Contributions of Cognitions,Psychological Flexibility,and Therapeutic Alliance to Suicidal Ideation in Psychiatric Inpatients

Although suicide treatment is an expanding area of research, there is relatively less in the literature with respect to how specific vulnerabilities to suicide are addressed by treatment. Utilizing measures of suicide cognitions, therapeutic alliance, and psychological flexibility, we compared their relative contributions to suicidal ideation during and posttreatment among a group of adult psychiatric inpatients (N  = 434). Results revealed that cognitions contributed considerably more unique variance to suicidal ideation than alliance and flexibility at discharge and at 2 weeks postdischarge, and to change in suicidal ideation over the course of treatment. Psychological flexibility explained a small amount of variance at the 6‐month time point. Factor level analyses also were conducted, with the unsolvability factor within suicide cognitions accounting for the largest portion of variance at both discharge and 2 weeks postdischarge. Study limitations, implications, and future directions 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.     

Disentangling the Interrelations Between Hopelessness,Loneliness, and Suicidal Ideation

We attempted to disentangle the interrelations between hopelessness, loneliness, and suicidal ideation, by comparing two conceptually driven models of their relationships, prospectively among 234 undergraduates, using a series of multiple regression/correlation equations. Model 1 framed loneliness as a risk factor for future suicidally that operates via its influence on hopelessness (the mediational view). Model 2 viewed hopelessness as a source variable that is predictive of both loneliness and suicidally, and postulated no relation between loneliness and suicidality beyond hopelessness. Model 2 received support, whereas Model 1 did not. We discuss the implications of our findings for the nomological status of hopelessness and loneliness as correlates of suicidality, and for exploration of the structural interrelations of suicide-related variables in general.     

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.     

Hopelessness,Depression, Suicidal Ideation,and Clinical Diagnosis of Depression

The relevance of a clinical diagnosis of depression for explaining the discrepant relationships of hopelessness and depression with suicidal ideation was studied. The Beck Depression Inventory (BDI), Hopelessness Scale (BHS), and the Scale for Suicide Ideation (SSI) were administered to 1,306 (72.8%) patients with at least one DSM-III-R mood disorder and 488 (27.3%) patients without any mood disorders. A multiple regression analysis was conducted, and hopelessness was 1.3 times more important than depression was for explaining suicidal ideation. The interactions of the BDI and BHS with diagnostic group were not significant.     

International and Domestic Students,Perceived Burdensomeness,Belongingness, and Suicidal Ideation

Suicide is the second leading cause of death for traditional‐age college students, and the interpersonal theory of suicide (ITS; Joiner, 2005) provides a cogent framework for predicting which students may be at highest risk. However, little is known about how constructs of ITS operate in cross‐cultural contexts. Findings, based on a sample of international and domestic undergraduate students (N = 254), indicated that the ITS construct of perceived burdensomeness was positively associated with suicidal ideation (SI) for both groups. However, campus belongingness emerged as connected with SI for international students, whereas family belongingness emerged as connected with SI for domestic students.     

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.     

Connection between Suicidal Ideation,Life Meaning,and Leisure Time Activities

This study is an examination of the links between adolescent suicidal ideation, life meaning, and the ways they spend their leisure time. The sample consisted of 450 students aged 15–18. Findings showed a significant negative correlation between suicidal ideation and sense of life meaning, encompassing factors such as age and gender. Adolescents with involvement in social activities demonstrated lower levels of suicidal ideation (total score), and lower levels of depression and anxiety, than the other two groups. The study discusses the research and practical implications of these findings. The findings suggest the possibility of establishing prevention, intervention, and therapy programs for adolescents based on life meaning.     

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.     

The Interrelations of Agency,Depression, and Suicidal Ideation Among Older Adults

The high rates of suicide among older men are cause for concern, and have prompted the investigation of factors that might explain these elevated rates. The current research examined whether the gender role construct agency was associated with depression and suicidal ideation among older adults. The results, based on self‐report data from a sample of older Australian men (n = 69) and women (n = 90), indicated that depression mediated the relation between agency and suicidal ideation. In addition, for older men only, agency moderated the depression‐suicidal ideation relation. The results suggest that older adults, and particularly men, with low levels of agency should be the targets for interventions aimed at increasing levels of agency and improving mental health.     

