The glass half-full or a hopeful outlook: Which explains more variance in interpersonal suicide risk in a psychotherapy clinic sample?

Recent research has suggested that constructs in the field of positive psychology may be important for understanding suicide risk. Specifically, both hope theory and dispositional optimism have been linked to lower levels of suicidal ideation and interpersonal suicide risk. Despite these encouraging findings, no study has investigated the relationships between hope, optimism, and suicide risk in a clinical sample. The current study aimed to address this gap and to determine if hope or optimism was more important for understanding suicide risk as operationalized by the interpersonal-psychological theory and suicidal ideation. Results of hierarchical regression analyses revealed that both hope and optimism predicted lower levels of burdensomeness and thwarted belongingness, but were not significant predictors of suicidal ideation. Further, results revealed that when both hope and optimism were entered into a hierarchical regression in the final step, only optimism remained significant. Theoretical and clinical implications of these findings are discussed.     

Forgiveness,Depression, and Suicidal Behavior in Adolescents: Gender Differences in this Relationship

With the development of positive psychology, protective factors have received increased attention as buffers against suicidal ideation and attempts and against the risk factors for suicide (e.g., depressive symptoms). Empirical evidence suggests that one of the protective factors associated with depression and suicide is forgiveness. Although previous studies have demonstrated a negative association between forgiveness and risk of suicide, studies on gender differences in adolescents are still scarce. Thus, the authors assessed the moderating role of gender in a sample of adolescents. The participants were 572 adolescents (50.9% boys; M age = 15.49 years, SD = 1.09 years) from secondary school centers. The results revealed that forgiveness moderated the relationship between depression and suicidal ideation for boys but not for girls. Specifically, for boys the relationship between depression and suicidal thoughts and behaviors weakened as levels of forgiveness increased. These findings suggest therapeutic applications to reduce the likelihood of suicide in the group of adolescent boys with higher scores on depression and lower levels of forgiveness. The study results are discussed in terms of the need to use gender perspectives in positive psychology intervention programs.     

Interaction of Combat Exposure and Unit Cohesion in Predicting Suicide‐Related Ideation Among Post‐Deployment Soldiers

Suicide is one of the leading causes of death among U.S. Army soldiers. Suicide‐related ideation, which is associated with suicide attempts and suicide, can cause considerable distress. In a sample of 1,663 recently redeployed soldiers, we used factor analysis and structural equation modeling to test the associations between combat exposure, unit cohesion, and their interaction in predicting suicide‐related ideation. We found that combat exposure was a significant risk factor for suicide‐related ideation, while unit cohesion was a significant protective factor. The significant interaction between the two factors indicated that soldiers who experienced greater combat exposure but also had higher levels of unit cohesion had relatively lower levels of suicide‐related ideation. In addition, those who had higher levels of combat exposure and lower unit cohesion were most at risk for suicide‐related ideation. Our findings indicate the importance of unit cohesion in protecting soldiers from suicide‐related ideation and suggest a higher risk group of soldiers who should be targeted for interventions.     

Perceived burdensomeness and suicide ideation in older adults

Older adults have the highest risk of death by suicide in the United States. Improving our understanding of the factors that lead to increased risk of suicide in older adults will greatly inform our ability to prevent suicide in this high-risk group. Two studies were conducted to test the effect of perceived burdensomeness, a component of the interpersonal-psychological theory of suicide (Joiner, 2005), on suicide ideation in older adults. Further, gender was examined as a moderator of this association to determine if perceived burdensomeness exerted a greater influence on suicide ideation in males. The results of these studies suggest that perceived burdensomeness accounts for significant variance in suicide ideation, even after predictors such as depressive symptoms, hopelessness, and functional impairment are controlled. Gender did not moderate the association. The implications of these findings for treatment of older adults with suicide ideation and elevated suicide risk are discussed.     

