Suicide and Life-Threatening Behavior最新文献

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.

Objective: Sharing one's suicidal thoughts and behaviors, or suicide-related disclosure, allows adolescents to recruit help from others. Despite elevated risk among culturally minoritized youth, their suicide-related disclosure remains understudied.

Methods: 191 adolescents (M = 15.98, SD = 1.04, range = 13-17), including minoritized youth (38% racially, 19% ethnically, 40% gender, and 77% sexually), were recruited via social media ads and completed an anonymous online survey on suicide-related disclosure to informal support sources (e.g., family, friends). Disclosure rates, targets, and reasons for disclosure and nondisclosure were compared based on race, ethnicity, gender identity, and sexual orientation.

Results: Racially minoritized adolescents less often disclosed suicidal ideation and more strongly endorsed fear of negative reactions and resistance to intervention as reasons for nondisclosure, and reciprocity as reasons for disclosure, than White adolescents. Cisgender adolescents less often disclosed suicidal ideation and more strongly endorsed dismissal of suicide risk as reasons for nondisclosure than gender minoritized adolescents. Non-Hispanic adolescents more strongly endorsed help-seeking as reasons for disclosure than Hispanic adolescents. While adolescents overall disclosed most often to friends, heterosexual adolescents disclosed more to family than sexually minoritized adolescents.

Conclusion: Racial and gender disparities in suicide-related disclosure may occur for distinct reasons among adolescents. Uncovering patterns of disclosure may facilitate detection of suicide risk among minoritized youth.

Introduction: People who identify as sexual minorities (SM) report higher rates of nonsuicidal self-injury (NSSI) than heterosexual individuals. One explanatory factor that may be important in this relation is self-defective beliefs. The present study examined the role of self-defective beliefs in the link between sexual orientation and NSSI.

Method: Participants were college-aged women (n = 145) with (n = 84) and without (n = 61) recent, recurrent NSSI, completed measures of NSSI and self-defective beliefs. Participants were recruited from a large college and surrounding area in the northeastern U.S.

Results: suggest that SM participants were more likely to report a history of NSSI, frequent and versatile NSSI, and greater self-defective beliefs compared to heterosexual participants, but not more likely to report medically severe NSSI. Results from cross-sectional mediation analyses revealed that self-defective beliefs mediated the relation between SM identity and lifetime NSSI history and partially mediated the relations for NSSI medical severity and versatility, but not NSSI frequency.

Conclusions: Taken together, our findings suggest that self-defective beliefs are a salient cognitive concern associated with indicators of NSSI severity in college-aged SM women. Additional research is needed to determine whether these findings replicate in SM men, transgender, and gender diverse populations.

Introduction: The development of evidence-based treatments relies on accurate theoretical frameworks sensitive to the lived realities of the populations from which they are derived. Yet, the perspectives of Black youth are vastly underrepresented in extant theories of suicidal behavior. Cultural Consensus Modeling provides an evidence-based approach for developing a culturally informed understanding of suicide risk among Black youth.

Method: Participants were 50 Black adolescents (M_age = 16.20 years; 76.0% male) who completed Phase 1 of a Cultural Consensus Modeling study. Participants freely listed reasons for suicide and reasons for living among similar peer Black youth. Responses were synthesized and coded for major themes.

Results: The most common reasons for suicide were racism (40%), depression (32%), poverty (26%), and bullying (22%). The most common reasons for living were family (58%), having a purpose or goals (36%), friends (30%), and hope for a better future (26%).

Conclusion: Responses highlighted issues of racism and social justice, depression, and poverty, as well as the protective role of relationships, living for the future, and contributing to Black empowerment. Future research should utilize Cultural Consensus Modeling to elevate the voices of Black youth, improving extant theories of suicide, and identifying unique mechanisms or opportunities for prevention.

Introduction: Sexual and gender minority (SGM) individuals report a higher prevalence rate of nonsuicidal self-injury (NSSI) compared to their cisgender heterosexual peers. Minority stress theory posits that the unique stressors experienced by those with a minoritized sexual orientation and/or gender identity increase the risk of negative health outcomes. As such, SGM stress may be a significant risk factor for NSSI and may help explain the disparate prevalence rates in the community.

Method: Thus, a meta-analysis was conducted to assess the relationship between SGM stress and NSSI (k = 42; N = 253,686).

