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.     

The Impact of Exposure to Peer Suicidal Self‐Directed Violence on Youth Suicidal Behavior: A Critical Review of the Literature

There is considerable evidence that being exposed to the suicide or suicidal behavior of another can increase the risk for suicide. Significant relationships between media coverage and youth suicide have been documented in the professional literature. Exposure to familial suicidal behavior has also been established as a risk factor for youth suicidal behavior; However, peer suicide exposure is not as clear cut as research results in this area have been mixed. In the current paper the empirical literature focused on the associations between exposure to peer suicides and suicide attempts and youth suicidal behavior is critically reviewed. Effect sizes were computed for each of the 23 studies included in the review to allow for cross‐study comparisons. The results demonstrate that having a friend or acquaintance attempt suicide is significantly related to risk for suicidal thoughts and behavior. However, the support for the relationship between the suicide of a peer and youth suicidal behavior was less consistent. Implications for clinical practice and suicide postvention as well as areas of future research are discussed.     

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.     

The Great Black Hope: Hope and Its Relation to Suicide Risk among African Americans

Positive psychology has garnered considerable scholarly interest recently and has been suggested to hold promise in the application to suicide research and prevention; however, empirical research has lagged behind these suggestions. This is the first study to examine the relationship between hope and a specific theory of suicide in African Americans. It was hypothesized that (1) hope would negatively predict the interpersonal suicide risk factors of burdensomeness and thwarted belongingness; and positively predict acquired capability to enact suicide; (2) hope would negatively predict suicidal ideation; and (3) the interpersonal suicide risk factors would predict suicidal ideation. Results were primarily as predicted. Implications for hope theory and Joiner's theory of suicidal behavior are discussed, as well as implications for clinical practice.     

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.     

Suicidal ideation in college students varies across semesters: the mediating role of belongingness

The interpersonal-psychological theory of suicidal behavior (Joiner, 2005) proposes that the need to belong is fundamental; when met it can prevent suicide and when thwarted it can substantially increase the risk for suicide. We investigate one source of group-wide variation in belongingness among college students--changes in the social composition of college campuses across academic semesters--as an explanation for variation in suicidal ideation across the academic year. Our results indicate that in a sample of college students at a large southern state university (n = 309), suicidal ideation varied across academic semesters, with highest levels in summer compared to both spring and fall. Differences in suicidal ideation between summer and spring were, in large part, accounted for by belongingness. Theoretical, as well as practical, implications are discussed regarding mechanisms for seasonal variation in suicidal ideation.     

Hopelessness and Lack of Connectedness to Others as Risk Factors for Suicidal Behavior Across the Lifespan: Implications for Cognitive-Behavioral Treatment

The rates of suicide attempts and death by suicide vary considerably over the lifespan, highlighting the influence of different contextual, risk, and protective factors at different points in development (Daniel & Goldston, 2009). Hopelessness and lack of connectedness to others are two factors that have been associated with increased risk for suicidal thoughts and behaviors across the lifespan. The primary purposes of this paper are to describe how hopelessness and lack of connectedness to others may contribute to risk for suicidal behaviors, and to outline empirically supported cognitive-behavioral interventions for these difficulties at three developmental periods during which suicidal behavior is prevalent: (a) adolescence and young adulthood, (b) middle adulthood, and (c) older adulthood. This paper is not intended as an exhaustive review, but rather an overview of selected developmental issues related to hopelessness and lack of connectedness to others as risk factors for suicidal behavior. Special emphasis is given to clinical implications for cognitive-behavioral interventions, which are illustrated through case conceptualizations and examples at each developmental period.     