Serum Lipids in Suicide Attempters

As other studies have shown possible associations of low serum cholesterol concentrations as well as serotonin and corticosteroid deviances with suicide or depression, the present study was undertaken to investigate the serum lipid levels in subgroups of suicide attempters. Serum lipids were determined in 72 suicide attempters. Cerebrospinal fluid monoamine metabolites and plasma cortisol levels were measured, and dexamethasone suppression tests were performed. Hopelessness and suicidality were rated by the Hopelessness Scale (HS) and the Suicidal Intent Scales (SIS). The mean total serum cholesterol (TSC) level was 5.0 ± 1.2 mmol/L. We found no significant correlations between TSC and the monoamine metabolites. High-density lipoprotein cholesterol showed positive correlations with the dopamine metabolite homovanillic acid (r = 0.39, p = 0.04) and the serotonin metabolite 5-hydroxyindoleacetic acid (r = 0.34, p = 0.07). The SIS and HS scales did not correlate significantly with serum lipids. “Violent” attempters showed somewhat higher serum lipid levels than “nonviolent” attempters. We found no significant differences in serum lipid levels between the diagnostic subgroups. Hence, we could not find much support for the hypothesis of associations between low cholesterol levels and decreased serotonin activity in the brain. However, this field merits further investigation.     

Suicide schema in schizophrenia: the effect of emotional reactivity, negative symptoms and schema elaboration

Suicide risk is thought to increase with a greater potential for activation of suicide-related schemas. Suicide schemas are less likely to be activated with reductions of emotional range associated with certain negative symptoms of schizophrenia. The study tested whether suicide risk would increase in patients with recent onset schizophrenia with increased potential for suicide schema activation as indicated by lower levels of specific negative symptoms that reflected emotional reactivity, namely emotional withdrawal and blunted affect. A logistic regression analysis of baseline data of 278 recent onset schizophrenic patients with a measure of suicide behaviour as the dependent variable and negative symptoms, delusions, hallucinations, depression, gender, episode, ethnicity, education, age, duration of untreated psychosis and substance use as independent variables was carried out. Emotional withdrawal, but not blunted affect was significant and negatively associated, and depression positively associated with suicide behaviour. There was evidence to indicate that restricted emotions are associated with reduced suicide risk as predicted.     

The Interpersonal Theory of Suicide Applied to Male Prisoners

The interpersonal theory of suicide proposes that severe suicide ideation is caused by the combination of thwarted belongingness (TB) and perceived burdensomeness (PB), yet few studies have actually examined their interaction. Further, no studies have examined this proposal in male prisoners, a particularly at‐risk group. To address this gap, the current study surveyed 399 male prisoners. TB and PB interacted to predict suicide ideation while controlling for depression and hopelessness. High levels of both TB and PB were associated with more severe suicide ideation. The interpersonal theory may aid in the detection, prevention, and treatment of suicide risk in prisoners.     

Memory specificity as a risk factor for suicidality in non-affective psychosis: The ability to recall specific autobiographical memories is related to greater suicidality

A difficulty in recalling specific autobiographical memories has been noted as a risk factor for suicidal behaviour. However, the relationship between memory specificity and suicide has not previously been investigated in those with non-affective psychosis. It was predicted that in this group, more specific memory recall would be associated with an increased risk of suicide. This is because such specific memories are likely to be associated with greater levels of distress and negative affect than less specific memories. This prediction contradicts the prevailing belief that lower memory specificity is associated with greater suicidality. Sixty participants with schizophrenia spectrum disorders were recruited, 40 of whom reported past suicide attempts. Analyses showed suicide attempters recalled a greater proportion of specific memories, whilst controlling for trait anxiety and depressive symptoms. These results supported the main hypothesis, and suggest non-specific memory may have adaptive qualities in individuals with psychosis.     

