Interoceptive Deficits,Nonsuicidal Self‐Injury,and Suicide Attempts Among Women with Eating Disorders

People with eating disorders (ED s) have an elevated risk for both nonsuicidal self‐injury (NSSI ) and suicide compared to the general population. This study tests two theoretically derived models examining interoceptive deficits as a risk factor for NSSI , and examining interoceptive deficits, NSSI , fearlessness about death, and pain tolerance as risk factors for suicide. Ninety‐six adult, treatment‐seeking women with ED s completed self‐report questionnaires at a single time point. Interoceptive deficits were significantly associated with NSSI , and NSSI was in turn associated with both pain tolerance and fearlessness about death. Further, pain tolerance was in turn associated with past suicide attempts, although fearlessness about death was not associated with suicide attempts. Interoceptive deficits had a direct association with fearlessness about death but not pain tolerance. Results regarding the relation between interoceptive deficits and suicide attempts were mixed, yet overall suggest that interoceptive deficits are related to suicide attempts largely indirectly, through the effects of mediating variables such as NSSI , fearlessness about death, and pain tolerance. Results suggest that interoceptive deficits and pain tolerance merit further investigation as potential risk factors for fatal and nonfatal self‐harm among individuals with ED s.     

Nonsuicidal Self‐Injury Is Predictive of Suicide Attempts Among Individuals with Mood Disorders

Nonsuicidal self‐injury (NSSI) prior to age 18 was evaluated as a risk factor for adulthood suicide attempt (SA). Archival data from 222 mood‐disordered participants were analyzed using multivariate Cox proportional hazards analysis. Participants with a youth SA were excluded. The hazards of SA among adult participants with a history of youth NSSI were twice than those of mood‐disordered participants without youth NSSI (hazard ratio = 2.00, 95% confidence interval = 1.16–3.44, p = .01). Moreover, participants who had both youth and adult NSSI attempted suicide significantly earlier than participants who began NSSI as an adult. Youth NSSI is associated with persistent, elevated SA risk in adulthood.     

Social and individual risk factors for suicide ideation among Chinese children and adolescents: A multilevel analysis

The objective of this study was to investigate the prevalence and predictors of suicide ideation among primary, middle and high school students. We used multilevel modelling to investigate suicide ideation among 12,733 Chinese children and adolescents aged 9–18 years from wide range of areas across China. Approximately, 32.09% of children and adolescents reported suicide ideation, with females were more likely to report suicide ideation than males (38.09% vs. 29.95%). Our results showed that the risk factors in primary school students were different from middle and high school student groups, whereas significant risk factors for middle and high school students were similar. The city's standard of living as indicated by the Engel coefficient and the city's divorce rate were positively associated with the prevalence of suicide ideation; in contrast, the school's pupil‐to‐teacher ratio was negatively correlated with elevated suicide ideation. Significant risk factors for suicide ideation included study anxiety, self‐accusation tendency, impulsive tendency, terror tendency and physical symptoms. These results have important implications for the prevention of suicide, suggesting that both contextual (city‐level) and compositional (individual‐level) factors could be important targets for prevention and intervention for children and adolescents at risk of suicide ideation.     

Moving Beyond Self‐Report: Implicit Associations about Death/Life Prospectively Predict Suicidal Behavior among Veterans

Reliance on self‐report limits clinicians' ability to accurately predict suicidal behavior. In this study the predictive validity of an objective measure, the death/suicide Implicit Association Test (d/sIAT), was tested among psychiatrically hospitalized veterans. Following acute stabilization, 176 participants completed the d/sIAT and traditional suicide risk assessments. Participants had similar d/sIAT scores regardless of whether they had recently attempted suicide. However, d/sIAT scores significantly predicted suicide attempts during the 6‐month follow‐up above and beyond other known risk factors for suicidal behavior (OR = 1.89; 95% CI: 1.15–3.12; based on 1SD increase). The d/sIAT may augment the accuracy of suicide risk assessment.     

Sexual Self‐Concept Ambiguity and the Interpersonal Theory of Suicide Risk

Mechanisms (i.e., thwarted belongingness, perceived burdensomeness, hopelessness) derived from the interpersonal theory of suicide which are hypothesized to account for the relation between sexual orientation self‐concept ambiguity and active suicide ideation were examined. Participants included 349 women, among whom 42% currently self‐ascribed a non‐exclusively heterosexual sexual identity. Among women reporting higher levels of sexual self‐concept ambiguity, greater risk for active suicide ideation is found when perceptions of burden and feelings of thwarted belonging co‐occur with feelings of hopelessness. Results support relevant theory useful for understanding suicide risk among sexual minority women who acknowledge ambiguity with regard to their sexual orientation.     

