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Introduction: Several characteristics of suicidal ideation, including frequency, duration, perceived controllability, and intensity, have been identified. The present study examined whether these characteristics of baseline suicidal ideation uniquely predicted (1) the severity, variability, and frequency of suicidal ideation assessed through real-time monitoring; and (2) suicide attempts at 3-week and 6-month follow-up among recently discharged psychiatric inpatients., Methods: A sample of 249 adults (M age  = 40.43, 55.1% female, 91.4% White) completed a baseline assessment of their suicidal ideation characteristics during psychiatric hospitalization, five daily ecological momentary assessments (EMA) for 21 days following discharge, and follow-up assessments of suicide-related outcomes at 3-week and 6-month follow-up., Results: Perceived controllability of suicidal thoughts was uniquely associated with the variability of EMA-assessed suicidal ideation and the presence of suicide attempts at 3-week, but not 6-month follow-up. No other characteristic of baseline suicidal ideation was uniquely associated with EMA-assessed suicidal ideation or the presence of suicide attempts at follow-up., Conclusions: Given links between the perceived controllability of suicidal ideation and (1) momentary variability of suicidal ideation and (2) suicide attempts over the subsequent 3 weeks, perceived controllability of suicidal thinking may be a useful marker of short-term risk that may be malleable to clinical intervention., (© 2024 The Author(s). Suicide and Life‐Threatening Behavior published by Wiley Periodicals LLC on behalf of American Association of Suicidology.)

Background: Emerging research suggests that poor sleep quality and some disruptive nocturnal behaviors (DNBs) may be advance markers of short-term worsening in suicidal intent. However, relationships between many types of DNBs and suicide risk have not been examined, and whether DNBs provide useful information apart from sleep quality in predicting suicidal intent is unknown. This study addressed these critical knowledge gaps by examining associations between sleep quality, DNBs, and next-day suicidal intent in a community sample of adults., Methods: A sample of 237 adults with severe suicidal ideation provided daily indices of sleep quality and DNBs, and suicidal intent 6 times per day for 2 weeks via ecological momentary assessment. Linear mixed models and general linear models were conducted to examine relationships between sleep quality and DNBs with measures of average severity of suicidal intent and fluctuations in intent over time., Results: Poor sleep quality and specific DNBs (sleep disruptions due to general nervousness, trauma-related memories and/or nightmares interrupting sleep, and non-trauma-related anxiety or panic) predicted more severe suicidal intent in multivariate models. Only poor sleep quality predicted within-day variability in suicidal intent., Conclusions: These findings suggest that monitoring sleep quality and specific DNBs may be a useful indicator of short-term risk for worsening in suicidal intent., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Megan Rogers reports financial support was provided by Military Suicide Research Consortium. If there are other authors, they 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. Published by Elsevier Ltd.)

Firearm availability is correlated with increased risk of suicide but its link with suicidal ideation remains unclear. Previous studies are limited by retrospective reports and prospective designs with lengthy gaps between assessments that are ill-suited for measuring fluctuations in suicidal ideation. This study used ecological momentary assessment (EMA) to repeatedly assess suicidal ideation in a sample of 138 U.S. adults (81 handgun owners, 57 non-owners). Participants received six EMA prompts per day for 28 consecutive days. Results revealed no group differences in the frequency, maximum amplitude, or variability of suicidal ideation across male and female handgun owners and non-owners. Stability of suicidal ideation significantly differed across groups, however ( F (1,132) = 4.5, p  = 0.036); male handgun owners had the strongest stability and male non-owners had the weakest stability. Stability of suicidal ideation was significantly lower when participants reported a firearm was nearby as compared to when no firearm was nearby ( F (4,17732) = 5.6, p  < 0.001). Results suggest firearm availability increases reactivity to the environment, slows recovery from acutely elevated risk states, and may increase vulnerability to sudden shifts to higher risk states characterized by increased probability of suicidal behavior. Although these effects were observed in both handgun owners and non-owners, they disproportionately impact handgun owners because they report being near firearms more often.

