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Background: Childhood trauma is associated with a variety of negative outcomes in psychosis, but it is unclear clear if childhood trauma affects day-to-day social experiences. We aimed to examine the association between childhood trauma and functional and structural characteristics of real-world social relationships in psychosis. Methods: Participants with psychotic disorders or affective disorders with psychosis completed ecological momentary assessments (EMAs) over ten days (N = 209). Childhood trauma was assessed retrospectively using the Childhood Trauma Questionnaire. Associations between childhood trauma and EMA-assessed social behavior and perceptions were examined using linear mixed models. Analyses were adjusted for sociodemographic characteristics and psychotic and depressive symptom severity. Results: Higher levels of childhood trauma were associated with more perceived threat (B = −0.19, 95 % CI [−0.33, −0.04]) and negative self-perception (B = −0.18, 95 % CI [−0.34, −0.01]) during recent social interactions, as well as reduced social motivation (B = −0.29, 95 % CI [−0.47, −0.10]), higher desire for social avoidance (B = 0.34, 95 % CI [0.14, 0.55]), and lower sense of belongingness (B = −0.24, 95 % CI [−0.42, −0.06]). These negative social perceptions were mainly linked with emotional abuse and emotional neglect. In addition, paranoia was more strongly associated with negative social perceptions in individuals with high versus low levels of trauma. Childhood trauma was not associated with frequency (i.e., time spent alone) or type of social interactions. Conclusion: Childhood trauma – particularly emotional abuse and neglect – is associated with negative social perceptions but not frequency of real-world social interactions. Our findings suggest that childhood trauma may affect day-to-day social experiences beyond its association with psychosis.

This study compared the "next day appointment" (NDA) use of the Collaborative Assessment and Management of Suicidality (CAMS) to treatment as usual (TAU) for individuals discharged from the hospital following a suicide-related crisis. We hypothesized that CAMS would significantly reduce suicidal thoughts and behaviors as well as improve psychological distress, quality of life/overall functioning, treatment retention and patient satisfaction.Participants were 150 individuals who had at least one lifetime actual, aborted, or interrupted attempt and were admitted following a suicide-related crisis. There were 75 participants in the experimental condition who received adherent CAMS and 75 participants who received TAU. Suicidal thoughts and behaviors, psychological distress, and quality of life/overall functioning were assessed at baseline and at 1, 3, 6, and 12 months post-baseline. Treatment retention and patient satisfaction were assessed at post-treatment.Participants in both conditions improved from baseline to 12 months but CAMS was not superior to TAU for the primary outcomes. A small but significant improvement was found in probability of suicidal ideation at 3 months favoring TAU and amount of suicidal ideation at 12 months favoring CAMS. CAMS participants experienced less psychological distress at 12 months compared to baseline.The study was limited by only one research clinic, lower than expected recruitment, and imbalance of suicidal ideation at baseline.All participants improved but CAMS was not more effective than TAU. The NDA clinic was feasible and acceptable to clients and staff in both conditions and future research should investigate its potential benefit.

Psychosis is associated with increased suicide risk. Safety planning is a suicide prevention practice that is associated with decreased suicidal behavior and psychiatric hospitalizations. A common feature of safety planning is listing of crisis line numbers. The primary purpose of this study was to compare Veterans with and without psychosis who completed a safety plan in terms of their next year crisis service use, including Veterans Crisis Line (VCL) calls, and suicidal behavior.Data were drawn from the VA San Diego's electronic medical record system for (N = 1602) safety plans from 2018 to 2021. Clinical records of crisis services and suicide attempt/death were recorded for one year after the safety plan.Following completion of a safety plan, Veterans with psychosis were more likely to have a next year psychiatric hospitalization (OR = 4.1), emergency department visit (OR = 2.3), and psychiatric emergency clinic visit (OR = 2.2) than those without psychosis. In contrast, there were no group differences in likelihood of calling the VCL.Veterans with psychosis who recently completed a safety plan do not show elevated rates of VCL use that are commensurate with increases in crisis service use. Interventions for this high-risk group may focus on understanding the motivation and ability to call the VCL as ways to enhance safety planning.

