Correlates of Serious Suicidal Ideation and Attempts in Female Adult Sexual Assault Survivors

Relations between (a) serious suicidal ideation and attempts and (b) demographics, trauma history, assault characteristics, post‐assault outcomes, and psy‐chosocial variables were examined among female adult sexual assault survivors. Younger, minority, and bisexual survivors reported greater ideation. More traumas, drug use, and assault disclosure related to greater attempts, whereas perceived control over recovery was related to fewer attempts. Child sexual abuse and some assault characteristics predicted suicidal behavior. Depression was related to suicidal behavior until psychosocial variables were accounted for. Specifically, using substances to cope and self‐blame predicted greater ideation, whereas receiving aid/information support was related to less ideation. Implications for research and treatment are discussed.     

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.     

Behavioral Activation as an Early Intervention for Posttraumatic Stress Disorder and Depression Among Physically Injured Trauma Survivors

This paper describes an adaptation of behavioral activation (BA) for the early intervention of posttraumatic stress disorder (PTSD) and depression among physically injured survivors of traumatic injury, and presents pilot data on a small randomized effectiveness trial (N = 8). The application of BA to PTSD is based on the theory that increases in guided activity may break patterns of avoidance that can maintain PTSD. Compared to treatment as usual (TAU), those who received BA showed improvement in PTSD symptom severity from pre- to posttreatment, and there was a trend for the BA group to score better than the TAU group on physical functioning. Contrary to expectation, this brief adaptation did not have an impact on depression. Implications of these results for the effective early intervention after trauma are discussed.     

Suicide Ideation in Female Survivors of Military Sexual Trauma: The Trauma Source Matters

Female veterans who have experienced military sexual trauma (MST) are at elevated suicide risk, yet knowledge is limited regarding correlates of suicide ideation (SI) in this population. MST is associated with a higher risk of posttraumatic stress disorder (PTSD) relative to other trauma types; however, no studies have examined whether experiencing SI differs based on the source of PTSD symptoms (MST‐related, non–MST‐related). Female service members/veterans (SM/Vs; n = 311) who screened positive for MST and reported exposure to a Criterion A event completed an online survey assessing self‐reported demographics, PTSD, depression, the source of their PTSD symptoms, and SI. Ninety‐one (29.3%) reported experiencing current SI, and 223 (71.7%) identified MST as the source of their current PTSD symptoms. Participants who identified MST as the source of their PTSD symptoms were over two times more likely to report SI, compared to those who described non–MST‐related events as the source of their PTSD symptoms. Compared to those who reported the source of their PTSD symptoms as combat‐/deployment‐related, those who identified MST as the source were at least three times as likely to report current SI. Results underscore the importance of efforts to address MST‐related PTSD symptoms when working with female SM/Vs.     

Self-Cutting and Suicidal Ideation among Adolescents: Gender Differences in the Causes and Correlates of Self-Injury

In recent years, non-suicidal self-injury (NSSI) among adolescents has been identified as alarmingly common place. Some studies have suggested that more than one in eight adolescents have engaged in self-cutting or other self-injuring behaviors. Even more of a concern is that self-injury often foreshadows suicide or suicide attempts. With self-cutting common in middle and high schools, understanding the antecedents and correlates of such behavior may help counselors and others public health officials identify troubled students and initiate preventative measures. This study utilizes data from 2,639 high school students from the Delaware Youth Risk Behavior Survey to investigate the gender differences in NSSI and suicidal ideation. Overall, 13% reported engaging in NSSI within the past year, with females reporting significantly higher rates (17%) of NSSI than males (9%). Results indicate that there are significant gender differences in NSSI and suicidal thoughts based upon previous victimization experiences, reported substance use, depression, health behaviors, and sexual orientation.     

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.     

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.     