Background: Strategies to detect the presence of suicidal ideation (SI) or characteristics of ideation that indicate marked suicide risk are critically needed to guide interventions and improve care during care transition periods. Some studies indicate that machine learning can be applied to momentary data to improve classification of SI. This study examined whether the classification accuracy of these models varies as a function of type of training data or characteristics of ideation., Methods: A total of 257 psychiatric inpatients completed a 3-week battery of ecological momentary assessment and measures of suicide risk factors. The accuracy of machine learning models in classifying the presence, duration, or intensity of ideation was compared across models trained on baseline and/or momentary suicide risk data. Relative feature importance metrics were examined to identify the risk factors that were most important for outcome classification., Results: Models including both baseline and momentary features outperformed models with only one feature type, providing important information in both correctly classifying and differentiating individual characteristics of SI. Models classifying SI presence, duration, and intensity performed similarly., Limitations: Results of this study may not generalize beyond a high-risk, psychiatric inpatient sample, and additional work is needed to examine temporal ordering of the relationships identified., Conclusions: Our results support using machine learning approaches for accurate identification of SI characteristics and underscore the importance of understanding the factors that differentiate and drive different characteristics of SI. Expansion of this work can support use of these models to guide intervention strategies., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: This study investigated whether honor ideology, or a belief that one's reputation must be defended at all costs, is related to firearms ownership in soldiers., Methods: N=301 active-duty soldiers completed online self-report measures in this cross-sectional study., Results: Honor ideology was higher in soldiers who privately own a firearm compared with those who do not currently own and do not plan to after military separation. Higher honor ideology was correlated with a disbelief that private firearms ownership is related to soldier suicide risk. Levels of honor ideology were equal in soldiers who own a private firearm for protection versus other reasons (eg, hunting, maintaining a collection)., Conclusions: Honor ideology may be related to suicide risk through increased likelihood of owning a private firearm and disbelief in private firearm ownership being related to one's own suicide risk in soldiers. Honor ideology could be relevant to consider when means safety initiatives are developed for active-duty military personnel., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Although suicide is complex and heterogeneous, most suicide theories assume that suicidal urges occur primarily in the context of extreme emotional distress. Newer models of suicide based on complex systems theory propose greater heterogeneity in suicidal experiences across individuals and groups, such that some, but not all, suicidal thoughts, urges, and behaviors are associated with extreme negative affect. The present study investigated individual differences in affective states experienced during suicidal urges among 138 adults recruited from the community; 81 (59.1 %) owned handguns and 57 (41.6 %) did not. Participants self-reported their current affect and urge to kill themselves 6 times per day for 28 consecutive days via ecological momentary assessment. Positive and negative affect ratings varied significantly during suicidal urges. The association of positive and negative affect with suicidal urges significantly varied within and between handgun owners and non-owners. Results suggest suicidal urges are characterized by high affective heterogeneity., Competing Interests: Declaration of competing interest Dr. C. J. Bryan reported grants from the Department of Defense, the National Institute of Mental Health, the New Jersey Gun Violence Research Center, the Bob Woodruff Foundation, the USAA Foundation, the Boeing Company, and the American Foundation for Suicide Prevention during the conduct of the study; personal fees from Oui Therapeutics outside the submitted work; and ownership of Anduril, LLC, outside the submitted work. Dr. M. L. Bozzay reported grants from the National Institute of Mental Health and the Department of Defense. Dr. Tabares reported grants from the New Jersey Gun Violence Research Center and the National Institute of Mental Health during the conduct of the study. Dr. S. E. Daruwala reported grants from the New Jersey Gun Violence Research Center. Dr. J. E. Butner reported grant funding from the National Institute of Mental Health during the conduct of the study. Dr. S. M. Gorka reported grants from the National Institute of Mental Health and the National Institute on Alcohol Abuse and Alcoholism during the conduct of this study., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Firearms account for more than half of suicide deaths in the United States (US) and both ownership and access are associated with increased risk of intentional and unintentional injury. Despite evidence linking ownership and access to suicide risk, individuals may be reticent to answer questionnaire items assessing ownership. The current study examined characteristics of individuals who do not provide a response (nonresponders) to a firearm ownership item in a community sample., Methods: Data were collected from a cross-sectional online survey of 10,625 US adults. Univariate and multivariate analyses were conducted to examine demographic, emotional distress, and suicide risk differences across three groups (firearm owners, nonowners, and nonresponders)., Results: Nonresponders were significantly younger, more likely to be female and non-White than firearm owners and nonowners. Nonresponders were less likely to endorse recent suicidal ideation and probable PTSD than firearm owners, but more likely to endorse probable PTSD than nonowners. Firearm owners were significantly more likely to report several correlates of suicide risk than nonowners., Conclusions: Nonresponders may be a unique subgroup with distinct demographic, emotional distress, and suicide risk profiles compared to both firearm owners and nonowners. Implications of these findings for future directions are discussed., (© 2024 The Author(s). Suicide and Life‐Threatening Behavior published by Wiley Periodicals LLC on behalf of American Association of Suicidology.)

Objective: Shorter sleep duration has been linked to increased suicidal ideation (SI). However, limited research has examined the relationship between nightly sleep duration and short-term fluctuations in suicide risk, as well as the potential clinical utility of leveraging indices of recent (ie, past 3 days) patterns of sleep duration as a marker of acute suicide risk. This study examined associations between nightly and cumulative sleep duration and suicidal desire and intent utilizing ecological momentary assessment (EMA) in a high risk sample of community-based adults., Methods: A sample of 237 community based adults with severe SI provided daily indices of self-reported sleep duration and ratings of suicidal desire and intent 6 times per day for 14 consecutive days of EMA monitoring. Data collection took place between February and May 2019., Results: Between-person nightly sleep duration and cumulative sleep duration were negatively associated with suicidal desire ( B s = -3.48 and -4.78) and intent ( B s = -1.96 and -2.46). At the within person level, nightly sleep duration was negatively related to suicidal desire ( B s = -0.51 and -0.47) and intent. Within person cumulative sleep duration, on the other hand, was unrelated to both suicidal desire and intent ( B s = -0.26 and -0.09)., Conclusion: Our findings highlight the clinical utility of examining individual differences in sleep duration as a marker for suicide-related outcomes, as well as deviations from one's typical nightly sleep as a potential acute predictor of suicide-related outcomes, in addition to information about recent duration over one or more nights of sleep. Limitations and future directions are discussed., (© Copyright 2024 Physicians Postgraduate Press, Inc.)

