Method choice, intent, and gender in completed suicide

Women who commit suicide use less violent methods, such as drugs and carbon monoxide poisoning, than do men, who more often use violent methods such as guns and hanging. Theories that attempt to explain this finding focus on gender differences in suicidal intent, socialization, emotions, interpersonal relationships, orientation and access to methods, and neurobiological factors. Data from a psychological autopsy study were used to test the theory that women who commit suicide use less violent means because they are less intent on dying. Although women were significantly less likely to use a violent method than men, there was no difference in the lethality of their suicidal intent.     

Dependency and self-criticism as predictors of suicidal behavior

Individuals have been theorized to develop anaclitic and introjective depression to the extent that they may be characterized as dependent and self-critical, respectively (e.g., Blatt, 1990). Blatt's theory was applied to suicidal behavior to determine if suicidal behavior could also be reliably broken down into two distinctive types, with respect to a number of parameters. Sixty-four undergraduate students who had attempted suicide were interviewed, and the lethality of their attempts was assessed with the Risk-Rescue Rating scale (Weisman & Worden, 1972). Participants were also administered an Intent and Precipitating Events scale, a modified version of the BDI-II, and the Depressive Experiences Questionnaire (DEQ). Self-critical individuals showed greater intent to die and greater lethality in their suicide attempts than did dependents. Self-critics were also more likely to attempt in response to an intrapsychic stressor, with the explicit motivation to escape. In contrast, dependents were more likely to attempt in response to an interpersonal stressor, with the motivation to communicate some form of unhappiness. Implications for suicide prediction and treatment are discussed, with special reference to the importance of identifying different suicidal subtypes.     

Moral Objections and Fear of Hell: An Important Barrier to Suicidality

This review explores the literature to test the hypothesis that ‘moral objections to suicide (MOS), especially the conviction of going to hell after committing suicide, exert a restraining effect on suicide and suicidality.’ Medline and PsycInfo were searched using all relevant search terms; all relevant articles were selected, rated and reviewed. Fifteen cross-sectional studies were available on this topic, and raise sufficient evidence to confirm a restraining effect of MOS, and sparse data on fear of hell. MOS seem to counteract especially the development of suicidal intent and attempts, and possibly the lethality of suicidal attempts. A differential pattern of influence of MOS on the suicidal continuum is suggested.     

Examining Intent to Die and Methods for Nonsuicidal Self‐Injury and Suicide Attempts

Nonsuicidal self‐injury (NSSI) is linked to suicidal behavior and future suicide attempts, but the process of NSSI‐to‐suicide attempts remains unclear. Additionally, little is known about how having a history of NSSI may relate to reports of intent to die during a suicide attempt. The current study examined methods of NSSI and suicide attempts, as well as intent to die, in a sample of 1,232 young adults, 54 of whom reported at least one suicide attempt. Cutting and overdose were the predominant methods of NSSI and suicide attempts, respectively, with the two often co‐occurring. Individuals with both NSSI and suicide attempt history were significantly more likely to report an intent to die than those with suicide attempt history only.     

Predicting Suicide Intent: The Roles of Experiencing or Committing Violent Acts

According to the interpersonal theory of suicide (Joiner, 2005), repeated exposure to painful or provocative experiences is associated with lethal or nearly lethal suicide attempts. However, suicide research often focuses on suicide ideation or attempts, rather than intent. Using data from the Collaborative Psychiatric Epidemiological Surveys, we examined traumatic experiences, with a focus on repeated exposure to traumas, in individuals who described their suicide attempts as a strong intent to die versus a cry for help. Only repeated acts of committing violence were associated with high suicide intent, suggesting that individuals who engage in violence are at heightened risk for suicide.     