Deliberate Self‐Harm in Adolescents Aged 12–18: A Cross‐Sectional Survey of 18,104 Students

Little is known about accurate prevalence and associated factors of deliberate self‐harm (DSH) among adolescents in Asian countries. In this study, the prevalence and associated factors of DSH among adolescents in Japan were examined. Data were derived from a cross‐sectional survey using an anonymous self‐report questionnaire and enrolling 8,620 adolescents aged 12–15 and 9,484 aged 15–18. DSH in the previous 12 months was reported by 3.3% (95% CI, 2.9–3.7) of junior and 4.3% (3.9%–4.7%) of senior high school respondents. The prevalence was more than four times as high among girls as among boys for both age groups. DSH was further strongly associated with having suicidal thoughts, having depression/anxiety symptoms, and having used recreational drugs. These associated factors were similar for both sexes and for both older and younger teenagers. A substantial minority of adolescents present with DSH, even among those aged 12–15. The prevalence of DSH in Japan was in the lower ranges of those reported for Western countries. The identified associated factors were not dissimilar from those reported in the West.     

Suicide on Railroad Rights‐of‐Way: A Psychological Autopsy Study

Findings from 55 psychological autopsies of decedents who perished on U.S. railroad rights‐of‐way between October 1, 2007, and September 30, 2010 are reported. Described are distal, proximal, and contextual factors of risk; understandings of why these suicides occurred on railroad rights‐of‐way; and opportunities for prevention of similar suicides. International comparisons of suicides on railroad rights‐of‐way are made to highlight distinct findings regarding U.S. cases. Decedents studied exhibited considerable predisposing risk for suicide, with a high prevalence of severe mental disorders and substance abuse. In addition, a number of acute risk factors were commonly observed, notably suicide ideation, hopelessness, anxiety, and anger. In the context of that acute risk, associated situational variables and a relative absence of protective factors are described.     

Suicidal Ideation,Depressive Symptomatology,and Self‐Concept: A Comparison Between Mexican Institutionalized and Noninstitutionalized Children

Previous research reports a significant prevalence of child depression worldwide and self‐concept as a predictor of depression and suicide behavior. Although suicide in children is an increasing problem in Mexico, there are scarce studies reporting risk factors and none of children in foster care institutions. This was a comparative, ex post facto study whose aim was to analyze associations between suicidal ideation, depression, and self‐concept in two paired samples of Mexican children (83 institutionalized and 83 noninstitutionalized). Results show 16% of the children reported suicidal ideation and statistically significant differences among variables in both samples. Suggestions are made to address this problem from early ages.     

Self‐Esteem and Suicide Ideation in Psychiatric Outpatients

Depression, hopelessness, and low self‐esteem are implicated as vulnerability factors for suicide ideation. The association of self‐esteem with suicide ideation after controlling for depressed mood and hopelessness was examined. Adult psychiatric outpatients (N = 338) completed measures of self‐esteem, suicide ideation, hopelessness, and depression. Self‐esteem was operationalized as beliefs about oneself (self‐based self‐esteem) and beliefs about how other people regard oneself (other‐based self‐esteem). Each dimension of self‐esteem was negatively associated with suicide ideation after controlling for depression and hopelessness. Of the two dimensions of self‐esteem, other‐based self‐esteem was the more robust predictor of suicide ideation. These findings suggest that even in the context of depression and hopelessness, low self‐esteem may add to the risk for suicide ideation.     

Suicidality,Self‐Harm,and Body Dissatisfaction in Transgender Adolescents and Emerging Adults with Gender Dysphoria

Prevalence of suicide attempts, self‐injurious behaviors, and associated psychosocial factors were examined in a clinical sample of transgender (TG) adolescents and emerging adults (n = 96). Twenty‐seven (30.3%) TG youth reported a history of at least one suicide attempt and 40 (41.8%) reported a history of self‐injurious behaviors. There was a higher frequency of suicide attempts in TG youth with a desire for weight change, and more female‐to‐male youth reported a history of suicide attempts and self‐harm behaviors than male‐to‐female youth. Findings indicate that this population is at a high risk for psychiatric comorbidities and life‐threatening behaviors.     