Medical comorbidity, particularly cardiovascular diseases, contributes to high rates of hospital admission and early mortality in people with schizophrenia. The 30 days following hospital discharge represents a critical period for mitigating adverse outcomes. This study examined the odds of successful community discharge among Veterans with schizophrenia compared to those with major affective disorders and those without serious mental illness (SMI) after a heart failure hospital admission. Data for Veterans hospitalized for heart failure were obtained from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services between 2011 and 2019. Psychiatric diagnoses and medical comorbidities were assessed in the year prior to hospitalization. Successful community discharge was defined as remaining in the community without hospital readmission, death, or hospice for 30 days after hospital discharge. Logistic regression analyses adjusting for relevant factors were used to examine whether individuals with a schizophrenia diagnosis showed lower odds of successful community discharge versus both comparison groups. Out of 309,750 total Veterans in the sample, 7377 (2.4%) had schizophrenia or schizoaffective disorder and 32,472 (10.5%) had major affective disorders (bipolar disorder or recurrent major depressive disorder). Results from adjusted logistic regression analyses demonstrated significantly lower odds of successful community discharge for Veterans with schizophrenia compared to the non-SMI (Odds Ratio [OR]: 0.63; 95% Confidence Interval [CI]: 0.60, 0.66) and major affective disorders (OR: 0.65, 95%; CI: 0.62, 0.69) groups. Intervention efforts should target the transition from hospital to home in the subgroup of Veterans with schizophrenia., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Adults with serious mental illness (SMI) have high rates of cardiovascular disease, particularly heart failure, which contribute to premature mortality. The aims were to examine 90- and 365-day all-cause medical or surgical hospital readmission in Veterans with SMI discharged from a heart failure hospitalization. The exploratory aim was to evaluate 180-day post-discharge engagement in cardiac rehabilitation, an effective intervention for heart failure., Methods: This study used administrative data from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services between 2011 and 2019. SMI status and medical comorbidity were assessed in the year prior to hospitalization. Cox proportional hazards models (competing risk of death) were used to evaluate the relationship between SMI status and outcomes. Models were adjusted for VHA hospital site, demographics, and medical characteristics., Results: The sample comprised 189,767 Veterans of which 23,671 (12.5%) had SMI. Compared to those without SMI, Veterans with SMI had significantly higher readmission rates at 90 (16.1% vs. 13.9%) and 365 (42.6% vs. 37.1%) days. After adjustment, risk of readmission remained significant (90 days: HR: 1.07, 95% CI: 1.03, 1.11; 365 days: HR: 1.10, 95% CI: 1.07, 1.12). SMI status was not significantly associated with 180-day cardiac rehabilitation engagement (HR: 0.98, 95% CI: 0.91, 1.07)., Conclusions: Veterans with SMI and heart failure have higher 90- and 365-day hospital readmission rates even after adjustment. There were no differences in cardiac rehabilitation engagement based on SMI status. Future work should consider a broader range of post-discharge interventions to understand contributors to readmission., Competing Interests: Declaration of competing interest None., (Published by Elsevier Inc.)

Although aggression occurs across a range of disorders, associations between dimensions of psychopathology and self- and other-directed aggression are not well understood. Investigating associations between psychopathology dimensions and aggression helps further understanding about the etiology of aggression, and ultimately, can inform intervention and prevention strategies. This study adopted a multi-method approach to examine associations between internalizing and externalizing dimensions of psychopathology and self- and other-directed aggression as a function of reporter (participant and informant) and modality of aggression measurement (subjective and objective). Participants were an unselected sample of 151 racially diverse adults recruited from the community. Dimensions of psychopathology were assessed using interview and questionnaire reports from participants and collateral informants, and forms of aggression were measured via subjective reports and an objective, laboratory aggression paradigm. Analyses of participant-reported psychological symptom data consistently linked externalizing symptoms to other-directed aggression, and internalizing symptoms to self-directed aggression. Results across informant and participant reporters replicated prior findings showing a significant interaction between internalizing and externalizing dimensions in predicting intimate partner violence. Most other effects in informant models were nonsignificant. The findings uncover consistency in and replicability of relationships between dimensions of psychopathology and certain manifestations of aggression and highlight the importance of examining multiple forms of aggression in etiological research. Examining aggression through a transdiagnostic lens can help us better understand and intervene upon processes implicated in devasting forms of self- and other-directed aggression., (© 2024 The Authors. Aggressive Behavior published by Wiley Periodicals LLC.)