Reevaluating Suicidal Behaviors: Comparing Assessment Methods to Improve Risk Evaluations

This study examined suicide assessment validity by comparing methods of measuring current risk associated with past suicidal behaviors. Three independent samples (Ns = 359, 1007, and 713; aged 18–76 years) all included participants covering a broad spectrum of suicidality. Information theory, item response theory, general linear modeling, and linear regression modeling tested seven competing methods/models of assessing past suicidal behaviors in relation to current suicidality. In contrast to contemporary theories, ANOVA results showed suicide plans can indicate higher risk than suicide attempts when intent to die is higher. Contrary to popular practice, evidence demonstrated that defining risk by suicide ideation (yes/no), attempts or serious attempts (yes/no), are false dichotomies, were the least valid models tested, and failed to explain substantial explainable variance in suicidality/risk. A newly proposed model, differentiating behaviors with or without intent to die, was the most efficacious dichotomous method. However, as predicted, continuous variables were superior to dichotomous. The proposed suicidal barometer model (SBM) exhibited robust evidence as the best available model for evaluating suicidal behaviors in all samples (100 % probability), explaining 47–61 % of suicidality variance and provided incremental improvement in risk evaluations. Findings were consistent by sample, sex, age-group, ethnicity, and psychiatric history. This study, and related evidence, demonstrate that there is a clear and present need for updating measures, clinical training and core competencies, for valid assessment and risk formulation.     

Is There a Relationship between Suicidal Intent and Lethality in Deliberate Self‐Poisoning?

The relationship between suicidal intent and lethality of deliberate self‐poisoning (DSP) episodes and their associations with suicide have yielded contradictory findings. The aims of this study were to investigate the association between patients’ suicidal intent and independently rated lethality of DSP episodes, and whether the association changes over time. Eighty‐nine DSP patients were investigated longitudinally. Self‐reported suicidal intent, including perceived likelihood of dying, wish to die, and whether or not the DSP was considered a suicide attempt, was measured at the time of the index episode (t1), 3 months (t2), and 12 months (t3) later. Lethality was assessed independently by three clinical toxicologists. Lethality was significantly associated with patients’ reported wish to die (p = .01) and perceived likelihood of dying (p = .04) at t1, but not at t2 and t3. No association was found between whether the episode was considered a suicide attempt or not and lethality at t1, t2, or t3. Lethality and suicidal intent should be considered as largely separate dimensions of self‐harm. Clinicians should bear this in mind during clinical assessment, especially regarding historical information.     

Dimensions of Suicide: Perceptions of Lethality,Time, and Agony

Two hundred ninety-one lay persons and 10 forensic pathologists rated the lethality, time, and agony for 28 methods of suicide for 4117 cases of completed suicide in Los Angeles County in the period 1988–1991. Whereas pathologists provided consistent ratings, lay persons demonstrated extreme variability and a tendency to inflate ratings of all three dimensions. Significant gender differences emerged, with females rating frequently used suicide methods more similarly to pathologists than the males did. Males who suicided used the most lethal and quickest methods whereas females selected methods varying in lethality, duration, and agony. African Americans were overrepresented in the use of the most lethal and quickest methods.     

Organizational Socialization: A Field Study into Socialization Success and Rate

The last decade has witnessed a resurgence of organizational socialization research. However, a critical question has been neglected: Is there a common underlying pattern to organizational socialization? We investigated newcomer learning, job satisfaction and intent to quit as common indicators of socialization, in research with 222 newcomers at two organizations during the crucial post‐entry period. The results support a learning‐dependent model of newcomer adjustment, with learning in specific domains related to improved attitudinal outcomes. Some aspects of organizational socialization were not uniform across the two organizations, suggesting a need for further development of socialization models and greater accounting for this in organizational socialization research.     

Assessing Motivations for Suicide Attempts: Development and Psychometric Properties of the Inventory of Motivations for Suicide Attempts

This study describes the psychometric properties of the Inventory of Motivations for Suicide Attempts (IMSA). The IMSA was designed to comprehensively assess motivations for suicide emphasized by major theories of suicidality. The IMSA was administered to two samples of recent suicide attempters, undergraduates (n = 66) and outpatients (n = 53). The IMSA exhibited a reliable two‐factor structure in which one factor represented Intrapersonal motivations related to ending emotional pain, and the second represented Interpersonal motivations related to communication or help‐seeking. Convergent validity and divergent validity of IMSA scales were supported by expected patterns of correlations with another measure of suicide motivations. In addition, the IMSA scales displayed clinical utility, in which greater endorsement of intrapersonal motivations was associated with greater intent to die, whereas greater endorsement of interpersonal motivations was associated with less lethal intent and greater likelihood of rescue. Findings suggest the IMSA can be of use for both research and clinical purposes when a comprehensive assessment of suicide motivations is desired.     

