Coping with Crisis Across the Lifespan: The Role of a Telephone Hotline

We describe over 300,000 crisis calls made to a large national hotline over a 5-year period. Callers consisted of males and females between the ages of 10 and 89. Overall, a slight majority of callers were first time callers (52%) and most (73%) sought assistance with issues related to parenting, youth concerns, and mental health. Across the lifespan, issues dealing with loneliness increased with age whereas depression-related calls decreased. Additionally, females were more likely than their male counterparts to call the hotline by over a 2- to 1-margin. Findings lend preliminary support to the efficacy of crisis call centers to utilize a flexible, yet well-defined problem-solving approach to assist those of all ages calling with the wide range of problems.     

Effects of Different Telephone Intervention Styles with Suicidal Callers at Two Suicide Prevention Centers: An Empirical Investigation

To determine the relative effectiveness of telephone intervention styles with suicidal callers, researchers listened unobtrusively to 617 calls by suicidal persons at two suicide prevention centers and categorized all 66,953 responses by the 110 volunteer helpers according to a reliable 20-category checklist. Outcome measures showed observer evaluations of decreased depressive mood from the beginning to the end in 14% of calls, decreased suicidal urgency ratings from the beginning to the end in 27% of calls, and reaching a contract in 68% of calls, of which 54% of contracts were upheld according to follow-up data. Within the context of relatively directive interventions, a greater proportion of Rogerian nondirective responses was related to significantly more decreases in depression. Reduction in urgency and reaching a contract were related to greater use of Rogerian response categories only with nonchronic callers.     

Psychometric Characteristics of the Adult Suicidal Ideation Questionnaire in College Students

There is a growing concern for identifying individuals at risk for suicidal behaviors. Suicidal ideation, that is, the thoughts and cognitions one has about suicidal behaviors and intent, may be considered a primary marker for the risk of more serious suicidal behaviors. This investigation examined the reliability and validity of the Adult Suicidal Ideation Questionnaire (ASIQ; Reynolds, in press-a), a 25-item self-report suicidal ideation measure designed for adults. Subjects were 474 college students from two Midwestern universities. Results indicated high internal consistency (rα = .97) and test-retest (r[sub tt] = .86) reliability of the ASIQ with college students. Significant correlations (rs = .38 to .60) were found with measures of depression, hopelessness, anxiety, and self-esteem. For the total sample, a multiple correlation of .67 was found between the ASIQ, the independent variables just noted, and history of prior suicide attempt. Factor analysis of the ASIQ produced a four-factor solution. Psychometric support for the utilization of the ASIQ in clinical and research settings is presented and discussed. There is a growing concern for identifying individuals at risk for suicidal behaviors. Suicidal ideation, that is, the thoughts and cognitions one has about suicidal behaviors and intent, may be considered a primary marker for the risk of more serious suicidal behaviors. This investigation examined the reliability and validity of the Adult Suicidal Ideation Questionnaire (ASIQ; Reynolds, in press-a), a 25-item self-report suicidal ideation measure designed for adults. Subjects were 474 college students from two Midwestern universities. Results indicated high internal consistency (rα = .97) and test-retest (r[sub tt] = .86) reliability of the ASIQ with college students. Significant correlations (rs = .38 to .60) were found with measures of depression, hopelessness, anxiety, and self-esteem. For the total sample, a multiple correlation of ...     

The Benefit of Forgetting Suicidal Ideation

In a sample of young adult Australians, those who had had suicidal ideation but who did not acknowledge ever having had it when asked 4 years later, were experiencing better mental health, as demonstrated by significantly better functioning on a range of psychometric measures, than those who recalled it. These results are consistent with several recent reports and indicate that forgetting painful events such as suicidal ideation is an adaptive defense mechanism. This has implications in terms of therapy focusing on contemporaneous events and the future, rather than on the past.     