Background: Older adults with heart failure are at elevated risk of Alzheimer's disease and related dementias (AD/ADRD). Research suggests that insomnia and depressive episodes contribute somewhat dissociable impacts on risk for AD/ADRD in this patient population, although the temporal ordering of effects is unknown., Objective: This study examined time to dementia diagnosis among patients with comorbid insomnia and/or depressive episodes in an epidemiological sample., Methods: Secondary data analyses were conducted using a cohort study of 203,819 Veterans with a primary admission diagnosis of heart failure in 129 VA Medical Centers., Results: Patients with diagnoses of both insomnia and depressive episodes had the shortest time to a dementia diagnosis at both 1-year (Hazard ratio = 1.43, 95% CI [1.36, 1.51]) and 3-year follow-up time points (Hazard ratio = 1.40, 95% CI [1.34, 1.47]) versus patients with one or neither comorbidity., Conclusions: Individuals with both comorbidities had the shortest time to dementia onset. Screening for these comorbidities may help to identify patients at elevated risk of dementia who could benefit from enhanced monitoring or early intervention strategies for more rapid detection and management of dementia symptoms.

The biobehavioral study of aggression has implications for expanding our understanding of transdiagnostic processes that increase risk for disinhibited behaviors. Toward this end, our study tested tenets from the process model of aggression (Verona & Bresin, 2015). First, we expected that the predictability of threat would differentially alter cognitive networks, including attentional alerting and executive control. Second, we examined the moderating effects of self- and informant reports of aggression on threat-related changes in cognitive functioning. Using event-related potential (ERP) measures of cognitive-attentional processes, 143 community individuals participated in a well-validated and translational threat manipulation (NPU) task (Schmitz & Grillon, 2012) while completing the Attention Network Test (Fan et al., 2002). Analyses revealed that relatively unpredictable threat quickened alerting-related reaction time, whereas predictable threat interfered with processing of flanker task stimuli. The results, however, failed to show reliable relationships between aggression proneness and threat-related cognitive alterations. The findings fit with a broader literature on cognitive and behavioral outputs of threat activation and provide fruitful avenues for better understanding threat-related aggression. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: To examine prevalence of Alzheimer Disease and related dementias (ADRD) and patient characteristics as a function of comorbid insomnia and/or depression among heart failure (HF) patients discharged from hospitals., Design: Retrospective cohort descriptive epidemiology study., Setting: VA Hospitals., Participants: N = 373,897 Veterans hospitalized with heart failure from October 1, 2011 until September 30, 2020., Measurements: We examined VA and Center for Medicare & Medicaid Services (CMS) coding in the year prior to admission using published ICD-9/10 codes for dementia, insomnia, and depression. The primary outcome was the prevalence of ADRD and the secondary outcomes were 30-day and 365-day mortality., Results: The cohort were predominantly older adults (mean age = 72 years, SD = 11), male (97%), and White (73%). Dementia prevalence in participants without insomnia or depression was 12%. In those with both insomnia and depression, dementia prevalence was 34%. For insomnia alone and depression alone, dementia prevalence was 21% and 24%, respectively. Mortality followed a similar pattern with highest 30-day and 365-day mortality higher in those with both insomnia and depression., Conclusions: These results suggest that persons with both insomnia and depression are at an increased risk of ADRD and mortality compared to persons with one or neither condition. Screening for both insomnia and depression, especially in patients with other ADRD risk factors, could lead to earlier identification of ADRD. Understanding comorbid conditions which may represent earlier signs of ADRD may be critical in the identification of ADRD risk., Competing Interests: DISCLOSURES The authors have no disclosures to report., (Copyright © 2023 American Association for Geriatric Psychiatry. All rights reserved.)

Although sleep loss is theorized to increase aggression risk, knowledge regarding the sleep-aggression relationship, or explanatory psychological processes, is limited. This study examined whether recent sleep duration predicted subsequent laboratory aggression, and whether neurocognitive indices of attentional and motor inhibition and negative emotional processing explained the sleep-aggression relationship. Participants ( n =141) wore Fitbit Flex devices and kept a sleep diary for three days. Event-related potentials were measured during an Emotional-Linguistic Go/No-Go task, followed by a laboratory aggression paradigm. Results of mixed-model repeated measures ANOVAs linked shorter sleep duration with reduced motor inhibition processing during negative and neutral word blocks, and greater aggression. However, neurocognitive indices did not explain the sleep-aggression link. This is the first evidence that naturally occurring sleep loss predicts increases in laboratory aggression across the task and suggests that shorter sleepers are more vulnerable to rash action in negative and neutral contexts. Implications of these findings for understanding aggression will be discussed., Competing Interests: Declaration of Conflicting Interests The author(s) declared no conflicts of interest with respect to the authorship or the publication of this article.

