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Many have expressed concerns about the safety and ethics of conducting suicide research, especially intense suicide research methods that expose participants to graphic depictions of suicidality. We conducted two studies to evaluate the effects of one such method called virtual reality (VR) suicide. Study 1 tested the effects of VR suicide exposure over the course of one month in participants with (n = 56) and without a history of suicidality (n = 50). Study 2 exposed some participants to VR suicide scenarios (n = 79) and others to control scenarios (n = 80). Participants were invited to complete a follow-up assessment after an average of 2 years. For both studies, the presence of suicidality post exposure was the primary outcome, with closely related constructs (e.g., capability for suicide, agitation) as secondary outcomes. Study 1 found no pre-post increases in suicidality or related variables, but revealed several significant decreases associated with small to medium effect sizes in suicide-related constructs. In Study 2, VR suicide exposure did not cause any significant increases in suicidality or related variables. Together with prior research, these findings suggest that methods involving intense suicide stimuli appear safe and consistent with utilitarian ethics.

Primary care represents a major opportunity for suicide prevention in the military. Significant advances have been made in using electronic health record data to predict suicide attempts in patient populations. With a user-centered design approach, we are developing an intervention that uses predictive analytics to inform care teams about their patients' risk of suicide attempt. We present our experience working with clinicians and staff in a military primary care setting to create preliminary designs and a context-specific usability testing plan for the deployment of the suicide risk indicator., (©2020 AMIA - All rights reserved.)

Self-injurious thoughts and behaviors (SITBs) are major public health concerns impacting a wide range of individuals and communities. Despite major efforts to develop and refine treatments to reduce SITBs, the efficacy of SITB interventions remains unclear. To provide a comprehensive summary of SITB treatment efficacy, we conducted a meta-analysis of published randomized controlled trials (RCTs) that have attempted to reduce SITBs. A total of 591 published articles from 1,125 unique RCTs with 3,458 effect sizes from the past 50 years were included. The random-effects meta-analysis yielded surprising findings: The overall intervention effects were small across all SITB outcomes; despite a near-exponential increase in the number of RCTs across five decades, intervention efficacy has not improved; all SITB interventions produced similarly small effects, and no intervention appeared significantly and consistently stronger than others; the overall small intervention effects were largely maintained at follow-up assessments; efficacy was similar across age groups, though effects were slightly weaker for child/adolescent populations and few studies focused on older adults; and major sample and study characteristics (e.g., control group type, treatment target, sample size, intervention length) did not consistently moderate treatment efficacy. This meta-analysis suggests that fundamental changes are needed to facilitate progress in SITB intervention efficacy. In particular, powerful interventions target the necessary causes of pathology, but little is known about SITB causes (vs. SITB correlates and risk factors). The field would accordingly benefit from the prioritization of research that aims to identify and target common necessary causes of SITBs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Due to the limitations of conducting experimental studies on suicide, little is known about its causes. Based on basic behavioral research, we hypothesized that the anticipated consequences of suicidal behavior (e.g., stress relief) are the primary causes of suicidal behavior, and experienced antecedents (e.g., stress) are secondary causes. We evaluated this general hypothesis by testing the causal effects of these two broad phenomena on virtual reality (VR) suicide in 497 participants across five groups. On their own, experienced antecedent manipulations (i.e., stress and rejection) did not significantly increase VR suicide rates relative to the control group. On its own, the anticipated consequence manipulation (i.e., instruction that engaging in VR suicide would allow one to avoid a future stressor) caused a large increase in the VR suicide rate. In the context of an experienced antecedent manipulation (i.e., stress), this anticipated consequence manipulation caused an even larger increase in the VR suicide rate. These findings suggest that the anticipated consequences of suicidal behavior (e.g., avoidance or escape from something unpleasant, attaining something pleasant) are the primary causes of suicidal behavior, and that experienced antecedents (e.g., stress) serve as secondary causes when they make an anticipated consequence of suicidal behavior seem more appealing., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Suicide accounts for nearly 800,000 deaths per year worldwide with rates of both deaths and attempts rising. Family studies have estimated substantial heritability of suicidal behavior; however, collecting the sample sizes necessary for successful genetic studies has remained a challenge. We utilized two different approaches in independent datasets to characterize the contribution of common genetic variation to suicide attempt. The first is a patient reported suicide attempt phenotype asked as part of an online mental health survey taken by a subset of participants (n = 157,366) in the UK Biobank. After quality control, we leveraged a genotyped set of unrelated, white British ancestry participants including 2433 cases and 334,766 controls that included those that did not participate in the survey or were not explicitly asked about attempting suicide. The second leveraged electronic health record (EHR) data from the Vanderbilt University Medical Center (VUMC, 2.8 million patients, 3250 cases) and machine learning to derive probabilities of attempting suicide in 24,546 genotyped patients. We identified significant and comparable heritability estimates of suicide attempt from both the patient reported phenotype in the UK Biobank (h 2 SNP  = 0.035, p = 7.12 × 10 -4 ) and the clinically predicted phenotype from VUMC (h 2 SNP  = 0.046, p = 1.51 × 10 -2 ). A significant genetic overlap was demonstrated between the two measures of suicide attempt in these independent samples through polygenic risk score analysis (t = 4.02, p = 5.75 × 10 -5 ) and genetic correlation (rg = 1.073, SE = 0.36, p = 0.003). Finally, we show significant but incomplete genetic correlation of suicide attempt with insomnia (rg = 0.34-0.81) as well as several psychiatric disorders (rg = 0.26-0.79). This work demonstrates the contribution of common genetic variation to suicide attempt. It points to a genetic underpinning to clinically predicted risk of attempting suicide that is similar to the genetic profile from a patient reported outcome. Lastly, it presents an approach for using EHR data and clinical prediction to generate quantitative measures from binary phenotypes that can improve power for genetic studies.