Single-Sign Rorschach Suicide Indicators: A Validity Study Using a Depressed Inpatient Population

This study attempted to test the validity of using single responses on the Rorschach as indicators of current suicidal risk. Forty-one depressed inpatients were administered the Rorschach along with a concurrent measure of depression and suicidality. Appelbaum and Holzman's (1962) color-shading sign was found to be related to low suicidal risk, whereas Blatt and Ritzler's (1974) transparency sign was found to be unrelated to current suicidal risk, but still related to a past history of suicide attempts. Patients who saw these signs while depressed were also likely to see them when recovered, suggesting that the signs may indicate a "suicidal personality" who may or may not be in any immediate danger of committing suicide.     

Explaining the Relation between Religiousness and Reduced Suicidal Behavior: Social Support Rather Than Specific Beliefs

Religiousness has been associated with decreased risk of suicidal ideation, suicide attempts, and completed suicide, but the mechanisms underlying these associations are not well characterized. The present study examined the roles of religious beliefs and social support in that relation. A survey measuring religiousness, social support, suicidal ideation, and suicide attempts was administered to 454 undergraduate students. Involvement in public, but not private, religious practices was associated with lower levels of both suicidal ideation and history of suicide attempts. Social support mediated these relations but religious beliefs did not. Results highlight the importance of social support provided by religious communities.     

Addressing Concealed Suicidality: A Flexible and Contextual Approach to Suicide Risk Assessment in Adults

Concealed suicidality can be a major impediment for clinicians conducting a suicide risk assessment. Client minimization and denial of suicidal thoughts can lead clinicians to undertreat and under-monitor clients experiencing a suicidal crisis. Five recommendations are given to address potential weak areas of suicide assessment with adults including routinized processes and a reliance on assessment instruments that may underestimate risk when individuals have no prior attempts or significant mental illness. Specifically, the authors highlight the importance of continued training and education in suicide assessment, how considering the context of the assessment can heighten one’s sensitivity to concealment of suicidal ideation and how different assessment instruments and interview techniques, when chosen with care, can increase the candor of client expression. The authors also recommend attending to clinician anxiety both as a way of maintaining rapport as well as a method of identifying clues that the assessment is not producing accurate information. Finally, application of recommendations is demonstrated through case vignettes.

     

Female self-injury and suicide attempts: Culturally reinforced techniques in human relations

There is a consistent and significant higher ratio of females who engage in self-injury or who attempt suicide as compared to males, or as compared to suicidal commits by both sexes. This paper focuses on the problem of female excess in self-injury and suicide attempts. Biological/psychological variables which have been linked to these female self-destructive behaviors are enumerated and an alternative sociocultural explanation is suggested. Sex-role expectations are shown to be essential in explaining female self-injury and suicide attempts. The notion that these female self-destructive behaviors offer self-preservation is criticized, as is the failure in the literature to investigate what female self-injury and suicidal attempts actually do accomplish. Direction for solutions is mentioned in terms of research findings on self-actualization and on androgynous persons.     

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.     

Considerations Regarding Online Methods for Suicide‐Related Research and Suicide Risk Assessment

Frequent advances in technology provide new and exciting opportunities for conducting suicide research and suicide risk assessments. However, to the authors' knowledge, best practices for using technology, specifically the Internet, to conduct research protocols involving suicide risk assessments have not been examined. In research contexts, the use of technology for research on suicidal behavior and suicide risk assessment can offer benefits relative to other forms of data collection. These advantages, which include increased validity, feasibility, and efficiency, as well as improvements in data collection and management, are presented. Considerations regarding the implementation of an online system for suicide risk assessment as well as limitations and future directions are discussed.     

An Examination of the Interpersonal Psychological Theory of Suicidal Behavior in Physicians

Physicians are commonly reported to die by suicide more frequently than individuals in the general population. Thus far, few reasons for this elevated suicide risk have been empirically investigated. Although the interpersonal psychological theory of suicidal behavior (IPTS) has been suggested as a fruitful means of explaining physician suicidality, it has yet to be examined quantitatively. Four hundred nineteen Pennsylvania physicians were assessed on a number of demographics, as well as all components of the IPTS. Findings indicated that physician scores on IPTS components are comparable to other groups displaying increased suicidality (e.g., military populations, prior attempters). Perceived burdensomeness was a significant predictor of suicidal ideation, while thwarted belongingness predicted prior suicide attempts. Acquired capability did not distinguish between prior attempters and nonattempters. Preliminary findings indicate the IPTS may be a useful framework for understanding and predicting physician suicidality.     