Suicide Attempt Self-Injury Interview (SASII): development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury

The authors describe the development of the Suicide Attempt Self-Injury Interview (SASII), an instrument designed to assess the factors involved in nonfatal suicide attempts and intentional self-injury. Using 4 cohorts of participants, authors generated SASII items and evaluated them with factor and content analyses and internal consistency statistics. The final measure was assessed for reliability and validity with collateral measures. The SASII assesses variables related to method, lethality and impulsivity of the act, likelihood of rescue, suicide intent or ambivalence and other motivations, consequences, and habitual self-injury. The SASII was found to have very good interrater reliability and adequate validity.     

Mental health professionals' determinations of adolescent suicide attempts

The degree of ambiguity in the term suicide attempt was examined among 14 expert suicidologists, and 59 general mental health clinicians who either did or did not receive a standard definition of the term. The participants judged whether each of ten vignettes of actual adolescent self-harm behaviors was a suicide attempt. Low levels of agreement were found within each group, although agreement was better for the most and least serious cases. Possible explanations were examined, including how professionals weight suicidal intent and medical lethality in their suicide attempt decisions, and the use of a "fuzzy," natural language conceptualization of suicide attempts was proposed.     

SEXUAL SOCIALIZATION DIFFERENCES BY GENDER, GREEK MEMBERSHIP, ETHNICITY, AND RELIGIOUS BACKGROUND

Socialization theories have included parents and peers as important determinants of the initial sexual standards and sexual behavior of teenagers and young adults. The purpose of the research reported here was to examine how parental and peer sexual socialization influences are related to gender, ethnicity, religious background, and college membership in a fraternity or sorority. A sample that included a majority of Caucasian university students and about 13% Asian and 7% Black students completed questionnaires both as entering first-year students and as seniors. Results indicated that compared to women, men continue to experience a more permissive sexual socialization from both parents and peers. Greek membership was associated with a more permissive socialization from peers but not parents. Asian students reported a more restrictive socialization than Blacks or Caucasians. Findings are discussed with respect to concerns of social scientists regarding the influence of fraternities and differential gender socialization.     

Suicide and suicide attempts in the European Economic Community: an analysis of trends, with special emphasis upon trends among the young

An attempt is made to explain the increase in adolescent suicidal behavior reported for most countries in the European Economic Community over the last two decades, within the framework of a social learning theory. A typology of suicidal acts based on an outcome-expectancy model is proposed that would make intelligible the observed positive correlation between the incidence of lethal and nonlethal suicidal acts, the latter having grown to epidemic proportions among the young. This epidemic can be attributed to the interplay of three groups of factors, namely, the socialization of a specific problem-solving behavior repertoire, socioeconomic conditions, and attitudes toward suicide. The implications for suicide prevention are briefly discussed.     

Miseries Suffered,Unvoiced, Unknown? Communication of Suicidal Intent by Men in “Rural” Queensland,Australia

It has long been argued that suicide prevention efforts in rural locations face not only structural barriers, such as a lack of accessible health care and specialized mental health services, but also a range of cultural barriers. A commonly discussed cultural factor that may contribute to higher rural suicide rates is low levels of help‐seeking behavior, which in turn act as a barrier to accessing and receiving care. However, the assumption that suicide by rural men is more likely to be accompanied by low help‐seeking behavior, relative to urban men, has not been well tested. Using data from the Queensland Suicide Register, this study evaluates one form of help‐seeking behavior—communication of suicidal intent—among men who died by suicide. Contrary to the expectation that suicide in rural areas would be associated with lower levels of help‐seeking behavior than suicide in urban areas, it was found that communication of suicidal intent was broadly comparable across rural and urban settings. The implications for suicide prevention policies and service delivery strategies are discussed.     