Objective: Suicide ideators and suicide attempters might differ in 3 possible ways. First, they might differ in a simple way such that one or a small set of factors are both necessary and sufficient to distinguish between the 2 groups. Second, ideators and attempters might differ in a complicated way such that a specific combination of a large set of factors is necessary and sufficient for the distinction. Third, complex differences might exist: many possible combinations of a large set of factors may be sufficient to distinguish the 2 groups, but no combination may be necessary. This study empirically examined these possibilities., Method: Across 5 samples (total N = 3,869), univariate logistic regressions were conducted to test for simple differences. To test for complicated and complex differences, machine learning (ML) methods were used to identify the optimized algorithm with all variables. Subsequently, the same methods were repeated after removing the top 5 most important or discriminative variables, and a randomly selected 10% subset of variables. Multiple logistic regressions were conducted with all variables., Results: Results were consistent across samples. Univariate logistic regressions on average yielded chance-level accuracy. ML algorithms with all variables showed good accuracy; substantial deviation from the optimized algorithms through the removal of variables did not result in significantly poorer performance. Multiple logistic regressions produced poor to fair accuracy., Conclusions: Differences between suicide ideators and attempters are complex. Findings suggest that their differences may be better understood on a psychological primitive level than a biopsychosocial factor level. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Background: Why do some people engage in nonsuicidal self-injury (NSSI) while others attempt suicide? One way to advance knowledge about this question is to shed light on the differences between people who engage in NSSI and people who attempt suicide. These groups could differ in three broad ways. First, these two groups may differ in a simple way, such that one or a small set of factors is both necessary and sufficient to accurately distinguish the two groups. Second, they might differ in a complicated way, meaning that a specific set of a large number of factors is both necessary and sufficient to accurately classify them. Third, they might differ in a complex way, with no necessary factor combinations and potentially no sufficient factor combinations. In this scenario, at the group level, complicated algorithms would either be insufficient ( i.e. , no complicated algorithm produces good accuracy) or unnecessary ( i.e. , many complicated algorithms produce good accuracy) to distinguish between groups. This study directly tested these three possibilities in a sample of people with a history of NSSI and/or suicide attempt., Method: A total of 954 participants who have either engaged in NSSI and/or suicide attempt in their lifetime were recruited from online forums. Participants completed a series of measures on factors commonly associated with NSSI and suicide attempt. To test for simple differences, univariate logistic regressions were conducted. One theoretically informed multiple logistic regression model with suicidal desire, capability for suicide, and their interaction term was considered as well. To examine complicated and complex differences, multiple logistic regression and machine learning analyses were conducted., Results: No simple algorithm ( i.e. , single factor or small set of factors) accurately distinguished between groups. Complicated algorithms constructed with cross-validation methods produced fair accuracy; complicated algorithms constructed with bootstrap optimism methods produced good accuracy, but multiple different algorithms with this method produced similar results., Conclusions: Findings were consistent with complex differences between people who engage in NSSI and suicide attempts. Specific complicated algorithms were either insufficient (cross-validation results) or unnecessary (bootstrap optimism results) to distinguish between these groups with high accuracy., (Copyright © 2020 Huang, Ribeiro and Franklin.)

This meta-analysis aims to evaluate whether the extant literature justifies any definitive conclusions about whether and how SITBs may be associated with brain differences. A total of 77 papers (N = 4,903) published through January 1, 2019 that compared individuals with and without SITBs were included, resulting in 882 coordinates. A pooled meta-analysis assessing for general risk for SITBs indicated a lack of convergence on structural differences. When all types of control groups were considered, functional differences in the left posterior cingulate cortex (PCC), right amygdala, left hippocampus, and right thalamus were significant using multi-level kernel density analysis (p corrected  < 0.05) but nonsignificant using activation-likelihood estimation. These results suggest that a propensity for internally-oriented, emotional processing coupled with under-active pain processing could potentially underlie SITBs, but additional research is needed to test this possibility. Separate analyses for types of SITBs suggested that the brain differences associated with deliberate self-harm were consistent with the overall findings. Checkered moderator effects were detected. Overall, the meta-analytic evidence was not robust. More studies are needed to reach definitive conclusions about whether SITBs are associated with brain differences.

Purpose: Suicidal thoughts and behaviors (STBs) have been a persistent problem worldwide. Identifying risk factors for STBs across distinct areas of the world may help predict who or where requires the greatest attention. However, risk factors for STBs are infrequently explored cross-nationally. The present study examined whether psychopathology prospectively predicts STBs across different areas of the world, and whether certain country-level factors moderate the degree of risk conferred., Methods: We conducted a meta-analysis of 71 longitudinal studies from 30 different countries that featured psychopathology-related variables predicting STB outcomes. Meta-regression was used to evaluate whether the following country-level factors modified risk: geographic region, income level, and degree of mental health structural stigma., Results: Over 90% of studies had been conducted in North America and Europe. When assessed by country income level, it was found that only one longitudinal study on psychopathology and STB was conducted outside of a high-income country. Moreover, less than 10% of studies were conducted in high structural stigma contexts. Meta-regression findings revealed that the variation in risk effect sizes across studies was not explained by models including country-level factors., Conclusions: Our findings show critical underrepresentation of low- and middle-income countries, which account for a large proportion of global suicide deaths. This reveals a need to broaden the scope of longitudinal research on STB risk, such that countries across more regions, income levels, and degrees of structural stigma are fully accounted for. Such lines of research will improve generalizability of findings, and more precisely inform prevention efforts worldwide.

Background: Many agree that the biopsychosocial contributions to psychopathology are complex, yet it is unclear how we can make sense of this complexity. One approach is to reduce this complexity to a few necessary and sufficient biopsychosocial factors; although this approach is easy to understand, it has little explanatory power. Another approach is to fully embrace complexity, proposing that each instance of psychopathology is caused by a partially unique set of biopsychosocial factors; this approach has high explanatory power, but is impossible to comprehend. Due to deficits in either explanatory power or comprehensibility, both approaches limit our ability to make substantial advances in understanding, predicting, and preventing psychopathology. Thus, how can we make sense of biopsychosocial factor complexity?, Main Text: There is a third possible approach that can resolve this dilemma, with high explanatory power and high comprehensibility. This approach involves understanding, predicting, and preventing psychopathology in terms of a small set of psychological primitives rather than biopsychosocial factors. Psychological primitives are the fundamental and irreducible elements of the mind, mediating all biopsychosocial factor influences on psychopathology. All psychological phenomena emerge from these primitives. Over the past decade, this approach has been successfully applied within basic psychological science, most notably affective science. It explains the sum of the evidence in affective science and has generated several novel research directions. This approach is equally applicable to psychopathology. The primitive-based approach does not eliminate the role of biopsychosocial factors, but rather recasts them as indeterminate causal influences on psychological primitives. In doing so, it reframes research away from factor-based questions (e.g., which situations cause suicide?) and toward primitive-based questions (e.g., how are suicidality concepts formed, altered, activated, and implemented?). This is a valuable shift because factor-based questions have indeterminate answers (e.g., infinite situations could cause suicide) whereas primitive-based questions have determinate answers (e.g., there are specific processes that undergird all concepts)., Conclusion: The primitive-based approach accounts for biopsychosocial complexity, ties clinical science more directly to basic psychological science, and could facilitate progress in understanding, predicting, and preventing psychopathology.