Distress Tolerance and Anxiety Sensitivity Cognitive Concerns: Testing the Incremental Contributions of Affect Dysregulation Constructs on Suicidal Ideation and Suicide Attempt

Empirical work has suggested relationships among suicide-related outcomes and several constructs related to affect dysregulation, notably anxiety sensitivity (AS) and distress tolerance (DT). However, important questions remain, including the relative contributions of these affect regulation variables as well as the direct contribution of DT on suicidal ideation and prior attempts. The current study sought to better elucidate the nature of these relationships by examining AS, DT, and suicidal ideation and attempt in a clinical sample (N = 192). Consistent with prior work and prediction, findings revealed a significant relationship between the AS cognitive concerns subfactor and suicidal ideation and suicide attempt history after accounting for the effects of DT, gender, and depressive symptoms. In addition, depressive symptoms significantly moderated the relationship between the AS cognitive concerns subfactor and suicidal ideation. After accounting for the influence of AS, analyses revealed that DT approached significance in predicting suicidal ideation, but did not significantly predict suicide attempt history. These results suggest that elevated AS cognitive concerns are particularly relevant to suicide in the context of depressive symptoms. Clinicians may benefit from implementing AS reduction strategies with individuals who endorse elevated suicide risk as well as elevated AS cognitive concerns.     

Association of solitary binge drinking and suicidal behavior among emerging adult college students

[Correction Notice: An Erratum for this article was reported in Vol 26(3) of Psychology of Addictive Behaviors (see record 2012-13892-001). In the article, there is an error in the introductory paragraph. The number of students who had seriously considered attempting suicide in the Barrios, Everett, Simon, & Brener (2000) study should have been reported as 11.4%, not 1.4%. Additionally, in the Participants section, data for the study were collected from March 2009 to September 2010, not March 2009 to January 2010 as reported.] Emerging adult college students who binge drink in solitary contexts (i.e., while alone) experience greater depression and suicidal ideation than do students who only binge drink in social contexts, suggesting that they may be at greater risk for suicidal behavior. This study examined the association of a previous suicide attempt, one of the best predictors of future suicide attempts and suicide, and severity of recent suicidal ideation with drinking in solitary and social contexts. Participants were binge drinking, emerging adult (18- to 25-year-old) college students (N = 182) drawn from two studies of college drinkers. A logistic regression analysis revealed that both suicide attempt history and severity of suicidal ideation were significantly associated with a greater likelihood of being a solitary binge drinker as opposed to only a social binge drinker. Students with a previous suicide attempt were nearly four times more likely to be solitary binge drinkers. Multiple regression analyses revealed that suicide attempt history was significantly associated with greater frequency and quantity of drinking in solitary, but not social contexts. Suicidal ideation was significantly associated with drinks per solitary drinking day, but not frequency of solitary drinking once suicide attempt history was accounted for. Given the associations found between solitary binge drinking and a history of suicide attempts, as well as greater severity of recent suicidal ideation, it appears that these students are in need of suicide prevention efforts, including treatment efforts aimed at reducing binge drinking. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Single-sign Rorschach suicide indicators: a validity study using a depressed inpatient population

This study attempted to test the validity of using single responses on the Rorschach as indicators of current suicidal risk. Forty-one depressed inpatients were administered the Rorschach along with a concurrent measure of depression and suicidality. Appelbaum and Holzman's (1962) color-shading sign was found to be related to low suicidal risk, whereas Blatt and Ritzler's (1974) transparency sign was found to be unrelated to current suicidal risk, but still related to a past history of suicide attempts. Patients who saw these signs while depressed were also likely to see them when recovered, suggesting that the signs may indicate a "suicidal personality" who may or may not be in any immediate danger of committing suicide.     