Abstract. Background: Although there are several studies focusing on group models for therapy specific to suicidal thoughts and behaviors, scoping reviews providing an overview of these studies’ findings are limited. Aims: The aim of this paper was to conduct a scoping review of group therapies that explicitly target suicidal thoughts and behaviors (i.e., suicide-focused) for adults and their suicide-related outcomes. Methods: Following the PRISMA-ScR guidelines, a literature search using PubMed, Cochrane Library, and PsycINFO to identify relevant records published between 2000 and 2021 as well as a review of reference lists from relevant records was conducted. Results: There were 14 records identified with 12 unique suicide-focused group therapies. Even with variable methodological designs, sample sizes ( M = 136, SD = 98), and population targeted, all records showed reductions in suicide-related outcomes by the end of the therapy; although most were not powered to determine effectiveness. Limitations: This review only included records written in English and excluded support groups that were led by peers as the focus was on therapy groups and gray literature. Conclusions: There are few evaluated therapy groups that explicitly address suicidal thoughts and behaviors. Available data indicate suicide-focused group therapy are generally feasible, acceptable, and may reduce suicidal-related outcomes. This is encouraging for future research; recommendations to include randomized controlled trials of the efficacy of suicide-focused group therapy are discussed.

Safety planning is a suicide prevention intervention that relies partly on an individual's social relationships as distractions during or help in a suicidal crisis. The primary objectives of this study were to estimate rates of missingness on social aspects of safety plans to determine whether rates differ by demographic characteristics and diagnoses and to examine whether missing social contacts on safety plans may affect clinical outcomes.Data were drawn from the U.S. Department of Veterans Affairs San Diego Healthcare System's electronic medical record (N=1,602 individuals) from 2018 to 2021. Safety plans were coded according to the absence of listed distraction or help contacts, and clinical records of suicide attempts, suicide deaths, and use of crisis services were recorded for 1 year after completion of the safety plan.In total, 30% of plans lacked a contact for distraction or help. Male veterans were less likely to have a distraction contact listed, and veterans identifying as Hispanic or Latino were more likely to have a help contact listed. The lack of a help contact (odds ratio [OR]=2.11) and having neither distraction nor help contacts (OR=2.45) were associated with a markedly higher risk for next-year suicide attempt or death. The lack of a help contact was associated with increased odds of a next-year psychiatric inpatient hospitalization (OR=1.90) and an emergency department visit (OR=1.88).A lack of social contacts on safety plans may be a potential indicator for increased suicide risk among veterans.

BackgroundCognitive tasks delivered during ecological momentary assessment (EMA) may elucidate the short-term dynamics and contextual influences on cognition and judgements of performance. This paper provides initial validation of a smartphone task of facial emotion recognition in serious mental illness.MethodsA total of 86 participants with psychotic disorders (non-affective and affective psychosis), aged 19–65, were administered in-lab ‘gold standard’ affect recognition, neurocognition, and symptom assessments. They subsequently completed 10 days of the mobile facial emotion recognition task, assessing both accuracy and self-assessed performance, along with concurrent EMA of psychotic symptoms and mood. Validation focused on task adherence and predictors of adherence, gold standard convergent validity, and symptom and diagnostic group variation.ResultsThe mean rate of adherence to the task was 79%; no demographic or clinical variables predicted adherence. Convergent validity was observed with in-lab measures of facial emotion recognition, and no practice effects were observed on the mobile facial emotion recognition task. EMA reports of more severe voices, sadness, and paranoia were associated with worse performance, whereas mood more strongly associated with self-assessed performance.ConclusionThe mobile facial emotion recognition task was tolerated and demonstrated convergent validity with in-lab measures of the same construct. Social cognitive performance, and biased judgements previously shown to predict function, can be evaluated in real-time in naturalistic environments.

