Hopelessness and Lack of Connectedness to Others as Risk Factors for Suicidal Behavior Across the Lifespan: Implications for Cognitive-Behavioral Treatment

The rates of suicide attempts and death by suicide vary considerably over the lifespan, highlighting the influence of different contextual, risk, and protective factors at different points in development (Daniel & Goldston, 2009). Hopelessness and lack of connectedness to others are two factors that have been associated with increased risk for suicidal thoughts and behaviors across the lifespan. The primary purposes of this paper are to describe how hopelessness and lack of connectedness to others may contribute to risk for suicidal behaviors, and to outline empirically supported cognitive-behavioral interventions for these difficulties at three developmental periods during which suicidal behavior is prevalent: (a) adolescence and young adulthood, (b) middle adulthood, and (c) older adulthood. This paper is not intended as an exhaustive review, but rather an overview of selected developmental issues related to hopelessness and lack of connectedness to others as risk factors for suicidal behavior. Special emphasis is given to clinical implications for cognitive-behavioral interventions, which are illustrated through case conceptualizations and examples at each developmental period.     

Epidemiologic Characteristics and Trends of Fatal Suicides among the Elderly in Taiwan

Taiwan has one of the highest suicide rates in the world, especially among its elderly. The epidemiologic characteristics and trends of the surging elderly suicide rates from 1993 to 2003 are described, with a special emphasis on the risk groups, the methods used in suicide, and their geographical variations. Data on annual mortality for persons over 65 years of age with external cause‐of‐death codes E950–E959 were obtained from the Death Certification data file provided by the Department of Health and used in the analysis. The suicide rate for each 5‐year age group over 65 years old increased during the 11‐year period. Elderly males had the highest suicide rate and experienced an increased rate of 49% during the decade. The average suicide ratio between elderly males and females was about 2:1. Never‐married males had the highest age‐adjusted as well as sex‐ and marital status‐specific suicide rates, and showed an increased rate of 66% over the 11‐year period. Geographical variations in suicide rates were significant, with the lest urbanized eastern Taiwan having a higher rate than other regions. Hanging, strangulation, and suffocation were the most used methods for committing suicide by the elderly, but their use had decreased from 63% to 54% during the decade; but jumping off a building and drowning increased significantly. Variation in suicide rate among months was not significant. With the increase in the elderly suicide rate, more governmental and societal interventions are needed to alleviate this social and human problem.     

Suicide and occupation: A review

This paper examines the available literature dealing with the relation of occupation to suicide for three occupational categories: health care providers, managerial and professional persons, and military and paramilitary personnel. Following a general introduction, evidence relating to group differences in suicidal behavior is presented and assessed. Sources of bias and inaccuracy in suicide statistics are identified and theories purporting to explain variations in the incidence of suicide are considered. Finally, implications are drawn from the analysis presented and possible directions for future research are identified.     

Where Are They Now? A Follow-up Study of Suicide Attempters from the Golden Gate Bridge

ABSTRACT: The Golden Gate Bridge is currently the number one suicide location in the world. From the opening day, May 18, 1937 to April 1, 1978, there have been 625 officially reported suicide deaths and perhaps more than 200 others which have gone unseen and unreported. Proposals for the construction of a hardware antisuicide barrier have been challenged with the untested contention that “they'll just go someplace else.” This research tests the contention by describing and evaluating the long-term mortality experience of the 515 persons who had attempted suicide from the Golden Gate Bridge but were restrained, from the opening day through the year 1971 plus a comparison group of 184 persons who made nonbridge suicide attempts during 1956–57 and were treated at the emergency room of a large metropolitan hospital and were also followed through the close of 1971. Results of the followup study are directed toward answering the important question: “Will a person who is prevented from suicide in one location inexorably tend to attempt and commit suicide elsewhere?”     