Suicide Crisis Syndrome: A review of supporting evidence for a new suicide‐specific diagnosis

Suicide is a major public health problem, and suicide rates are still on the rise. Current strategies for identifying individuals at risk for suicide, such as the use of a patient's self‐reported suicidal ideation or evidence of past suicide attempts, have not been sufficient in reducing suicide rates. Recently, research groups have been focused on determining the acute mental state preceding a suicide attempt. The development of an acute suicidal diagnosis, the Suicide Crisis Syndrome (SCS), is aimed at capturing this state to better treat individuals. The SCS has five main evidence‐based components—entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal. The SCS may provide clinicians with the ability to identify individuals who are experiencing an acute pre‐suicidal mental state, regardless of their self‐reported suicidal ideation. Future research leading to the incorporation of this diagnosis into clinical practice could improve the quality of care and reduce the personal, societal, and legal burden of suicide.     

Correction to gonzalez (2012)

Reports an error in "Association of solitary binge drinking and suicidal behavior among emerging adult college students" by Vivian M. Gonzalez (Psychology of Addictive Behaviors, Advanced Online Publication, Jan 30, 2012, np). In the article, there is an error in the introductory paragraph. The number of students who had seriously considered attempting suicide in the Barrios, Everett, Simon, & Brener (2000) study should have been reported as 11.4%, not 1.4%. Additionally, in the Participants section, data for the study were collected from March 2009 to September 2010, not March 2009 to January 2010 as reported. (The following abstract of the original article appeared in record 2012-02608-001.) Emerging adult college students who binge drink in solitary contexts (i.e., while alone) experience greater depression and suicidal ideation than do students who only binge drink in social contexts, suggesting that they may be at greater risk for suicidal behavior. This study examined the association of a previous suicide attempt, one of the best predictors of future suicide attempts and suicide, and severity of recent suicidal ideation with drinking in solitary and social contexts. Participants were binge drinking, emerging adult (18- to 25-year-old) college students (N = 182) drawn from two studies of college drinkers. A logistic regression analysis revealed that both suicide attempt history and severity of suicidal ideation were significantly associated with a greater likelihood of being a solitary binge drinker as opposed to only a social binge drinker. Students with a previous suicide attempt were nearly four times more likely to be solitary binge drinkers. Multiple regression analyses revealed that suicide attempt history was significantly associated with greater frequency and quantity of drinking in solitary, but not social contexts. Suicidal ideation was significantly associated with drinks per solitary drinking day, but not frequency of solitary drinking once suicide attempt history was accounted for. Given the associations found between solitary binge drinking and a history of suicide attempts, as well as greater severity of recent suicidal ideation, it appears that these students are in need of suicide prevention efforts, including treatment efforts aimed at reducing binge drinking. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

The Gender Paradox in Suicide

In most Western countries females have higher rates of suicidal ideation and behavior than males, yet mortality from suicide is typically lower for females than for males. This article explores the gender paradox of suicidal behavior, examines its validity, and critically examines some of the explanations, concluding that the gender paradox of suicidal behavior is a real phenomenon and not a mere artifact of data collection. At the same time, the gender paradox in suicide is a more culture-bound phenomenon than has been traditionally assumed; cultural expectations about gender and suicidal behavior strongly determine its existence. Evidence from the United States and Canada suggests that the gender gap may be more prominent in communities where different suicidal behaviors are expected of females and males. These divergent expectations may affect the scenarios chosen by females and males, once suicide becomes a possibility, as well as the interpretations of those who are charged with determining whether a particular behavior is suicidal (e.g., coroners). The realization that cultural influences play an important role in the gender paradox of suicidal behaviors holds important implications for research and for public policy.