Using the Suicide Index Score to Predict Treatment Outcomes among Psychiatric Inpatients

For many suicidal people, the desire to die is moderated by a competing desire to live. This study aimed to demonstrate the ability of a wish‐to‐live versus wish‐to‐die index score to measure ambivalence and trichotomize suicidal inpatients into distinct stratified risk groups. Analyses revealed that index scores calculated for patients at treatment start significantly discriminated among the groups at index and uniquely predicted suicidal ideation, hopelessness, and depression scores across treatment. On average, patients with wish‐to‐live and wish‐to‐die orientations resolved suicidal ideation by discharge. Changes in suicidal ideation among ambivalently oriented patients were more variable. Clinical and research implications are discussed.     

Examining the Three-Step Theory (3ST) of Suicide in a Prospective Study of Adult Psychiatric Inpatients

This study examined the validity and predictive utility of the three-step theory (3ST) of suicide in psychiatric patients. Participants were 190 consecutively admitted adult psychiatric inpatients (53% female, 60% White, ages 18–73) assessed at three time points: baseline, 4 weeks later (n = 112), and 3 months postdischarge (n = 102). Results were broadly supportive of the 3ST. First, at baseline, an interactive model of pain and hopelessness accounted for substantial variability in suicidal desire, even when controlling for depression and lifetime ideation. This result replicated in different genders and age ranges (i.e., 18–32 and 33–73). Further, pain and hopelessness were robust predictors of suicidal desire weeks and months into the future. Second, among those with pain and hopelessness, lower connectedness, as well as the extent to which pain exceeds connectedness, were robust predictors of higher suicidal desire. Last, a baseline measure of practical capability for suicide predicted suicide attempts both retrospectively and prospectively, even when controlling for lifetime ideation—however, dispositional and acquired contributors to capability were less predictive. Results support the validity and predictive utility of the 3ST, and suggest that the theory may have utility for guiding risk assessment and intervention.     

Exposure to Violence in Young Inner-City Adolescents: Relationships With Suicidal Ideation, Depression, and PTSD Symptomatology

This study examined the relationship of exposure to violence to suicidal ideation, depression, and post-traumatic stress disorder (PTSD) symptomatology in 94 young adolescents from an inner-city school. Participants completed self-report measures of the Reynolds Adolescent Depression Scale, the Suicidal Ideation Questionnaire—Junior, Adolescent Psychopathology Scale—Posttraumatic Stress Disorder Subscale, and the Exposure to Violence Questionnaire. Using a hierarchical multiple regression design, exposure to violence demonstrated a unique relationship with PTSD symptomatology. Specifically, the relationship between violence exposure and PTSD symptomatology remained significant after controlling for depression and suicidal ideation severity. Controlling for PTSD symptomatology resulted in nonsignificant relationships between violence exposure and depression and suicidal ideation in adolescents. Additional analyses suggest that PTSD functions as a mediating variable between exposure to violence and depression and suicidal ideation. The implication of these results and suggestions for future research 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.     

An Ecological Momentary Intervention Study of Emotional Responses to Smartphone-Prompted CBT Skills Practice and the Relationship to Clinical Outcomes

The practice of therapeutic skills outside of sessions in which they are learned is one presumed key component of cognitive behavioral therapy (CBT). Yet, our understanding of how skills practice relates to clinical outcomes remains limited. Here, we explored patients’ emotional responses to CBT skills practice in a pilot study pairing smartphone-app-delivered skills reminders and guided practice (ecological momentary intervention [EMI]) using ecological momentary assessment (EMA). Participants (n = 25) were adults recently hospitalized for a suicide attempt or severe suicidal thinking. They received brief inpatient CBT (1 to 3 sessions covering core CBT skills from the Unified Protocol), followed by 1 month of EMI and EMA after discharge. On average, participants reported modest reductions in negative affect after skills use (i.e., immediate responses; median time elapsed = 4.30 minutes). Additionally, participants tended to report less negative affect when the timepoint preceding the current assessment included EMI skills practice, rather than EMA alone (i.e., delayed responses; median time elapsed between prompts = 2.17 hours). Immediate effects were unrelated to longer-term clinical outcomes, whereas greater delayed effects were associated with lower symptom severity at follow-up. Future studies should further examine how CBT skills use in daily life may alleviate symptoms.     

