Examining Intent to Die and Methods for Nonsuicidal Self‐Injury and Suicide Attempts

Nonsuicidal self‐injury (NSSI) is linked to suicidal behavior and future suicide attempts, but the process of NSSI‐to‐suicide attempts remains unclear. Additionally, little is known about how having a history of NSSI may relate to reports of intent to die during a suicide attempt. The current study examined methods of NSSI and suicide attempts, as well as intent to die, in a sample of 1,232 young adults, 54 of whom reported at least one suicide attempt. Cutting and overdose were the predominant methods of NSSI and suicide attempts, respectively, with the two often co‐occurring. Individuals with both NSSI and suicide attempt history were significantly more likely to report an intent to die than those with suicide attempt history only.     

Effect of Socioeconomic Status on the Linkage Between Suicidal Ideation and Suicide Attempts

Previous suicide attempts are a leading risk factor for completed suicide. To identify specific characteristics of those at high risk for attempts, we investigated associations with socioeconomic status (SES). Data from the 2013 Korean Community Health Survey (KCHS) included adults who reported suicidal ideation (N = 220,245). Attempts in the past 12 months were assessed. Associations of demographic, socioeconomic, and suicide‐related behavioral factors were analyzed using multiple logistic regression. Among those with suicidal ideation, 862 (3.9%) had attempted suicide. After stratification by age and gender, results showed that low education and unemployed young adult men and women had significantly higher rates of attempts. The lowest income level was associated with significantly higher rates of attempts in only young adult women. Among those with the lowest and highest income, the association between ideation and attempts was attenuated, whereas it was enhanced among other income groups.     

Community Reactions to Attempted and Completed Child Suicide1

In order to assess community reactions to attempted and completed child suicide, 180 shoppers were asked to read a short newspaper article about a 10-year-old who either (a) attempted suicide, (b) completed suicide, (c) completed suicide after having previously attempted, (d) was psychiatrically hospitalized, (e) died of a viral illness, or (f) died of an accident. Subjects then completed a 9-item Likert scale designed to assess their reactions. A2 × 6 (Gender of Victim × Type of Incident) multivariate analysis of variance indicated a significant effect only for type of incident. Families of psychiatrically hospitalized adolescents received milder reactions than families of suicide attempters, in terms of (a) other's assessment of their psychological health, (b) how long they were expected to be sad and depressed after the incident, and (c) how tense respondents expected to feel while visiting them. Apparently, families of suicide attempters must face many of the same negative community reactions as families whose loved ones actually die by suicide, whereas families who have a loved one psychiatrically hospitalized face less problematic reactions from others in the community.     

The impact of the nature of relationships on perceived burdensomeness and suicide ideation in a community sample of older adults

Older adults die by suicide at very high rates, and previous research indicates that perceived burdensomeness may contribute to deaths by suicide. In this study, the impact of the nature of relationships on perceived burdensomeness and suicide ideation was examined. Results indicated that older adults' perceptions of burden on younger generations were associated with greater overall perceived burdensomeness and suicide ideation when compared to the older adults' own or older generations. Thus, clinicians should examine general perceived burdensomeness as well as the types of relationships the older adult perceives himself or herself to be a burden on.     

High-lethality status in patients with borderline personality disorder

Recurrent suicidal behaviors in patients with Borderline Personality Disorder (BPD) are often considered communicative gestures; however, 10% complete suicide. This study seeks to identify risk factors for suicide within a BPD sample by comparing patients with High- and Low-Lethality attempts. BPD attempters (n = 113) were assessed on demographic, diagnostic, and personality variables: clinical symptoms, suicidal behaviors; childhood, family, and treatment histories; social adjustment; and recent life events. Forty-four High-Lethality attempters, defined by a score of 4 or more on Beck's Medical Lethality Scale, were compared to 69 Low-Lethality attempters. Discriminating variables were entered in a multivariate logistic regression model to define predictors of High-Lethality status. High-Lethality attempters were older, with children, less education, and lower socioeconomic class (SES) than Low-Lethality attempters. They were more likely to have Major Depressive Disorder (MDD), co-morbid Antisocial Personality Disorder (ASPD), and family histories of substance abuse. They reported greater intent to die, more lifetime attempts, hospitalizations, and time in the hospital. High-Lethality status was best predicted by low SES, co-morbid ASPD, extensive treatment histories, and greater intent to die. These characteristics resemble profiles of patients who complete suicide, are not specific for BPD, and do not include impulsivity, aggression, or severity of BPD criteria.     

