The Influence of Intersecting Identities on Self‐Harm,Suicidal Behaviors,and Depression among Lesbian,Gay, and Bisexual Individuals

Individuals with lesbian, gay, and bisexual (LGB) identities have higher prevalence of self‐directed violence, but very little is known about racial/ethnic differences between LGB populations. This study aimed to examine racial/ethnic differences in self‐harm, suicidal ideation, suicide attempt, and depression among LGB and heterosexual emerging adults. Data are compiled from the Fall 2008 and Spring 2009 National College Health Assessment and limited to respondents within emerging adulthood (ages 18–24) who indicated their sexual orientation and racial/ethnic identities (n = 89,199). Within each racial/ethnic group, LGB individuals were significantly more likely to report self‐harm, suicidal ideation, suicide attempt, and depression than non‐LGB individuals.     

Residential Transience,Major Depressive Episodes,and the Risk of Suicidal Thoughts,Plans, and Attempts

The association between past‐year residential transience (frequent moving) and suicidal ideation among a nationally representative sample of over 190,000 U.S. adults was evaluated. Suicidal thoughts, plans, and attempts were more prevalent among transient adults. Among adults without major depressive episodes (MDE), transience was associated with 70% to 90% greater odds of suicidal ideation compared to nontransient adults. Among adults with MDE, transience was associated with a 60% to 80% increased odds of suicidal ideation compared to nontransient adults. Residential transience may be an indicator for increased suicide risk even in the absence of depression.     

Determinants and Predictive Value of Clinician Assessment of Short‐Term Suicide Risk

We examine the interrelations among clinicians' judgment of patients' suicide risk, clinicians' emotional responses, and standard risk factors in the short‐term prediction of suicidal thoughts and behaviors. Psychiatric outpatients (n = 153) with a lifetime history of suicide ideation/attempt and their treating clinicians (n = 67) were evaluated at intake. Clinicians completed a standard suicide risk instrument (modified SAD PERSONS scale), a 10‐point Likert scale assessment of judgment of patient suicide risk (Clinician Prediction Scale), and a measure of their emotional responses to the patient (Therapist Response Questionnaire‐Suicide Form). The Columbia Suicide Severity Rating Scale and the Beck Scale for Suicide Ideation were administered at a one‐month follow‐up assessment (n = 114, 74.5%). Clinician judgment of risk significantly predicted suicidal thoughts and behaviors at follow‐up. Both the standard suicide risk instrument and clinician emotional responses contributed independently to the clinician assessment of risk, which, in turn, mediated their relationships with suicidal thoughts and behaviors. Our findings validate the importance of clinical judgment in assessing suicide risk. Clinical judgment appears to be informed both by concrete risk factors and clinicians' emotional responses to suicidal patients, highlighting emotional awareness as a promising area for research and training.     

Understanding the Pathways from Depression to Suicidal Risk from the Perspective of the Interpersonal–Psychological Theory of Suicide

Suicide is a major public health concern, especially in adolescence. Identifying risk factors for suicide is important to effectively prevent such behavior. Depression is one of the most widely examined risk factors for suicidal risk. How depression and suicidal risk are related, however, is still not clear. This study tested a model with three key constructs of the interpersonal–psychological theory of suicidal behavior (IPTS)—perceived burdensomeness, thwarted belongingness, and nonsuicidal self‐injury (NSSI)—as mediators in the relationship between depression and suicidal risk among Chinese adolescents. Chinese high school students (N = 1,074; 54.2% male; M_age = 13.87 years, SD = 1.48) completed questionnaires assessing all study variables. Results suggested that perceived burdensomeness and NSSI partially mediated the relationship between depression and suicidal risk. Findings of this study emphasize the importance of the IPTS framework in understanding the possible mechanisms underlying the relationship between depression and suicidal risk, and suggest a possible avenue for suicide interventions.     

Suicide Risk Documented During Veterans' Last Veterans Affairs Health Care Contacts Prior to Suicide

A total of 295 veterans who died by suicide in 2009 across 11 states and received Veterans Affairs (VA) health care in the 6 months prior to death were identified. The suicide risk factors documented and the care received at these veterans' last VA contacts are described, and the study explores whether veterans present differently to VA care (i.e., different risk factors documented or different care settings accessed) based on the proximity of their last contact to suicide. Many veterans were seen in primary care (n = 136; 46%) for routine follow‐up (n = 168; 57%). Fifty‐three (18%) were assessed for suicidal thoughts; 20 (38%) of whom endorsed such thoughts. Although higher frequencies of some risk factors at last contacts more proximal to suicide compared to those more distal were observed, findings overall highlight the challenges clinicians face detecting enhanced risk prior to suicide.     

