Suicide and Life-Threatening Behavior最新文献

Introduction: Emphasis on medical severity when assessing the lethality of suicide attempts may overlook important contextual factors. We examined if distinguishing between medical severity and chance of rescue improves evaluation and understanding of suicidal mental states.

Methods: Seventy adolescent inpatients with a recent suicide attempt were interviewed with the Suicide Intent Scale, and clinicians rated the Risk-Rescue Rating Scale, which provides separate ratings for medical severity (Risk) and chance of rescue (Rescue). They also completed the Interpersonal Needs Questionnaire and Fearlessness about Death scale.

Results: The lethality components Risk and Rescue were uncorrelated (r = -0.02). However, Rescue was significantly negatively correlated with suicidal intent (r = -0.46), fearlessness about death (r = -0.29), and unmet interpersonal needs (r = -0.28), while Risk was only correlated with suicidal intent (r = 0.29). In a hierarchical regression model, Rescue was the strongest predictor of suicidal intent.

Conclusion: Rescue factors, more than medical severity factors, were consistently related to our measures of suicidal mental state. Including the rescue component in lethality assessments may improve both the accuracy of clinical evaluations and our understanding of adolescents' mental state during suicidal crisis.

Introduction: Nondisclosure of suicidal ideation (SI) presents a challenge to assessing suicide risk, as assessments often rely on self-reported SI. Cross-national comparisons of rates of, and reasons for, SI nondisclosure remain understudied. The present study examined whether rates of SI nondisclosure from clinicians differed, and if there were differences in rates of reasons for SI nondisclosure, across 12 countries.

Method: A subset of adult participants (n = 6770) who reported a lifetime history of SI from 12 countries responded to the question: "Have you ever denied or concealed thinking about suicide from a doctor or clinician?" Those who selected "Yes" provided reason(s) for SI nondisclosure. Responses were coded according to inductively and deductively derived reasons for SI nondisclosure.

Results: Rates of nondisclosure among participants who reported lifetime SI ranged from 7.2% (Taiwan) to 48.2% (United States). Among those participants, rates of reasons for SI nondisclosure ranged from 2.0% (participant was unsure/did not know why they concealed SI) to 35.6% (negative internal experiences).

Conclusions: Findings provide insight into the frequency of and reasons for SI nondisclosure from clinicians at a country-specific level. Results could serve as a rationale for clinicians to incorporate indirect suicide risk factors into risk assessments.

Background: Major depressive disorder (MDD) is associated with maladaptive self-reported interoception, that is, abnormal bodily self-experience. Although diminished body trust predicts suicidal ideation, interoceptive measures have not been considered in depressed inpatients, whose suicide risk regularly peaks post-discharge. This study aims to explore interoceptive characteristics at admission that help identify inpatients at risk for suicidal ideation at discharge.

Methods: The observational study included 87 depressed inpatients providing self-ratings at both hospital admission (T0) and discharge (T1) on the BDI-II and MAIA-2. The statistical analysis included hierarchical logistic regression models and used ROC curve analysis to establish optimal cutpoints.

Results: Suicidal ideation was found in 17.24% of patients at discharge, who reported lower baseline MAIA-2 Trusting scores than non-ideators (p = 0.01). Diminished Trusting (OR = 0.19), somatic comorbidity (OR = 16.77), and baseline suicidal ideation (OR = 24.01) significantly predicted suicidal ideation (T1). For Trusting, we estimated an optimal classification of subsequent suicidal ideation for the cutpoint ≤ 2.33 (AUC = 0.70 [95% CI 0.57, 0.83], sensitivity = 0.87, specificity = 0.44, positive predictive value = 0.25, negative predictive value = 0.94).

Conclusions: Diminished body trust is a significant predictor for post-treatment suicidal ideation in depressed inpatients. This finding emphasizes the importance of incorporating body-centered approaches into multimodal treatment strategies, especially in inpatients under risk to prevent suicidal incidents.