Clinical assessment of suicide risk in depressive disorder

Efforts to identify clinical risk factors for complete suicide through the follow-up of depressed patients have yielded relatively few robust predictors. Those identified by at least three studies are (in order of decreasing frequency) suicidal plans/attempts, male sex, being single or living alone, inpatient status, and hopelessness. Because the best established of these predictors has only modest sensitivity and specificity, the need for other robust tools is clear. A rich body of research has identified two biological risk factors for suicide in depressive disorder: hypothalamic-pituitary-adrenal axis hyperactivity and deficits in serotonin function. Moreover, there is now considerable evidence that the dexamethasone suppression test and measures of serum cholesterol concentrations, respectively, may provide a clinically useful reflection of these two mechanisms. Observations that these measures appear to be additive, both with each other and with other clinical risk factors, indicate that a substantial improvement in the clinician's ability to assess suicide risk is possible.     

Suicide Ideation and Attempts among Inhalant Users: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Few studies have examined associations of inhalant use and inhalant use disorders (IUDs) to suicide ideation and attempts. We investigated these relationships in the largest comorbidity survey conducted in the United States. Suicidal ideation was significantly more prevalent among inhalant users than nonusers and severity of inhalant use problems was positively related to suicidal ideation. Among persons with IUDs, 67.4% had thought about committing suicide and 20.2% had attempted suicide. Multivariate logistic regression analyses indicated that respondents with IUDs reported significantly higher levels of suicide ideation than inhalant nonusers. Inhalant use is associated with significantly increased risk for suicide ideation, especially among women and persons with DSM‐IV IUDs.     

Youth suicide risk and sexual orientation

Using a broad suicide risk assessment (suicidal ideation, hopelessness, hostility) with 100 youth ages 17 to 19, this study examined the relationship between sexual orientation and youth suicide risk. Participants were compared across sexual orientation, as well as level of perceived external support, which may be a mitigating variable in suicide risk. The suicide risk demonstrated by sexual minorities in this study was no greater than that of their heterosexual peers. Youth who reported more external support demonstrated lower overall suicide risk and, specifically, lower levels of hostility, hopelessness, and suicidal ideation. The results indicated that suicide risk is not determined by demographic criteria alone, and may be influenced by psychosocial variables, such as support.     

The Impact of Exercise on Suicide Risk: Examining Pathways through Depression,PTSD, and Sleep in an Inpatient Sample of Veterans

Suicide has a large public health impact. Although effective interventions exist, the many people at risk for suicide cannot access these interventions. Exercise interventions hold promise in terms of reducing suicide because of their ease of implementation. While exercise reduces depression, and reductions in depressive symptoms are linked to reduced suicidal ideation, no studies have directly linked exercise and suicide risk. The current study examined this association, including potential mediators (i.e., sleep disturbance, posttraumatic stress symptoms, and depression), in a sample of Veterans. SEM analyses revealed that exercise was directly and indirectly associated with suicide risk. Additionally, exercise was associated with fewer depressive symptoms and better sleep patterns, each of which was, in turn, related to lower suicide risk.     

Recent life events, social adjustment, and suicide attempts in patients with major depression and borderline personality disorder

This study investigated the impact of recent life events and social adjustment on suicide attempter status in 34 patients with major depression, 24 patients with borderline personality disorder, and 22 patients with co-morbid major depression and borderline personality disorder. Suicide attempters reported more recent life events and scored lower on a measure of social adjustment in their families and overall social adjustment, compared with non-attempters. Borderline disordered and borderline or depressed patients were more likely to have attempted suicide than patients with major depression only. Recent life events did not predict attempter status. Lower social adjustment in the immediate family and lower overall social adjustment were predictive of suicide attempter classification, regardless of diagnosis. Borderline disordered patients low on overall social adjustment were over 16 times more likely to have attempted suicide than patients diagnosed with major depression only. Recent life events may elevate suicide risk in groups already at high risk for suicide completion, whereas high levels of social adjustment may be protective against stress-related suicidal behavior.     