Claims data are a valuable resource for studying Alzheimer's disease and related dementias (ADRD). Alzheimer's disease and related dementias is often identified using a list of claims codes and a fixed lookback period of 3 years of data. However, a 1-year lookback or an approach using all-available lookback data could be beneficial based on different research questions. Thus, the purpose of this study was to compare 1-year and all-available lookback approaches to ascertaining ADRD compared to the standard 3-year approach. Using a cohort of Veterans hospitalized for heart failure (N = 373, 897), our results suggested high agreement (93% or greater) between the lookback periods. The 1-year lookback period had lower sensitivity (60%) and underestimated the prevalence of ADRD. These results suggest that 1-year and all-available lookback periods are viable approaches when using claims data.

Research identifying the biobehavioral processes that link threat exposure to cognitive alterations can inform treatments designed to reduce perpetration of stress-induced aggression. The present study attempted to specify the effects of relatively predictable versus unpredictable threat on two attention networks, attentional alerting and executive control. In a sample of adults (n = 74, 35 % identifying as women, M age  = 32.85) with high rates of externalizing behaviors (e.g., substance use, criminal/legal system involvement, aggressivity), we measured event-related brain activity during an attention network test that manipulated cognitive systems activation under relatively unpredictable and predictable threat conditions. Results showed that threat exposure alters attentional alerting and executive control. The predictable threat condition, relative to unpredictable threat, increased visual alerting (N1 amplitude to alert vs. no alert cue conditions) and decreased attention to the task (P3 amplitude to subsequent task-relevant flankers, but these effects did not survive adjusting for multiple tests. In contrast, overall threat and unpredictable threat conditions were associated with faster response time to alert cue (versus no cue) and poorer conflict processing, operationalized as flanker N2 reductions and slower response time to incongruent (versus congruent) flanker trials. These results expand what is known about threat-related modulation of cognition in a sample of individuals with histories of externalizing behaviors., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest for this research., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Childhood abuse and/or neglect adversely influences development of neurocognitive systems that regulate affect and behavior. Poor inhibitory control over emotional reactions is thus one potential pathway from maltreatment to suicide. Adult psychiatric inpatients completed the Childhood Trauma Questionnaire and an emotional stop-signal task indexing negative emotional action termination (NEAT): the ability to inhibit ongoing motor reactions to aversive stimuli triggered by negative affect. Clinical interviews assessed suicidal thoughts and behaviors during hospitalization (n = 131) and at follow-up assessments 6 months later (n = 87). Our primary aim was to examine whether maltreatment history and NEAT explain overlapping variance in suicidal behaviors (1) retrospectively and (2) 6 months following hospital discharge. Contrary to prediction, childhood maltreatment was unrelated to history of suicidal behaviors. However, NEAT was consistently associated with prior suicidal acts, even controlling for suicidal ideation and demographic covariates. NEAT similarly contributed to the prediction of post-discharge suicidal behaviors, whereas we found no effect of maltreatment history. The present study suggests that NEAT captures suicide risk independently of childhood maltreatment. Results implicated NEAT impairment specifically, rather than broader response inhibition deficits (e.g., to positive stimuli), in past and future suicidal behaviors. These findings provide preliminary support for NEAT as a behavioral vulnerability marker for suicide, with implications for understanding links between maltreatment history and suicidal acts., Competing Interests: Conflict of Interest Statement The authors declare no conflicts of interest., (Copyright © 2021. Published by Elsevier Ltd.)

Background: Alcohol use disorder (AUD) is highly comorbid with depression and posttraumatic stress disorder (PTSD) and can complicate their treatment. Transcranial magnetic stimulation is a promising treatment for these disorders, yet prior research often excluded AUD patients out of concern for safety or poorer outcomes. To this end, we revisited a prior study of intermittent theta burst stimulation (iTBS) for PTSD, to evaluate whether mild AUD impacted safety and clinical outcomes., Methods: Fifty veterans with PTSD (n=17, with comorbid AUD) received 10 days of sham-controlled iTBS, followed by 10 unblinded sessions. Stimulation was delivered at 80% of the motor threshold for 1800 pulses to the right dorsolateral prefrontal cortex. Safety, PTSD and depressive outcomes were evaluated with repeated measures analysis of variance, to examine the effects of time, treatment group and comorbid AUD., Results: iTBS was safe, although AUD patients reported more adverse events, regardless of whether they received active or sham stimulation. Regarding clinical outcomes, patients with AUD who received active stimulation demonstrated a greater rate of improvement in depression symptoms than those without comorbid AUD. The presence of AUD did not impact PTSD symptom change., Limitations: Limitations include a modest sample size and use of a categorical, rather than continuous, index of AUD diagnosis., Conclusion: While these results require replication, they indicate that iTBS is likely safe in patients with mild comorbid AUD. We propose that comorbid AUD should not preclude clinical use of iTBS, and that iTBS should be further investigated as a novel treatment option for AUD., (Copyright © 2021. Published by Elsevier B.V.)

