in two samples, one of which was the adolescent sample. Largely consistent with our predictions, self-reported ID exhibited an indirect effect on suicide attempts through versatility of NSSI in four of the five adult samples tested. Finally, the indirect effects of self-reported ID on suicide attempts through NSSI versatility did not act indirectly through behaviorally assessed pain tolerance., Conclusions: We found that, in adults, self-reported ID are not associated with suicidal ideation, but are connected with a history of suicide attempts, through an indirect effect via NSSI. Our findings also indicate that the mechanism of action leading from self-reported ID to suicidal behavior may differ between adolescents and adults, and relate to suicidal behavior independent of pain tolerance. Clinical implications and future directions are discussed.

Thwarted social connection is a critical risk factor for suicidality, and several theoretical perspectives highlight the importance of interpersonal affect to social connection. Given that marriage is an increasingly important source of social connection, we examined the role of automatic spousal attitudes-conceptualized as spontaneously activated affective associations involving one's spouse-in predicting suicidal thoughts in 3 longitudinal studies of married couples. Studies 1a ( N = 204) and 1b ( N = 159) demonstrated that more positive automatic spousal attitudes, assessed implicitly shortly after the marriage as the speed with which people categorized positive relative to negative words following photo-primes of their spouse, were associated with a weakened probability of the self-reported suicidal thoughts 1 year later. Study 2 ( N = 229) provided further evidence that automatic spousal attitudes predict suicidal thoughts by showing that newly conditioned automatic spousal attitudes predicted suicidal thoughts. In that study, more positive automatic spousal attitudes exhibited after an evaluative conditioning procedure were associated with a reduced probability of suicidal thoughts 2 months later. Across studies, an increase (1 SD) in automatic spousal attitudes was associated with approximately a 50% decreased probability of suicidal thought. In all 3 studies, implicitly measured spousal attitudes captured variance in suicidal thoughts not captured by implicitly measured attitudes toward oneself and self-reported marital satisfaction, both of which proved to be less reliable predictors of suicidal thoughts. These findings highlight the importance of automatic interpersonal processes to well-being generally and suicidality specifically, and may thereby suggest novel methods for reducing risk of suicidality. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A core component of suicide risk assessment and management is determining one's physical proximity to specific suicide means and counseling individuals to minimize their physical access to these means. However, this approach ignores other potentially relevant parameters, such as perceptions of how psychologically close/distant one feels to a particular suicide method. The present study examined the degree to which novel, brief measures of physical and psychological distance to suicide methods were associated with and prospectively predicted suicide-related outcomes at (1) two-month follow-up among 121 students with current/recent suicidality; and (2) one-week follow-up among 91 community-dwelling adults at high suicide risk. Results indicated that both physical and psychological distance to means were related to suicidal intent at baseline. Additionally, in Study 2, lower psychological distance, but not physical distance, predicted suicidal intent and increased likelihood of having made suicide plans and suicide preparations at one-week follow-up. Overall, these findings highlight the importance of considering not only physical proximity to suicide means, but also psychological distance, pointing to the potential import of assessing and intervening upon psychological distance during lethal means counseling. Our findings also highlight the potential clinical utility of two brief measures of physical and psychological closeness to suicide means., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

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., (© 2019 Wiley Periodicals, Inc.)

Few clinical practices are as important for simultaneously augmenting patient safety and mitigating legal risk as the judicious evaluation and stratification of a patient's risk for suicide, proportionate clinical actions based thereon taken by the healthcare provider, and contemporaneous documentation of the foregoing. In this article, we draw from our combined decades of multidisciplinary experience as a clinical psychologist, forensic psychiatrist, medical malpractice attorney, and clinical psychology trainee to discuss the documentation of suicide risk assessment and management as a conduit to patient safety and legal risk mitigation. We additionally highlight documentation as a core clinical competency across disciplines and note areas of improvement, such as increased training, to bolster documentation practices., (© 2019 John Wiley & Sons, Ltd.)

Objective: Posttraumatic stress disorder (PTSD) symptoms are associated with increased suicide risk among firefighters. Few studies have examined modifiable factors, such as mindfulness facets, that might attenuate this association. This study examined the interactive effects of PTSD symptoms and mindfulness facets in relation to suicide risk among firefighters., Method: Overall, 831 career firefighters were assessed for PTSD symptoms, mindfulness facets, and suicide risk via the PTSD Checklist for DSM-5, Five Facet Mindfulness Questionnaire, and Suicidal Behaviors Questionnaire-Revised, respectively., Results: Greater PTSD symptoms were associated with more severe suicide risk; however, higher levels of two specific mindfulness facets, acting with awareness and nonjudging of inner experience, attenuated this association. By contrast, higher levels of the observing facet of mindfulness potentiated the association between PTSD symptoms and suicide risk., Conclusions: Suicide prevention initiatives among firefighters, particularly those experiencing trauma-related sequelae, might benefit from the inclusion of mindfulness-based practices alongside frontline empirically-supported approaches., (© 2019 Wiley Periodicals, Inc.)