Suicidal Ideation of Psychiatrically Hospitalized Adolescents has One-Year Predictive Validity for Suicide Attempts in Girls Only

Clinicians commonly incorporate adolescents’ self-reported suicidal ideation into formulations regarding adolescents’ risk for suicide. Data are limited, however, regarding the extent to which adolescent boys’ and girls’ reports of suicidal ideation have clinically significant predictive validity in terms of subsequent suicidal behavior. This study examined psychiatrically hospitalized adolescent boys’ and girls’ self-reported suicidal ideation as a predictor of suicide attempts during the first year following hospitalization. A total of 354 adolescents (97 boys; 257 girls; ages 13–17 years) hospitalized for acute suicide risk were evaluated at the time of hospitalization as well as 3, 6, and 12 months later. Study measures included the Suicidal Ideation Questionnaire-Junior, Multidimensional Anxiety Scale for Children, Children’s Depression Rating Scale-Revised, Beck Hopelessness Scale, Youth Self-Report, and Personal Experiences Screen Questionnaire. The main study outcome was presence and number of suicide attempt(s) in the year after hospitalization, measured by the Diagnostic Interview Schedule for Children. Results indicated a significant interaction between suicidal ideation, assessed during first week of hospitalization, and gender for the prediction of subsequent suicide attempts. Suicidal ideation was a significant predictor of subsequent suicide attempts for girls, but not boys. Baseline history of multiple suicide attempts was a significant predictor of subsequent suicide attempts across genders. Results support the importance of empirically validating suicide risk assessment strategies separately for adolescent boys and girls. Among adolescent boys who have been hospitalized due to acute suicide risk, low levels of self-reported suicidal ideation may not be indicative of low risk for suicidal behavior following hospitalization.     

Suicide compared to other causes of mortality in physicians

Physicians frequently are early adopters of healthy behaviors based on their knowledge and economic resources. The mortality patterns of physicians in the United States, particularly suicide, have not been rigorously described for over a decade. Previous studies have shown lower all-cause mortality among physicians yet reported conflicting results about cause-specific mortality such as suicide. In this study, we compared all-cause and cause-specific mortality in a sample of physicians to the age-gender matched general U.S. population from 1948 through 1998. We also compared the mortality experience across medical specialties. The risk of all-cause mortality was 56% lower than expected in men, and 26% lower in women, compared to the general population. Standardized mortality ratios (SMRs) were markedly lower for diseases strongly linked to smoking, e.g., cardiovascular diseases, respiratory diseases, and lung cancer. Suicide was the only cause of death where risk was greater than the general population. Overall, we found that physicians are at substantially lower risk of dying compared to the general population for all causes of death except suicide. The findings for suicide are strikingly different than other causes of death and should provide impetus for new research on the mental health of physicians.     

Anxiety,depression, and the suicidal spectrum: a latent class analysis of overlapping and distinctive features

ABSTRACT

Anxiety and depression diagnoses are associated with suicidal thoughts and behaviours. However, a categorical understanding of these associations limits insight into identifying dimensional mechanisms of suicide risk. This study investigated anxious and depressive features through a lens of suicide risk, independent of diagnosis. Latent class analysis of 97 depression, anxiety, and suicidality-related items among 616 psychiatric outpatients indicated a 3-class solution, specifically: (1) a higher suicide-risk class uniquely differentiated from both other classes by high reported levels of depression and anxious arousal; (2) a lower suicide-risk class that reported levels of anxiety sensitivity and generalised worry comparable to Class 1, but lower levels of depression and anxious arousal; and (3) a low to non-suicidal class that reported relatively low levels across all depression and anxiety measures. Discriminants of the higher suicide-risk class included borderline personality disorder; report of worthlessness, crying, and sadness; higher levels of anxious arousal and negative affect; and lower levels of positive affect. Depression and anxiety diagnoses were not discriminant between higher and lower suicide risk classes. This transdiagnostic and dimensional approach to understanding the suicidal spectrum contrasts with treating it as a depressive symptom, and illustrates the advantages of a tripartite model for conceptualising suicide risk.     