Causal knowledge is crucial for understanding and preventing suicide. Unfortunately, we have little direct knowledge about suicide causes because we cannot conduct experiments that seek to make suicide more likely. In such situations, translational approaches can provide valuable, though tentative, information. We sought to establish a new translational approach by developing a laboratory approximation of suicide with new virtual reality (VR) technologies. Such an approach would allow researchers to tentatively investigate the causes of suicide by conducting experiments that introduce purported causes of suicide and observe their effects on VR suicide rates. Across three studies (total N = 498), results indicated that our two VR suicide scenarios (jumping from heights; shooting oneself) were safe; rated as unpleasant, realistic, and suicide-relevant; associated with several relevant predictors of VR suicide completion, including male sex, suicidal desire, suicidal capability, agitation, and prior suicidality; associated with reasons for not engaging in VR suicide that are similar to the reasons people give for not engaging in actual suicide; and produced 5% completion rates under neutral conditions and 25% completion rates after reward/avoid manipulations. We hope that future work further improves this approach and applies it to more directly test ideas about suicide causes and suicide prevention., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: Efforts to predict nonsuicidal self-injury (NSSI; intentional self-injury enacted without suicidal intent) to date have resulted in near-chance accuracy. Incongruence between theoretical understanding of NSSI and the traditional statistical methods to predict these behaviors may explain this poor prediction. Whereas theoretical models of NSSI assume that the decision to engage in NSSI is relatively complex, statistical models used in NSSI prediction tend to involve simple models with only a few theoretically informed variables. The present study tested whether more complex statistical models would improve NSSI prediction., Method: Within a sample of 1,021 high-risk self-injurious and/or suicidal individuals, we examined the accuracy of three different model types, of increasing complexity, in predicting NSSI across 3, 14, and 28 days. Univariate logistic regressions of each predictor and multiple logistic regression with all predictors were conducted for each timepoint and compared with machine learning algorithms derived from all predictors., Results: Results demonstrated that model complexity was associated with predictive accuracy. Multiple logistic regression models (AUCs 0.70-0.72) outperformed univariate logistic models (average AUCs 0.56). Machine learning models that produced algorithms modeling complex associations across variables produced the strongest NSSI prediction across all time points (AUCs 0.87-0.90). These models outperformed all multiple logistic regression models, including those involving identical study variables. Machine learning algorithm performance remained strong even after the most important factor across algorithms was removed., Conclusions: Results parallel recent findings in suicide research and highlight the complexity that underlies NSSI. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background: Adolescents have high rates of nonfatal suicide attempts, but clinically practical risk prediction remains a challenge. Screening can be time consuming to implement at scale, if it is done at all. Computational algorithms may predict suicide risk using only routinely collected clinical data. We used a machine learning approach validated on longitudinal clinical data in adults to address this challenge in adolescents., Methods: This is a retrospective, longitudinal cohort study. Data were collected from the Vanderbilt Synthetic Derivative from January 1998 to December 2015 and included 974 adolescents with nonfatal suicide attempts and multiple control comparisons: 496 adolescents with other self-injury (OSI), 7,059 adolescents with depressive symptoms, and 25,081 adolescent general hospital controls. Candidate predictors included diagnostic, demographic, medication, and socioeconomic factors. Outcome was determined by multiexpert review of electronic health records. Random forests were validated with optimism adjustment at multiple time points (from 1 week to 2 years). Recalibration was done via isotonic regression. Evaluation metrics included discrimination (AUC, sensitivity/specificity, precision/recall) and calibration (calibration plots, slope/intercept, Brier score)., Results: Computational models performed well and did not require face-to-face screening. Performance improved as suicide attempts became more imminent. Discrimination was good in comparison with OSI controls (AUC = 0.83 [0.82-0.84] at 720 days; AUC = 0.85 [0.84-0.87] at 7 days) and depressed controls (AUC = 0.87 [95% CI 0.85-0.90] at 720 days; 0.90 [0.85-0.94] at 7 days) and best in comparison with general hospital controls (AUC 0.94 [0.92-0.96] at 720 days; 0.97 [0.95-0.98] at 7 days). Random forests significantly outperformed logistic regression in every comparison. Recalibration improved performance as much as ninefold - clinical recommendations with poorly calibrated predictions can lead to decision errors., Conclusions: Machine learning on longitudinal clinical data may provide a scalable approach to broaden screening for risk of nonfatal suicide attempts in adolescents., (© 2018 Association for Child and Adolescent Mental Health.)

Objective: Our primary objective was to determine the potency of externalizing psychopathology as a risk factor for suicidal thoughts and behaviors (STBs)., Method: We conducted a random effects meta-analysis of 174 prospective studies (839 unique statistical tests) examining externalizing psychopathology and suicidal thoughts and behaviors (STBs) published prior to December 8, 2017. The weighted mean odds ratios for the overall relationship between externalizing psychopathology and STBs were below 2.00 in magnitude, and all risk factor subcategories were also fairly modest predictors of STBs. Taking publication bias into account reduced the magnitude of these associations, particularly for death. Although externalizing psychopathology modestly predicts STBs, this may be due to design limitations of existing studies. Future research should employ shorter follow-up periods, consider risk factors in combination, and focus on forms of externalizing psychopathology that have not been studied extensively., Results: The weighted mean odds ratios for the overall relationship between externalizing psychopathology and STBs were below 2.00 in magnitude, and all risk factor subcategories were also fairly modest predictors of STBs. Taking publication bias into account reduced the magnitude of these associations, particularly for death. Additionally, our results were mostly consistent regardless of sample age, sample severity, follow-up length, and predictor scale., Conclusions: Although externalizing psychopathology modestly predicts STBs, this may be due to design limitations of existing studies. Future research should employ shorter follow-up periods, consider risk factors in combination, and focus on forms of externalizing psychopathology that have not been studied extensively., (© 2018 Wiley Periodicals, Inc.)

Research indicates that people who identify as a sexual minority are at higher risk of numerous negative outcomes, including self-injurious thoughts and behaviors (SITBs). The minority stress model proposes that people identifying as a sexual minority are at higher risk of these behaviors due to sexual orientation-specific stressors-however, it does not clarify whether SITBs will be more severe among these individuals. The present study tested whether SITBs are more common and more severe among people identifying as a sexual minority using several metrics, including frequency of SITB engagement, age of onset of SITB, desire to discontinue SITB engagement, and likelihood of future SITBs. Four independent research samples were used to test this model. Results were then combined and tested in an internal meta-analysis. Findings converge to indicate a longer and more severe course of SITB engagement among people identifying as a sexual minority. Future research is needed to replicate these findings and to advance the understanding of why this imbalance in risk and severity might exist, and how it can be prevented., (Copyright © 2017. Published by Elsevier Ltd.)