Objective: The interpersonal theory of suicide has contributed to advances in the understanding and prevention of suicidal behavior, with over a decade of empirical examination. Few studies, however, have used a longitudinal design with repeated short-term follow-ups to examine the temporal trajectories of perceived burdensomeness, thwarted belongingness, and suicidal ideation, nor have any studies to our knowledge investigated the propositions of the interpersonal theory of suicide using a dynamic systems theory approach. The present study examined the temporal dynamics of perceived burdensomeness, thwarted belongingness, and suicidal ideation, as moderated by capability for suicide, using dynamic systems modeling analyses in a sample of 91 adults at high risk for suicide (Mage = 27.03 years, SD = 8.64; 53.8% female, 44.0% male, 1.1% nonbinary, 1.1% transgender female)., Method: Participants completed brief online self-report measures at 6 time-points, each 3 days apart., Results: Results were generally in support of the interpersonal theory of suicide: perceived burdensomeness, thwarted belongingness, and suicidal ideation exhibited patterns of temporal stability that were accentuated at high levels of capability for suicide; perceived burdensomeness and thwarted belongingness exhibited a reciprocal temporal pattern, as did perceived burdensomeness and suicidal ideation. However, thwarted belongingness did not have an incremental influence on suicidal ideation., Conclusions: Overall, these findings provide additional information about the nature of suicidal ideation and interpersonal risk factors over time and point to nonlinear dynamic systems modeling as an analytic technique that may prove useful in understanding trajectories of suicidal thoughts and behaviors. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Objective: To examine experiences with suicide exposure and bereavement among women firefighters., Methods: Women firefighters (N = 266, M age  = 37.64y) completed self-report measures assessing their experiences with suicide exposure, history of suicidality, current psychiatric symptoms, and suicide risk., Results: Three-fourths (74.4%) of participants reported knowing someone who had died by suicide; of these participants, 31.3% reported losing a fellow firefighter to suicide. Exposure to suicide during one's firefighting career was associated with more severe psychiatric symptoms and suicide risk. Greater impact of a suicide death was significantly associated with more severe current suicide risk, even after controlling for prior suicidality and other psychiatric symptoms., Conclusions: Women firefighters exposed to suicide during their careers may experience more severe psychiatric symptoms and increased suicide risk as compared to their counterparts without this exposure. In particular, women firefighters who are more severely impacted by a suicide loss may be at increased suicide risk., (© 2018 Wiley Periodicals, Inc.)

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.

Objective: Suicide is a global public health concern. To inform the prevention and treatment of suicidality, it is crucial to identify transdiagnostic vulnerability factors for suicide and suicide-related conditions. One candidate factor is anxiety sensitivity (AS)-the fear of anxiety-related sensations-which has been implicated in the pathogenesis of a host of mental health outcomes, including suicidal thoughts and behaviors. Importantly, AS is distinct from trait anxiety and negative affectivity, highlighting its potential incremental utility in the understanding of psychopathology. Despite a burgeoning body of literature demonstrating that AS is linked to suicidal thoughts and behaviors, this research has yet to be synthesized., Method: This meta-analysis includes 33 articles representing 34 nonredundant samples (N = 14,002) that examined at least one relationship between AS global or subfactor (i.e., cognitive, physical, social) scores and suicidal ideation and/or suicide risk., Results: Findings revealed small-to-moderate and moderate associations between global AS and suicidal ideation (r = .24, 95% confidence interval (CI): [.21, .26], p < .001) and suicide risk (r = .35, 95% CI [.31, .38], p < .001), respectively. All AS subfactors evinced significant associations with suicidal ideation (rs = .13-.24) and suicide risk (rs = .22-.32)., Conclusions: AS is related to suicidal ideation and global suicide risk. Research is needed to disentangle AS from other indices of distress in the prediction of suicidal thoughts and behaviors. Theoretical and clinical implications of these findings are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Suicide is more highly stigmatized than most mental health conditions; however, no interventions have aimed to modify the stigma of suicide in the general population. This study tested the efficacy of two brief web-based interventions-psychoeducation and interpersonal exposure-in reducing suicide-related stigma in a student/community sample. A sample of 266 adults completed baseline measures of suicide-related stigma, were randomized into one of three conditions (psychoeducation, interpersonal exposure, control), in which they browsed an assigned website for twenty minutes, and completed post-intervention and one-month follow-up stigma measures. Results indicated that the two interventions were more efficacious than the control in reducing suicide-related stigma; this effect was accentuated for individuals without prior exposure to suicide. Although future research is needed to understand the mechanisms of change and the generalizability of these findings, it is possible that web-based interventions could be a cost- and time-effective avenue of targeting the widespread stigma of suicide., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

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)., (Copyright © 2018. Published by Elsevier Ltd.)

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