Predictive and concurrent validity of the Suicidal Ideation Questionnaire among American Indian adolescents

Suicide is currently the second leading cause of death for ages 15–24 years; reports indicate that 6–8% of American teens have attempted suicide. Rates of suicide and suicide attempts are at least as high, if not higher, for American Indian adolescents and young adults. The Suicidal Ideation Questionnaire (Junior High School Version) (SIQ-JR) could be used to identify young people who may be at risk for attempting suicide, since this questionnaire focuses on suicidal ideation, a major risk factor for suicide attempt. However, little is known about the predictive validity of the SIQ-JR, particularly in American Indian adolescent populations. A suicide attempt cluster at an American Indian boarding school provided the unique opportunity to examine the performance of the SIQ-JR in a group of American Indian high school students who had taken the SIQ-JR approximately 2 months prior to the outbreak of attempts. The SIQ-JR proved to be an excellent predictor of future suicide attempts when compared to other measures of distress: anxiety, depression, and alcohol use. The SIQ-JR is an effective screener for suicide risk in this American Indian adolescent population.     

Suicidality,Self‐Harm,and Body Dissatisfaction in Transgender Adolescents and Emerging Adults with Gender Dysphoria

Prevalence of suicide attempts, self‐injurious behaviors, and associated psychosocial factors were examined in a clinical sample of transgender (TG) adolescents and emerging adults (n = 96). Twenty‐seven (30.3%) TG youth reported a history of at least one suicide attempt and 40 (41.8%) reported a history of self‐injurious behaviors. There was a higher frequency of suicide attempts in TG youth with a desire for weight change, and more female‐to‐male youth reported a history of suicide attempts and self‐harm behaviors than male‐to‐female youth. Findings indicate that this population is at a high risk for psychiatric comorbidities and life‐threatening behaviors.     

Suicidal behavior in borderline personality disorder: prevalence, risk factors, prediction, and prevention

Suicidal behavior is frequent in patients with borderline personality disorder (BPD); at least three-quarters of these patients attempt suicide and approximately 10% eventually complete suicide. Borderline patients at greatest risk for suicidal behavior include those with prior attempts, comorbid major depressive disorder, or a substance use disorder. Comorbidity with major depression serves to increase both the number and seriousness of the suicide attempts. Hopelessness and impulsivity independently increase the risk of suicidal behavior, as does a turbulent early life and the presence of antisocial traits. In summary, because BPD is frequently complicated by suicidal behavior, clinicians must avoid the mistake of thinking that a pattern of repeated attempts indicates little desire to die. Clinicians have an important role in preventing suicide attempts and completed suicides by understanding the risk factors.     

Social and psychiatric influences on urban-rural differentials in Australian suicide

The purpose of this study was to investigate urban-rural differentials in Australian suicide rates, and to examine influences that previously have remained largely speculative. Suicide rates for males (all ages and young adults) were significantly higher in rural areas compared to urban areas. Urban-rural suicide rate differences in males were rendered nonsignificant after adjustment for migrant and area socioeconomic status. Adjusting for mental disorder prevalence, in addition to migrant status, reduced the excess suicide risk in rural areas; the excess was reduced further with addition of mental health service utilization. The implications of this study are that socioeconomic circumstances in rural populations contribute to higher male suicide rates compared to urban areas, but these conditions may be partly mediated by mental disorder prevalence and mental health service utilization.     

A Developmental Comparison of Social Class and Verbal Ability Influences on Piagetian Tasks

Summary

The present investigation attempted to evaluate the respective influences of socioeconomic status and verbal ability levels, as determinants of performance on Piagetian concrete operations tasks. A sample of 160 subjects (kindergarten to fourth grade) were matched on socioeconomic status and verbal ability levels. A battery of Piagetian tasks was administered, including a relational terms pretest, provoked and unprovoked numerical correspondence, unidimensional seriation, height and width, multiple seriation, and conservation of surface area. Results of factorial (grade level × sodoeconomic status × verbal ability × sex) analyses of variance indicated (a) an absence of significant socioeconomic status effects for any of the Piagetian tasks, (6) a significant main effect for the verbal ability and age-grade level factors on the majority of tasks excluding unidimensional height seriation, (c) a general absence of sex main effects or higher order interactions. The lack of difference with regard to socioeconomic-status levels indicates that the previous research which revealed notable socioeconomic-status influences may have had socioeconomic status confounded to varying degrees with differences in underlying verbal skills.     

SEX TRAIT STEREOTYPES OF ADULTS ACROSS DIFFERENT LIFE PERIODS

An attempt was made to identify the stereotypes that young Indian people hold of adults of their community representing the different life periods. Twelve groups of 30 subjects aged 18 to 19 years were the subjects. A 2×2×3 (sex of subjects × sex of target figures to be rated × age of target figures, young, middle-aged, elderly) experimental design was used. Each group rated one target figure on the Adjective Check List (ACL) devised by Gough and Heilbrun (1965). The major findings include (a) a decrease in the number of adjectives attributed to the target figures as a function of increasing age, (b) a greater number of traits to describe male than female target figures, (c) a similar trend for the stereotypes of the different figures, and (d) an increase in the unfavourable evaluation of the adjectives comprising the stereotypes related to the age of the target figures. Possible reasons for the findings were discussed.     