Prospective Associations of Coping Styles With Depression and Suicide Risk Among Psychiatric Emergency Patients

Suicide is the second leading cause of death for those ages 13–25 in the United States. Coping is a mediator between stressful life events and adverse outcomes, and coping skills have been incorporated into interventions (e.g., cognitive-behavioral therapy, dialectical behavior therapy, safety-planning interventions) for suicidal populations. However, longitudinal research has not directly examined the prospective associations between multiple coping styles and suicide-related outcomes in high-risk samples. This study identified cross-sectional and 4-month longitudinal associations of coping styles with suicide risk factors (i.e., depression, suicidal ideation, suicidal behavior) in a sample of 286 adolescent and young adult psychiatric emergency patients. Positive reframing was the coping style most consistently associated with positive outcomes, whereas self-blame and disengagement were consistently associated with negative outcomes. Active coping protected against suicidal behavior for males, but not for females. This was the first study to examine longitudinal relationships between coping and suicide-related outcomes in a high-risk clinical sample. Findings suggest that clinical interventions with suicidal adolescents and young adults may benefit from a specific focus on increasing positive reframing and reducing self-blame.     

Prospective and Concurrent Affective Dynamics in Self-Injurious Thoughts and Behaviors: An Examination in Young Adult Women

Affective dynamics, assessed using ecological momentary assessment (EMA), provide a nuanced understanding of within-person fluctuations of negative affect (NA) and positive affect (PA) in daily life. NA and PA dynamics have been associated with psychopathology and response to psychological treatments. NA and PA dynamics have been rarely studied concurrently in association with self-injurious thoughts and behaviors (SITB), transdiagnostic difficulties encountered regularly in clinical and community settings. Here we present EMA data from a large, diverse sample of young adult women with high rates of SITB to examine NA and PA dynamics (mean intensity, variability, and inertia). Specifically, we considered the prospective associations between past-year suicidal thoughts and past-year nonsuicidal self-injury and affective dynamics, as well as the concurrent associations between affective dynamics, EMA-reported suicidal thoughts, and EMA-reported urges for nonsuicidal self-injury. Results demonstrate that elevated mean NA and NA variability are robustly associated with all types of SITB assessed prospectively or concurrently. Interestingly, these associations were weakest for past-year nonsuicidal self-injurious behaviors, relative to past-year and concurrent suicidal or nonsuicidal self-injurious thoughts. Past-year suicidal thoughts further predicted increased NA inertia. Decreased PA inertia was associated with past-year nonsuicidal self-injury behavior, as well as concurrent EMA suicidal thoughts. We found no associations (prospective or concurrent) between SITB and mean PA intensity or PA variability. These results highlight the importance of understanding affective processes to develop real-world interventions to prevent nonsuicidal self-injury and suicidal behavior in daily life.     

Effects of a Self-Help Program on Depressed Mood for Women with an Unfulfilled Child Wish

This randomized controlled trial aimed to examine the effectiveness of a cognitive behavioral self-help program (CBS) with minimal coaching in improving depressed mood for women with a permanent unfulfilled child wish. Participants completed pretest, posttest, and follow-up questionnaires and were randomly allocated to CBS (n = 27) or a waiting list condition (WLC, n =27). Respondents who followed the CBS improved significantly on depression scores compared to the WLC. This positive effect remained at follow-up. This study suggests that a low-resource, low-cost self-help program could be an effective intervention in reducing depressed mood in women living with the loss of a desired child.     

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.     

Naturalistic evaluation of suicidal ideation: variability and relation to attempt status

Suicidal ideation has been thought to have a relatively stable course across weeks and months. However, daily changes in levels of ideation have not been adequately examined despite the importance of potential variability clinically and conceptually. For example, it has been suggested that variability in suicidal ideation may become less closely tied to variability in other mood symptoms (e.g., depression, hopelessness) among individuals with multiple suicide attempts. The present report had two related goals: (1) to prospectively evaluate suicidal ideation and related mood symptoms, and (2) to determine whether suicide attempt status predicted a decreased association between ideation and other mood symptoms. Non-clinical participants (N=108) with varying levels of suicidal ideation and number of previous suicide attempts completed the beck hopelessness scale (BHS), beck depression inventory (BDI), and suicide probability scale (SPS) every day for 4 weeks. Findings suggested considerable variability in suicidal ideation, especially for multiple attempters. Multiple attempt status predicted a decreased association between suicidal ideation and depression, although the results were only marginally significant. These findings have implications for conceptual models of suicide risk as well as assessment and treatment of suicidal individuals.     

