Hopelessness Predicts Suicide Ideation But Not Attempts: A 10‐Year Longitudinal Study

Hopelessness is one of the most commonly cited risk factors for suicidal behaviors. However, several retrospective studies suggest that hopelessness, while strongly correlated with suicide ideation, does not distinguish attempters from ideators without attempts. This study is the first to utilize a prospective design to disambiguate the relationship of hopelessness to ideation versus attempts. Participants were 142 depressed patients followed up over 10 years. Hopelessness and suicidality (ideation and attempts) were assessed using validated questionnaires and structured interviews. Both retrospective and prospective analyses revealed that hopelessness was higher among those reporting any suicidality (ideation or attempts) compared with nonsuicidal individuals. However, hopelessness failed to meaningfully distinguish attempters from ideators in both retrospective and prospective analyses. Taken together with results from previous studies, our findings suggest hopelessness is best conceptualized as a risk factor for suicide ideation but not progression from ideation to attempts.     

Suicide Risk Assessment and Risk Formulation Part I: A Focus on Suicide Ideation in Assessing Suicide Risk

The main procedure used by clinicians to determine whether an individual may be at risk of suicidal behaviors is the suicide risk assessment (SRA). The purpose of the SRA is to identify risk and protective factors that then provide the data for the formulation of suicide risk. The suicide risk formulation (SRF) assigns a level of suicide risk that ideally leads to triage and treatment deemed appropriate for that level of risk. Some of the problems with the SRA are explored here, with an emphasis on addressing the over reliance on communicated suicide ideation, and recommendations are made for improvements. Part II of this article (Berman & Silverman, 2013, also appears in this issue of STLB) examines the process of an SRF and, similarly, makes recommendations to improve clinical practice toward the desired end of saving lives.     

Longitudinal Relationships Between Positive Affect,Loneliness, and Suicide Ideation: Age‐Specific Factors in a General Population

The aims of this study were to analyze whether positive and negative affect, social support, and loneliness are factors longitudinally related to suicide ideation in the general population in different age groups. A total of 2,392 individuals from a nationally representative sample of the Spanish general population were evaluated in 2011–2012 and in 2014–2015. After including relevant control variables in the analyses, lower positive affect was prospectively related to ideation in 18‐ to 59‐year‐old individuals, whereas feelings of loneliness were related to ideation in 60‐year‐and‐older individuals. Social support was not associated with suicide ideation in any age group. These results are in line with the need for age‐tailored suicide prevention programs. The present findings might also suggest that health care professionals should consider feelings of loneliness rather than social support to assess the presence of suicide ideation in older people.     

Risk Factors Proximate to Suicide and Suicide Risk Assessment in the Context of Denied Suicide Ideation

Health care providers have significant opportunities to identify individuals at near‐term risk for suicide, but lack empirical data on near‐term risk factors. This study aimed to identify dynamic, state‐related risk factors observed by clinical practitioners within the last 30 days of life of 157 patients who died by suicide and to compare these near‐term risk factors among patients who denied versus responded positively to having suicide ideation (SI ) when last asked by a clinical practitioner prior to their death. Risk factors charted for the majority of all decedents were a history of prior suicide ideation and/or suicide attempt, current anxiety/agitation and sleep problems, current interpersonal problems or job/financial strain, current comorbid diagnoses, current social isolation/withdrawal, and a family history of mental disorder. Two‐thirds of patients denied having SI when last asked and one‐half of these patients were dead by suicide within 2 days. Decedents who denied having SI were quite similar in charted diagnoses, symptoms, behaviors, and environmental circumstances to decedents who responded affirmatively to having SI . Reliance on verbalized or reported SI as a gateway to a suicide risk assessment is questioned and the need for better understanding near‐term risk for suicide, particularly in the absence of stated SI , is highlighted.     

The Association Between Anhedonia,Suicide Ideation,and Suicide Attempts: A Replication in a Persian Student Sample

Research suggests that anhedonia, a common symptom of depression, may be uniquely associated with suicidal behavior. However, little research has examined this association across cultures. To address this limitation, this study attempted to replicate a recent anhedonia and suicide study (conducted in a western culture) in a Persian sample using the Specific Loss of Interest and Pleasure Scale, Persian version. Participants consisted of 404 students who were recruited from a Persian university. Surprisingly, our results indicated that anhedonia levels were more than double those found in similar American student sample. Despite this marked difference in anhedonia symptoms, we found that anhedonia was associated with suicide risk, even when it was statistically accounting for other depressive symptoms. These findings suggest that anhedonia is a robust predictor of suicide risk across these two cultures. Further, anhedonia may be a particularly important treatment target among Persian students.     