Recent reviews and national statistics indicate that, so far, our field has made limited progress on fulfilling its central mission of preventing future suicidal thoughts and behaviors (STBs). We posit that a fundamental reason for our lack of progress is the way in which our field tends to think about and select STB intervention targets. Specifically, the vast majority of our intervention targets are derived from untested theoretical assertions, moderate correlates of STBs, or weak risk factors for STBs. None of these forms of evidence permits causal inferences, which is problematic because successful STB interventions must target the causes of STBs. To develop effective interventions, we must employ experimental designs to identify targets that are causal, necessary, and viable., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Many studies have documented robust relationships between depression and hopelessness and subsequent suicidal thoughts and behaviours; however, much weaker and non-significant effects have also been reported. These inconsistencies raise questions about whether and to what degree these factors confer risk for suicidal thoughts and behaviours.AimsThis study aimed to evaluate the magnitude and clinical utility of depression and hopelessness as risk factors for suicide ideation, attempts and death., Method: We conducted a meta-analysis of published studies from 1971 to 31 December 2014 that included at least one longitudinal analysis predicting suicide ideation, attempt or death using any depression or hopelessness variable., Results: Overall prediction was weaker than anticipated, with weighted mean odds ratios of 1.96 (1.81-2.13) for ideation, 1.63 (1.55-1.72) for attempt and 1.33 (1.18-1.49) for death. Adjusting for publication bias further reduced estimates. Effects generally persisted regardless of sample severity, sample age or follow-up length., Conclusions: Several methodological constraints were prominent across studies; addressing these issues would likely be fruitful moving forward.Declaration of interestNone.

Research on suicidal thoughts and behaviors (STB) has identified many risk factors, but whether these findings generalize to diverse populations remains unclear. We review longitudinal studies on STB risk factors over the past 50 years in the United States and evaluate the methodological practices of sampling and reporting sample characteristics. We found that articles frequently reported participant age and sex, less frequently reported participant race and ethnicity, and rarely reported participant veteran status or lesbian, gay, bisexual, and transgender status. Sample reporting practices modestly and inconsistently improved over time. Finally, articles predominantly featured White, non-Hispanic, young adult samples., (© 2017 The American Association of Suicidology.)

Background: Research has long noted higher prevalence rates of suicidal thoughts and behaviors among individuals with psychotic symptoms. Major theories have proposed several explanations to account for this association. Given the differences in the literature regarding the operationalization of psychosis and sample characteristics, a quantitative review is needed to determine to what extent and how psychosis confers risk for suicidality., Methods: We searched PsycInfo, PubMed, and GoogleScholar for studies published before 1 January 2016. To be included in the analysis, studies must have used at least one psychosis-related factor to longitudinally predict suicide ideation, attempt, or death. The initial search yielded 2541 studies. Fifty studies were retained for analysis, yielding 128 statistical tests., Results: Suicide death was the most commonly studied outcome (43.0%), followed by attempt (39.1%) and ideation (18.0%). The median follow-up length was 7.5 years. Overall, psychosis significantly conferred risk across three outcomes, with weighted mean ORs of 1.70 (1.39-2.08) for ideation, 1.36 (1.25-1.48) for attempt, and 1.40 (1.14-1.72) for death. Detailed analyses indicated that positive symptoms consistently conferred risk across outcomes; negative symptoms were not significantly associated with ideation, and were protective against death. Some small moderator effects were detected for sample characteristics., Conclusions: Psychosis is a significant risk factor for suicide ideation, attempt, and death. The finding that positive symptoms increased suicide risk and negative symptoms seemed to decrease risk sheds light on the potential mechanisms for the association between psychosis and suicidality. We note several limitations of the literature and offer suggestions for future directions.

Few risk factors for nonsuicidal self-injury (NSSI) have been identified. This study investigated diminished aversion toward self-injury (i.e., NSSI, suicide/death stimuli) and self-criticism as unique NSSI risk factors. After terminating a treatment study, 154 adults with a recent and frequent NSSI history completed self-report and computer-based measures of psychopathology, implicit and explicit self-criticism, and implicit aversion to NSSI and suicide/death. Participants were then contacted 4 weeks later to test factors predicting NSSI frequency over this follow-up period. Diminished aversion toward NSSI stimuli and self-criticism significantly predicted NSSI 4 weeks later. These effects were unique from other theoretically important predictors, such as past week NSSI frequency and total number of NSSI methods used. Findings provide support that erosion of barriers to NSSI (e.g., aversion to self-injurious stimuli, decreased self-worth) may facilitate continued engagement in these dangerous behaviors. Results shed light on potential treatment targets for NSSI., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: The field is in need of novel and transdiagnostic risk factors for suicide. The National Institute of Mental Health's Research Domain Criteria (RDoC) provides a framework that may help advance research on suicidal behavior., Method: We conducted a meta-analytic review of existing prospective risk and protective factors for suicidal thoughts and behaviors (ideation, attempts, and deaths) that fall within one of the five RDoC domains or relate to a prominent suicide theory. Predictors were selected from a database of 4,082 prospective risk and protective factors for suicide outcomes., Results: A total of 460 predictors met inclusion criteria for this meta-analytic review and most examined risk (vs. protective) factors for suicidal thoughts and behaviors. The overall effect of risk factors was statistically significant, but relatively small, in predicting suicide ideation (weighted mean odds ratio: wOR = 1.72; 95% CI: 1.59-1.87), suicide attempt (wOR = 1.66 [1.57-1.76), and suicide death (wOR = 1.41 [1.24-1.60]). Across all suicide outcomes, most risk factors related to the Negative Valence Systems domain, although effect sizes were of similar magnitude across RDoC domains., Conclusions: This study demonstrated that the RDoC framework provides a novel and promising approach to suicide research; however, relatively few studies of suicidal behavior fit within this framework. Future studies must go beyond the "usual suspects" of suicide risk factors (e.g., mental disorders, sociodemographics) to understand the processes that combine to lead to this deadly outcome., (© 2017 Wiley Periodicals, Inc.)

This prospective, naturalistic study examined the association between major loss life experiences, other psychiatric risk factors (depression, hopelessness, and anxiety), and suicidal thoughts and behaviors (STBs) among adolescents followed through young adulthood for up to 14 years. Major loss life events were related to subsequent increases in STBs. Major loss life events were primarily related to increases in suicide ideation in the presence of lower levels of other risk factors. There was a bidirectional relationship between major losses and other risk factors. Implications for the association between loss experiences, other risk factors, and future STBs are discussed., (© 2016 The American Association of Suicidology.)

