Suicide and Life-Threatening Behavior最新文献

Introduction: Bipolar disorder, socioeconomic deprivation, and social isolation are major risk factors for suicide. The interpersonal theory of suicide (IPTS) posits perceived burdensomeness and thwarted belongingness as proximal causes of suicidal thoughts and behaviors, while the social determinants of health (SDOH) framework highlights distal socioeconomic factors. Studies of suicidality in bipolar disorder have used the IPTS and the SDOH framework, but few have integrated them to explore connections between distal and proximal factors.

Methods: This study examined perceived burdensomeness and thwarted belongingness as mediators of the relationship between cumulative socioeconomic risk and suicide risk. Participants were 171 outpatients in a United States (U.S.) bipolar clinic (mean age = 39.0, 69.6% female, 73.7% Black/African American).

Results: Cumulative socioeconomic risk, perceived burdensomeness, and thwarted belongingness were positively associated with suicide risk. Perceived burdensomeness mediated the relationship between cumulative socioeconomic risk and suicide risk, but thwarted belongingness did not.

Conclusion: Findings broadly suggest the IPTS and the SDOH framework can be fruitfully integrated to guide research and prevent suicide. The pathway from cumulative socioeconomic risk to suicide risk via perceived burdensomeness warrants further attention, particularly for individuals diagnosed with bipolar disorder. Implications for future studies of the IPTS, SDOH, and suicidality are discussed.

Introduction: The period following discharge from psychiatric hospitalization is one of particularly elevated suicide risk. It is essential to better understand risk factors for suicide during this period; however, retention and compliance in longitudinal research can be a challenge with high-risk populations.

Methods: We examined compliance rates in the six-month period following psychiatric hospital discharge among 174 adults (149 psychiatric patients and 25 healthy controls) across three data collection methods: ecological momentary assessment (EMA), weekly clinical assessment phone calls, and clinical follow-up assessments at two- and six-months post-discharge. We examined whether clinical and demographic characteristics influenced compliance rates.

Results: Results suggested low rates of EMA compliance, but strong rates of completion of weekly phone calls and follow-up assessments. Compared to psychiatric patients, healthy controls completed more EMA and weekly phone calls, but not follow-up assessments. Participants who met current diagnostic criteria for a major depressive episode and who scored above the clinical threshold for borderline personality disorder symptoms had lower EMA compliance rates.

Conclusions: These findings have important implications for strategies to improve patient engagement in research during this high-risk period.

Introduction: Secure firearm storage has been proposed as a suicide prevention method within the military; however, secure storage practices are uncommon. Service members may perceive limited value in secure storage as a suicide prevention tool and threat-related factors may influence such perceptions.

Method: A nationally representative sample of firearm-owning military service members (n = 719) was recruited between December 3, 2021 and January 4, 2022 to complete a self-report survey by Ipsos using their KnowledgePanel calibration approach to optimize representativeness.

Results: Threat sensitivity was associated with less perceived suicide prevention value across all within-home storage practices as well as out-of-home storage. Defensive firearm ownership was associated with less perceived out-of-home storage value. Contrary to expectations, PTSD symptoms were associated with greater perceived suicide prevention value across all storage practices and intolerance of uncertainty was associated with greater perceived out-of-home storage value.

Discussion: Perceptions of, sensitivity to, and reactions to threat represent a complicated confluence of factors that may influence firearm views and behaviors in disparate ways. Viewing the world as dangerous and other people as a threat may limit perceived suicide prevention value for secure storage and increase the drive for firearm access.

Objective: The study aims to investigate the efficacy of sertraline medication plus dialectical behavior therapy (DBT) in reducing nonsuicidal self-injury (NSSI) behavior and depression among adolescents.

Methods: Participants were 100 adolescents with depression and NSSI behaviors, 50 of whom received sertraline medication plus DBT and 50 of whom received sertraline medication plus cognitive behavioral therapy (CBT) for 12 weeks.

Results: During 6 months post intervention, 26 (57.8%) participants did not report having engaged in any form of NSSI in the sertraline + DBT group and 15 (32.6%) in the sertraline + CBT group, showing significant difference. The sertraline + DBT group and the sertraline + CBT group exhibited significant difference regarding the proportions of cutting skin and biting self. The scores of anxiety, depression, aggression against self in four modified overt aggression scale categories, and Personal and Social Performance were notably lower in the sertraline + DBT group than those in the sertraline + CBT group at 6 months post intervention.

Conclusion: Sertraline medication plus DBT could decrease NSSI episodes and improve symptoms of anxiety and depression for adolescents, and these changes were comparable to those of CBT. More importantly, DBT was demonstrated better clinical improvements at 6-month follow-up.

Background: People bereaved by suicide are at increased risk of suicide. Potential explanations include changes in the cognitive availability of suicide after suicide bereavement, but this has been under-investigated. This study aimed to investigate how suicide bereavement influences thoughts about suicide, including methods considered.

Method: We interviewed 20 UK-based adultswho reported having been preoccupied by the suicide of a close contact, analyzing qualitative data using reflexive thematic analysis.

Results: We identified four main themes: divergent changes in views about suicide as an option; impact of the method used on consideration of own potential method of suicide (including an aversion to the same method); experience of suicidal ideation as a means of understanding the deceased's state of mind; and thoughts related to reunion with the deceased.

Conclusions: Our findings suggest that the trauma of exposure to a close contact's suicide can modify the cognitive availability of suicide in divergent ways, including suicide being perceived as a more or less acceptable option, and a tension between the two. These insights assist clinicians in sensitive exploration of suicide bereavement and in risk mitigation. They suggest revisions to existing models of cognitive availability and the potential for psychological interventions that modify the cognitive availability of suicide.