Objective There is growing interest in the development of composite precision treatment rules (PTRs) to guide the selection of the treatments most likely to be helpful for individual patients. We present here the results of an effort to develop a preliminary PTR for Collaborative Assessment and Management of Suicidality (CAMS) relative to enhanced-care as usual based on secondary analysis of the Operation Worth Living (OWL) randomized controlled trial. The outcome of interest is eliminating suicide ideation (SI) within 3 months of initiating treatment. Method A state-of-the-art ensemble machine learning method was used to develop the PTR among the n = 148 U.S. Soldiers (predominately male and White, age range 18-48) OWL patients. Results We estimated that CAMS was the better treatment for 77.8% of patients and that treatment assignment according to the PTR would result in a 13.6% (95% CI: 0.9%-26.3%) increase in 3-month SI remission compared to random treatment assignment. Conclusions Although promising, results are limited by the small sample size, restrictive baseline assessment, and inability to evaluate effects on suicidal behaviors or disaggregate based on history of suicidal behaviors. Replication is needed in larger samples with comprehensive baseline assessments, longer-term follow-ups, and more extensive outcomes.

Objective A novel avatar system (Virtual Collaborative Assessment and Management of Suicidality System; V-CAMS) for suicidal patients and medical personnel in emergency departments (EDs) was developed and evaluated. V-CAMS facilitates the delivery of CAMS and other evidence-based interventions to reduce unnecessary hospitalization, readmissions, and suicide following an ED visit. Method Using iterative user-centered design with 24 suicidal patients, an avatar prototype, “Dr. Dave” (based on Dr. Jobes) was created, along with other patient-facing tools; provider-facing tools, including a clinical decision support tool were also designed and tested to aid discharge disposition. Results Feasibility tests supported proof of concept. Suicidal patients affirmed the system's overall merit, positive Perception of Care, and acceptability; medical providers (n = 21) viewed the system as an efficient, effective, and safe method of improving care for suicidal ED patients and reducing unnecessary hospitalization. Conclusions Technology tools including a patient-facing avatar and e-caring contacts, along with provider-facing tools may offer a powerful method of facilitating best-practice suicide prevention interventions and point-of-care tools for suicidal patients seeking ED services and their medical providers. Future directions include full development of V-CAMS and integration into a health electronic medical record and a rigorous randomized controlled trial to study its effectiveness.

Even though suicide theories highlight the importance of interpersonal connection, little is known about how romantic relationships impact suicide risk among military personal seeking treatment for suicidal thoughts and behaviors. Data were drawn from active-duty U.S. Soldier participants with suicidal ideation engaged in a suicide-focused treatment – the Collaborative Assessment and Management of Suicidality (CAMS). This exploratory study used a mixed-methods approach to examine two aims: (a) frequencies in which romantic relationships were endorsed in the context of the initial the Suicide Status Form (SSF; the multipurpose clinical tool used in CAMS) and (b) if having endorsed romantic relationships were implicated in their suicidal thoughts and self-inflicted injuries regardless of intent (i.e., non-suicidal self-injury and suicide attempts). We found that 76% of participants mentioned a romantic partner in at least one qualitative assessment item on the SSF. More specifically, 22.6% identified their romantic relationship as a reason for living or a reason for dying, and half of those participants indicated that their romantic relationship was both a reason for living and dying. Soldier participants who identified a current romantic relationship problem, were significantly more likely to have made a self-inflicted injury regardless of intent in their lifetime. Overall, suicidal thoughts and behaviors are intertwined with romantic relationship dynamics, and suicide-focused interventions may benefit from directly addressing these relationship issues with active-duty Soldiers.

There is a need to develop, evaluate, and implement interventions that reduce Veteran suicide. Caring Cards (CC) is a novel intervention that integrates aspects of caring contacts and peers (i.e., persons with lived mental health experience). In CC, Veterans meet in a weekly group to create hope-filled cards that are sent to Veterans with mental health concerns. This study will examine feasibility and acceptability of CC with Veterans with a history of and current elevated suicide risk via in-person and virtual modalities and preliminarily evaluate pre/post changes on suicide-specific outcomes.This 2-year open-trial study will employ a pre/post research design. Recruited Veterans with a history of suicide risk (This study builds on preliminary data which indicate Veterans are interested in and find participating in CC highly meaningful. This study is innovative as it will target two new Veteran populations and use both in-person and virtual modalities. If feasible and acceptable, a large-scale efficacy trial will be conducted to further examine CC as a suicide prevention intervention for Veterans.