The Relationship Between Attitudinal Ambivalence and Desire to Quit Smoking Among College Smokers1

Growing evidence shows that attitudes can exist on a bivariate rather than a bipolar plane. This conceptualization provides a more dynamic approach to studying how attitudinal ambivalence (i. e., evaluating an attitude object as both positive and negative) affects smoking‐related behaviors. Based on a sample of 157 college smokers, we obtained preliminary validational support for a smoking‐specific felt attitudinal ambivalence scale. Felt attitudinal ambivalence correlated positively with potential for ambivalence, negative attitudes, and negative as well as positive outcome expectancies related to smoking. Smokers who felt more ambivalent reported a greater desire to quit and were more likely to be contemplators, as defined by the transtheoretical model of behavioral change. In multivariate analyses, felt ambivalence toward smoking predicted desire to quit after controlling for positive and negative attitudes and negative smoking consequences. These results provide promising support for the smoking‐specific felt‐ambivalence scale, and suggest that attitudinal ambivalence should be investigated further as a motivational mechanism to affect smoking cessation.     

高中生自杀意念的素质-应激模型：多时段追踪研究

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

The acuity of vice: Attitude ambivalence improves visual sensitivity to increasing portion sizes

A rapid increase in the size of food portions has underlined the importance of understanding consumers' ability to accurately perceive portion sizes. Drawing on research on motivated perception, we posit that attitude ambivalence (simultaneously desiring a food and perceiving it as unhealthy) enhances visual sensitivity to increasing portion sizes. We manipulate or measure attitude ambivalence in three experimental studies conducted among children and adults and find that visual sensitivity is driven not simply by desire but by the coexistence of desire and perceived unhealthiness of the food (e.g., for hedonic food and among restrained eaters). Our findings suggest that framing foods as vices improves the estimation of portion sizes among health-conscious people.     

Ability Emotional Intelligence Predicts Quality of Life beyond Personality,Affectivity, and Cognitive Intelligence

The current study explored the incremental validity of the ability emotional intelligence test to predict suicidal ideation (a subjective indicator of Quality of Life) beyond the ‘Big Five’ personality dimensions, affectivity, and general cognitive ability in a sample of 184 university students (mean age 29.50 years). Hierarchical regression analyses revealed that after controlling for demographic variables, the Big Five personality traits, affectivity, and the cognitive intelligence, the block of ability emotional intelligence scores explained a statistically significant increment of variance in suicidal ideation. It is noteworthy that the predictive power of the ability emotional intelligence appeared to be mostly due to the contribution of its two branch scores–regulation of emotion and understanding of emotion. Findings are discussed with reference to emotional intelligence theory and suicidal behaviors.     

Suicidal Ideation and Eating Disorder Symptoms in Adolescents: The Role of Interoceptive Deficits

Eating disorder symptoms and suicidal ideation are relatively common, and often begin to emerge in adolescence. Interoceptive deficits, or the inability to perceive and accurately identify the physiological condition of the body, is an established risk factor for both eating disorders and suicidal thoughts and behaviors. Despite this, longitudinal research examining the temporal dynamics between these variables is scarce, especially within adolescent samples. Using a three-wave longitudinal design, the present study tested bidirectional relationships between interoceptive deficits, eating disorder symptoms, and suicidal ideation to examine whether interoceptive deficits predicted eating disorder symptoms and suicidal ideation over the course of a year among a sample of adolescents. Participants were 436 community adolescents recruited from local middle- and high-schools. Data were collected at baseline, 6-month follow-up, and 12-month follow-up. Study measures assessed current suicidal ideation, eating disorder symptom severity, and interoceptive deficits. Autoregressive cross-lagged modeling was conducted in MPlus. We found baseline eating disorder symptoms significantly predicted suicidal ideation at 6-month follow-up when controlling for baseline suicidal ideation. Baseline interoceptive deficits significantly predicted eating disorder symptoms 6-months later, while 6-month follow-up interoceptive deficits significantly predicted 12-month follow-up suicidal ideation. Our findings highlight the need for early and regular assessment of suicidal ideation and eating disorder symptoms in adolescents. Given that interoceptive deficits was a shared risk factor for both conditions within this sample, these results underscore the need for targeted interventions aimed at improving interoception.     

An investigation of concurrent validity between two optimism/pessimism questionnaires: The life orientation test-revised and the optimism/pessimism scale

The purpose of this investigation was to investigate the concurrent validity of the Life Orientation Test-Revised (LOT-R) (Scheier et al., 1994) and Optimism/Pessimism Scale (OPS) (Dember et al., 1989) by administering each questionnaire to the same group of participants. The 154 participants (84 men and 70 women) were volunteer university students enrolled in physical activity classes at a southeastern university. The questionnaires were counterbalanced to reduce possible bias due to taking one questionnaire before taking the other. Due to recent suggestions concerning scoring mechanisms for the LOT-R (Dember et al., 1989; Hummer, Dember, Melton & Schefft, 1992; Lightsey, 1996; Marshall and Lang, 1990) the instrument was scored to produce a unidimensional score and two subscale scores. The analysis suggested that the LOTR and OPS may not be measuring similar constructs. The results revealed that the LOT-R may be measuring “trait” optimism and pessimism, while the OPS may be measuring “state” optimism and pessimism. It was also suggested that future research investigate racial differences on these constructs.     