Body Mass Index Is an Important Predictor for Suicide: Results from a Systematic Review and Meta‐Analysis

Public health concerns for the independent management of obesity and suicidal behavior are rising. Emerging evidence suggests body weight plays an important role in quantifying the risk of suicide. In light of these findings, we aimed to clarify the association between body mass index (BMI) and suicidal behavior by systematically reviewing and evaluating the literature. Studies were identified by searching MEDLINE, EMBASE, PsycINFO, and CINAHL from inception to January 2015, supplemented by hand and grey literature searches. Study screening, data extraction, and risk of bias assessment were conducted in duplicate. We included 38 observational studies. Meta‐analyses supported an inverse association between BMI and completed suicide. Pooled summary estimates demonstrated that underweight was significantly associated with an increased risk of completed suicide (HR = 1.21, 95% CI 1.07 to 1.36, p = .002), and obesity (HR = 0.71, 95% CI 0.56 to 0.89, p = .003) and overweight (HR = 0.78, 95% CI 0.75 to 0.82, p < .0001) were significantly associated with a decreased risk of completed suicide relative to normal weight. A qualitative summary of the literature demonstrated conflicting evidence regarding the association between BMI and attempted suicide and revealed no association between BMI and suicidal ideation. BMI may be used to aid the assessment of suicide risk, especially that of completed suicide. However, unmeasured confounders and systematic biases of individual studies limit the quality of evidence.     

Emergency Department Youth Patients With Suicidal Ideation or Attempts: Predicting Suicide Attempts Through 18 Months of Follow‐Up

This prospective study of suicidal emergency department (ED) patients (ages 10–18) examined the timing, cumulative probability, and predictors of suicide attempts through 18 months of follow‐up. The cumulative probability of attempts was as follows: .15 at 6 months, .22 at 1 year, and .24 by 18 months. One attempt was fatal, yielding a death rate of .006. Significant predictors of suicide attempt risk included a suicide attempt at ED presentation (vs. suicidal ideation only), nonsuicidal self‐injurious behavior, and low levels of delinquent symptoms. Results underscore the importance of both prior suicide attempts and nonsuicidal self‐harm as risk indicators for future and potentially lethal suicide attempts.     

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.     

Suicide Ideations,Suicide Attempts,and Completed Suicide in Persons with Pathological Gambling and Their First‐Degree Relatives

We examined the relationship between suicidal ideations and attempts in 95 probands with pathological gambling (PG), 91 controls, and 1075 first‐degree relatives. The results were analyzed using logistic regression with generalized estimating equations. Thirty‐four PG probands (35.8%) and 4 controls (4.4%) had attempted suicide (OR = 12.12, p < .001); in 13 probands, the attempt occurred before PG onset. Lifetime suicidal ideations occurred in 60 PG probands (63.2%) and 12 controls (13.2%) (OR = 11.29, p < .001). Suicidality in PG probands is a marker of PG severity and is associated with greater psychiatric comorbidity. Offspring of PG probands had significantly higher rates of suicide attempts than control offspring.     

Marital Discord and Suicidal Outcomes in a National Sample of Married Individuals

Suicide is the tenth leading cause of death in the United States, with an average of 105 suicides committed daily. The association between marital discord and 12‐month prevalence of suicidal ideation and suicide attempt was studied in a population‐based sample of married adults (N = 1,384). Marital discord was significantly and positively associated with suicidal ideation and suicide attempt, and these associations remained significant when controlling for demographics and 12‐month prevalence of mood, anxiety, and substance use disorders. Results suggest that marital discord is an important correlate of suicidal outcomes and may be important to target in preventing and treating suicide.     