Telehealth Monitoring of Patients with Schizophrenia and Suicidal Ideation

A telehealth system was developed to monitor risk following hospitalization for suicidal ideation. We hypothesized that 3 months of telehealth monitoring will result in a greater reduction in suicidal ideation. Veterans with schizophrenia admitted with recent suicidal ideation and/or a suicidal attempt were recruited into a discharge program of VA Usual Care with daily Health Buddy© monitoring (HB) or Usual Care (UC) alone. Fifteen of 25 were randomized to HB and 10 received UC. Daily adherence in the use of the HB system during months 1–3 was, respectively, 86.9%, 86.3%, and 84.1%. There were significant improvements in Beck Scale for Suicide Ideation scores in HB participants. There were no changes in depressive symptoms. Telehealth monitoring for this population of patients appears to be feasible.     

Adolescent Suicidal Ideation Subgroups and their Association with Suicidal Plans and Attempts in Young Adulthood

Suicidal ideation during adolescence is quite common. Longitudinal ideation patterns may predict adolescents at greatest risk of progressing to more serious suicidal behaviors. We enumerated suicidal ideation trajectory subgroups and estimated subgroup association with later suicidal plans and attempts using data collected across a 13‐year period from 552 Caucasian adolescents. Three subgroups were found: non‐ideators (no ideation), decreasers (ideation decreased), and increasers (ideation persisted or increased). Probability of planning a suicide was greatest among increasers (females: .54, males: 51, p < .01). Probability of attempting suicide was greatest among male decreasers (.36, p < .01) and female increasers (.25, p < .01).     

Dysfunctional Attitudes and Suicidal Ideation in Psychiatric Outpatients

To determine if specific sets of dysfunctional attitudes were related to suicidal ideation, the 100-item Dysfunctional Attitude Scale (DAS) was administered to 908 psychiatric outpatients along with the Beck Depression Inventory (BDI), Hopelessness Scale (BHS), Self-Concept Test (BST), and Scale for Suicide Ideation (SSI). The SSI was used to classify the outpatients into 97 (10.7%) suicide ideators and 811 (89.3%) nonideators, and the DAS was scored for nine subscales described by Beck, Brown, Steer, and Weissman (1991) . None of the DAS subscales discriminated the ideators and nonideators or was significantly related to SSI total scores of the suicide ideators after controlling for sex, age, diagnosis of a mood or panic disorder, comorbidity, presence of a personality disorder, a history of a past suicide attempt, the BDI, the BHS, and the BST. The contributions of sets of dysfunctional attitudes for identifying and explaining suicidal ideation were overshadowed by a history of a past suicide attempt and hopelessness.     

Psychosocial Correlates of Suicidal Ideation in Adolescent Psychiatric Inpatients

The Beck Scale for Suicide Ideation (BSI) was administered to 121 inpatients between 12 and 17 years old who were diagnosed with mixed psychiatric disorders. Twelve background and clinical characteristics, previously found to be associated with adolescent suicidal ideation, were entered into a multiple regression to estimate the BSI scores, along with the Beck Anxiety Inventory, the revised Beck Depression Inventory (BDI), the Beck Hopelessness Scale (BHS), and the Youth Self-Report. The BHS and the BDI were the only two variables that contributed unique variance to the explanation of the BSI scores.     

Correlates of Suicidal Ideation in Physically Injured Trauma Survivors

Epidemiologic studies have documented that injury survivors are at increased risk for suicide. We evaluated 206 trauma survivors to examine demographic, clinical, and injury characteristics associated with suicidal ideation during hospitalization and across 1 year. Results indicate that mental health functioning, depression symptoms, and history of mental health services were associated with suicidal ideation in the hospital; being a parent was a protective factor. Pre‐injury posttraumatic stress disorder symptoms, assaultive injury mechanism, injury‐related legal proceedings, and physical pain were significantly associated with suicidal ideation across 1 year. Readily identifiable risk factors early after traumatic injury may inform hospital‐based screening and intervention procedures.     