Despite significant advances in psychiatric and psychological treatment over the last 30 years, suicide deaths have increased. Unfortunately, neuroscience insights have yielded few translational interventions that specifically target suicidal thoughts and behaviors. In our view, this is attributable to two factors. The first factor is our limited integration of neurocircuitry models with contemporary suicide theory. The second challenge is inherent to the variable nature of suicide risk over time. Few interventional neuroscience studies evaluate how temporal fluctuations in risk affect treatment, despite evidence that temporality is a key component distinguishing suicide phenotypes. To wit, individual variability in risk trajectories may provide different treatment targets to engage as a patient moves between suicidal ideation and attempt. Here, we first review contemporary ideation-to-action theories of suicide from a neurobiological perspective, focusing on valence and executive function circuits and the key role of state-induced (e.g., within stressful contexts) functional modulation on longitudinal risk trajectories. We then describe neural correlates of suicide reduction following various interventions, ranging from circuit specific (i.e., transcranial magnetic stimulation) to broader pharmacological (i.e., ketamine, lithium) to psychological (i.e., brief cognitive therapy). We then introduce novel strategies for tracking risk in naturalistic settings and real time using ecological momentary interventions. We provide a critical integration of the literature focusing on the intersection between targets and temporality, and we conclude by proposing novel research designs integrating real-time and biologically based interventions to generate novel strategies for future suicide reduction research., (Published by Elsevier Inc.)

A prominent characteristic of externalizing psychopathology is the inability to suppress or modulate behavioral responses and impulses. These tendencies have been associated with cognitive indicators of inhibitory control (P3) and error processing (error-related negativity [ERN] and positivity [Pe]). However, the extent to which these trait-like components are characteristic of specific manifestations, or externalizing proneness more generally, remains unclear. Our study aimed to further contextualize externalizing behaviors by examining associations between distinct facets of externalizing symptoms and relevant behavioral phenotypes (substance use, aggression, pathological personality and internalizing symptoms) as well as electrophysiological and behavioral indices of inhibitory control (congruence and no-go P3, flanker interference, commission errors) and error processing (ERN and Pe, post-error slowing). Using a sample of community and jail dwelling offenders (N = 497), we used Confirmatory Factor Analyses to estimate a general externalizing factor (EXT), representing shared variance, and latent factors representing symptoms related to callous-aggression (CAL; conduct disorder and antisocial personality disorder) and alcohol and drug dependence (AD and DD). Additionally, a subset of participants (N = 89) had their brain activity recorded during a flanker task. Factor analyses supported general EXT and CAL factors; however, unique AD/DD overlapped highly with shared EXT, suggesting that DSM substance use symptoms in our study reflect more general problems with disconstraint/impulsivity rather than variance specific to substances. The general EXT was marked by behavioral correlates of impulsivity and negative affect, and laboratory task deficits in error monitoring, but with greater differential processing of inhibitory cues. The CAL specific factor was associated with affective shallowness phenotype, and, interestingly, laboratory measures of enhanced processing of inhibitory cues and error adjustment. This research has implications for understanding neurocognitive processes associated with distinct manifestations of disordered behavioral inhibition., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: At least 17 veterans die every day from suicide. Although existing treatments such as brief cognitive behavioral therapy (BCBT) have been found to reduce suicide attempts in military personnel, a number of patients go on to attempt suicide after completing therapy. Thus, finding ways to enhance treatment efficacy to reduce suicide is critical. Repetitive transcranial magnetic stimulation (TMS) is a noninvasive technique that can be used to stimulate brain regions that are impaired in suicidal patients, that has been successfully used to augment treatments for psychiatric disorders implicated in suicide. The goal of this study is to test whether augmenting BCBT with TMS in suicidal veterans reduces rates of suicidal ideation, attempts, and other deleterious treatment outcomes., Methods: One hundred thirty veterans with a suicide plan or suicidal behavior in the prior 2 weeks will be recruited from inpatient and outpatient settings at the Providence VA Medical Center in the USA. Veterans will be randomly assigned to receive 30 daily sessions of active or sham TMS in concert with a 12-week BCBT protocol in a parallel group design. Veterans will complete interviews and questionnaires related to psychiatric symptoms, suicidal ideation and behavior, treatment utilization, and functioning during a baseline assessment prior to treatment, at treatment endpoint, and 6- and 12-month follow-ups. Primary analyses will use mixed effect regressions to examine effects of treatment condition on suicidal behaviors, improvements in psychosocial functioning, and psychiatric hospitalization. Similar models as well as exploratory latent growth curve analyses will examine mediators and moderators of treatment effects., Discussion: This protocol provides a framework for designing multilayered treatment studies for suicide. When completed, this study will be the first clinical trial evaluating the efficacy of augmenting BCBT for suicide with TMS. The results of this trial will have implications for treatment of suicide ideation and behaviors and implementation of augmented treatment designs. If positive, results from this study can be rapidly implemented across the VA system and will have a direct and meaningful impact on veteran suicide., Trial Registration: This study was registered prior to participant enrollment with ClinicalTrials.gov NCT03952468 . Registered on May 16, 2019., Trial Sponsor Contact: Robert O'Brien (VA Health Services R&D), robert.obrien7@va.gov.