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

Introduction This pilot study investigates feasibility and acceptability of Caring Cards, a suicide prevention intervention inspired by Caring Contacts and the Recovery Model, where Veteran peers create cards that are sent to Veterans recently discharged from a VA psychiatric hospitalization for suicide risk. Methods Caring Cards consists of: (1) a weekly outpatient group where Veterans (card makers) create cards, and (2) sending cards to recently discharged Veterans (card recipients). Feasibility for card makers was measured by attendance; acceptability (satisfaction) was examined. Card recipients were sent one caring card, one week post-discharge. Feasibility for recipients was measured by the percentage of Veterans that met eligibility and follow-up response rate; acceptability (satisfaction) was examined. Results Caring Cards is feasible and acceptable. The outpatient group had a higher attendance rate (81%) compared with other clinic groups. The percentage of eligible card recipients was 61%. Of these, 69% were reached for follow-up and 50% provided follow-up responses. Card makers and recipients both expressed positive experiences with Caring Cards. Conclusion Caring Cards is a low-intensity, feasible, and acceptable intervention with potential benefits for both Veteran card makers and recipients. Additional research is needed to determine the efficacy of Caring Cards as a suicide prevention intervention.

Given historically high rates of suicide among military personnel over the past decade the present study analyzed whether key demographic, military, and research-based variables moderated clinical ...

Social-environmental factors have been found to be an integral part in the recovery process for individuals with psychiatric disabilities. There are few studies that have obtained patient perspectives of how their social and treatment environments help facilitate or impede the recovery process. The following study examined the self-reported interpersonal barriers to recovery among a sample of individuals (N = 31) with borderline personality disorder who were receiving dialectical behaviour therapy. The goal of study was to identify self-reported problematic behaviour that interferes with recovery goals and identify types of family, friend and/or provider behaviours that increased the likelihood of patients engaging in these problematic behaviours. A content analysis yielded three themes of problematic behaviour, and how these behaviours were reinforced by others, including (1) avoidance behaviours, (2) encouragement of negative coping and (3) communication of low behavioural expectations. Implications for the impact of these patterns of reinforcement within behavioural health settings are discussed. Copyright © 2017 John Wiley & Sons, Ltd.

This study describes a randomized controlled trial called "Operation Worth Living" (OWL) which compared the use of the Collaborative Assessment and Management of Suicidality (CAMS) to enhanced care as usual (E-CAU). We hypothesized that CAMS would be more effective than E-CAU for reducing suicidal ideation (SI) and suicide attempts (SA), along with secondary behavioral health and health care utilization markers for U.S. Army Soldier outpatients with significant SI (i.e.,13 on Beck's Scale for Suicide Ideation).Study participants were 148 Soldiers who presented to a military outpatient behavioral health clinic. There were 73 Soldiers in the experimental arm of the trial who received adherent CAMS; 75 Soldiers received E-CAU. Nine a-priori treatment outcomes (SI, past year SA, suicide-related emergency department (ED) admits, behavioral health-related ED admits, suicide-related inpatient psychiatric unit (IPU) days, behavioral health-related IPU days, mental health, psychiatric distress, resiliency) were measured through assessments at Baseline and at 1, 3, 6, and 12 months post-Baseline (with a 78% retention of intent-to-treat participants at 12 months).Soldiers in both arms of the trial responded to study treatments in terms of all primary and secondary outcomes (effect sizes ranged from 0.63 to 12.04). CAMS participants were significantly less likely to have any suicidal thoughts by 3 months in comparison to those in E-CAU (Cohen's d = 0.93, p=.028).Soldiers receiving CAMS and E-CAU significantly improved post-treatment. Those who received CAMS were less likely to report SI at 3 months; further group differences were not otherwise seen.