The Sexual Harassment–Suicide Connection in the U.S. Military: Contextual Effects of Hostile Work Environment and Trusted Unit Leaders

Sexual harassment has been associated with suicidal behaviors, and with the rise in suicides in the U.S. military, sexual harassment's role in suicide has been of growing interest. Lacking are studies that examine group‐ or unit‐level variables in the relationship of sexual harassment to suicidal behaviors (thoughts, plans, and attempts). In this study, survey data from soldiers (12,567 soldiers in 180 company‐sized units) who completed the Unit Risk Inventory administered during calendar year 2010 were analyzed using hierarchical linear modeling. At the individual level, sexual harassment was associated with a fivefold increase for risk of suicide. Reporting that leaders could be trusted was associated with a decreased suicide risk by about one‐third. There was no statistically significant interaction between sexual harassment and trusted leaders in predicting the suicidal behaviors. At the group level, units or companies having higher levels of sexual harassment also had soldiers three times more at risk for suicide. A cross‐leveling effect was also observed: Among units having higher levels of sexual harassment, the negative correlation (buffering effect of unit leaders on suicidal behaviors) was diminished. Implications of findings for preventing sexual harassment and suicide risk are discussed.     

Loneliness and Suicidal Risk in Young Adults: Does Believing in a Changeable Future Help Minimize Suicidal Risk Among the Lonely?

This study examined loneliness and future orientation as predictors of suicidal risk, namely, depressive symptoms and suicide ideation, in a sample of 228 college students (54 males and 174 females). Results of regression analyses indicated that loneliness was a significant predictor of both indices of suicidal risk. The inclusion of future orientation was found to significantly augment the prediction model of both depressive symptoms and suicide ideation, even after accounting for loneliness. Noteworthy, beyond loneliness and future orientation, the Loneliness × Future Orientation interaction term was found to further augment both prediction models of suicidal risk. Consistent with the notion that future orientation is an important buffer of suicidal risk, among lonely students, those with high future orientation, compared to low future orientation, were found to report significantly lower levels of depressive symptoms and suicide ideation. Some implications of the present findings for studying both risk and protective factors associated with suicidal risk in young adults are discussed.     

Biology of elderly suicide.

Most studies of suicide in younger patients have demonstrated significant alterations in the serotonin system. Although a high percentage of completed suicides occur in late-life, to date very few studies of the biology of suicide have focused on this age group. This chapter describes age-related changes in the central nervous system pertinent to the biology of suicide, then reviews post-mortem biological studies of the brains of suicides and suicide attempters. As suicide attempts in the elderly are characterized by the use of violent means, biologic studies of impulsive violence are discussed. Finally we describe data on the effect of degenerative diseases on the serotonin system and the possible link to increased suicidal behavior in affected patients. This review underscores the need for further study of the biology of suicide in the geriatric age group.     

Differentiating Adolescent Suicide Attempters from Ideators: Examining the Interaction between Depression Severity and Alcohol Use

Depressed mood, frequency of alcohol use, and their combination were examined to see if they differentiated nonsuicidal adolescents from those with suicidal ideation and adolescents with suicidal ideation from those who have made a suicide attempt. Hierarchical logistic regressions indicated that frequency of alcohol use did not differentiate nonsuicidal adolescents from those with current suicidal ideation, but severity of depressed mood did so. In contrast, alcohol use was a significant differentiating factor between adolescents who had attempted suicide compared to those with suicidal ideation only, with severity of depressed mood not being significant. However, there was also a significant interaction effect such that for adolescents with suicidal ideation and low levels of depression, increased frequency of alcohol use was associated with increased odds of a suicide attempt. These findings suggest that alcohol use may hasten the transition from suicidal ideation to suicide attempt in adolescents with low levels of depressed mood.