While studies suggest that youth who experience violence in the home are more likely to engage in externalizing behaviors (e.g., aggression, substance use, rule breaking), research is needed to understand factors that may explain how family violence is linked to externalizing, and whether there may be gender-specific trajectories to this outcome. The present study used a cross-sectional design and multigroup, path analytic modeling to test the degree to which personality traits (negative emotionality, constraint) in boys and girls (Model 1), as well as status offending primarily in girls (Model 2), may help explain relationships between exposure to familial adversity (witnessing family violence and child abuse) and adolescent externalizing behaviors in a mixed-gender, community sample with both caregiver and youth reports ( N = 237, 57% female, 10-17 years old). Results indicated that personality traits fully explained the relationship between witnessing family violence and externalizing and partially explained the relationship between child abuse and externalizing among youth. Despite theory suggesting a female-specific trajectory involving status offenses, both models were similarly relevant for boys and girls. These findings have implications for understanding processes by which adverse family circumstances may relate to externalizing behavior in youth. Preliminary suggestions are provided for future longitudinal research, policy changes, and clinical techniques that may be essential in preventing the progression to long-term adverse outcomes among youth.

Although there is growing interest in the use of repetitive Transcranial Magnetic Stimulation (TMS) as a treatment for suicidality, efficacy data in this area, and knowledge of potential treatment mechanisms, remains limited. The first objective of this study was to systematically review clinical trial data examining the effectiveness of TMS as a treatment for suicidal ideation. Our secondary objective was to investigate the extent to which changes in suicidality are independent of improvements in depression in a clinical sample of veterans who received TMS treatment. In Study 1, we searched the Pubmed and biRxiv databases from inception until July 2019 to identify studies that examined the efficacy of TMS for suicidal thoughts and/or behaviors. Data regarding sample characteristics, treatment parameters, and results were synthesized from six randomized controlled trials and five unblinded trials (total n = 593). Our systematic review indicated that while TMS was consistently associated with reduced depression, its impact on suicidality is unclear. Interpretation of results related to suicidality were complicated by study design elements and modest sample sizes. In Study 2, we conducted a retrospective analysis of 43 patients who received care for depression in a neuromodulation clinic at a Veteran's Affairs hospital. Results found significant decreases in suicidal ideation, and depressive symptom change did not always account for improvements in ideation. Taken together, our literature review and clinic study indicate preliminary promise of TMS for suicide, and underscore the need for more fine-grained, suicide-specific TMS research., Competing Interests: Declaration of competing interest The authors report no biomedical conflicts of interest related to this work. In the past three years, Dr. Philip has received grant support from Neuronetics and Neosync through clinical trial contracts and has been an unpaid scientific advisory board member for Neuronetics. Other coauthors report no conflicts of interest., (Published by Elsevier Ltd.)

The transition from psychiatric hospitalization to home is marked by high clinical vulnerability, characterized by risk of symptom rebound, exposure to preexisting stressors, and challenges with outpatient treatment linkage. Rates of rehospitalization during this post-discharge period, particularly for those with bipolar disorder, are reported to be high. This study evaluated demographic and clinical predictors of early rehospitalization (within 30 days) in a sample of hospitalized adults with Bipolar I disorder (BD-I). A chart review was conducted for 215 patients with BD-I admitted to an academically-affiliated psychiatric hospital within one calendar year. A computer algorithm was used to extract relevant demographic, clinical, and treatment information. Univariate and multivariate logistic regression models were used to examine predictors of early rehospitalization. Overall, 12% of participants were readmitted within 30 days of discharge. Controlling for other clinical and demographic variables, patient functioning and pre-admission psychiatric polypharmacy, but not comorbid psychiatric diagnoses, predicted early readmission in patients with BD-I. Findings highlight the relative importance of considering low psychosocial functioning, and medication regimens containing multiple psychiatric medications, during hospitalizations. These features may indicate a subset of patients with BD-I who require more comprehensive discharge planning and support to transition to the community following a psychiatric hospitalization., (Published by Elsevier B.V.)

Objective: This study evaluated the mental health characteristics and beliefs of student service members/veterans (SSM/Vs) who have been exposed to another's death by suicide., Participants: A total of 39 SSM/Vs exposed to suicide and 32 SSM/Vs not exposed to suicide were sampled from a larger, epidemiological survey. An age- and gender-matched group of 39 civilian (C) students was drawn from a larger sample of individuals exposed to suicide., Methods: Data were collected as part of an Internet-based, campus needs survey that occurred in Fall 2014. Participants were asked to complete measures about suicide-related behaviors, suicide prevention, help-seeking, and demographics., Results: SSM/Vs exposed to suicide had more positive mental health/suicide prevention beliefs than SSM/Vs not exposed to suicide. Cs exposed to suicide were not significantly different from either group. Unique help-seeking patterns were also identified., Conclusions: The current study identifies unique characteristics of SSM/Vs exposed to suicide that may inform prevention programming.