This study (a) provides descriptive information about the personal technology use of a suicide sample of active-duty military personnel and (b) uses a traditional and a technology-based measure of social connectedness to examine their relation to suicide ideation and behaviors. Higher thwarted belongingness, and therefore lower perceived social connectedness, was associated with higher current and worst suicide ideation and a greater lifetime self-directed violence regardless of intent to die. Higher social connectedness based on personal technology usage was associated with higher current suicide ideation and a higher number of lifetime self-directed violence and suicide attempts.

The growth of the evidence based practice (EBP) movement has created a need for efficient models of EBP training that provide timely feedback to trainees. This feasibility trial examined a technological approach to clinical supervision called bug-in-the-eye (BITE) among trainees learning Dialectical Behavior Therapy (DBT). Eight DBT trainees within a psychiatry residency program were randomized to receive either supervision-as-usual (SAU; n = 4) or BITE group supervision (n = 4) during a 1-year elective clinical rotation. A mixed method design was used to evaluate acceptability, feasibility, and preliminary effectiveness of BITE to improve DBT knowledge transfer and reduce burnout relative to SAU. Qualitative analyses indicate that BITE was feasible to implement and acceptable among trainees. Trainees assigned to the BITE condition had significantly better postsupervision scores on a DBT case formulation assignment compared to those receiving SAU. The BITE condition also showed a trend toward higher scores on an exam measuring knowledge of DBT skills and theory. There were no trends noted over time or between condition on pre-post reports of burnout or satisfaction with supervision. This study finds preliminary support for a supervision approach using BITE technology as a feasible and acceptable model of clinical supervision that is associated with differentially greater learning for DBT case conceptualization compared to traditional supervision. A key limitation of the study is the small sample size, which limits both statistical power and generalizability; however, findings suggest that technological methods of enhancing supervision may be implemented successfully in evidence-based behavioral therapies.

Objective: This study examines the association of pre- versus post-enlistment timing of first suicide attempt with suicidal ideation, depressive symptoms, single vs. multiple attempts, and highest suicide attempt lethality in an active duty military sample with suicidal thoughts. Method: Data were pooled from baseline assessments of 784 help-seeking Service Members. Results: Adjusting for demographic and military covariates, suicidal ideation was higher for those with a history of suicide attempt. A pre-enlistment suicide attempt was associated with over four times the risk of multiple lifetime attempts. Conclusions: Pre-enlistment suicide attempts are important to assess as they increased risk of multiple attempts.

Few studies have examined effects of challenging behaviors of clients with borderline personality disorder (BPD) on psychotherapy outcomes. Dialectical behavior therapy (DBT) is an evidence-based treatment designed to treat chronic suicidality, self-directed violence (SDV), and emotion dysregulation, while targeting challenging behaviors. DBT has been shown to be effective with clients with BPD. We evaluated whether therapist reported challenging behaviors, such as high volume phone contacts or violating the therapist's limits, during DBT would be associated with dropping out of DBT, severity and frequency of SDV, emotion regulation deficits, psychological symptom severity and client's and therapist's satisfaction of treatment. The current study examined challenging behaviors reported by therapists in a sample of 63 psychiatrically disabled outpatient DBT clients diagnosed with BPD (73% women, average age 37 years). More frequent phone contacts were associated with a decrease in dropout and psychological symptoms, and an increase in client and therapist satisfaction. More avoidance/disengagement behavior was associated with more than twice the risk of SDV and a decrease in therapist satisfaction. Findings suggest that the phone coaching might serve to maximize client satisfaction and reduce the likelihood of dropout.

