Predicting Suicide Ideation in the Military: The Independent Role of Aggression

The purpose of this study was to examine the longitudinal relationship between aggression and suicide ideation when controlling for other externalizing (i.e., alcohol misuse and risk‐taking) and internalizing (i.e., depression and sleep problems) risk factors in an active duty, military sample. Preexisting data from a longitudinal study were analyzed to assess the wellness of service members across the deployment cycle. Participants were 944 active duty service members (95% male, 48% between 18 and 24 years old) who completed surveys upon initial return from deployment and approximately 3 months later. After controlling for other externalizing (alcohol misuse, risk‐taking) and internalizing (depression, sleep problems) risk factors, service members reporting aggression were significantly more likely to report suicide ideation than those reporting no aggression (OR = 3.19; OR 95% CI: 1.16–8.80). The independent nature of the relationship between anger and suicidality suggests aggression may be an important indicator of suicidality for service members. Understanding the role of aggression in suicidality may improve the ability to identify at‐risk service members and to develop effective interventions to reduce suicide risk.     

Longitudinal Associations between Violence and Suicidality from Adolescence into Adulthood

The link between violence and suicide is well documented. Previous studies, however, largely rely on cross‐sectional designs or only consider violence as an antecedent of suicide. The purpose of the current study was to investigate the longitudinal relationship between violence and suicide from adolescence into young adulthood. Data were derived from Wave II (1995–1996), Wave III (2001–2002), and Wave IV (2007–2008) of the National Longitudinal Study of Adolescent Health (N = 8,966). We tested (2011–2013) a series of path analysis models in Mplus to determine the longitudinal associations between violence and suicidality. Results from the path analyses indicated that violence and suicidality mutually affect each other from adolescence into young adulthood. We found some evidence that the association between suicidality and violence was stronger for males compared to females, particularly in early and young adulthood. The current study confirms previous findings by demonstrating that violence is a risk factor for future suicide. We also extended the previous literature by demonstrating that a history of suicidality is associated with future risk for violence. Our findings highlight the importance of further integrating prevention efforts to reduce violence and suicidality during adolescence and early/young adulthood.     

Suicide in the media: a quantitative review of studies based on non-fictional stories

Research on the effect of suicide stories in the media on suicide in the real world has been marked by much debate and inconsistent findings. Recent narrative reviews have suggested that research based on nonfictional models is more apt to uncover imitative effects than research based on fictional models. There is, however, substantial variation in media effects within the research restricted to nonfictional accounts of suicide. The present analysis provides some explanations of the variation in findings in the work on nonfictional media. Logistic regression techniques applied to 419 findings from 55 studies determined that: (1) studies measuring the presence of either an entertainment or political celebrity were 5.27 times more likely to find a copycat effect, (2) studies focusing on stories that stressed negative definitions of suicide were 99% less likely to report a copycat effect, (3) research based on television stories (which receive less coverage than print stories) were 79% less likely to find a copycat effect, and (4) studies focusing on female suicide were 4.89 times more likely to report a copycat effect than other studies. The full logistic regression model correctly classified 77.3% of the findings from the 55 studies. Methodological differences among studies are associated with discrepancies in their results.     

The impact of rock videos and music with suicidal content on thoughts and attitudes about suicide

In Experiment 1, 133 college student volunteers watched a rock music video with or without suicidal content and then completed written measures assessing mood, priming of suicide-related thoughts, perceptions of personal risk, sensitivity to suicidality in others, and attitudes/beliefs about suicide. In Experiment 2, 104 college student volunteers listened to rock music with either suicidal or neutral content and then completed measures similar to Experiment 1, with the addition of a hopelessness measure. In both experiments, participants exposed to suicidal content wrote more scenarios with suicide-related themes in a projective storytelling task than those exposed to nonsuicidal content. However, there were virtually no group differences on explicit measures of affect, attitudes, and perceptions. Music and videos with suicide content appeared to prime implicit cognitions related to suicide but did not affect variables associated with increased suicide risk.     

