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PurposeFew studies have compared acute use of alcohol in suicide decedents with that in a nonsuicide group. This study provides the first national analysis of acute use of alcohol before suicide compared with an estimate of acute use of alcohol in a living sample.MethodsPooled 2003-2011 National Violent Death Reporting System data were used to estimate the prevalence of postmortem blood alcohol content positivity (blood alcohol content >0.0 g/dL) and intoxication (blood alcohol content ≥0.08 g/dL). Population estimates of comparable use of alcohol (within the past 48 hours) were based on the National Epidemiologic Survey on Alcohol and Related Conditions.ResultsCompared with the living sample, male and female suicide decedents showed, respectively, a 1.83-fold (95% confidence interval [CI], 1.73-1.93) and 2.40-fold (95% CI, 2.24-2.57) increased risk of alcohol ingestion before their death after age, race/ethnicity, and chronic alcohol problems were controlled. Furthermore, male and female decedents exhibited, respectively, a 6.18-fold (95% CI, 5.57-6.86) and a 10.04-fold (95% CI, 8.67-11.64) increased risk of being intoxicated before their death after confounders were considered.ConclusionsThe findings underscore the crucial need to include among the essential components of suicide prevention policies programs that minimize the use of alcohol, particularly drinking to intoxication.

Introduction Suicide claims more than 800,000 lives each year worldwide and is the second-leading cause of death among people ages 15 to 29. (1) For every suicide, at least 20 [...]

Objective: The purpose of this study was to examine whether positive health attitudes are associated with suicidal ideation among university students after accounting for other health risk factors linked to suicidal ideation. Participants: Participants were 690 undergraduates from a large midwestern university during fall semester 2011. Methods: Participants reported demographics and health characteristics. Regression models compared individuals who reported suicidal ideation and those who did not. Results: In unadjusted models, suicidal ideation was significantly negatively associated with positive health attitudes, and positively associated with depression, drug use problems, sleep problems, and being overweight. In adjusted models, more positive health attitudes continued to be significantly negatively associated with suicidal ideation. Conclusions: This study suggests a link between positive health attitudes and lower probability of suicidal ideation. Additional research is needed to assess enhancing general health attitudes as a suicide prevention effort.

There are meager prospective data from nonclinical samples on the link between anxiety disorders and suicide or the extent to which the association varies over time. We examined these issues in a cohort of 309,861 U.S. Air Force service members, with 227 suicides over follow-up. Mental disorder diagnoses including anxiety, mood, and substance-use disorders (SUD) were based on treatment encounters. Risk for suicide associated with anxiety disorders were lower compared with mood disorders and similar to SUD. Moreover, the associations between mood and anxiety disorders with suicide were greatest within a year of treatment presentation. (Contains 4 tables.)

Background: Near-term risk factors for suicidal behavior, referred to as 'warning signs' (WS), distinguish periods of acute heightened risk from periods of lower risk within an individual. No prior published study has examined, using a controlled study design, a broad set of hypothesized WS for suicide attempt. This study addressed this gap through examination of hypothesized behavioral/experiential, cognitive, and affective WS among patients recently hospitalized following a suicide attempt. Methods: Participants were recruited during hospitalization from five medical centers across the USA including two civilian hospitals and three Veterans Health Administration facilities (n = 349). A within-person case-crossover study design was used, where each patient served as her/his own control. WS were measured by the Timeline Follow-back for Suicide Attempts Interview and were operationalized as factors that were present (v. absent) or that increased in frequency/intensity within an individual during the 6 h preceding the suicide attempt (case period) compared to the corresponding 6 h on the day before (control period). Results: Select WS were associated with near-term risk for suicide attempt including suicide-related communications, preparing personal affairs, drinking alcohol, experiencing a negative interpersonal event, and increases in key affective (e.g. emptiness) and cognitive (e.g. burdensomeness) responses. Conclusions: The identification of WS for suicidal behavior can enhance risk recognition efforts by medical providers, patients, their families, and other stakeholders that can serve to inform acute risk management decisions. [ABSTRACT FROM AUTHOR]

The psychological autopsy (PA) is a systematic method of assessing the psychological and contextual circumstances preceding suicide. The method requires interviews with one or more proxy respondents (i.e., informants) of suicide decedents. Procedural challenges that need to be addressed to conduct PA interviews are described in this article and recommendations for meeting these challenges in future PA investigations are made. Procedures addressed include determining the timing of PA interviews after suicide, designing the structure and flow of interviews, selection of proxy respondents, integrating interview data with information gathered from records, and selecting and training interviewers. This methodological article is the second in a two-part series--the first article focused on interview content. [For Part 1, see EJ966343.]

The psychological autopsy (PA) is a systematic method to understand the psychological and contextual circumstances preceding suicide. The method requires interviews with one or more proxy respondents (i.e., informants) of decedents. The methodological challenges that need to be addressed when determining the content of these research interviews for PA studies are described and recommendations are made for meeting these challenges in future PA investigations. Ways to improve the data collected about mental disorders and life events--domains that are assessed in almost all PA studies--are discussed at length. Other understudied content areas considered include the role of personality traits, medical illness and functional limitations, availability of lethal agents, medications, and select distal variables including child maltreatment and family history of mental disorders and suicide. The benefits and challenges to using common protocols across studies are also discussed.