Suicide occurs at high rates among veterans, underscoring a need for improved identification of veterans at risk of engaging in suicidal behavior. Considering dimensions of psychopathology in the context of an ideation-to-action framework, the present study examined the utility of the Minnesota Multiphasic Personality Inventory-2-Restructured Form in distinguishing depressed, psychiatrically hospitalized male veterans ( N = 430) at varying levels of suicide risk. Analysis of variance and hierarchical logistic regression analyses indicated that internalizing scales differentiated depressed ideators ( n = 147) and depressed controls ( n = 143); and in line with expectations, both broad and narrowly focused externalizing scales provided incremental validity in distinguishing depressed attempters ( n = 140) from depressed ideators. Interactions between Suicidal/Death Ideation and externalizing scale scores were found to differentiate only depressed ideators from depressed controls. Clinical implications in the areas of suicide risk assessment and therapeutic interventions with suicidal veterans are discussed.

Depression has been linked with long-term risk for a variety of physical health ailments, including coronary heart disease (CHD). Little is known about resilience factors that may attenuate this relationship. The current study assessed whether social support moderates the long-term risk for CHD associated with this disorder. Data were drawn from the Americans' Changing Lives study, a nationally representative longitudinal survey of adults in the United States. Participants (unweighted n=1636) completed initial assessments of functional social support, body mass index, recent history of major depression, CHD, hypertension, and diabetes. Participants were again assessed for CHD at a follow-up assessment 13 years later. Social support was found to moderate the relationship between depression and the occurrence of CHD 13 years later. Specifically, among individuals with low social support, depression was prospectively associated with CHD. In contrast, depression was not prospectively associated with CHD among individuals with high social support. The results indicate that social support may function as a resilience factor against the long-term cardiovascular risk associated with depression. Clinical interventions focusing on the development of social support systems are important not only for addressing depression itself, but also for associated long-term physical health outcomes., (Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.)

The present study examined differences in symptom presentation in screening for pediatric depression via evaluation of the Patient Health Questionnaire-9 (PHQ-9). In particular, we examined whether PHQ-9 items function differentially among deaf and hard-of-hearing (DHH; n = 75) and hearing (n = 75) youth based on participants recruited from crisis assessment services. Multiple indicators multiple causes models were used to examine whether items of the PHQ-9 functioned differently between groups as well as whether there were group differences in the mean severity of depressive symptoms. Results indicate that DHH youth were more likely to endorse psychosomatic items, and less likely to endorse an affective item. These findings indicate that the PHQ-9 functions differently when used with DHH youth. Implications of these findings are discussed, including both for future work with the PHQ-9 and with regard to the conceptualization of depression across hearing groups., (© The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: Although insomnia symptoms are associated with risk of suicide ideation, the means by which insomnia influences ideation, as well as the role depression plays in these relationships, require further study. In this study, we examined whether certain socio-cognitive variables (fatigue, social problem-solving, and hopelessness) in conjunction with depression explained this relationship among female college students., Methods: 483 female students completed measures assessing insomnia and depressive symptoms, fatigue, social problem-solving ability, hopelessness, and suicide ideation., Results: Path analyses indicated that socio-cognitive variables partially explained the insomnia-ideation relationship above the influence of depressive symptoms. Higher depressive symptoms exacerbated relationships between social problem-solving and hopelessness, heightening ideation risk., Conclusions: Our findings expand knowledge of intermediate socio-cognitive variables that may contribute to the insomnia-ideation relationship, and indicate that clinically-severe depressive symptoms compound the contribution of negative self and future appraisals to thoughts of suicide. Suicidal females with insomnia and depressive symptoms may benefit from interventions targeting problem-solving skills and improving sleep., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objective: Males are more likely than females to die by all forms of violent death, including suicide. The primary purpose of the present study was to explore whether the gender difference in suicide rates is largely accounted for by males' general greater tendency to experience violent deaths. The current study examined gender and age differences in suicides and other violent deaths, using data from a population-based surveillance system., Method: Pearson's chi-square tests and logistic regression analyses were conducted with data for 32,107 decedents in the 2003-2005 National Violent Death Reporting System (NVDRS). Decedents were categorized by gender, age, and death by suicide versus other violent means., Results: When suicides were examined in the greater context of violent death, the total proportion of violent deaths due to suicide did not differ across gender. When deaths were examined by age group, after controlling for ethnicity, marital status, and U.S. location in which the death occurred, males in early to mid childhood were significantly more likely than same-aged females to die by suicide relative to all other violent deaths. The portion of deaths due to suicide was for the most part equal across both genders in late childhood, young adulthood, and mid-adulthood. Older males were more likely than older females to die by suicide relative to other violent deaths., Conclusion: Our findings suggest that that the risk of dying by suicide relative to other violent deaths may be more pronounced at certain developmental stages for each gender. This knowledge may be valuable in tailoring prevention strategies., (Copyright © 2014 Elsevier Inc. All rights reserved.)