Treating the Capability for Suicide: A Vital and Understudied Frontier in Suicide Prevention

Current efforts at suicide prevention center largely on reducing suicidal desire among individuals hospitalized for suicidality or being treated for related psychopathology. Such efforts have yielded evidence‐based treatments, and yet the national suicide rate has continued to climb. We propose that this disconnect is heavily influenced by an unmet need to consider population‐level interventions aimed at reducing the capability for suicide. Drawing on lessons learned from other public health phenomena that have seen drastic declines in frequency in recent decades (HIV, lung cancer, motor vehicle accidents), we propose that current suicidality treatment efforts trail current suicidality theories in their lack of focus on the extent to which individuals thinking about suicide are capable of transitioning from ideation to attempt. We summarize extant evidence for specific capability‐centered approaches (e.g., means safety) and propose other options for improving our ability to address this largely overlooked variable. We also note that population‐level approaches in this regard would represent an important opportunity to decrease risk in individuals who either lack access to evidence‐based care or underreport suicidal ideation, as a reduced capability for suicide would theoretically diminish the potency of suicidal desire and, in this sense, lower the odds of a transition from ideation to attempt.     

Clarifying the Relationship of Parental Bonding to Suicide Ideation and Attempts

Suicide and suicidal behavior are major public health problems, especially among adolescents and young adults. Previous research has established links between parental bonding and suicidality; however, it remains unclear whether parental bonding is associated with suicide ideation, the progression from suicide ideation to suicide attempts, or both. This study examined the relation of parental bonding to suicide ideation and suicide attempts in adolescents from two settings: (1) acute psychiatric care (n = 172) and (2) high school (n = 426). All participants were administered validated measures of parental bonding, suicide ideation, and suicide attempts, as well as emotion dysregulation, loneliness, and self‐worth. In the psychiatric sample, lower parental care significantly differentiated adolescents with a history of suicide attempts from those with suicide ideation only or without histories of suicidality. This pattern remained even after controlling for other known correlates of suicidality (i.e., emotional dysregulation, loneliness, and low self‐worth). Similar effects were found in the community sample, although these findings failed to reach statistical significance. In both samples, parental overprotection was not associated with suicide ideation or suicide attempts. Results suggest that parental care may be an important risk factor for youth suicidal behavior and may help differentiate suicide attempters from suicide ideators.     

Effects of a Military Parenting Program on Parental Distress and Suicidal Ideation: After Deployment Adaptive Parenting Tools

Few studies have examined whether parenting prevention programs might mitigate risk for suicidality in parents, yet parent suicidality is a strong risk factor for offspring suicidality. We report results from a randomized controlled trial of a parenting program for deployed National Guard and Reserve families with a school‐aged child. Intent‐to‐treat analyses showed that random assignment to the parenting program (ADAPT) was associated with improved parenting locus of control (LOC). Improved parenting LOC was concurrently associated with strengthened emotion regulation which predicted reductions in psychological distress and suicidal ideation at 12 months postbaseline. Results are discussed in the context of ongoing efforts to reduce suicide rates in military populations.     

On the Iatrogenic Risk of Assessing Suicidality: A Meta‐Analysis

Previous studies have failed to detect an iatrogenic effect of assessing suicidality. However, the perception that asking about suicide may induce suicidality persists. This meta‐analysis quantitatively synthesized research concerning the iatrogenic risks of assessing suicidality. This review included studies that explicitly evaluated the iatrogenic effects of assessing suicidality via prospective research methods. Thirteen articles were identified that met inclusion criteria. Evaluation of the pooled effect of assessing suicidality with regard to negative outcomes did not demonstrate significant iatrogenic effects. Our findings support the appropriateness of universal screening for suicidality, and should allay fears that assessing suicidality is harmful.     

Introduction to the Special Issue on Interoception and Suicidality

Empirically informed theories of suicide highlight the importance of identifying factors that lead from suicide ideation to suicidal behavior. Interoceptive dysfunction may be one such differentiating factor. Interoceptive dysfunction refers to a disconnection from the internal sensations of the body, which can cause difficulty in truly understanding and knowing one’s own body. Specifically, interoceptive dysfunction may lead to such disconnection from the self that the body comes to be seen as “other” and potentially even “nonhuman.” A burgeoning body of research supports these theoretical links and also highlights the need for methodologically rigorous studies that employ careful measurement of these constructs. Thus, this special section is devoted to articles that advance the understanding of the relationship between interoception and suicidality. A more nuanced understanding of the relationship between interoceptive dysfunction and suicidality is critical for improving suicide prevention and treatment efforts.     

Predictors and Outcomes of Psychiatric Hospitalization in Youth Presenting to the Emergency Department with Suicidality

Youth suicide attempters presenting to the emergency department (ED) are frequently admitted to psychiatric inpatient hospitals, yet little is known about how clinicians decide which youths to admit versus discharge to outpatient care. We examine predictors of inpatient hospitalization and describe service use outcomes associated with hospitalization in 181 youths drawn from consecutive ED admissions for suicidality. Predictors of hospitalization include ED site, suicide plan, and parent report of problems. Hospitalization was associated with improved linkage to outpatient treatment and more intensive service use. Future research is needed to understand the best service delivery and treatments for these high‐risk youth.     