Self‐Esteem and Suicide Ideation in Psychiatric Outpatients

Depression, hopelessness, and low self‐esteem are implicated as vulnerability factors for suicide ideation. The association of self‐esteem with suicide ideation after controlling for depressed mood and hopelessness was examined. Adult psychiatric outpatients (N = 338) completed measures of self‐esteem, suicide ideation, hopelessness, and depression. Self‐esteem was operationalized as beliefs about oneself (self‐based self‐esteem) and beliefs about how other people regard oneself (other‐based self‐esteem). Each dimension of self‐esteem was negatively associated with suicide ideation after controlling for depression and hopelessness. Of the two dimensions of self‐esteem, other‐based self‐esteem was the more robust predictor of suicide ideation. These findings suggest that even in the context of depression and hopelessness, low self‐esteem may add to the risk for suicide ideation.     

Positive and Negative Expectations of Hopelessness as Longitudinal Predictors of Depression,Suicidal Ideation,and Suicidal Behavior in High‐Risk Adolescents

The relationship between hopelessness and depression in predicting suicide‐related outcomes varies based on the anticipation of positive versus negative events. In this prospective study of adolescents at elevated risk for suicide, we used two Beck Hopelessness Scale subscales to assess the impact of positive and negative expectations in predicting depression, suicidal ideation, and suicidal behavior over a 2‐ to 4‐year period. In multivariate regressions controlling for depression, suicidal ideation, and negative‐expectation hopelessness, positive‐expectation hopelessness was the only significant predictor of depressive symptoms and suicidal behavior. Clinical interventions may benefit from bolstering positive expectations and building optimism.     

Awareness of Suicide Risk and Communication Between Health Care Professionals and Next‐of‐Kin of Suicides in the Month Before Suicide

Based on psychological autopsy data, the study compared awareness of suicide risk in the deceased among next‐of‐kin (NOK ) and health care professionals (HCP s), and communication between these two groups in the month before death. The NOK s had significantly more knowledge about the decedent's suicide warning signs than the HCP s (90.5% vs. 44.6%). Contact between NOK and HCP was initiated more often by the family than the HCP s (29.4% vs. 5.9%). The study found communication gaps between HCP s and NOK and stresses the need for suicide prevention strategies strengthening communication between these two groups.     

Changing Rates of Suicide Ideation and Attempts Among Inuit Youth: A Gender‐Based Analysis of Risk and Protective Factors

Inuit in Canada currently suffer from one of the highest rates of suicide in the world. The objective of this study was to explore the prevalence of suicide ideations and attempts among 15–24 year olds living in Nunavik, Québec, and to explore risk and protective factors of suicide attempts as a function of gender. A cross‐sectional survey was conducted in 2004 across Nunavik. Univariate and multivariate logistic regressions were conducted. A total of 22% of young males and 39% of females adults reported past suicidal attempts. Gender differences were observed in relation to associated risk and protective factors as well as degree of exposure to risk factors. Suicide prevention must include alcohol and drug prevention programs and rehabilitation services, interventions to reduce physical and sexual violence and their long‐term impacts on Inuit youth, as well as exposure to culturally meaningful activities.     

A Longitudinal Study of Racial Discrimination and Risk for Death Ideation in African American Youth

Although multiple studies have found that African Americans commonly experience racial discrimination, available studies have yet to examine how perceived racism might be related to suicide vulnerability in African American youth. The purpose of this study was to examine a framework for how perceived racial discrimination contributes to symptoms of depression and anxiety as well as subsequent suicide ideation and morbid ideation. Data were obtained from 722 African American youth at mean age 10.56 years (SD = 0.64); a second wave of data was obtained 2 years later. Results revealed both a direct effect and mediated effects of perceived racism on later suicide and morbid ideation. For boys and girls, the effect of perceived racism was mediated by symptoms of depression. However, the association was mediated by anxiety for girls, but not for boys in the current sample. Implications for future research and interventions are discussed.     

Loneliness,Depressive Symptomatology,and Suicide Ideation in Adolescence: Cross-Sectional and Longitudinal Analyses

The paper presents the first known longitudinal study of the relationship between loneliness, depressive symptoms, and suicide ideation in adolescence, in a stratified sample of high school students (Time 1 N = 1009; 57 % female; Time 2 N = 541; 60 % female). Cross-lagged structural equation modeling indicated that depressive symptoms led to more loneliness across time, whereas loneliness did not predict higher levels of depressive symptoms across time. Loneliness was found to be a correlate of depressive symptoms at the cross-sectional level, independent of gender, other demographic factors, multiple psychosocial variables, and social desirability. Loneliness did not predict suicide ideation over time or at the cross-sectional level, when controlling for depressive symptoms. Gender did not predict loneliness, depressive symptoms or suicide ideation across time. Future longitudinal studies of the relationship between loneliness, depressive symptoms, and suicide ideation in adolescence should use more extensive designs.     