The interpersonal-psychological theory of suicide (IPTS) differentiates the desire to die from the capability to inflict lethal self-injury. Despite increasing agreement in the literature regarding the theoretical relevance of the construct in understanding military suicide, acquired capability has rarely been evaluated among currently or recently suicidal active-duty service members. To this end, the present study pooled baseline data for 733 active-duty service members enrolled in one of two clinical trials to prevent suicide. We hypothesized that self-reported acquired capability would be higher among men, and would increase with (a) suicide attempt frequency and (b) combat deployment frequency. Lifetime history of suicide attempts was assessed using the Suicide Attempt Self-Injury Count. Scores of self-reported acquired capability were based on the 20-item version of the Acquired Capability for Suicide Scale (ACSS) and the 7-item fearlessness about death subscale (ACSS-FAD). Consistent with the IPTS, ...

Mobile devices, and the apps (software applications) that operate on them, have potential to help manage and prevent suicidal behavior by assisting with assessment of risk, providing educational and support information, and facilitating access to safety plans, crisis support, and coping tools. This clinician-friendly review provides an overview of the principal features of currently available mobile health apps that are specially designed for suicide prevention. The use of patient contact interventions (i.e., text messaging and e-mail interventions) on mobile devices is also discussed. Recommendations for selecting and integrating these tools into patient care are provided, along with discussion of emerging capabilities and limitations including the lack of research regarding the clinical effectiveness of mobile health apps. The topics presented should be informative to individual practitioners as well as health care organizations that are considering adopting these technologies into their services.

Impulsivity is inconsistently defined in the literature. While there are some clear operationalizations of the trait of impulsivity, there is no consensus about the impulsivity of a specific suicidal behavior. Using a sample of 131 suicide attempters identified in a county emergency room, we used interviewer ratings from the Suicide Attempt Self-Injury Interview (SASII) and the Borderline Personality Disorder (BPD) trait impulsivity criterion from the Structured Clinical Interview for the DSM-IV Axis-II (SCID-II) to examine seven core constructs most commonly used in the literature on impulsivity of suicidal behavior. These constructs are resisting the urge/delaying, planning, trait impulsivity, communication to others, leaving a suicide note, the ability to be rescued, and intoxication. Comparison of these constructs shows relatively small relationships between them, and they clearly do not represent the same underlying concept. The ability of these constructs to predict intent and lethality of the index...

The phenomenology of the suicidal mind is central to many effective clinical approaches for suicidal risk. In this chapter we review this notion through a consideration of broad perspectives of the phenomenology of suicide offered by Edwin Shneidman and the collective perspective of the “Aeschi approach” to suicidal risk. We then examine phenomenological aspects of specific theoretical perspectives for suicidal risk including psychodynamic, cognitive, behavioral, and mentalization approaches. This chapter concludes with an examination of the Collaborative Assessment and Management of Suicidality (CAMS) approach to suicidal risk. Perhaps more than any other clinical method, CAMS fundamentally embraces the phenomenology of suicidal states by always emphasizing the patient’s perspectives on suicidal suffering in direct relation to clinical assessment and treatment. Various challenges in clinical practice with suicidal patients are considered, and CAMS is offered as a potential remedy for issues of countertransference, power struggles, and fears of being sued (or blamed) following a death by suicide. Throughout this chapter, the overarching importance of understanding the suicidal mind through the eyes of the patient is a unifying focus for effective clinical assessment and treatment of the suicidal risk.

While the existence of mental illness has been documented for centuries, the understanding and treatment of such illnesses has evolved considerably over time. Ritual exorcisms and locking mentally ill patients in asylums have been fundamentally replaced by the use of psychotropic medications and evidence-based psychological practices. Yet the historic roots of mental health management and care has left a certain legacy. With regard to suicidal risk, the authors argue that suicidal patients are by definition seen as mentally ill and out of control, which demands hospitalization and the treatment of the mental disorder (often using a medication-only approach). Notably, however, the evidence for inpatient care and a medication-only approach for suicidal risk is either limited or totally lacking. Thus, the “one-size-fits-all” approach to treating suicidal risk needs to be re-considered in lieu of the evolving evidence base. To this end, the authors highlight a series of evidence-based considerations for suicide-focused clinical care, culminating in a stepped care public health model for optimal clinical of suicidal risk that is cost-effective, least-restrictive, and evidence-based.