We examined internal consistency and test-retest reliability of a measure of dispositional optimism, the Life Orientation Test-Revised, in 121 opiate-dependent patients seeking methadone treatment. Internal consistency was adequate at baseline (alpha = 0.69) and follow-up (alpha = 0.72). Low socioeconomic status and being on disability were significantly associated with reduced internal consistency; ethnic and educational differences approached significance. Test-retest reliability was good (ICC = 0.72), varying across gender, race, ethnicity, education, employment and income (ICC Range = 0.24-0.85). Criterion validity was strong; the LOT-R was significantly negatively correlated with hopelessness (r = -0.65, p less than 0.001) and depression (r = -0.60, p less than 0.001). Findings support the use of this measure of optimism and pessimism to assess positive cognitive and emotional attributes and improve treatment strategies for opiate-dependent individuals. Future research should address the measurement and significance of optimism in minority, low socioeconomic status and poorly-educated individuals.

There are limited prospective data on suicide attempts (SA) during the months following treatment for substance use disorders (SUD), a period of high risk. In an analysis of the Drug Abuse Treatment Outcomes Study, a longitudinal naturalistic multisite study of treated SUDs, variables associated with SA in the 12 months following SUD treatment were examined. Participants included 2,966 patients with one or more SUDs. By 12 months, 77 (2.6%) subjects had attempted suicide. Multivariate logistic regression analyses were used to identify variables associated with SA. Variables collected at baseline that were associated with SA included lifetime histories of SA, suicidal ideation (SI), depression, cocaine as primary substance of use, outpatient methadone treatment, and short-term inpatient treatment. Male sex, older age, and minority race or ethnicity were associated with lower likelihood of SA. After controlling for baseline predictors, variables assessed at 12 months associated with SA included SI during follow-up and daily or more use of cocaine. The data contribute to a small but growing literature of prospective studies of SA among treated SUDs, and suggest that SUDs with cocaine use disorders in particular should be a focus of prevention efforts.

The authors tested hypotheses concerning personality differences in treatment-seeking suicide attempters (AT; n = 60) and a community sample of suicides (SU; n = 43) over age 50. On the basis of prior research, the authors hypothesized that SU would be lower in Neuroticism and Openness and higher in Conscientiousness. A 2-group (AT vs. SU) multivariate analysis of covariance with NEO Personality Inventory--Revised (Informant Version) domain scores as dependent variables revealed that SU were lower in Neuroticism and higher in Conscientiousness. The authors conclude that AT and SU in this age group can be distinguished on the basis of informant ratings of personality traits. These differences can inform risk detection.

To test the hypothesis that higher levels of optimism reduce the association between hopelessness and suicidal ideation, 284 college students completed self-report measures of optimism and Beck scales for hopelessness, suicidal ideation, and depression. A statistically significant interaction between hopelessness and one measure of optimism was obtained, consistent with the hypothesis that optimism moderates the relationship between hopelessness and suicidal ideation. Hopelessness is not inevitably associated with suicidal ideation. Optimism may be an important moderator of the association. The development of treatments to enhance optimism may complement standard treatments to reduce suicidality that target depression and hopelessness.

Purpose: Mandatory COVID‐19 shelter‐in‐place (SIP) orders have been imposed to fight the pandemic. They may also have led to unintended consequences of increased use of controlled substances especially among rural communities due to increased social isolation. Using the data from the American Association of Poison Control Centers, this study tests the hypothesis that the poison control centers received higher rates of calls related to exposures to controlled substances from rural counties than they did from urban counties during the SIP period. Methods: Call counts received by the poison control centers between October 19, 2019 and July 6, 2020 due to exposure to controlled substance (methamphetamine, opioids, cocaine, benzodiazepines, and other narcotics) were aggregated to per‐county‐per‐month‐per‐10,000 population exposure rates. A falsification test was conducted to reduce the possibility of spurious correlations. Findings: During the study period, 2,649 counties in the United States had mandatory SIP orders. The rate of calls reporting exposure to any of the aforementioned controlled substances among the rural counties was higher (14%; P =.047) relative to the urban counties. This overall increase was due to increases in the rates of calls reporting exposure to opioids (26%; P =.017) and methamphetamine (39%; P =.077). Moreover, the rate of calls reporting exposures at home was also higher among the rural counties (14%; P =.069). Conclusion: The mandatory SIP orders may have had an unintended consequence of exacerbating the use of controlled substances at home in rural communities relative to urban communities. [ABSTRACT FROM AUTHOR]

Information on the association of impulsivity and measures of aggression with suicidal ideation in adolescents and young adults is limited. Data were gathered from a community sample of 625 adolescent and young adult males. Analyses were based on multivariate generalized estimating equations. Impulsivity and irritability were associated strongly with suicidal ideation after accounting for alcohol dependence and other aggression-related constructs including psychopathy. Given that irritable, impulsive adolescent males appear to contemplate suicidal behavior, their heightened suicide risk may be anticipated and mitigated.

Unplanned acts of suicidal behavior involve little preparation or forethought whereas planned acts may be carefully conceived and implemented. Planned acts are associated with greater depression, hopelessness, and lethality, but there are meager data on other factors associated with planning. The prevention of planned and unplanned acts may require different strategies, but in either case improved knowledge is required to tailor prevention efforts. Improved knowledge can be facilitated by the acceleration of validation studies on assessments of planning, taking steps to avoid the conflation of assessments of planning with measurements of psychopathology such as impulsivity, and the use of controlled research designs.