高中生自杀意念的素质-应激模型：多时段追踪研究

目的：探讨神经质人格和负性生活事件的跨层相互作用对自杀意念的影响。方法：采用自杀意念问卷、青少年生活事件问卷和大五人格量表-神经质分量表等自评量表对618名高中生进行评估,每三个月追踪1次,共追踪7次,历时21个月,用多层线性模型分析数据。结果：在控制了第一次自杀意念和性别的影响后,负性生活事件的主效应（b = 0.08, F(1, 2963) = 37.93, p < 0.001）、负性生活事件与神经质人格的相互作用（b = 0.03, F(1, 2963) = 4.35, p < 0.001）显著,而神经质人格的主效应不显著（b = 0.59, F(1, 557)= 3.05, p > 0.05）。结论：神经质人格和负性生活事件的跨层相互作用可以预测自杀意念的变化,支持素质-应激模型。     

Social Integration and Suicide‐Related Ideation from a Social Network Perspective: A Longitudinal Study among Inner‐City African Americans

Social network density, as measured by the extent to which network members know each other, was examined to determine whether it is associated with suicide‐related ideation and plan approximately 3 years later. Eight hundred and nineteen African Americans were interviewed at Wave 1 (1997–1999) and Wave 4 (2001–2003) of the Self‐Help In Eliminating Life‐Threatening Diseases (SHIELD) study, a HIV preventive intervention study in Baltimore, MD. Multinomial logistic regression models were used to compare risks of suicide‐related ideation and plan at Wave 4 by Wave 1 density. Even after adjusting for baseline sociodemographic characteristics and depressive symptoms, individuals with a lower level of density were three times more likely to report suicide‐related ideation and plan in the past year at Wave 4. The findings reinforce the importance of social integration among inner‐city African Americans from a social network perspective. Future research should examine the mechanisms associated with this relationship and other social network constructs.     

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.     

The Relationship Between General Population Suicide Rates and Educational Attainment: A Cross‐National Study

Suicides are associated with both high and low levels of intelligence and educational attainment in both individual‐level and aggregate‐level studies. A cross‐national study examining the relationship between general population suicide rates (y) and educational attainment (x) was undertaken with the a priori hypothesis that the relationship would be curvilinear and follow a U‐shaped curve with the quadratic equation Y = A + BX + CX², where A, B, and C are constants. Data on suicide rates and the Education Index (a proxy measure of educational attainment) were ascertained from the World Health Organization and the United Nations Web sites, respectively. The main finding was the predicted curvilinear relationship between general population suicide rates, in both sexes, and the Education Index fit the above quadratic equation. Given the cross‐sectional study design, a causal relationship cannot be assumed. The impact of educational attainment on general population suicide rates may occur through interaction with other factors, mediation of the effects of other factors, or by its effects being mediated by other factors, and require further study.     

The Relationship between General Population Suicide Rates and the Internet: A Cross‐National Study

Internet Web sites and chat rooms have been reported both to promote suicides and have a positive beneficial effect on suicidal individuals. There is a paucity of studies examining the role of the Internet in general population suicide rates. The relationship between general population suicide rates and the prevalence of Internet users was examined in a cross‐national study using data from the World Health Organization and the United Nations Web sites. The prevalence of Internet users was significantly and positively correlated with general population suicide rates in both sexes. On multiple regression analysis the prevalence of Internet users was independently associated with general population suicide rates in males, and this independent relationship in females approached statistical significance. Caution should be exercised in the attribution of a causal relationship and the direction of this relationship because of the cross‐sectional and ecological study design whereby the findings are subject to ecological fallacy. However, the findings identify and support a need for further research.     

Loneliness and Suicidal Ideation in Drug‐Using College Students

The college years are marked by social changes and behavioral experimentation which may increase risk of suicidal ideation. We propose a novel pathway for the development of suicidal thoughts between two established suicide risk factors, loneliness and drug use, which have not been examined in a nonclinical sample. Data were collected from 207 undergraduate drug‐using students at a large southeastern university. As hypothesized, suicidal ideation was positively correlated with both loneliness (r = .40) and drug use (r = .29). After controlling for several demographic variables, social desirability, and anxiety sensitivity, drug use was tested as a potential mediator in the loneliness–suicidal ideation link using a single‐mediator model. Results indicated a significant indirect (mediated) effect of loneliness on suicidal ideation via drug use (ab = 0.09, 95% CI: 0.02–0.18), suggesting that loneliness may contribute to suicidal ideation through increased drug use among college students. Identification of and intervention with students reporting loneliness and drug use may be a promising suicide prevention strategy on college campuses.     

A Preliminary Validation Study of Two Ultra‐Brief Measures of Suicide Risk: The Suicide and Perceived Burdensomeness Visual Analog Scales

The advent of rapid‐acting suicide‐focused interventions and longitudinal research designs employing high‐frequency, repeated measurement of suicide risk has resulted in a need to quantify suicide risk during very brief windows of time (e.g., minutes, hours, days). This has rapidly outpaced traditional methods for assessing suicide risk, which often focus on measuring indicators of suicide risk during much broader intervals of time (e.g., weeks to months). Valid and practical methods for rapidly assessing suicide risk during small time intervals are therefore needed. This study reports a preliminary examination of the Suicide Visual Analog Scale (S‐VAS) and the Perceived Burdensomeness Visual Analog Scale (PB‐VAS) in a clinical sample of suicidal adults. Results support the convergent validity, predictive validity, responsiveness, and clinical utility of both scales, suggesting the S‐VAS and PB‐VAS are valid methods for rapidly quantifying two dimensions of suicide risk.