The Association Between Gender,Ethnicity, and Suicidality Among Vocational Students in Israel

Gender and ethnicity are significant factors when evaluating suicidal risk, especially among ethnically diverse populations. In the current study we explored the association between gender, ethnicity, and suicide ideation and attempts among Arab and Jewish vocational education and training high school students in Israel. Students (N = 3,554) completed a self‐report survey evaluating suicide ideation and attempts, depression, anxiety, somatization, and sense of belonging. Hierarchical generalized linear modeling indicated that female Arab adolescents had elevated levels of suicide ideation, higher rates of suicide attempts, and greater psychological distress than Arab males and Jewish students. Furthermore, female Arab adolescents were found to be more susceptible to suicide ideation when depression levels were high. These results are discussed in the context of the double‐jeopardy Arab young women face, as members of a minority ethnic group in Israel and their status as women within the patriarchal Arab culture.     

Gender in Suicide Attempt Rates and Childhood Sexual Abuse Rates: Is There an Interaction?

Two competing explanations for higher rates of attempted suicide in women than men were compared. Because childhood sexual abuse is more prevalent in girls than boys, one explanation of higher rates of suicide attempts in women is that it is a direct result of the higher incidence of sexual abuse in girls. Alternatively, higher rates of suicide attempts might result from gender differences in the impact of childhood sexual abuse on suicidal behavior. To compare these theories, data from 1,889 abstinent, substance-dependent patients who completed the Childhood Trauma Questionnaire (CTQ) and who were interviewed about suicide attempts was examined. Scores on each scale of the CTQ were examined as a function of gender and attempter status. Results showed higher rates of suicide attempts in women than in men, higher CTQ scores in women than men, and a higher CTQ score in attempters than nonattempters. However, logistic regression indicated that gender and abuse did not interact to determine attempter status. Thus, the data support the first hypothesis that the greater frequency of suicide attempts in women may be partly attributed to the higher prevalence of childhood sexual abuse in girls. The generalizability of these results to the general population and to other diagnostic groups requires further study.     

Risk factors for medically serious suicide attempts: evidence for a psychodynamic formulation of suicidal crisis

This study explored a psychodynamic model for suicide risk by examining risk factors for medically serious suicide attempts, including assessments of affect flooding, negative self-schema / fragmentation, and impaired reality testing, closely approximating Maltsberger's psycho-dynamic formulation of suicide crisis. Baseline risk factors including age, gender, psychiatric symptoms, high-risk behaviors, and the Implicit Risk for Suicide Index (IRSI) were used to detect medically serious suicide attempts monitored for up to a year after the assessment. Twenty-five psychiatric inpatients who made life-threatening suicide attempts after assessment were compared to 25 inpatients and 25 psychotherapy outpatients who made no suicide attempts during follow-up. Statistical analysis revealed that a history of at least one suicide attempt and elevated IRSI scores accounted for 60 percent of the variance in detecting medically serious suicide attempts. Elevated IRSI accurately identified suicide attempt status above and beyond past suicide attempts and other empirically validated risk factors. Results are discussed in light of psychodynamic formulations of suicide risk.     

The Influence of Geographic Mobility on Nearly Lethal Suicide Attempts

T eenagers and young adults are very mobile and mobility has been identified as a potential risk factor for suicidal behavior. We conducted a population‐based, case‐control study of nearly lethal suicide attempts with 153 cases and 513 controls. Study participants were asked about changing residence over the past 12 months. Results indicate that moving in the past 12 months is positively associated with a nearly lethal suicide attempt (adjusted odds ratio of 2.1, with 95% confidence interval of 1.4–3.3), as are specific characteristics of the move (e.g., frequency, recency, distance, and difficulty staying in touch). These findings confirm and extend prior ecologic research by demonstrating a relationship, at the individual level, between the geographic mobility of adolescents and young adults and nearly lethal suicide attempts.     

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.     