An AIDS Hotline: Analysis of Callers,Presenting Problems,and Social Factors1

This research is an analysis of all calls received by an AIDS hotline over an 8-month period. Caller demographics and types of presenting problems of callers are reported. Overall, callers were most concerned about how the virus was transmitted and requested information about HIV testing for themselves, a partner, a friend, or a relative. Despite the fact that adolescents are at high risk for contracting HIV, few adolescents called the hotline, but those who did were more likely to request safer sex information than HIV testing information. In contrast, all other age groups requested HIV testing more than safer sex information, often by a 2:1 or 3:1 margin. Men called most frequently because of concerns about self, whereas women called most frequently with concerns about others. These results are discussed in the context of the AIDS epidemic and in terms of social factors.     

The Relation of Cognitive Reappraisal and Expressive Suppression to Suicidal Ideation and Suicidal Desire

The differential relations between the emotion regulation strategies “cognitive reappraisal” and “expressive suppression” and suicidality in a mixed inpatient sample (N = 232, 69.4% female) of a German psychotherapeutic hospital were examined. Patients filled in the Emotion Regulation Questionnaire and items on suicidal ideation and desire. A structural equation model fitted the data (RMSEA = .044; CFI = .96) and revealed that “expressive suppression” significantly predicted increased suicidal ideation. Moderation analysis showed that results were independent from a current depressive episode. Potential implications for psychotherapeutic treatment of suicidality are discussed.     

An Indicator of Suicidal Ideation on the Rorschach Test

We examined the impact of patient- and therapist-rated alliance developed during psychological assessment on the subsequent alliance measured early and late in formal psychotherapy. We hypothesized that a working alliance developed during psychological assessment conducted from a collaborative therapeutic model of assessment (TMA; Finn &; Tonsager, 1992, 1997; Fischer, 1994) between the patient and therapist would carry into formal psychotherapy. We also hypothesized that alliance for those patients receiving a TMA would be significantly greater than patients receiving psychological testing as usual. To test this hypothesis, we administered the Combined Alliance Short Form-Patient Version (Hatcher &; Barends, 1996) and the Combined Alliance Short Form-Therapist Version (Hatcher, 1999) to a sample of outpatients and their therapists at the end of the assessment feedback session, early, and late in psychotherapy. The hypotheses were supported as alliance scales rated at the assessment feedback session demonstrated positive and significant relationships with alliance throughout formal psychotherapy and in relation to a control group. The clinical utility and research implications of these findings are discussed.     

Concerns of Older Veteran Callers to the Veterans Crisis Line

When the Veterans Crisis Line (VCL) was implemented, it was uncertain if veterans, and particularly older male veterans, would utilize the service. We examined VCL use by a growing group of veterans at increased risk for suicide: those aged 60 and older. Real‐time clinical data were gathered from a weekly random sampling of calls. Approximately 25% of calls were from veterans aged 60 or older; over 80% reported benefit from the call. Several significant differences in presenting concerns between older and younger callers were found. Targeted outreach to encourage older veterans to use the VCL is suggested.     

Basic Psychological Needs,Suicidal Ideation,and Risk for Suicidal Behavior in Young Adults

Associations between the satisfaction of basic psychological needs of autonomy, competence, and relatedness with current suicidal ideation and risk for suicidal behavior were examined. Two logistic regressions were conducted with a cross‐sectional database of 440 university students to examine the association of need satisfaction with suicidal ideation and risk for suicidal behavior, while controlling for demographics and depressive symptoms. Suicidal ideation was reported by 15% of participants and 18% were found to be at risk for suicidal behavior. A one standard deviation increase in need satisfaction reduced the odds of suicidal ideation by 53%, OR (95% CI) = 0.47 (0.33–0.67), and the odds of being at risk for suicidal behavior by 50%, OR (95% CI) = 0.50 (0.37–0.69). Young adults whose basic psychological needs are met may be less likely to consider suicide and engage in suicidal behavior. Prospective research is needed to confirm these associations.     