Suicidal Ideation and Associated Factors Among School-Going Adolescents in Harare,Zimbabwe

This study determined the prevalence and associated factors of suicidal ideation among school-going adolescents in Harare, Zimbabwe. Data on 1970 respondents were obtained from a cross sectional study of the Global School-based health survey. Respondents were selected using a two-stage probability sampling technique. The prevalence of suicidal ideation was 21.6%. Males were less likely to have suicidal ideation than females (OR=0.70; 95% CI 0.54,0.91). Worrying (OR=1.81; 95% CI 1.29,2.56), feeling of loneliness (OR=2.04; 95% CI 1.43,2.90), cigarette smoking (OR=1.87; 95% CI 1.11, 3.16), and drinking alcohol (OR=1.74; 95% CI 1.17, 2.60) were associated with suicidal ideation. Public health programs designed to control cigarette smoking and alcohol use may also impact positively on suicidal ideation.     

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.     

Relations Between Suicidal Ideation,Depression, and Emotional Autonomy from Parents in Adolescence

We examined the relations between depression, emotional autonomy quality-related constructs of separation and detachment, and suicidal ideation, focusing on the unique and common contribution that depression, separation and detachment made to suicidal ideation. We also examined gender differences. 403 adolescents, 196 boys and 207 girls, completed self-report measures of depression, separation and detachment, and suicidal ideation. The data showed a significant relation between depression and suicidal ideation both for boys and girls, and between detachment and suicidal ideation only for boys. Results for boys supported an additive model such that depression and detachment each contributed unique variance to boys’ suicidal ideation, and an interactive model such that detachment contributed to exacerbate the risk of suicidal ideation when boys were already at risk because of depression. The data for girls supported an interactive, but not additive, model such that depression and detachment did not contribute independently to girls’ suicidal ideation but in a joint way.     

Physical Activity,Suicide Risk Factors,and Suicidal Ideation in a Veteran Sample

The association between current level of suicidal ideation and physical activity was tested in a broad sample of veterans seeking care from the Veterans Health Administration. It was hypothesized that the two variables would be significantly inversely related. It was further hypothesized that the relationship would be mediated by depressive symptoms, disturbed sleep, and a measure of heart rate variability based on existing research regarding physical activity and sleep. Due to the first hypothesis not being supported, the second could not be tested. Post hoc correlation analyses did find associations between physical activity and depressive symptoms, in expected directions, and are discussed. Possible explanations for the negative findings along with recommendations for future research to continue exploring links between suicide risk and physical activity are presented. We conclude by suggesting that physical activity may have promise as a risk reduction intervention and that prospective data are more likely to yield significant results than the cross‐sectional methodology employed in the current study.     

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).     

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.     

Correlates of Suicidal Ideation in Physically Injured Trauma Survivors

Epidemiologic studies have documented that injury survivors are at increased risk for suicide. We evaluated 206 trauma survivors to examine demographic, clinical, and injury characteristics associated with suicidal ideation during hospitalization and across 1 year. Results indicate that mental health functioning, depression symptoms, and history of mental health services were associated with suicidal ideation in the hospital; being a parent was a protective factor. Pre‐injury posttraumatic stress disorder symptoms, assaultive injury mechanism, injury‐related legal proceedings, and physical pain were significantly associated with suicidal ideation across 1 year. Readily identifiable risk factors early after traumatic injury may inform hospital‐based screening and intervention procedures.     

The Presence of Self-Stigma,Perceived Stress,and Suicidal Ideation among Selected LGBT Filipinos

Minority group members experience what is known as “minority stress,” by which individuals suffer stress because of their membership in stigmatized social categories. In turn, minority stress may lead to self-stigmatization. This occurs when minority group members experience a sense of shame created by the view of the majority culture and then incorporate the majority opinion into their self-image. Because it is cumulative with the stress an individual is already experiencing, self-stigmatization may become a significant stressor itself, possibly contributing to the development of suicidal ideation. A total of 609 self-identified LGBT individuals were asked to answer a battery of psychological tests to assess the interrelationships between self-stigma, perceived stress, and suicidal ideation. As expected, perceived stress predicted suicidal ideation, whereas self-stigmatization predicted both perceived stress and suicidal ideation. Structural equation modeling confirms the predictive value of self-stigma together with perceived stress in determining the suicidal ideation present among LGBT Filipinos. Self-stigma exerted a direct effect upon suicidal ideation not accounted for by perceived stress.