Modifiable risk factors for attempted suicide in Australian clinical and community samples

Modifiable risk factors for suicide attempt require identification in clinical and community samples. The aim of this study was to determine if similar social and psychiatric factors are associated with suicide attempts in community and clinical settings and whether the magnitude of effect is greater in clinical populations. Two case-control studies were used: nationwide community-based lifetime attempted suicide (ComAS) cases compared to nationwide community controls; and clinical deliberate self-poisoning (ClinDSP) cases that had hospital treatment compared to normative controls of similar demographic composition. The pattern of risk factors in ComAS and ClinDSP cases was similar, the magnitude of risk usually greater in clinical cases. Greatest attributable fractions were: ComAS current unemployment (39.8% male, 15.5% female) and anxiety disorders (14.0% males, 22.6% females); and ClinDSP current unemployment (69.6% male, 55.5% female) and affective disorders (45.4% male, 39.1% female). Practical intervention targets were unemployment, anxiety and substance use disorders, affective disorders (clinical only), and personality disorder (females only).     

Firearm Storage Practices and Risk Perceptions Among a Nationally Representative Sample of U.S. Veterans With and Without Self‐Harm Risk Factors

Despite the disproportionate use of firearms in Veteran suicides and the well‐established link between firearm access and suicide, little is known about how Veterans store their firearms or what they think about the relationship between firearm access and suicide risk. Using data from 2015 nationally representative online survey (response rate 60.9%), we compare characteristics of Veteran firearm owners with and without self‐harm risk factors with respect to how they store their firearms and their beliefs about suicide risk related to firearms. Overall, one in three U.S. Veteran firearm owners store household firearms loaded and unlocked, one in twenty believe that a firearm increases household suicide risk, and one in four consider their loaded and unlocked firearm to be inaccessible to suicidal household members. Storage practices and risk perceptions are similar among those with and without self‐reported suicide risk factors. Affecting risk perceptions may be a critical aspect of interventions addressing lethal means safety among U.S. Veterans.     

Risk‐Related and Protective Correlates of Nonsuicidal Self‐Injury and Co‐Occurring Suicide Attempts among Incarcerated Women

Individual and environmental correlates of nonsuicidal self‐injury (NSSI) and co‐occurring suicide attempts (SA) among incarcerated women (N = 104) were examined. Participants completed measures of putative risk and protective factors, including coping styles, childhood maltreatment, and hopelessness. Results indicated that active coping was uniquely, negatively associated with the presence and frequency of NSSI, whereas avoidant coping and childhood physical/emotional abuse were positively associated with NSSI frequency. Conversely, among women with a history of NSSI, hopelessness was uniquely, positively associated with the presence and frequency of SA. Further, childhood sexual abuse was associated with the presence of SA, while physical/emotional abuse was associated with SA frequency. Hopelessness was more strongly related to SA frequency than NSSI frequency. These findings help disentangle the unique risk and protective factors for NSSI and co‐occurring SA in incarcerated samples.     

Victimization and Exposure to Pro‐Self‐Harm and Pro‐Suicide Websites: A Cross‐National Study

The study of websites displaying methods of both physical self‐harm and suicide has become an important aspect of deliberate self‐injury and suicide research. However, little is known about contextual factors related to entering such sites. Using data from 3,567 respondents aged 15–30 in the US, UK, Germany, and Finland, we found that experiences of victimization are associated with entering pro‐self‐harm sites and pro‐suicide sites. Also, the victimization context had relevance, as online victimization was particularly related to pro‐self‐harm behavior. The findings suggest a need to organize more specific online support for the victims of violence and online aggression.     

Predicting Suicide Attempts among Treatment‐Seeking Male Alcoholics: An Exploratory Study

Documented risk factors for suicide among alcohol‐dependent patients are sensitive but insufficiently specific to effectively identify individuals who are prone to future suicide attempt. As a first step to assess factors not previously considered, this pilot study involved a group of male alcohol‐dependent patients (N = 175) coming to detoxification to examine the potential utility of adverse childhood experiences (ACE) along with other documented events to discriminate individuals with a history of attempted suicide from their detoxifying peers. Family health history questionnaires were used to evaluate their ACEs. Receiver operating characteristic (ROC) analysis was applied to examine the predictive power of ACEs, alone or in combination with documented risk factors, to lifetime history of attempted suicide. Among our participants, 48 (27.4%) had a history of a suicide attempt and 156 (89.1%) reported at least one out of the nine categories of ACEs. Modeling by ROC analysis, we found that a cutoff of four or more ACEs plus a history of personal violence achieved the best predictive power to a history of any suicide attempt, producing a sensitivity of 0.7, specificity of 0.81, and area under curve of 0.75. A prospective study to replicate and extend our findings is necessary.     