Feasibility of Assessing Suicide Ideation and History of Suicidal Behavior in Rural Communities

Suicide in rural areas has not received significant attention in the research literature to this point, although suicide rates are higher among adults and older adults in rural areas than in urban areas. The aims of the study were as follows: (1) establish the feasibility of assessing suicide ideation and history of suicidal behavior; (2) determine preliminary estimates of the prevalence of suicide ideation, and history of suicide attempts; and (3) examine the effectiveness and acceptability of safety and referral plans for individuals whose responses indicated elevated suicide risk, in rural communities with limited access to referral care. Participants were 96 adults aged 40 to 85 years old (M  =  57.34, SD  = 11.47) residing in West Texas. Our results indicate that 26% of participants endorsed a lifetime history of suicide ideation and/or suicide attempt(s) and 12.5% reported suicide ideation in the past year. In addition, 93.4% of participants reported that participation in our suicide‐focused study was an excellent or good experience. Results suggest that individuals in rural communities are willing to talk about suicide, found the experience helpful, and were satisfied with the referral process.     

Mental Disorders,Comorbidity, and Pre‐enlistment Suicidal Behavior Among New Soldiers in the U.S. Army: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

We examined the associations between mental disorders and suicidal behavior (ideation, plans, and attempts) among new soldiers using data from the New Soldier Study (NSS) component of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS; N = 38,507). Most new soldiers with a pre‐enlistment history of suicide attempt reported a prior mental disorder (59.0%). Each disorder examined was associated with increased odds of suicidal behavior (ORs = 2.6–8.6). Only PTSD and disorders characterized by irritability and impulsive/aggressive behavior (i.e., bipolar disorder, conduct disorder, oppositional defiant disorder, and attention‐deficit/hyperactivity disorder) predicted unplanned attempts among ideators. Mental disorders are important predictors of pre‐enlistment suicidal behavior among new soldiers and should figure prominently in suicide screening and prevention efforts.     

The Suicidal Ideation Attributes Scale (SIDAS): Community‐Based Validation Study of a New Scale for the Measurement of Suicidal Ideation

While suicide prevention efforts are increasingly being delivered using technology, no scales have been developed specifically for web‐based use. The Suicidal Ideation Attributes Scale (SIDAS) was developed and validated as a brief, web‐based measure for severity of suicidal ideation, using an online survey of Australian adults (n = 1,352). The SIDAS demonstrated high internal consistency and good convergent validity. Frequency and controllability of thoughts were more strongly associated with suicide plans and attempts than other attributes assessed. Scores ≥ 21 indicated high risk of suicide behavior. The SIDAS appears to be a valid web‐based measure for severity of suicidal ideation.     

Clarifying the Role of Psychological Pain in the Risks of Suicidal Ideation and Suicidal Acts among Patients with Major Depressive Episodes

The role of psychological pain in the risk of suicide was explored using a three‐dimensional psychological pain model (pain arousal, painful feelings, pain avoidance). The sample consisted of 111 outpatients with major depressive episodes, including 28 individuals with suicidal histories. They completed the Chinese version of the Beck Scale for Suicide Ideation (BSI), the Beck Depression Inventory (BDI), the Psychache Scale, and the three‐dimensional Psychological Pain Scale (TDPPS). A structured clinical interview was conducted to assess the history of suicidal acts. Significant correlations were found among BDI, BSI, and TDPPS scores (p < .01). Stepwise regression analyses showed that only pain avoidance scores significantly predicted suicide ideation at one's worst point (β = .79, p < .001) and suicidal acts (β = .46, p < .001). Pain avoidance was also a better predictor of current suicidal ideation (β = .37, p = .001) than were BDI scores (β = .31, p < .01). Increased levels of pain avoidance during a major depressive episode may be a dominant component of the motivation for suicide. Future clinical assessments for populations at high risk of suicide should include measures of psychological pain to reduce the incidence of suicide.     

Coping Card Usage can Further Reduce Suicide Reattempt in Suicide Attempter Case Management Within 3‐Month Intervention

This randomized controlled trial was designed to evaluate the effectiveness of using crisis coping cards (n = 32) in the case management of suicide prevention compared with case management without the use of coping cards (n = 32) over a 3‐month intervention period. The generalized estimating equation was used to examine the interaction effect between treatments and time on suicide risk, depression, anxiety, and hopelessness. Results indicated that subsequent suicidal behaviors, severity of suicide risk, depression, anxiety, and hopelessness were reduced more in the coping card intervention group compared to the case management only group. Moreover, for the survival curves of time to suicide reattempt, the coping card group showed a significantly longer time to reattempt than the case management only group at 2‐month and 3‐month intervention periods.     