A Paradigm for the Telephonic Assessment of Suicidal Ideation

A three‐stage paradigm for telephonically assessing suicidal risk and triaging suicidal callers as practiced in an Employee Assistance Program Call Center was investigated. The first hypothesis was that the use of the procedure would increase the probability that callers would accept the clinician's recommendations, evidenced by fewer police interventions. The second hypothesis was that there would be an increase in confirmed appointments with providers. Samples involved three separate 6‐month periods. Results indicate the effectiveness of the paradigm with both hypotheses supported. Follow‐up data for the year after completion of this study yielded similar results.     

Trajectories of Suicidal Ideation among Adolescents Following Psychiatric Hospitalization

Suicidal ideation (SI) is a common presenting problem for psychiatric hospitalizations in adolescents and often persists following discharge. This study examines whether distinct trajectories of SI could be delineated following hospitalization and the risk factors most strongly related to these trajectories. Adolescents (N = 104; 76 females; 28 males) were followed for 6 months after discharge from inpatient or partial hospitalization. Semi-parametric group modeling identified SI trajectory group membership. In all, 33.7% of adolescents fell in a Subclinical SI group, 43.3% in a Declining SI group, and 23.1% in a Chronic SI group. Multinomial logistic regression was utilized to examine baseline predictors of group membership. Emotion dysregulation differentiated Chronic SI from Declining SI. In multivariate analyses, adolescents endorsing greater non-acceptance of emotional responses (OR =1.18) and more limited access to emotion regulation strategies (OR =1.12) were more likely to belong to the Chronic SI than Declining SI trajectory. Those in the Chronic SI group also had the greatest number of suicide attempts and hospitalizations in the 6 months post-discharge. These results suggest that clinicians should closely monitor and address emotion dysregulation when assessing suicide risk. Greater dysregulation may require more intensive services in order to have an effect on chronic SI.     

Six‐Month Trajectory of Suicidal Ideation in Adolescents with Borderline Personality Disorder

Few studies have longitudinally examined suicidal ideation in those with adolescent‐onset borderline personality disorder (BPD). The current study aimed to examine the trajectory of suicidal ideation in adolescents with BPD longitudinally over 6 months, with follow‐ups at 2, 4, and 6 months posthospitalization for elevated suicide risk. Results indicated that the BPD group exhibited a greater decrease in suicidal ideation in the months following hospitalization than those without a BPD diagnosis. The findings of this study indicated that suicidal ideation in adolescents with BPD is not stable, and although ideation may decrease quickly after hospitalization, regular assessment of ideation is recommended.     

A Minority Stress Model for Suicidal Ideation in Gay Men

There is a dearth of research on mechanisms underlying higher rates of suicidal ideation among gay men compared to heterosexual men. The purpose of this study was to establish the link between social/psychological predictor variables and suicidal ideation by testing a hypothesized minority stress model. Structural equation modeling was used to assess the relationships posited in the model using data from a community sample of 167 gay men. Model fit was adequate and hypothesized relationships were partially supported. Also, depressive symptoms partially mediated the relationship between (less) outness predicting suicidal ideation. These findings imply that therapeutic approaches targeting the coming out process may be more effective than approaches targeting internalized homophobia when suicidal ideation is indicated in the clinical presentation of gay and bisexual men.     

Factors Associated with Achieving Complete Mental Health among Individuals with Lifetime Suicidal Ideation

The objective of this study was to identify factors associated with complete mental health among Canadians who had ever seriously considered suicide. Data for this study were obtained from Statistics Canada's 2012 Canadian Community Health Survey–Mental Health (N = 2,844). The outcome variable examined in this study was complete mental health and was analyzed using binary logistic regression. Of the 2,844 respondents with lifetime suicidal ideation, 1,088 (38.2%) had complete mental health (i.e., had flourishing mental health, no mental illness, and no suicidal ideation in the past 12 months). Those who had a confidant were seven times more likely to have complete mental health. Other factors associated with achieving complete mental health among formerly suicidal respondents include being older, being a woman, having higher income, use of religious coping, and never previously having a mental illness. Considering the importance of these protective factors in formulating public health policies will allow for a more wide‐reaching approach to suicide prevention.