A Closer Examination of Sexual Trauma During Deployment: Not all Sexual Traumas are Associated with Suicidal Ideation

Military personnel can be exposed to a wide range of sexual trauma while deployed, including sexual harassment and sexual assault. We examined whether different types of sexual trauma during deployment associated with recent suicidal ideation among previously deployed OEF/OIF/OND veterans admitted to trauma‐focused treatment (n = 199). More severe forms of sexual trauma (e.g., sexual assault) were significantly and positively associated with suicidal ideation. In contrast, sexual trauma involving verbal remarks (e.g., sexual harassment) was not associated with suicidal ideation. Our findings suggest that sexual harassment and sexual assault during deployment may be differentially associated with suicidal ideation.     

Association Between Suicidal Ideation and Exposure to Suicide in Social Relationships Among Family,Friend, and Acquaintance Survivors in South Korea

Exposure to suicide in social relationships may be associated with suicidal ideation among survivors. In South Korea, which is known for having the highest suicide rate among OECD countries, exposure to suicide in social relationships can have serious consequences as social relationships are greatly emphasized in the society. The purpose of this study was to examine the association between survivors' suicidal ideation and their exposure to suicide in close relationships. Data collected through a telephone survey of a total of 1,000 men and women selected from across the nation using a stratified sampling method were analyzed. The results show that individuals who lost a family member, friend, or acquaintance in their lifetime are 4.5 times, 3.7 times, 2.2 times, respectively, more likely to have suicidal ideation in the past year compared to those without such experience. These findings suggest that special intervention for suicide survivors should be considered for those who experience suicide in close relationships.     

Psychiatric Distress and Suicidal Tendencies in Adult Cancer Survivors: Verifying the Validity of the Brief Symptom Inventory-18 for Identifying Suicidal Ideation in the Hospitalized Population of Mainland China

The Brief Symptom Inventory-18 (BSI-18) is widely used to assess psychiatric distress but has not been verified in the Chinese population. From March to April 2019, 293 hospitalized cancer patients, aged 20–87, completed the cross-sectional survey with demographics questionnaire, BSI-18, and PHQ-9. We analyzed the single suicide-related item of PHQ-9 with the full score clinical outpoint for BSI-18 and PHQ-9 using SPSS 22.0 and R 2.15, including Pearson's χ² test and ROC curve analyses. A Pearson's χ² test was carried out to compare the three different methods with the gold screening criteria. The p-value was correspondingly to .006, .066, .838. When the PHQ-9?≥?10 criteria for the BSI-18, receiver operating characteristic analysis revealed that AUC values were 0.839, optimal cut-off points for both BSI-18?≥?50, the sensitivity of 85.8%, and 62.5%, respectively. The BSI-18 is suitable for a screening tool for psychological distress and could also be used in clinical settings for preliminary screening of hospitalized cancer patients.

     

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.     

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.     

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.     

Functions of Nonsuicidal Self‐Injury Are Differentially Associated with Suicide Ideation and Past Attempts among Childhood Trauma Survivors

Research into factors for suicide has revealed relations between trauma exposure and suicidality (e.g., Bridge, Goldstein, & Brent, 2006 ; Joiner, Sachs‐Ericson, Wingate, Brown, Anestis, & Selby, 2007 ) wherein painful and provocative experiences (e.g., nonsuicidal self‐injury [NSSI]) are an important link (e.g., Van Orden, Witte, Cukrowicz, Braithwaite, Selby, & Joiner, 2010 ; Smith, 2013 ). No prior research has assessed the relationship between functions of NSSI and suicidality among childhood trauma survivors. Participants who endorsed childhood trauma exposure (N = 121; M_age = 18.69, range 18–22) completed measures of posttraumatic stress disorder (PTSD) symptoms, NSSI, and suicidality. Multiple regressions assessing whether the four functions of NSSI predicted suicide ideation and past attempts after controlling for PTSD symptom severity found that only social negative reinforcement was associated with SI ( = .304, SE = .243, t = 2.23, p = .028), while only automatic negative reinforcement was associated with past attempts ( = .470, SE = .066, t = 2.25, p = .028). Findings highlight the importance of assessing NSSI functions when assessing suicidality among trauma survivors.     

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.     

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).     

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.