Background: Although perceived burdensomeness and suicidal ideation are intended to be distinct constructs, they are often overlapping in both research and clinical settings. Such overlap provides room for error during assessment and analysis, with uncertainty in the degree to which PB and SI represent unique constructs. The present study evaluated what is represented in a SI variable with PB covaried out, and vice versa.

Methods: 312 students with lifetime suicidal ideation (M_age = 19.10, 79.8% cisgender women, 75.6% White) completed self-report measures. We computed two variables-PB with SI covaried out and SI with PB covaried out-and examined relationships between these residuals and other suicide-related risk factors.

Results: When SI was covaried out of PB, the PB residual remained significantly associated with nearly all risk factors. However, when PB was covaried out of SI, more than half of these suicide risk factors were no longer significantly associated with the SI residual.

Conclusions: Our findings could hold relevance for advancing both clinical and research efforts, as most risk factors were uniquely associated with PB, as opposed to SI. Specifically, PB may act as a mediator between a plethora of suicide risk factors and SI, while also holding relevancy in other domains.

Background: As the Army continues to modernize in the domains of technology, strategy, and training, there remains a need for research that intersects across research fields to promote the identification of transdiagnostic mechanisms that impact both psychological health and performance by designing more efficient and effective interventions. Bodily awareness (i.e., interoception and exteroception) has significant implications in military contexts, whereby both psychological health (e.g., suicide) and physical performance are key components to training, readiness, and wellbeing. However, although promising research exists focused on the etiological impacts of interoception on suicide, no work has directly examined exteroception-awareness of the body with respect to space and movement-within a military sample.

Objective/purpose: The current study aimed to address this gap by examining the impact of bodily awareness on measures of suicide and military performance.

Methods: A total of 1462 ADSM completed surveys assessing exteroception, suicidal ideation, readiness, and specific job related performance indicators.

Results: Awareness of one's body in space (i.e., exteroception) was associated with suicidal ideation, over and above thwarted belongingness and perceived burdensomeness. Notably, exteroception was significantly associated with all measures of military performance.

Conclusion: The results of this study suggest that improving exteroception may be an appropriate transdiagnostic target for interventions designed to improve mental health while simultaneously optimizing performance among ADSM.

Background: Increases in suicide attempts in preadolescents represent a serious public health concern. This study aimed to identify prospective and concurrent risk factors that differentiate children with suicidal ideation (SI) from those with a suicide attempt (SA) across childhood.

Method: 195 participants comprised of 8-12-year-olds from the Pediatric Suicidality Study, which followed a sample of preschoolers enriched for depression into preadolescence. Clinical diagnostic interviews and surveys to assess children's thoughts, behaviors, and experiences were administered to caregivers (preschool, preadolescence) and children (preadolescence).

Results: Three groups were created based on preadolescents' lifetime history of SI/SA: Suicide Attempt (SA; n = 25), Suicide Ideation without Attempt (SI-only; n = 102), and No SI/SA (n = 68). Compared to preadolescents with SI-only, preadolescents with SA exhibited increased depression (OR = 1.52), anxiety (OR = 1.32), maladaptive guilt (OR = 3.31), catastrophizing (OR = 1.24), stressful (OR = 1.20) and traumatic events (OR = 1.82) by preadolescence. Preadolescents with SA also exhibited increased anxiety (OR = 1.07) and maladaptive guilt during preschool (OR = 4.10). Family SA and social relationships did not differentiate groups.

Conclusions: Findings demonstrate unique and separable risk factors for SI and SA in children under age 13 with clinical implications for assessing suicide risk. Alongside depression and anxiety, assessments of maladaptive guilt may be important to identify at-risk children for increased monitoring and intervention.

Introduction: Given the high frequency and persistence of suicidal thoughts and behaviors among individuals with borderline personality disorder (BPD), characterizing mitigating factors of risk is critical. Suicide-related coping (SRC; knowledge and confidence in using internal coping strategies and external supports to manage suicidal thoughts and urges) is beneficial for suicide risk management. However, SRC has not been characterized longitudinally in suicidal individuals with BPD.