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.     

The Validity of a Brief Risk Assessment Tool for Predicting Suicidal Behavior in Veterans Utilizing VHA Mental Health Care

Suicide risk among military veterans is an important and ongoing concern. The Veterans Administration (VA) mandates suicide risk screening of all veterans seen for mental health issues, but little is known about the effectiveness of this screening. A retrospective chart review to examine all suicide risk screens at VA San Diego between October and December 2012 (n = 3,365) was conducted to assess whether results were associated with suicidal behavior over the subsequent 12 months. Patients judged to be at increased risk for suicide were 3 to 16 times more likely to attempt suicide and 7 to 25 times more likely to engage in self‐directed violence over the next 12 months compared with others. The screening tool may be a useful addition to clinical practice.     

The Suicidal Narrative and Its Relationship to the Suicide Crisis Syndrome and Recent Suicidal Behavior

In this study, we introduce the construct of the suicidal narrative, a hypothetical personal narrative linked to imminent suicide, and explore its relationship to near‐term suicidal risk and the suicide crisis syndrome (SCS). Psychiatric outpatients (N = 289) were administered the Columbia Suicide‐Severity Rating Scale (C‐SSRS), Suicide Crisis Inventory (SCI), and Suicide Narrative Inventory (SNI), a novel instrument combining the documented risk factors of Thwarted Belongingness, Perceived Burdensomeness, Humiliation, Social Defeat, Goal Disengagement, and Goal Reengagement. Dimensional measures of past month, lifetime, and past suicidal phenomena, incorporating ideation and behavior, were calculated from the C‐SSRS. Structural equation modeling was used to explore the interaction among variables. Factor analysis of the SNI yielded two orthogonal factors, termed Interpersonal and Goal Orientation. The former factor was comprised of Perceived Burdensomeness, Social Defeat, Humiliation, and Thwarted Belongingness, the latter of Goal Disengagement and Goal Reengagement. The Interpersonal factor correlated with both SCS severity and suicidal phenomena in each time frame and the Goal Orientation factor with no other variable. As hypothesized, the proposed model was significant for the past month only. Our findings support the construct of the suicidal narrative and its function as a near‐term suicidal risk factor.     

Suicidal Ideation and Behavior in Adolescents Aged 12–16 Years: A 17‐Year Follow‐Up

The prevalence of suicidal ideation/behavior in 1983 or 1987 and its association with future mental health in 2001 were evaluated in a provincially representative sample of Canadian adolescents (n = 1,248) aged 12 to 16 years. Approximately 13.3% (95% CI = 11.5–15.3) of adolescents self‐reported suicidal ideation/behavior. Adolescent agreement with parent (κ = .07) and teacher (κ = .05) reports at baseline was low because adults identified so few subjects. In adulthood, the associations between adolescent self‐reports of suicidal behavior/ideation and major depression and other mental health indicators were explained by respondent sex and adolescent emotional problems reported in 1983/1987. Adolescents with suicidal behavior/ideation often are not recognized by their parents and teachers and may be at risk for persistent psychiatric problems attributable to coexisting mental health problems early‐on.     

Predicting Suicide Attempts for Racial and Ethnic Groups of Patients During Routine Clinical Care

The aim of this study was to examine variation in suicide ideation and its relationship to risk of suicide attempt in the subsequent 90 days by race and ethnicity. Participants were adults who completed the Patient Health Questionnaire depression module (PHQ9) during an outpatient encounter between January 10, 2010, and December 12, 2012 (N = 509,945 patients; N = 1,228,308 completed PHQ9). Data came from the Virtual Data Warehouse from four health care systems in the Mental Health Research Network. The sample was majority female (73.7%), primarily 30–64 years old (60.1%), healthy (64.5% comorbidity index = 0), and over half were non‐Hispanic White (52.9%). Only Asian patients (OR: 1.31; 95% CI: 1.24, 1.39) had higher odds of reporting suicide ideation when compared to non‐Hispanic White people. All racial and ethnic groups had increased risk for suicide attempt with increased frequency of suicide ideation. The PHQ9 item 9 can be used as an indicator of suicide ideation and risk for suicide attempt up to 90 days after the reported ideation in racial and ethnic minority patients during routine clinical care.