Association between serotonin transporter gene polymorphism and family history of attempted and completed suicide

The purpose of this study was to examine the association of the serotonin transporter gene to family history of suicidality. Forty-seven volunteers responded to questionnaires about family history of suicide, and provided buccal swabs for analysis of the polymorphism. Allelic homozygocity (the short variant) was associated with family history of suicidality. These data, to be interpreted with the study's limitations in mind, suggest a link between the serotonin transporter gene polymorphism and suicide-related variables, which should be the focus of future research.     

Examining the relationship between at-risk gambling and suicidality in a national representative sample of young adults

Although many clinical studies document a relationship between gambling and suicidality, evidence of this association in general population surveys has been mixed. Probing this association in a nationally representative sample of young adults with data from the National Longitudinal Survey of Adolescent Health, we made same gender comparisons of depression and suicidality between 298 at-risk gamblers and 13,000 others. Although gamblers of both genders showed higher depression, only females reported significantly higher suicide thoughts and attempts. Males with gambling problems were no more likely than nongamblers to have suicide thoughts or to make prior suicide attempts on three separate measurement occasions.     

Violent obsessions are associated with suicidality in an OCD analog sample of college students

The picture of suicide in obsessive-compulsive disorder (OCD) is unclear because previous research did not uniformly control for depressive symptoms when examining the relationship between OCD and suicidality. Specific links between OC symptom dimensions and suicidality were also not adequately studied. As such, we investigated specific associations between OC symptom dimensions and suicidality, beyond the contribution of depressive symptoms, in an OCD analog sample of college students, a group traditionally at risk for suicide. One hundred and forty-six college students (103 females; 43 males) who exceeded the clinical cut-off for OC symptoms on the Obsessive-Compulsive Inventory, Revised (OCI-R) were recruited. Participants completed an online questionnaire containing measures that assessed suicidality and OC and depressive symptom severity. Total OC symptom severity, unacceptable thoughts, and especially violent obsessions exhibited significant positive zero-order correlations with suicidality. However, analyses of part correlations indicated that only violent obsessions had a significant unique association with suicidality after controlling for depressive symptoms. Our findings support the hypothesis that violent obsessions have a specific role in suicidality beyond the influence of depressive symptoms in an OCD analog sample of college students. A strong clinical focus on suicide risk assessment and safety planning in college students reporting violent obsessions is therefore warranted. Future related research should employ longitudinal or prospective designs and control for other possible comorbid symptoms in larger and more representative samples of participants formally diagnosed with OCD in order to verify the generalizability of our findings to these groups.     

Validation of the reasons for living inventory in general and delinquent adolescent samples

Two studies are reported that discuss the validation of an adult suicide prediction questionnaire for use with adolescents. The Reasons for Living Inventory (RFL; Linehan, Goodstein, Nielsen, & Chiles, 1983) was slightly modified and administered to two samples of adolescents: one from a general high school population and one from a population of juvenile delinquents receiving psychological treatment in a correctional facility. As with adults, adolescents who reported more reasons for staying alive were less apt to report past or recent suicidal thoughts or behaviors. Evidence of convergent validity emerged via correlations of RFL subscales with depression, hopelessness, and other suicide inventories. Evidence of discriminant validity emerged in that correlations with social desirability were not large. Evidence of construct validity emerged in that the RFL subscales related to suicidal thoughts and behaviors over and above depression and hopelessness. Differences between general and delinquent adolescents' reasons for living are discussed.Special gratitude is due to the Indiana Department of Corrections and the Penn-Harris-Madison Public School System for their cooperation and assistance in data collection for this project.     

Suicidality in Bipolar Disorder: The Role of Emotion‐Triggered Impulsivity

A growing body of research suggests that impulsive responses to emotion more robustly predict suicidality than do other forms of impulsivity. This issue has not yet been examined within bipolar disorder, however. Participants diagnosed with bipolar I disorder (n = 133) and control participants (n = 110) diagnosed with no mood or psychotic disorder completed self‐report measures of emotion‐triggered impulsivity (Negative and Positive Urgency Scales) and interviews concerning lifetime suicidality. Analyses examined the effects of emotion‐triggered impulsivity alone and in combination with gender, age of onset, depression severity, comorbid anxiety, comorbid substance use, and medication. A history of suicide ideation and attempts, as well as self‐harm, were significantly more common in the bipolar disorder group compared with the control group. Impulsive responses to positive emotions related to suicide ideation, attempts, and self‐harm within the bipolar group. Findings extend research on the importance of emotion‐triggered impulsivity to a broad range of key outcomes within bipolar disorder. The discussion focuses on limitations and potential clinical implications.     