Given the vast public health problem of suicide, the need for more effective assessment of suicidal risk is clear. The major approaches applied to this challenge include various direct approaches (e.g., suicide-focused interviews) and indirect approaches (e.g., implicit methodologies or "occult" assessments) that tend to assess an attentional bias for suicidal risk, the latter of which the present investigation sought to study. Using the Suicide Status Form (SSF)-the central multi-purpose tool that is used within a collaborative assessment process with suicidal patients who are engaged in the "Collaborative Assessment and Management of Suicidality" (CAMS; Jobes, 2016)-we aimed to investigate the influence of perseverative, hand-written content responses pertaining to potential suicidal risk. Specifically, we explored whether repeating certain topic content might reflect a perseverative response style; we thus compared written content results of first session SSFs taken from a sample of suicidal U.S. Army Soldiers (Study 1) and a sample of suicidal college students (Study 2). Across the two studies, patients who repeated the same content ("1-Topic Repeaters") had significantly higher ratings related to suicidal ideation in comparison to those with more heterogeneous response styles. This replicated finding perhaps reveals a form of behavioral perseveration that is potentially related to increased suicidal risk with possible implications for successful treatment.

Background Rates of treatment dropout in outpatient Dialectical Behavior Therapy (DBT) in the community can be as high as 24 % to 58 %, making dropout a great concern. The primary purpose of this article was to examine predictors of dropout from DBT in a community mental health setting. Methods Participants were 56 consumers with borderline personality disorder (BPD) who were psychiatrically disabled participating in a larger feasibility trial of Dialectical Behavior Therapy- Accepting the Challenges of Exiting the System. The following variables were examined to see whether they predicted dropout in DBT: age, education level, baseline level of distress, baseline level of non-acceptance of emotional responses, and skills module in which a consumer started DBT skills group. These variables were chosen based on known predictors of dropout in consumers with BPD and in DBT, as well as an interest in what naturally occurring variables might impact dropout. Results The dropout rate in this sample was 51.8 %. Results of the logistic regression show that younger age, higher levels of baseline distress, and a higher level of baseline non-acceptance of emotional responses were significantly associated with dropout. The DBT skills module in which an individual started group did not predict dropout. Conclusions The implications of these findings are that knowledge of consumer age and pretreatment levels of distress and non-acceptance of emotional responses can impact providers’ choice of commitment and treatment strategies to reduce dropout. Future research should examine these strategies, as well as the impact of predictor variables on outcome and reasons for dropout.

A series of metal-chelating lipid conjugates has been designed and synthesized. Each member of the series bears a 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA) macrocycle attached to the lipid head group, using short n-ethylene glycol (n-EG) spacers of varying length. Liposomes incorporating these lipids, chelated to Gd(3+), (64)Cu(2+), or (111)In(3+), and also incorporating fluorescent lipids, have been prepared, and their application in optical, magnetic resonance (MR) and single-photon emission tomography (SPECT) imaging of cellular uptake and distribution investigated in vitro and in vivo. We have shown that these multimodal liposomes can be used as functional MR contrast agents as well as radionuclide tracers for SPECT, and that they can be optimized for each application. When shielded liposomes were formulated incorporating 50% of a lipid with a short n-EG spacer, to give nanoparticles with a shallow but even coverage of n-EG, they showed good cellular internalization in a range of tumour cells, compared to the limited cellular uptake of conventional shielded liposomes formulated with 7% 1,2-distearoyl-sn-glycero-3-phosphoethanolamine-N-[carboxy(polyethyleneglycol)(2000)] (DSPE-PEG2000). Moreover, by matching the depth of n-EG coverage to the length of the n-EG spacers of the DOTA lipids, we have shown that similar distributions and blood half lives to DSPE-PEG2000-stabilized liposomes can be achieved. The ability to tune the imaging properties and distribution of these liposomes allows for the future development of a flexible tri-modal imaging agent.