Introduction: Despite evidence that participation in suicide research is not associated with worsening ideation, behaviors, or intent, the rise of intensive longitudinal methods to assess ideation and behaviors necessitates further investigation for potential iatrogenic effects. The present study assessed rates of change in suicide ideation (SI) in a 10-day daily diary study.

Methods: Seventy-two adult participants with ongoing SI participated in 10 daily diary surveys and three follow-up assessments. One open-ended item was included to address participant experiences in the study.

Results: A multilevel piecewise growth model revealed steady declines in SI for participants over the 10 days. However, rates of SI increased during the follow-up assessments, indicating that participation in the daily surveys was associated with general reductions in SI. Further, qualitative analyses of experiences in the study revealed the following themes: Useful (n = 34), Heightened Awareness (n = 21), Functional (n = 6), Not Useful (n = 6), and Beneficence (n = 4).

Conclusion: This study demonstrated that participation in suicide research, including intensive longitudinal methods such as daily diary studies, did not have iatrogenic effects on participants with SI. Qualitative results demonstrated the numerous benefits participants derived while taking part in this study.

Introduction: Nonsuicidal self-injury (NSSI) often helps regulate affect, yet there is conflicting research on the immediate affective outcomes of pain and NSSI. People also engage in NSSI for intrapersonal and interpersonal reasons. It is unclear whether affective shifts post-pain task differentiate individuals with and without NSSI histories, and are influenced by interpersonal or intrapersonal motives for NSSI. The present study examined the effect of pain on affective shifts, and to investigate motives for NSSI as moderators.

Methods: Participants were 134 women (n = 77 with recent/recurrent NSSI), that completed measures of NSSI and reported their positive and negative affect pre- and post-pain-task.

Results: Our findings suggest that participants without a history of NSSI reported greater decreases in positive affect pre-to-post task. NSSI history did not predict fluctuations in negative affect after controlling for stress. Namely, at low levels of stress, participants reported greater decreases in negative affect following the pain task. Finally, interpersonal motives for NSSI predicted increased positive affect following the endurance of pain.

Conclusion: Findings suggest that affect changes in response to pain may not be differentially associated with NSSI history; however, among people with a history of NSSI, interpersonal motives may predict changes in positive affect following a pain task.

Introduction: Emerging and young adulthood is associated with heightened risk for suicide, with interpersonal factors potentially exerting disproportionate effects during this critical life stage. Research examining the interplay of subjective and objective interpersonal factors for suicide ideation (SI) in daily life is limited.

Methods: Dynamic structural equation models were used to analyze ecological momentary assessment data (21 days; 7 semi-random daily surveys) in a sample of at-risk young adults (N = 140) to test within-person main and interactive effects of objective social proximity (alone vs. not alone) and subjective social preference (desire to be alone or with others) on SI severity concurrently and prospectively over 2-h intervals in daily life.

Results: Preferring to be alone (while alone or with others) was associated with intraindividual near-term increases in SI severity, whereas preferring to be with others (while alone or with others) was associated with near-term decreases in SI severity.

Conclusions: Being with others can be either a risk or protective factor for near-term SI severity depending on whether the present company is desired. Considering multiple interpersonal factors combined may be necessary to understand and treat SI as these factors may either buffer or confer greater near-term risk depending on other factors.

Emptiness and identity pathology are understudied clinical constructs that overlap, co-occur, and predict suicidal ideation (SI). However, specific risk pathways have yet to be formally tested.

Aim: We examined whether identity pathology was indirectly associated with future SI via emptiness, and tested impulsivity and emotion dysregulation as moderators.

Methods: Participants (N = 251) completed baseline questionnaires assessing SI, borderline personality disorder symptoms, emotion dysregulation, and impulsivity, and SI 2 months later.

Results: Identity pathology was indirectly associated with future SI via emptiness, controlling for baseline SI (β = 0.15, Bootstrap 95% CI = [0.06, 0.24]). There was a two-way interaction between emptiness and both poor use of emotion regulation strategies (β = 0.06, p < 0.001) and impulsive lack of premeditation (β = 0.09, p = 0.03) predicting SI.

Conclusion: Those with greater identity pathology were more likely to experience emptiness, which was in turn associated with future SI. Participants who felt empty were also more likely to experience SI when they also reported an inability to use emotion regulation strategies and a tendency to act without considering the consequences. We provide preliminary support for an untested risk pathway for SI, highlighting the need to further study these important experiences.

Introduction: The interpersonal theory of suicide (IPTS) is used to evaluate suicide risk. Yet, it has not been sufficiently tested with ethnoracially minoritized youth. This study aimed to test whether thwarted belongingness (TB) and perceived burdensomeness (PB) were associated with passive suicide ideation (SI) among Latinx and Black youth.

Methods: Data were obtained from a cross-sectional study. Some youth participants were recruited from an ongoing NIMH study of depressed Black youth in schools (N = 20). The rest were participants in a supplemental study of non-depressed Latinx and Black youth in community agencies (N = 61). Multivariate logistic regression analyses were conducted to examine the relationships between passive SI and the IPTS constructs.

Results: Most participants identified as male (63.5%) and Latinx (59.5%), mean age 15.23 (SD = 1.4). Only TB remained significant when adjusting for age and gender, even after adding a measure of depression symptoms as a covariate. Notably, the interaction term (TBXPB) was not significantly associated with increased odds of passive SI in this sample.

Conclusion: These findings confirm the importance of examining the IPTS constructs and their relationship to passive SI in diverse populations. The relationship between TB and SI in Latinx and Black youth suggests it may be an important target for suicide prevention.