Observations on Long-Term Group Therapy with Suicidal and Depressed Persons

ABSTRACT: A long-term, open-ended group for depressed and suicidal individuals who had made suicide attempts is described. Two hundred persons participated in the sample groups over a 46-month period, with only 10 suicide attempts and 1 suicide occurring in this high risk group during the period of the study. Our observations corroborated some findings and differed with others reported of experiences with groups of individuals who have manifested suicidal behavior. The paper includes recommendations for starting groups of suicidal persons and emphasizes that this method of therapy appears to be an effective mode of suicide prevention.     

MMPI inmate profiles: suicide completers, suicide attempters, and non-suicidal controls

Results from the Minnesota Multiphasic Personality Inventory (MMPI) were compared for three groups of male inmates in federal penitentiaries: 47 suicide completers, 43 suicide attempters and, 123 non-suicidal controls. Analyses show that the groups differed on all 10 clinical scales and on at least 8 after Bonferroni correction. Attempters obtained the highest scores on 4 of 8 scales; they also posted the highest scores on 3 others, but differences were significant only against non-suicidal controls. Completers posted the highest score on only one scale (Mf), but the difference was significant only against non-suicidal controls. All told, completers proved more similar to non-suicidal controls than to attempters. Regarding profiles, completers are more strongly correlated with non-suicidal controls (r=0.95) than with attempters (r=0.86); non-suicidal controls are less strongly correlated with attempters (r=0.88). The fact that attempters seem more pathological than the others can mislead clinicians screening for suicide risk.     

Circadian variation in suicide attempts in Tokyo from 1978 to 1985

Circadian variations in suicide attempts in Tokyo from 1978 to 1985 were analyzed on the basis of records of the Ambulance Service of Tokyo. A significant circadian variation in suicide attempts was demonstrated by the cosinor method, power spectrum analysis (by the maximum-entropy method), and analysis of variance. The peak time for suicide attempts was established by cosinor analysis as about 1800 hours (6:00 P.M.). The circadian variation in suicide attempts seemed to be associated with endogenous rhythms such as mood, as well as with daily variation in social activities.     

有自杀意念大学生的内隐态度探析

该文结合Greenwald开创的内隐联想测验,自编IAT程序,对有自杀意念大学生的内隐态度进行了相关研究。结果显示,有自杀意念大学生较无自杀意念大学生的内隐态度对自杀类词语敏感等。家庭所在地为农村对有自杀意念大学生的内隐态度有显著性影响。     

Female suicide and wife abuse: a cross-cultural perspective

Data from a number of societies, including North America, indicate that wife abuse may be one of the most significant precipitants of female suicide. Anthropological analysis indicates that in some societies female suicide is a culturally recognized behavior that enables the weak to influence the strong and/or take revenge on those who oppress them. Case studies from West New Britain Province in Papua New Guinea and comparisons with data from other societies suggest that if a woman's support group does not defend her when she is the victim of violence that passes the bounds of normative behavior, her suicide may be revenge suicide, intended to force others to take vengeance on the abusive husband. Research focused on the relationship between domestic violence and female suicide should be a priority of anthropologists as well as suicidologists.     

Suicide ideation: its relation to depression, suicide and suicide attempt

A random sample of 3,935 adults from a general population were interviewed and asked to report how often they had thoughts of suicide as well as their opinion on the frequency of suicide ideation in others. Depression was found to be related to the respondent's reports of his/her own suicidal thoughts and to reports of frequent suicide ideation in others. A total of 5.4 percent of the respondents reported some degree of suicide ideation in the previous month and 9.1 percent reported that others think about suicide once a month or more. When the demographic characteristics of those who report suicide ideation in themselves or others were compared to those of suicide attempters and committers, some consistencies were found, suggesting that such questions may be useful in identifying those "at risk." Nevertheless, sufficient discrepancies were found which suggest that there may be a number of factors which increase or decrease the likelihood that someone with thoughts of suicide will attempt or commit suicide. Follow-up studies are necessary to uncover such factors and the degrees to which they influence the occurrence of suicide.     