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 risk among dentists: A multivariate analysis

Dentists are recognized as an occupational group with a high incidence of suicide. Past work, however, has focused only on the bivariate dentist‐suicide relationship. It is not clear whether this risk of suicide is because of occupational stress or sociodemographic factors, such as gender and divorce, which are covariates of dentist status. The present study reassesses the link between dentistry and suicide by controlling for dentistry's covariates. Controlling for sociodemographic factors, dentists still have a significantly higher risk of suicide, indicating that occupational stress may be a source of their high suicidality.     

Self-Reported Interoceptive Sensibility Does Not Moderate the Relationship Between Eating Disorder Symptoms and Suicidal Thoughts and Behaviors

Past research has demonstrated a strong relationship between eating disorders (EDs) and suicidality (i.e., suicidal thoughts, plans, and attempts), and preliminary work within the framework of the interpersonal psychological theory of suicide (Joiner, 2007) suggests that potentially painful ED behaviors (binge eating, purging, fasting, excessive exercise) may contribute to increased risk of suicide through heightened pain tolerance and increased capability of suicide. However, additional explanations are needed for why only some individuals with EDs actually engage in suicidal behaviors (i.e., attempt suicide), whereas others do not. A growing body of literature suggests that interoceptive deficits (a disconnection from one’s own bodily sensations and emotions; IDs) might be a factor linking eating disorders and suicide. To better understand this relationship, the current study tests the moderating effects of self-reported IDs on the relations between ED behaviors and suicidality and past suicide attempts in a transdiagnostic ED sample (N = 181). We hypothesized that ED behaviors would directly relate to suicidality, but that IDs would moderate the relationship between ED behaviors and past suicide attempts, such that those high in IDs would demonstrate a stronger relationship between ED behaviors and suicide attempts. Contrary to our hypothesis, IDs did not moderate the relationship; instead, fasting and purging had significant and strong main effects on suicidality and past suicide attempts without moderation effects. Results suggest that fasting and purging may be important ED behaviors to consider in the relationship between EDs and suicidality. Future directions include further examining the relationship between IDs, suicidality, and EDs using measures of IDs that better encompass physical (as opposed to emotional) aspects of IDs.     

The Longitudinal Association of Being Bullied and Gender with Suicide Ideations,Self‐Harm,and Suicide Attempts from Adolescence to Young Adulthood: A Cohort Study

Longitudinal associations between being bullied during adolescence and suicide ideations, self‐harm, and suicide attempts into young adulthood were examined. A large representative sample was examined in 1998 (N  = 2,464, MA 13.7), 1999/2000, and 2012 to reassess the outcome measures. At all ages, bullied participants showed more suicide ideation, self‐harm, and suicide attempts, regardless of gender. Bullied females showed a decrease in suicide ideation from adolescence to adulthood, while bullied males showed an increase in suicide attempts in the same time period. Being bullied in adolescence strongly predicts suicidal behavior and self‐harm. Preventive efforts might reduce the risk of later suicidality.     

A brief screening tool for suicidal symptoms in adolescents and young adults in general health settings: reliability and validity data from the Australian National General Practice Youth Suicide Prevention Project

Using data from a nationwide project on young people in Australia aimed at assessing suicidality in general health settings, we present a brief screening tool for suicidality (the depressive symptom index suicidality subscale). Two thousand eight hundred and fifty-one (15-24 year old) patients presenting to 247 Australian general practitioners between 1996 and 1998 were assessed. In addition to the suicide screen, patients completed the general health questionnaire-12 and the Center for Epidemiological Studies depression scale. Patients' chief complaints were taken from the summary sheets completed by their general practitioners. Using inter-item correlational and factor-analytic techniques, as well as a general approach to construct validity, we show that the measure has favorable reliability and validity characteristics. We also provide results on cut-points that may facilitate its use in clinical and research settings. Because the screen is brief, easy to use, reliable, and valid, we encourage its use to combat the vexing international health problem of suicide.