Gender differences in coping: A further test of socialization and role constraint theories

To further test role constraint and socialization theories of gender differences in coping, two studies were conducted to examine coping strategies in individuals occupying similar roles. The relations between coping strategy frequency and effectiveness and between coping strategy use and psychological functioning also were examined. Predominantly Caucasian female and male college students participated in the studies. Results indicated support for both socialization and role constraint theories. Effectiveness and frequency of coping strategy use were moderately correlated. Gender differences in cognitive appraisal varied with dispositional vs. situational assessment. The need for a more integrated model to explain gender differences in coping and implications for existing theories are discussed.     

Mental disorders and communication of intent to die in indigenous suicide cases, Queensland, Australia

In comparing Indigenous to non-Indigenous suicide in Australia, this study focussed on the frequency of the association between some psychiatric conditions, such as depression and alcohol abuse, and some aspect of suicidality, in particular communication of suicide intent. Logistic regression was implemented to analyze cases of Indigenous (n = 471) versus non-Indigenous suicides (n = 6,655), using the Queensland Suicide Register as a data source. Compared to non-Indigenous suicides, Indigenous cases had lower odds of being diagnosed with unipolar depression, seeking treatment for psychiatric conditions or leaving a suicide note. Indigenous suicides had greater odds of verbally communicating suicide intent and having a history of alcohol and substance use. The magnitude of these differences is remarkable, underscoring the need for culturally sensitive suicide prevention efforts.     

A Review of “Suicidal Intent” Within the Existing Suicide Literature

The results of a systematic literature review that investigated suicide intent are presented. Of the 44 relevant articles identified, 17 investigated the relationships between various suicide risk factors and suicide intent and 25 publications investigated the relationships between suicide intent and various suicide outcomes. Despite recent advancements in the definition and nomological validity of suicide intent, a high degree of variability in the empirical measurement and analysis of suicide intent was found. Such variability limits future research related to measuring suicidal risk and outcomes, reporting suicide intent, or the meaningful comparison of diagnostic approaches or treatments across multiple studies.     

Correlates of relative lethality and suicidal intent among deliberate self-harm patients

Conflicting findings have been reported regarding the relationship between the potential lethality of acts of deliberate self-harm (DSH) and suicidal intent, and how each relates to patient characteristics. This study examines the relationship of suicidal intent of DSH to lethality, the relationship of both to patient characteristics, and determines if intent or lethality are risk factors for repetition of DSH. Potential lethality and Suicide Intent Scale (SIS) scores for DSH episodes were examined in a representative sample of 150 patients presenting to a general hospital. Follow-up interviews were completed 12 to 20 months later. Lethality was strongly associated with high intent. Both lethality and intent were associated with male gender. Suicidal intent but not lethality was associated with the presence of psychiatric disorder and depression. Intent was significantly correlated with hopelessness scale score. Although intent was correlated with both depression and self-esteem scale scores, these correlations became nonsignificant when the effect of hopelessness was removed. Repetition of DSH during the follow-up period was related to neither lethality nor intent scores for the original episodes. Lethality and suicidal intent, although related, have somewhat different correlates. Both should be considered when assessing DSH patients, but their relationship to further suicidal behavior does not appear to be straightforward.     

Gender Differences in Experimental Disclosure: Evidence, Theoretical Explanations, and Avenues for Future Research

Interest in emotional expression is long-standing. Given well-established gender differences in expressivity, it is surprising that researchers have not consistently examined gender as a potential moderator of outcome in the context of experimental disclosure studies. This article comments on Range and Jenkins’ (2010) research recommendations in light of the suggestion that males evidence greater benefit of disclosure than females and three gender theories: gender schema theory, social role theory, and gender socialization theory. Further avenues for research are also presented, including the examination of gender differences in subjective, expressive and physiologic indicators of emotion during disclosure. Such data could elucidate mechanisms by which persons of different genders or persons with different schemata/ social roles/ socialization histories differ on pre/ post disclosure outcomes.