Suicide in Detroit 1975: Changes and Continuities

ABSTRACT: Data on 193 cases of suicide in Detroit are analyzed to assess changes and continuities in the etiology of suicide. A significant change in the correlates of suicide is a shift in the group with the highest rate of suicide from the elderly to the relatively young age cohorts. A tentative explanation for this new pattern is suggested in terms of youth culture and underemployment. Continuities in the traditional etiology of suicide included the findings that males, persons in manual occupations, whites, and immigrants had relatively high rates of suicide.     

Some sociopsychological factors in attempted suicide among urban black males.

This study tests three hypotheses relating to suicidal behavior among urban black males: that black consciousness and group cohesiveness will be lower and depression will be higher. Inner-city, young adult black males with a suicide attempt in the last 6 months, and matched controls were examined. Hypothesis was one supported; the other two received partial support. The validity of the theory of black self-hatred as the basic cause of suicidal behavior among blacks is questioned. Atwo-factor theory of suicide, focusing on forces moving the person away from suicide toward positive subgroup ties, is proposed.     

Validity of the Self-Harm Behavior Questionnaire with Diverse Adolescents

Suicide and non-suicidal self-injurious behavior (NSSI) continue to be significant health problems for adolescents. Although there are many instruments available to assess self-harm behaviors, few have been validated for use with adolescents, and even fewer have been validated for use with different racial/ethnic groups. The Self-Harm Behavior Questionnaire (SHBQ) assesses NSSI, suicidal ideation, suicide threats, and past suicide attempts. Data from 1,386 racially/ethnically diverse adolescents (57.5% minority) were collected to examine the validity of the SHBQ in this age group. Analyses supported the four-factor structure, revealed the SHBQ is internally consistent, and provided evidence for convergent validity within Caucasian, African American, and Hispanic adolescents. However, slight differences were noted. Overall, the findings suggest the SHBQ is a useful assessment tool appropriate for use with Caucasian, African American, and Hispanic adolescents.     

Why people engage in parasuicide: a cross-cultural study of intentions

Information obtained at interview from 1,646 parasuicide patients in 14 regions in 13 European countries participating in the WHO/EURO Multicentre Study on Suicidal Behaviour was used to study self-reported intentions involved in parasuicide. Comparisons were made across cultures, genders, and age groups. Although some statistically significant differences were found, the effect sizes were very small. The main finding from this study is thus that parasuicide patients in different countries tend to indicate that similar types of intentions are involved in their acts of parasuicide, and that the intentions do not vary greatly with gender or age. The hypothesis that rates of suicide and parasuicide vary between regions with the frequency with which suicidal intention is indicated by the patients was also tested, but was supported only for women and in relation to national suicide rates. The findings from this study are likely to be generalizable to other settings and have implications for clinical practice.     

Targeting Perceived Burdensomeness to Reduce Suicide Risk

Perceived burdensomeness (PB), defined by an intractable perception of burdening others, often reflects a false mental calculation that one’s death is worth more than one’s life and has been supported as a significant risk factor for suicide. Because PB often reflects a distorted cognition, it may serve as a corrective and promising target for the intervention of suicide. More work on PB is needed in clinically severe and in military populations. Sixty-nine (Study 1) and 181 (Study 2) military participants at high baseline suicide risk engaged in interventions targeting constructs relating to PB. Baseline and follow-up measures (at 1, 6, 12, 18, and 24 months) of suicidal ideation were administered, and various statistical approaches—including repeated-measures ANOVA, mediation analyses, and correlating standardized residuals—explored whether suicidal ideation decreased specifically by way of PB. In addition to utilizing a larger sample size, Study 2 included an active PB-intervention arm (N = 181) and a control arm (N = 121), who received robust care as usual. In both studies, participants improved considerably regarding baseline to follow-up suicidal ideation. The results of Study 2 mirrored those of Study 1, corroborating a potential mediational role for PB in treatment-related improvements in suicidal ideation in military participants. Effect sizes ranged from .07–.25. Interventions tailored at decreasing levels of perceived burdensomeness may be uniquely and significantly effective in reducing suicidal thoughts.     