In this response to the commentary by Nielsen, Kirtley, & Townsend (in press), the authors note several points of agreement related to further testing of therapeutic evaluative conditioning (TEC) for self-injurious thoughts and behaviors (SITBs), navigating logistical and ethical issues surrounding mobile interventions, and integrating such interventions into traditional practice. They also note a common mission held by Nielsen et al., themselves, and the SITB research community more broadly: the large-scale reduction of SITBs. Given that national rates of SITBs have never declined appreciably and have been on the rise in recent decades, there is an urgent need for progress toward this goal. However, they also highlight several unsupported or inaccurate assumptions and specific points made by Nielsen et al. that are important to correct for the sake of accuracy and progress in the prediction and prevention of SITBs. These include an overly narrow conceptualization of what constitutes an intervention; an unsupported model of the causes of SITBs and how to best prevent them; an erroneous belief about the iatrogenic effects of SITB stimulus exposure; and inaccuracies in their description of the development, testing, and release of TEC. The authors hope that this brief discussion of the evidence will facilitate progress toward the mission of large-scale reductions in SITBs. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Background: Certain demographic factors have long been cited to confer risk or protection for suicidal thoughts and behaviors. However, many studies have found weak or non-significant effects. Determining the effect strength and clinical utility of demographics as predictors is crucial for suicide risk assessment and theory development. As such, we conducted a meta-analysis to determine the effect strength and clinical utility of demographics as predictors., Methods: We searched PsycInfo, PubMed, and GoogleScholar for studies published before January 1st, 2015. Inclusion criteria required that studies use at least one demographic factor to longitudinally predict suicide ideation, attempt, or death. The initial search yielded 2,541 studies, 159 of which were eligible. A total of 752 unique statistical tests were included in analysis., Results: Suicide death was the most commonly studied outcome, followed by attempt and ideation. The average follow-up length was 9.4 years. The overall effects of demographic factors studied in the field as risk factors were significant but weak, and that of demographic factors studied as protective factors were non-significant. Adjusting for publication bias further reduced effect estimates. No specific demographic factors appeared to be strong predictors. The effects were consistent across multiple moderators., Conclusions: At least within the narrow methodological constraints of the existing literature, demographic factors were statistically significant risk factors, but not protective factors. Even as risk factors, demographics offer very little improvement in predictive accuracy. Future studies that go beyond the limitations of the existing literature are needed to further understand the effects of demographics.

Self-injurious behaviors (SIBs), including both suicidal and nonsuicidal self-injury, are major public health problems that have been on the rise in recent decades. There are few effective SIB interventions, and those that are effective cannot reach most people who are in need of help-that is, these interventions are not scalable. To address this need, we recently developed a scalable, app-based treatment called Therapeutic Evaluative Conditioning (TEC) that preliminary studies have shown causes reductions in SIBs (Franklin et al., 2016). Although TEC was developed and evaluated as a standalone, self-administered intervention, it may also be a valuable therapeutic tool within traditional clinical settings. Here we provide a case illustration of a young adult female who presented at an outpatient clinic with a long history of self-injurious behaviors and multiple failed treatment attempts. In discussing this case, we describe how to implement TEC within such a setting and what might be expected as a result., (© 2017 Wiley Periodicals, Inc.)

Suicidal thoughts and behaviors (STBs) are major public health problems that have not declined appreciably in several decades. One of the first steps to improving the prevention and treatment of STBs is to establish risk factors (i.e., longitudinal predictors). To provide a summary of current knowledge about risk factors, we conducted a meta-analysis of studies that have attempted to longitudinally predict a specific STB-related outcome. This included 365 studies (3,428 total risk factor effect sizes) from the past 50 years. The present random-effects meta-analysis produced several unexpected findings: across odds ratio, hazard ratio, and diagnostic accuracy analyses, prediction was only slightly better than chance for all outcomes; no broad category or subcategory accurately predicted far above chance levels; predictive ability has not improved across 50 years of research; studies rarely examined the combined effect of multiple risk factors; risk factors have been homogenous over time, with 5 broad categories accounting for nearly 80% of all risk factor tests; and the average study was nearly 10 years long, but longer studies did not produce better prediction. The homogeneity of existing research means that the present meta-analysis could only speak to STB risk factor associations within very narrow methodological limits-limits that have not allowed for tests that approximate most STB theories. The present meta-analysis accordingly highlights several fundamental changes needed in future studies. In particular, these findings suggest the need for a shift in focus from risk factors to machine learning-based risk algorithms. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Self-injurious behaviors (SIBs) are leading causes of death and injury. Unfortunately, disagreement regarding whether and how to classify suicidal and nonsuicidal SIBs has contributed to their misclassification, likely hindering clinical care and impeding scientific progress. The present study utilized a data-driven approach to facilitate classification and measurement of three forms of SIBs, with a particular focus on one with scant clinical and scientific attention: nonsuicidal overdoses (i.e. intentional overdoses where the person states that they had no intention of dying from the overdose). Results from this study demonstrated that nonsuicidal overdoses were similar to suicide attempts in terms of age of onset, and similar to nonsuicidal self-injury (NSSI) in terms of suicidal thoughts and desire to die when engaging in these behaviors. Nonsuicidal overdoses were unique from NSSI and suicide attempts in terms of the reported likelihood of dying from the behavior. The present study highlighted that current definitions for nonsuicidal behaviors (including requirements that the person has zero intent to die) may not accurately represent people's intent when engaging in these behaviors. Additionally, the present study highlighted that empirical analysis of SIBs can provide important insights for classification of SIBs., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Prior studies have proposed a wide range of potential biological risk factors for future suicidal behaviors. Although strong evidence exists for biological correlates of suicidal behaviors, it remains unclear if these correlates are also risk factors for suicidal behaviors. We performed a meta-analysis to integrate the existing literature on biological risk factors for suicidal behaviors and to determine their statistical significance. We conducted a systematic search of PubMed, PsycInfo and Google Scholar for studies that used a biological factor to predict either suicide attempt or death by suicide. Inclusion criteria included studies with at least one longitudinal analysis using a biological factor to predict either of these outcomes in any population through 2015. From an initial screen of 2541 studies we identified 94 cases. Random effects models were used for both meta-analyses and meta-regression. The combined effect of biological factors produced statistically significant but relatively weak prediction of suicide attempts (weighted mean odds ratio (wOR)=1.41; CI: 1.09-1.81) and suicide death (wOR=1.28; CI: 1.13-1.45). After accounting for publication bias, prediction was nonsignificant for both suicide attempts and suicide death. Only two factors remained significant after accounting for publication bias-cytokines (wOR=2.87; CI: 1.40-5.93) and low levels of fish oil nutrients (wOR=1.09; CI: 1.01-1.19). Our meta-analysis revealed that currently known biological factors are weak predictors of future suicidal behaviors. This conclusion should be interpreted within the context of the limitations of the existing literature, including long follow-up intervals and a lack of tests of interactions with other risk factors. Future studies addressing these limitations may more effectively test for potential biological risk factors.