An investigation of concurrent validity between two optimism/pessimism questionnaires: The life orientation test-revised and the optimism/pessimism scale

The purpose of this investigation was to investigate the concurrent validity of the Life Orientation Test-Revised (LOT-R) (Scheier et al., 1994) and Optimism/Pessimism Scale (OPS) (Dember et al., 1989) by administering each questionnaire to the same group of participants. The 154 participants (84 men and 70 women) were volunteer university students enrolled in physical activity classes at a southeastern university. The questionnaires were counterbalanced to reduce possible bias due to taking one questionnaire before taking the other. Due to recent suggestions concerning scoring mechanisms for the LOT-R (Dember et al., 1989; Hummer, Dember, Melton & Schefft, 1992; Lightsey, 1996; Marshall and Lang, 1990) the instrument was scored to produce a unidimensional score and two subscale scores. The analysis suggested that the LOTR and OPS may not be measuring similar constructs. The results revealed that the LOT-R may be measuring “trait” optimism and pessimism, while the OPS may be measuring “state” optimism and pessimism. It was also suggested that future research investigate racial differences on these constructs.     

Family support,family stress,and suicidal ideation in a combat-exposed sample of Operation Enduring Freedom/Operation Iraqi Freedom veterans

Background and Objectives: Deployment-related risk factors for suicidal ideation among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans have received a great deal of attention. Studies show that mental health symptoms mediate the association between most deployment stressors and suicidal ideation; however, family-related factors during deployment are largely unexplored. We examined posttraumatic stress disorder (PTSD) and depression symptoms as mediators of the associations between deployment family support and stress and post-deployment suicidal ideation in combat-exposed OEF/OIF veterans. Design: National cross-sectional mail survey. Methods: 1046 veterans responded to the survey. The sample for this study was 978 veterans who experienced combat. Regression-based path analyses were conducted. Results: Family support and stress had direct associations with suicidal ideation. When PTSD and depression symptoms were examined as mediators of these associations, results revealed significant indirect paths through these symptoms. Conclusions: This study contributes to the literature on suicidal ideation risk factors among OEF/OIF veterans. Deployment family support and family stress are associated with suicidal ideation; however these associations occur primarily through mental health symptomatology, consistent with findings observed for other deployment factors. This research supports ongoing efforts to treat mental health symptomatology as a means of suicide prevention.     

Cognitive vulnerability to depression, rumination, hopelessness, and suicidal ideation: multiple pathways to self-injurious thinking

In order to advance the detection and prevention of suicide, recent research has focused on predictors of suicidal ideation and behavior such as negative cognitive styles, dysfunctional attitudes, hopelessness, and rumination. In this study the relationships among these risk factors in the context of the Attention Mediated Hopelessness (AMH) theory of depression are examined. One hundred and twenty-seven undergraduates in the Cognitive Vulnerability to Depression (CVD) project were followed for 2.5 years. The CVD project followed initially nondepressed freshmen, at either high or low cognitive risk for depression, in order to predict onsets and recurrences of depressive disorders. The presence and duration of suicidal ideation were predicted prospectively by rumination and hopelessness, and hopelessness partially mediated the relationship between rumination and ideation and fully mediated the association between rumination and duration of suicidality. Further, rumination mediated the relationship between cognitive vulnerability and suicidal ideation.     

Affective instability: measuring a core feature of borderline personality disorder with ecological momentary assessment

Ecological momentary assessment (EMA; Stone & Shiffman, 1994) was used to characterize and quantify a dynamic process--affective instability in borderline personality disorder (BPD). Sixty outpatients (34 with BPD and affective instability; 26 with current depressive disorder but not with BPD or affective instability) carried electronic diaries for approximately 1 month and were randomly prompted to rate their mood state up to 6 times a day. Results indicated that BPD patients (a) did not report significantly different mean levels of positive or negative affect; (b) displayed significantly more variability over time in their positive and negative affect scores; (c) demonstrated significantly more instability on successive scores (i.e., large changes) for hostility, fear, and sadness than did patients with depressive disorders; and (d) were more likely to report extreme changes across successive occasions (>or=90th percentile of change scores across participants) for hostility scores. Results illustrate different analytic approaches to quantifying variability and instability of affect based on intensive longitudinal data. Further, results suggest the promise of electronic diaries for collecting data from individuals in their natural environment for purposes of clinical research and assessment.