Childhood physical and sexual abuse in depressed patients with single and multiple suicide attempts

Research has shown both childhood physical and sexual abuse to be associated with later suicide attempts, although some studies have not supported these findings. However, few studies have investigated differences in physical and sexual abuse histories among single and multiple suicide attempters. The goals of the current study were two-fold: (a) to replicate previous findings of associations between childhood sexual and physical abuse and suicide attempts, and (b) to explore differences in reports of childhood physical and sexual abuse among single and multiple suicide attempters. While our results supported the findings that individuals with a history of suicide attempts are more likely to report histories of childhood physical and sexual abuse, we did not find a difference in reported abuse between single and multiple suicide attempters. Implications of these findings, as well as implications for future research, are discussed.     

Sociocultural determinants of suicide ideation: a comparison between American and Ghanaian college samples

This study investigated the role of gender, family cohesion, religiosity, and negative suicide attitudes as potential determinants of cultural differences in suicide ideation among 375 college students from Ghana and the United States. Significant cultural differences were found for suicide ideation, family closeness, religiosity, and negative suicide attitudes. Family cohesion and negative attitudes were significant predictors for both cultural groups. Gender was a significant determinant for suicide ideation among Ghanaians, but not Americans; religiosity was not a significant determinant for either group. More extensive research on sociocultural influences on suicide, especially among countries in which suicide is underreported or not documented, is encouraged.     

Apparent higher brain weight in suicide victims: possible reasons

In 2000 we tested previously reported findings by Salib and Tadros that brain weight of fatal self-harm victims is higher than of those who died of natural causes. Our results were based on data from 15 suicides and 15 deaths of other causes. Data included matching variables of age, sex, time between death and postmortem examination, and temperature of the surrounding environment. The exploratory variables were brain weight and method of death. No significant difference was found between the brain weights of suicides and others. On the other hand, some differences were obtained for different suicide methods, which also differed in the temperature of the environment, this being lower for the group of suicides that occurred outdoors (around or below 0 degrees C). Once we excluded all the outdoor cases and controls, a significantly higher brain weight was obtained for suicide cases. These and previous results are intriguing and require explanation. Respirator brain syndrome as described by Moseley, Molinari, and Walker in 1976 may provide only a partial explanation. Another possible suggestion is that higher brain weight in suicide victims may be related to previously demonstrated increased amygdala blood flow and subsequent amygdala enlargement due to the increased processing of emotional information.     

Effect of various discriminative stimuli on choice behavior in male siamese fighting fish (Betta splendens)

The current experiment was an exploratory study empirically comparing three discrimination methodologies proposed for use in choice preparations with food rewards. Subjects were thirty-five, healthy, adult male Siamese fighting fish (Betta splendens). Subjects were randomly assigned to one of three discrimination groups: a Direction group (using left or right as discriminative stimuli), a Color group (using red or green as discriminative stimuli), and a Bubble group (using the presence or absence of air bubbles as discriminative stimuli). For all three discrimination groups, subjects chose between one or three food pellets in a submerged T-maze. The results from the experiment indicated a statistically significant preference for the three pellets of food over one pellet of food only for the Bubble group. Of particular note is the effect size and observed power obtained for the Bubble group, which was the only group which supported a reasonably powerful test for discrimination, given a sample size of 12 subjects and 0.94 effect size.     

Perceived burdensomeness, fearlessness of death, and suicidality among deployed military personnel

The interpersonal-psychological theory of suicide posits that the interaction of three elements is required for lethal suicidal behaviors: the perception that one is a burden on others, the perception that one does not belong, and fearlessness about death combined with high pain tolerance (termed “acquired capability” for suicide). Although an ever expanding research base supports the theory, very limited data exist supporting the theory among military personnel, a group that has experienced a rapid increase in suicides during the past several years. The current study tests the interpersonal-psychological theory in two clinical samples of military personnel while deployed to Iraq: those seeking treatment for mild traumatic brain injury, and those seeking outpatient mental health treatment. In both samples, perceived burdensomeness and acquired capability were significantly associated with suicidality, as was their interaction term. Results partially support the interpersonal-psychological theory of suicide, and indicate that perceptions of burdensomeness combined with fearlessness about death are associated with increased suicidality among deployed military personnel.