Methods: A clinical sample of 98 high-risk veterans (83% male; 21-73 years old [M = 44.7]) with BPD features was assessed in up to four waves over 1 year. Multilevel models evaluated between- and within-person relationships of SRC with thwarted interpersonal needs, depressive symptoms, hopelessness, and reasons for living.

Results: Results found significant (p < 0.001) between- and within-person relationships between SRC and suicide risk and protective factors. Within-person heterogeneity accounted for ≥ 50% variance (between-person ≤ 50% variance). SRC's relationships with all outcomes were maintained when considering suicidal characteristics besides between-person SRC with depressive symptoms.

Discussion: These findings suggest that SRC tracks with fluctuations in suicide risk and protective profiles over time in veterans with clinically meaningful BPD features, positioning it as a promising protective factor for suicidal thoughts and behaviors in this population.

Objective: To identify firearm behaviors and perceptions that differentiate firearm owners with a history of suicidal thoughts from other firearm owners and from nonfirearm owners with a history of suicidal thoughts.

Methods: A nationally representative sample (n = 8009) of adults residing in the United States completed a self-report survey May 15-May 28, 2024.

Results: Firearm owners with a history of suicidal thoughts were 45% likelier to store firearms loaded and unlocked and reported a stronger belief that home firearm access increases suicide risk. Some subgroups of firearm owners more heavily represented among those with a history of suicidal thoughts (e.g., women) were more likely to store firearms loaded and unlocked if they endorsed a history of suicidal thoughts.

Conclusions: Firearm owners with a history of suicidal thoughts are more likely to recognize the link between firearm access and suicide risk, but nonetheless are more likely to store firearms unsecured. Identification of firearm owners with suicidal ideation remains difficult, but findings point toward subgroups and beliefs to target with messages aimed at promoting secure firearm storage.

Introduction: The suicide Implicit Association Test (S-IAT) captures the strength of the implicit identification between self and death and is one of the few suicide-specific behavioral tasks that uniquely predicts future suicide risk. Thus, identifying brain regions associated with the S-IAT provides insights into the neural mechanisms underlying suicidality.

Methods: This study measured brain activation during the S-IAT with concurrent fMRI in a post-9/11 trauma-exposed veteran sample. In total, 37 post-9/11 veterans at low risk for suicide participated in this study as part of an ongoing longitudinal study.

Results: Behaviorally, participants were slower to categorize words during incongruent (death-me) contexts relative to congruent (life-me) contexts (p < 0.001). Whole-brain voxelwise fMRI contrasts revealed a brain network that was significantly more active during incongruent trials than congruent trials that included the bilateral occipital, posterior parietal, and cerebellum (corrected p < 0.05). This increased brain activation corresponded with task performance, suggesting that more brain resources are needed to complete death-me identifications.

Conclusions: These results suggest that death-me implicit identifications involve resolving conflict between self and death representations in the brain and mark an important step towards characterizing neural mechanisms contributing to suicidality.

Background: Previous literature suggests that adolescent psychotic-like experiences (PLEs) are associated with depressive symptoms and suicidal ideation. This study aimed to explore these prospective relationships between PLEs, depressive symptoms, and suicidal ideation among adolescents.

Methods: A large-scale web-based survey was conducted using repeated measures at three time points: from 21 April to 12 May 2021 (T1), from 17 to 26 December 2021 (T2), and from 17 May to 6 June 2022 (T3). A total of 17,722 adolescents were assessed at both T1 and T2, and 15,694 adolescents also provided complete responses at both T1 and T3. Self-reported scales were used to assess PLEs and depressive symptoms, and suicidal ideation was assessed.

Results: PLEs at baseline were significantly associated with increased odds of depressive symptoms and suicidal ideation at both follow-up intervals after adjusting for covariates (all p < 0.001). Moreover, baseline depressive symptoms and suicidal ideation were significantly associated with increased likelihoods of subsequent PLEs (all p < 0.001).

Conclusions: This study underscores bidirectional prospective associations between PLEs, depressive symptoms, and suicidal ideation among adolescents, and its findings underscore the critical educational and clinical importance of screening for PLEs while treating depressive symptoms and suicidal ideation.