The Role of Sleep Disturbance in Suicidal and Nonsuicidal Self‐Injurious Behavior among Adolescents

The relationship between different sleep disturbances and self‐harm thoughts and behaviors was examined among 223 adolescents presenting to a community clinic for mood disorders and suicidal and nonsuicidal self‐injurious behaviors. Two‐thirds of the adolescents reported nightly, severe sleep complaints. Relative to adolescents without significant sleep complaints, patients with severe sleep complaints at the time of clinic entry endorsed significantly more engagement in nonsuicidal self‐injury. Middle insomnia and circadian reversal were both significant predictors of suicide attempts. Terminal insomnia was significantly associated with suicidal ideation. Results support the importance of assessing sleep difficulties among adolescents at risk for suicide.     

Prevalence of Suicide Risk Factors and Suicide‐Related Outcomes in the National Mental Health Study,Colombia

A community survey in 4,426 adults was undertaken as part of the World Mental Health Survey Initiative reporting the prevalence and risk factors for suicide‐related outcomes in Colombia. Lifetime prevalence estimates of suicide ideation, plans, attempts, and risk factors for suicide‐related outcomes were assessed. Retrospective reports of disorders age‐of‐onset were used to study associations between primary mental disorders and first onset of suicide‐related outcomes. Risks of plans and attempts were highest with ideation early age‐of‐onset and within the first year. The highest risk for ideation and attempt among ideators occurred in the 18–29 age group. After first employment (defined as the first paid job accepted by the respondent) and presence of mental disorders constituted risk factors. Impulse‐control disorders were strongest diagnostic predictors.     

Changing Rates of Suicide Ideation and Attempts Among Inuit Youth: A Gender‐Based Analysis of Risk and Protective Factors

Inuit in Canada currently suffer from one of the highest rates of suicide in the world. The objective of this study was to explore the prevalence of suicide ideations and attempts among 15–24 year olds living in Nunavik, Québec, and to explore risk and protective factors of suicide attempts as a function of gender. A cross‐sectional survey was conducted in 2004 across Nunavik. Univariate and multivariate logistic regressions were conducted. A total of 22% of young males and 39% of females adults reported past suicidal attempts. Gender differences were observed in relation to associated risk and protective factors as well as degree of exposure to risk factors. Suicide prevention must include alcohol and drug prevention programs and rehabilitation services, interventions to reduce physical and sexual violence and their long‐term impacts on Inuit youth, as well as exposure to culturally meaningful activities.     

Wall/Object Punching: An Important but Under‐Recognized Form of Nonsuicidal Self‐Injury

The present research investigated wall/object punching as a form of nonsuicidal self‐injury (NSSI ) among 1,143 veterans seeking treatment for posttraumatic stress disorder (PTSD ). Wall/object punching was remarkably common in this sample (43%), and its inclusion in the definition of NSSI increased estimated prevalence of recent NSSI by 14%. As expected, wall/object punching was strongly associated with other traditional forms of NSSI , post‐NSSI relief, and suicide ideation. Male veterans and veterans with PTSD were significantly more likely to engage in wall/object punching than female veterans and veterans without PTSD . More research on this important but under‐recognized form of NSSI is needed.     

The Role of Help‐Seeking in Preventing Suicide Attempts among Lesbians,Gay Men,and Bisexuals

One possible approach to prevention of suicide attempts is to encourage help‐seeking among individuals at risk. We assessed whether different forms of treatment were associated with lower odds of a suicide attempt in a diverse group of 388 lesbian, gay, and bisexual (LGB) adults aged 18–59, sampled from New York City venues. Of individuals who attempted suicide, 23% sought mental health or medical treatment and 14% sought religious or spiritual treatment prior to the suicide attempt. Black and Latino LGBs were underrepresented in mental health or medical treatment and Black LGBs were overrepresented in religious or spiritual treatment. Seeking mental health or medical treatment was not associated with lower odds of a suicide attempt; seeking religious or spiritual treatment was associated with higher odds of a suicide attempt. We discuss these results and posit hypotheses for further research of this understudied topic.