Roles of cognitive load and self-relevance during emotional information searching on decision-making

Older adults have been found to favor positive stimuli over negative stimuli; further, developing a negative preference may be a cognitively demanding process. In the present study, we focused on the joint effects task self-relevance and cognitive load have on older adults' emotional information preferences when performing decision-making. To examine this, we used multi-attribute decision tasks and process-tracing procedure to measure their searching process. The study composed of a 2 (age: young/old) × 2 (cognitive load: load/non-load) × 3 (attribute valence: positive/neutral/negative) × 3 (task self-relevance: high/medium/low) mixed design. Sixty-one young adults and 62 older adults viewed 5 (alternatives) × 5 (attributes) decision matrices that contained positive, negative, and neutral information, with the total views and mean time spent viewing each different valence (positive, negative, and neutral information) set as dependent variables. The results indicated that both young and old adults have no emotional information preference in regard to self-relevance. When under no cognitive load, both positive and negative information were viewed more than neutral information; however, under cognitive load, preference for negative information decreased; this effect size was more robust in older adults. There was also a main effect of self-relevance on total views and mean checking time, with attributes concerning higher self-relevance tasks being more likely to attract attention. Older adults exhibited a consistent hedonic focus, even in highly self-relevant contexts; however, this effect disappeared under cognitive load. Overall, the findings suggest that cognitive resources play an important role in emotional information processing during decision processes.     

Spreading activation in episodic memory: Further evidence for age independence

Seventy-two young (mean age = 25 years) and 72 old adults (mean age = 71 years) participated in an experiment that addressed the influence of episodic and semantic prime activation on speeded episodic recognition judgements. On each test block, subjects studied two paragraphs at their own pace to achieve a designated level of episodic recognition performance. Following the study period, subjects were presented a series of prime-target trials for speeded episodic recognition. The primes were either (a) episodically related to the target, (b) semantically related to the target, (c) episodically and semantically related to the target, or (d) episodically and semantically unrelated to the target. The stimulus onset asynchrony (SOA) between the primes and targets was either 200 msec, 600 msec, or 1000 msec to address age-related changes in the rate at which these different prime types influenced performance. The results indicated that, compared to young adults, the old adults (a) studied the paragraphs for a longer period of time, (b) responded to the targets more slowly, and (c) were less accurate in their episodic recognition decisions. Although there were these main effects of age, the young and old adults were influenced in a similar fashion by the different prime-target relationships and by the interactive influences of the prime-target relationships and SOA. Correlational analyses indicated that the pattern of priming effects was as similar across the two age groups as across two pseudo-groups that were matched on the age dimension. These results were viewed as further support for the notion that the characteristics of the spreading activation mechanism as reflected by prime-target manipulations are relatively stable across young and old adults.     

Impact of Huntington Disease Gene-Positive Status on Pre-Symptomatic Young Adults and Recommendations for Genetic Counselors

Huntington disease (HD) is an autosomal dominant, progressive neurodegenerative disorder for which there is no cure. Predictive testing for HD is available to asymptomatic at-risk individuals. Approximately half of the population undergoing predictive testing for HD consists of young adults (≤35 years old). Finishing one’s education, starting a career, engaging in romantic relationships and becoming a parent are key milestones of young adulthood. We conducted a qualitative study to explore how testing gene-positive for HD influences young adults’ attainment of these milestones, and to identify major challenges that pre-symptomatic young adults face to aid the development of targeted genetic counseling. Results of our study demonstrate that 1) knowing one’s gene-positive status results in an urgency to reach milestones and positively changes young adults’ approach to life; 2) testing positive influences young adults’ education and career choices, romantic relationships, and family planning; 3) young adults desire flexible and tailored genetic counseling to address needs and concerns unique to this population. Findings of this study contribute to the understanding of the impact of predictive testing for HD on young adults, and highlight issues unique to this population that call for further research, intervention and advocacy.     

Lesbian,gay, and bisexual suicidal behavior: testing a constructivist model

The present investigation surveyed 162 self-identified lesbian, gay, and bisexual individuals recruited from LGB-related social organizations or contacted through networking procedures with regard to suicidal behaviors, suicide risk factors, and reasons for living. Approximately 41% of the respondents indicated a serious consideration of suicide including the identification of a specific suicide plan (23%) or a past suicide attempt (36%) with significant intent to die (13%). Forty-six percent of the sample indicated at least some degree of chance of attempting suicide in the future. Grounded in the existential-constructivist theory of suicide (Rogers, 2001), empirically and theoretically identified suicide risk factors were found as a group to predict suicidal ideation (R2 = .16) and attempts (R2 = .17), with abuse-related items independently predicting both suicidal ideation (R2 = .03) and attempts (R2 = .08). Items related to self-identity issues and social acceptance were predictive of suicidal ideation (R2 = .04), while substance abuse was predictive of suicidal ideation (R2 = .05) and attempts (R2 = .13) for males only. The established factor structure of the Reasons for Living Inventory (Linehan et al., 1983) was not supported in the current data, suggesting that it may not be an appropriate measure of reasons for living with LGB individuals.