Objective: Self-injurious thoughts and behaviors (SITBs) are a major public health problem that traditional interventions have been unable to address on a large scale. The goal of this series of studies was to take initial steps toward developing an effective SITB treatment that can be easily delivered on a very large scale., Method: We created a brief (1-2 min), game-like app called Therapeutic Evaluative Conditioning (TEC), designed to increase aversion to SITBs and decrease aversion to the self. In 3 separate studies, we recruited participants with recent and severe histories of SITBs from web forums focused on self-injury and psychopathology (Ns = 114, 131, and 163) and randomly assigned them to receive access to the mobile treatment TEC app or a control app for 1 month. We tested the effect of TEC on the frequency of self-cutting, nonsuicidal self-injury more generally, suicide ideation, suicide plans, and suicidal behaviors., Results: Analyses showed that, compared with the control app, TEC produced moderate reductions for all SITBs except suicide ideation. Across studies, the largest and most consistent reductions were for self-cutting episodes (32%-40%), suicide plans (21%-59%), and suicidal behaviors (33%-77%). Two of the 3 studies showed that TEC impacted its intended treatment targets and that greater change in these targets was associated with greater SITB reductions. TEC effects were not maintained at the 1-month posttreatment follow-up., Conclusions: Future versions of brief, mobile interventions like that tested here may have the potential to reduce SITBs and related behaviors on a large scale. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Suicidal thoughts and behaviors are highly prevalent public health problems with devastating consequences. There is an urgent need to improve our understanding of risk factors for suicide to identify effective intervention targets. The aim of this meta-analysis was to examine the magnitude and clinical utility of anxiety and its disorders as risk factors for suicide ideation, attempts, and deaths. We conducted a literature search through December 2014; of the 65 articles meeting our inclusion criteria, we extracted 180 cases in which an anxiety-specific variable was used to longitudinally predict a suicide-related outcome. Results indicated that anxiety is a statistically significant, yet weak, predictor of suicide ideation (OR=1.49, 95% CI: 1.18, 1.88) and attempts (OR=1.64, 95% CI: 1.47, 1.83), but not deaths (OR=1.01, 95% CI: 0.87, 1.18). The strongest associations were observed for PTSD. Estimates were reduced after accounting for publication bias, and diagnostic accuracy analyses indicated acceptable specificity but poor sensitivity. Overall, the extant literature suggests that anxiety and its disorders, at least when these constructs are measured in isolation and as trait-like constructs, are relatively weak predictors of suicidal thoughts and behaviors over long follow-up periods. Implications for future research priorities are discussed., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: A history of self-injurious thoughts and behaviors (SITBs) is consistently cited as one of the strongest predictors of future suicidal behavior. However, stark discrepancies in the literature raise questions about the true magnitude of these associations. The objective of this study is to examine the magnitude and clinical utility of the associations between SITBs and subsequent suicide ideation, attempts, and death., Method: We searched PubMed, PsycInfo, and Google Scholar for papers published through December 2014. Inclusion required that studies include at least one longitudinal analysis predicting suicide ideation, attempts, or death using any SITB variable. We identified 2179 longitudinal studies; 172 met inclusion criteria., Results: The most common outcome was suicide attempt (47.80%), followed by death (40.50%) and ideation (11.60%). Median follow-up was 52 months (mean = 82.52, s.d. = 102.29). Overall prediction was weak, with weighted mean odds ratios (ORs) of 2.07 [95% confidence interval (CI) 1.76-2.43] for ideation, 2.14 (95% CI 2.00-2.30) for attempts, and 1.54 (95% CI 1.39-1.71) for death. Adjusting for publication bias further reduced estimates. Diagnostic accuracy analyses indicated acceptable specificity (86-87%) and poor sensitivity (10-26%), with areas under the curve marginally above chance (0.60-0.62). Most risk factors generated OR estimates of <2.0 and no risk factor exceeded 4.5. Effects were consistent regardless of sample severity, sample age groups, or follow-up length., Conclusions: Prior SITBs confer risk for later suicidal thoughts and behaviors. However, they only provide a marginal improvement in diagnostic accuracy above chance. Addressing gaps in study design, assessment, and underlying mechanisms may prove useful in improving prediction and prevention of suicidal thoughts and behaviors.

Nonsuicidal self-injury (NSSI) is a prevalent and dangerous phenomenon associated with many negative outcomes, including future suicidal behaviors. Research on these behaviors has primarily focused on correlates; however, an emerging body of research has focused on NSSI risk factors. To provide a summary of current knowledge about NSSI risk factors, we conducted a meta-analysis of published, prospective studies longitudinally predicting NSSI. This included 20 published reports across 5078 unique participants. Results from a random-effects model demonstrated significant, albeit weak, overall prediction of NSSI (OR=1.59; 95% CI: 1.50 to 1.69). Among specific NSSI risk factors, prior history of NSSI, cluster b, and hopelessness yielded the strongest effects (ORs>3.0); all remaining risk factor categories produced ORs near or below 2.0. NSSI measurement, sample type, sample age, and prediction case measurement type (i.e., binary versus continuous) moderated these effects. Additionally, results highlighted several limitations of the existing literature, including idiosyncratic NSSI measurement and few studies among samples with NSSI histories. These findings indicate that few strong NSSI risk factors have been identified, and suggest a need for examination of novel risk factors, standardized NSSI measurement, and study samples with a history of NSSI., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The recently proposed Research Domain Criteria (RDoC) project has the potential to stimulate new research and overcome many of the limitations of the Diagnostic and Statistical Manual of Mental Disorders taxonomy. In the present article we focus, in three main sections, on how theory and research from developmental psychopathology can inform RDoC. First, we discuss the ontology of mental illness and the potential advantages of the RDoC approach to understanding the nature of mental illness. Second, we note potential issues to consider when implementing the RDoC framework, including (a) integrating developmental processes, (b) classifying mental illness within a dimensional approach, and (c) avoiding problems associated with biological reductionism. Third, we describe how a developmental psychopathology perspective may inform each of these potential issues within RDoC. Finally, we highlight the study of emotion and the centrality of affective processes within the RDoC framework. Specifically, we describe how constructionist models of emotion are consistent with developmental psychopathology and how this perspective on emotion can help to guide RDoC research.