Results: Broadly, SGM stress was significantly positively related to NSSI engagement (r = 0.15). While this effect size is small in absolute size, it is comparable to other evidence-based risk factors for NSSI, such as impulsivity. Contrary to our hypothesis, the number of items used to assess NSSI engagement did not significantly moderate the relationship (b = -0.001). Exploratory analyses found no significant difference between proximal and distal SGM stressors (b = 0.07), sexual minority stress and gender minority stress (b = 0.03), nor assessment of lifetime compared to past year NSSI engagement (b = 0.08).

Conclusion: Overall, the results of this meta-analysis support that SGM stress is a significant risk factor for NSSI and should be integrated into interventions for NSSI.

Background: Literature on how to translate information extracted from clinical progress notes into numeric scores for 3-step theory of suicide (3ST) factors is nonexistent. We determined which scoring option would best discriminate between patients who will attempt or die by suicide and patients with neither suicidal ideation nor attempts, and we tested hypotheses related to the 3ST.

Methods: We used terminology-driven natural language processing (NLP) to extract information from Veterans Health Administration (VHA) clinical progress notes. Counts of those extractions served as input to evaluate candidate scoring options for each 3ST factor (psychological pain, hopelessness, connectedness, capability for suicide). Logistic regression models adjusted for common demographic characteristics were used to test the 3ST hypotheses.

Results: Optimal contrasts between groups were obtained with P - A for psychological pain, hopelessness, and capability for suicide, and $A/\left(P+1\right)$ for connectedness, where P and A, respectively, indicate the patient-level number of extractions indicating presence and absence of the factor.

Limitations: Additional research is necessary to verify whether our conclusions hold in a cohort that is more reflective of the general VHA population.

Conclusion: Terminology-driven 3ST factor scores discriminate patients who attempt or die by suicide from patients without suicidal ideation or attempts. Our results corroborate the validity of the 3ST for VHA patients.

Introduction: Rising rates of suicidal thoughts and behaviors (STBs) among U.S. Latina adolescents urgently need attention. Life is Precious (LIP) is a culturally responsive, community-based, afterschool-model program offering wellness-support services to supplement outpatient mental health treatment for Latina adolescents experiencing STB's. This 12-month quasi-experimental pilot study explored LIP's impact on clinical outcomes.

Methods: Latina adolescents newly enrolled in LIP and receiving outpatient treatment (n = 31) and those newly starting outpatient treatment only (n = 12; Usual Care) were assessed for Suicidal Ideation (Suicidal Ideation Questionnaire; SIQ) and depressive symptoms (Patient Health Questionnaire-9). We estimated differences in mean scores using longitudinal linear mixed models and adjusted risk ratios (ARRs) of SIQ-25%, SIQ-50%, and PHQ-9-5-point improvements using exact logistic models.

Results: The direction of the estimated impact of LIP was positive [differences (95% CIs): -15.5 (-34.16, 3.15) for SIQ; -1.16 (-4.39, 2.07) for PHQ-9], with small-to-moderate nonsignificant effect sizes (0.19-0.34). LIP participants saw two to three times higher prevalence than controls of SIQ-25%, SIQ-50%, and PHQ-9-5-point improvements; ARRs (95% CIs) were 1.91 (0.61, 3.45), 3.04 (0.43, 11.33), and 1.97 (0.44, 5.07), respectively. Suicidal behaviors also decreased in LIP.

Conclusion: The effects of LIP were in positive directions across clinical outcomes, warranting further research on its effectiveness in decreasing STBs.

Introduction: To expand access to suicide prevention and support services, the Veteran Crisis Line (VCL) added text capabilities in 2011. It is unknown whether the likelihood of a contact being terminated by the user varies by contact type. We aimed to assess whether contact resolution varies by contact type after accounting for Veterans' sociodemographic and clinical characteristics, contact risk, and reasons for contact.

Method: A retrospective cohort study of VCL phone and text contacts regarding identified VHA enrollees between 2016 and 2021 was performed. To examine differences in contact resolution between contact types, inverse probability of treatment weights were used to balance characteristics of text and phone contacts.

Results: Relative to phone contacts, text contacts were associated with 3.39 percentage point (PP) (95% CI, 3.27-3.50; p < 0.001) lower likelihood of receiving an emergency dispatch/welfare check, 2.65 PP (95% CI, 2.55-2.76; p < 0.001) lower likelihood of requiring arrangement for same-day care, and 9.47 (95% CI, 9.34-9.59; p < 0.001) PP higher likelihood of being terminated by the user.

Conclusions: VCL text contact was associated with an increased likelihood of being terminated by the user. Further investigation is needed to understand the reasons for terminating contact for those who texted VCL.