The purpose of this study was to review the current evidence base of psychosocial treatments for suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) in youth. We reviewed major scientific databases (HealthSTAR, MEDLine, PsycINFO, PubMed) for relevant studies published prior to June 2013. The search identified 29 studies examining interventions for suicidal or nonsuicidal SITBs in children or adolescents. No interventions currently meet the Journal of Clinical Child and Adolescent Psychology standards for Level 1: well-established treatments. Six treatment categories were classified as Level 2: probably efficacious or Level 3: possibly efficacious for reducing SITBs in youth. These treatments came from a variety of theoretical orientations, including cognitive-behavioral, family, interpersonal, and psychodynamic theories. Common elements across efficacious treatments included family skills training (e.g., family communication and problem solving), parent education and training (e.g., monitoring and contingency management), and individual skills training (e.g., emotion regulation and problem solving). Several treatments have shown potential promise for reducing SITBs in children and adolescents. However, the probably/possibly efficacious treatments identified each have evidence from only a single randomized controlled trial. Future research should focus on replicating studies of promising treatments, identifying active treatment ingredients, examining mediators and moderators of treatment effects, and developing brief interventions for high-risk periods (e.g., following hospital discharge).

Although non-suicidal self-injury (NSSI) involves self-inflicted physical harm, many self-injurers report feeling little or no pain during the act. Here we test: (1) whether the pain analgesia effects observed among adult self-injurers are also present among adolescents, and (2) three potential explanatory models proposing that habituation, dissociation, and/or self-criticism help explain the association between NSSI and pain analgesia among adolescents. Participants were 79 adolescents (12-19 years) recruited from the community who took part in a laboratory-based pain study. Results revealed that adolescent self-injurers have a higher pain threshold and greater pain endurance than non-injurers. Statistical mediation models revealed that the habituation and dissociation models were not supported; however, a self-critical style does mediate the association between NSSI and pain analgesia. The present findings extend earlier work by highlighting that a self-critical style may help to explain why self-injurers exhibit pain analgesia. Specifically, the tendency to experience self-critical thoughts in response to stressful events may represent a third variable that increases the likelihood of both NSSI and pain analgesia. Prospective experimental studies are needed to replicate and tease apart the direction of these associations, and may provide valuable leads in the development of effective treatments for this dangerous behavior problem., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

There is a pressing need to improve the ability to identify individuals at risk for nonsuicidal self-injury (NSSI; e.g., cutting or burning oneself); unfortunately, beyond prior NSSI, there are few powerful longitudinal predictors of NSSI. The present study addressed this limitation by investigating the ability of a novel factor--low aversion to self-cutting stimuli--to longitudinally predict NSSI in 49 individuals with a history of self-cutting. Results revealed that both low implicit and explicit aversion to self-cutting stimuli were significantly associated with future NSSI (rs = .32-.51), and that these associations were unique from several other theoretically important predictors, including prior NSSI, number of NSSI methods, implicit identification with self-cutting, self-prediction of future NSSI, emotion dysregulation, and therapy status. These findings are consistent with the notion that instinctive barriers (e.g., aversion to NSSI stimuli, pain) dissuade most people from engaging in NSSI, and that the erosion of these barriers may facilitate NSSI.

Chronic pain conditions are associated with an elevated risk for suicide. Of particular importance is the question of why pain conditions might be linked to increased suicide risk. We discuss the association between chronic pain and psychological pain, particularly in the context of depression, and the use of suicide as an attempt to escape from what is perceived as unbearable suffering. We also consider the role that chronic pain may play in increasing the capacity for suicide. Bridging across research areas and drawing on the interpersonal-psychological theory of suicide, we suggest that chronic pain may facilitate the development of a key risk factor for suicide: fearlessness about death. Given that chronic pain can lead to (and be exacerbated by) depression, engender hopelessness, facilitate a desire for escape through death, and erode the natural fear of dying, clinicians must be aware of psychological processes that can combine to create elevated suicide risk in patients with chronic pain, and they should also assess and treat suicide risk factors in these patients.

Although pain itself induces negative affect, the removal (or offset) of pain induces a powerful state of relief. Despite being implicated in a wide range of psychological and behavioral phenomena, relief remains a poorly understood emotion. In particular, some theorists associate relief with increased positive affect, whereas others associate relief with diminished negative affect. In the present study, we examined the affective nature of relief in a pain-offset paradigm with psychophysiological measures that were specific to negative valence (startle eyeblink reactivity) and positive valence (startle postauricular reactivity). Results revealed that pain offset simultaneously stimulates positive affect and diminishes negative affect for at least several seconds. Results also indicated that pain intensity differentially affects the positive and negative valence aspects of relief. These findings clarify the affective nature of relief and provide insight into why people engage in both normal and abnormal behaviors associated with relief.

Startle habituation is present in all startle studies, whether as a dependent variable, discarded habituation block, or ignored nuisance. However, there is still much that remains unknown about startle habituation, including the following: (1) what is the nature of the startle habituation curve?; (2) at what point does startle habituation approach an asymptote?; and (3) are there gender differences in startle habituation? The present study investigated these three questions in a sample of 94 undergraduates using both traditional means-based statistical methods and latent curve modeling. Results provided new information about the nature of the startle habituation curve, indicated that the optimal number of habituation trials with a 100dB startle stimulus is 13, and showed that females display greater startle reactivity but habituate toward the same level as males., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Nonsuicidal self-injury (NSSI) is the deliberate destruction of one's own body tissue in the absence of suicidal intent (e.g., cutting or burning the skin). Previous studies have found that people with a history of NSSI display diminished pain perception. However, it remains unclear why this effect occurs. In the present study, we used a sample of participants with (n = 25) and without (n = 47) a history of NSSI to test the hypothesis that emotion dysregulation partially explains why NSSI is associated with diminished pain perception. Pain perception was quantified as pain threshold, pain tolerance, and pain intensity ratings assessed during the cold pressor task. Nonsuicidal self-injury was associated with increased emotion dysregulation and diminished pain perception. Results showed that emotion dysregulation was correlated with diminished pain perception within both groups, demonstrating that this association exists regardless of NSSI history. Results also specified that emotion dysregulation partially accounted for the association between NSSI and pain tolerance but not other pain variables. Overall, results were consistent with the hypothesis that emotion dysregulation may increase NSSI risk in part by increasing the willingness to experience the pain involved in self-injury. Studies are needed to more directly investigate this hypothesis., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Joiner's (2005) interpersonal-psychological theory of suicide hypothesizes that painful and provocative events increase pain tolerance. The theory further proposes that increased pain tolerance represents one component of increased suicidal capability. Although initial studies have been consistent with this model, several key aspects remain untested. In 67 undergraduates, we investigated associations among painful and provocative events, nonsuicidal self-injury, acquired capability for suicide, and pain tolerance, threshold, and perceived intensity. Results were highly consistent with the interpersonal-psychological theory: a multiple mediation model specified that pain tolerance - but not other pain variables - accounted for significant variance within the association between painful and provocative events and acquired capability for suicide. These results held even when the pain tolerance item was removed from the suicidal capability questionnaire. Results also supported the interpersonal-psychological theory hypothesis that nonsuicidal self-injury represents an important painful and provocative event that increases suicidal capability. Specifically, participants with a history of nonsuicidal self-injury displayed increased suicidal capability and decreased pain perception. Overall, these results indicate that pain tolerance plays an important and specific role in suicidal capability., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Monosomy 1p36 is a clinically recognizable syndrome that is considered to be the most common terminal deletion syndrome. It has characteristic clinical features that include craniofacial dysmorphism, congenital anomalies, hearing deficits, developmental delay, mental retardation, hypotonia, seizures, and brain anomalies. Brain anomalies in patients with 1p36 deletion are frequent but inconsistent. To date, 2 cases with monosomy 1p36 associated with periventricular nodular heterotopia (PNH) have been reported. We report a 2-month-old boy with multiple congenital anomalies; brain magnetic resonance imaging revealed PNH. The first 2 described cases were pure terminal deletions, whereas our patient carried unbalanced translocation due to an adjacent 1 segregation of a balanced maternal translocation, resulting in monosomy 1p36.3 and trisomy 19p13.3 identified by whole-genome array comparative genomic hybridization analysis. Our patient, with a smaller deletion that the 2 previously reported cases, can help narrow the critical region for PNH in association with the 1p36 deletion. Several potential candidate genes are discussed., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Although research on the reasons for engaging in nonsuicidal self-injury (NSSI) has increased dramatically in the last few years, there are still many aspects of this pernicious behavior that are not well understood. The purpose of this study was to address these gaps in the literature, with a particular focus on investigating whether NSSI (a) regulates affective valence in addition to affective arousal and (b) serves a cognitive regulation function in addition to an affect regulation function. To elucidate these issues, the present study utilized a sample of 112 participants (33 controls, 39 no pain controls, 16 NSSI individuals, and 24 controls matching the affect dysregulation levels of the NSSI group), employed psychophysiological measures of affective valence (startle-alone reactivity) and quality of information processing (prepulse inhibition), and used experimental methods involving an NSSI-proxy to model the NSSI process. Results largely were consistent with predictions, supporting the hypotheses that NSSI serves to regulate cognitive processing and affective valence. On this latter point, however, the control groups also showed a decrease in negative affective valence after the NSSI-proxy. This unexpected finding is consistent with the hypothesis that opponent processes may contribute to the development of self-injurious behaviors (Joiner, 2005). Overall, the present study represents an important extension of previous laboratory NSSI studies and provides a fertile foundation for future studies aimed at understanding why people engage in NSSI., (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Research suggests that adolescents' engagement in nonsuicidal self-injurious (NSSI) behaviors may be increasing over time, yet little is known regarding distal longitudinal factors that may promote engagement in these behaviors. Data from two longitudinal studies are presented to examine whether NSSI may be associated with peer influence processes. Study 1 included 377 adolescents from a community-based sample; Study 2 included 140 clinically-referred adolescents recruited from a psychiatric inpatient facility. In Study 1, adolescents' NSSI was examined at baseline and one year later. Adolescents' nominated best friend reported their own levels of NSSI. In Study 2, adolescents' NSSI was examined at baseline as well as 9 and 18-months post-baseline. Adolescents' perceptions of their friends' engagement in self-injurious behavior (including suicidality) and depressed mood also were examined at all three time points. Baseline depressive symptoms were measured in both studies; gender and age were examined as moderators of peer influence effects. Results from both studies supported longitudinal peer socialization effects of friends' self-injurious behavior on adolescents' own NSSI for girls, but not for boys, even after controlling for depressive symptoms as a predictor. Study 1 suggested socialization effects mostly for younger youth. Results from Study 2 also suggested longitudinal socialization effects, as well as peer selection effects; adolescents' NSSI was associated with increasing perceptions of their friends' engagement in depressive/self-injurious thoughts and behavior. Findings contribute to the nascent literature on longitudinal predictors of NSSI and to work on peer influence.

Previous studies of the relationship between anger, anger expression, and suicidal behavior have been largely cross-sectional and have yielded mixed findings. In a prospective, naturalistic study, we examined how trait anger and anger expression influenced the likelihood of suicide attempts among 180 adolescents followed for up to 13.3 years after discharge from an inpatient psychiatry unit. Results showed that higher trait anger and anger expressed outwardly over the follow-up was related to increased likelihood of suicide attempts among boys. For girls, trait anger and both the inward and outward expression of anger moderated the risk for suicide attempts associated with major depression. These results are interpreted in light of theory regarding behavioral activation and behavioral inhibition systems.

Down syndrome (DS) is one of the most frequent congenital birth defects, and the most common genetic cause of mental retardation. In most cases, DS results from the presence of an extra copy of chromosome 21. DS has a complex phenotype, and a major goal of DS research is to identify genotype-phenotype correlations. Cases of partial trisomy 21 and other HSA21 rearrangements associated with DS features could identify genomic regions associated with specific phenotypes. We have developed a BAC array spanning HSA21q and used array comparative genome hybridization (aCGH) to enable high-resolution mapping of pathogenic partial aneuploidies and unbalanced translocations involving HSA21. We report the identification and mapping of 30 pathogenic chromosomal aberrations of HSA21 consisting of 19 partial trisomies and 11 partial monosomies for different segments of HSA21. The breakpoints have been mapped to within approximately 85 kb. The majority of the breakpoints (26 of 30) for the partial aneuploidies map within a 10-Mb region. Our data argue against a single DS critical region. We identify susceptibility regions for 25 phenotypes for DS and 27 regions for monosomy 21. However, most of these regions are still broad, and more cases are needed to narrow down the phenotypic maps to a reasonable number of candidate genomic elements per phenotype.