A Prospective Examination of the Interpersonal‐Psychological Theory of Suicidal Behavior Among Psychiatric Adolescent Inpatients

The challenge of identifying suicide risk in adolescents, and particularly among high‐risk subgroups such as adolescent inpatients, calls for further study of models of suicidal behavior that could meaningfully aid in the prediction of risk. This study examined how well the Interpersonal‐Psychological Theory of Suicidal Behavior (IPTS)—with its constructs of thwarted belongingness (TB), perceived burdensomeness (PB), and an acquired capability (AC) for lethal self‐injury—predicts suicide attempts among adolescents (N = 376) 3 and 12 months after hospitalization. The three‐way interaction between PB, TB, and AC, defined as a history of multiple suicide attempts, was not significant. However, there were significant 2‐way interaction effects, which varied by sex: girls with low AC and increasing TB, and boys with high AC and increasing PB, were more likely to attempt suicide at 3 months. Only high AC predicted 12‐month attempts. Results suggest gender‐specific associations between theory components and attempts. The time‐limited effects of these associations point to TB and PB being dynamic and modifiable in high‐risk populations, whereas the effects of AC are more lasting. The study also fills an important gap in existing research by examining IPTS prospectively.     

A Suicide Prevention Campaign for Firearm Dealers in New Hampshire

A spate of suicides involving a just‐purchased firearm led a statewide coalition of firearm dealers, firearm rights advocates, and suicide prevention professionals to discuss the role of gun shops in preventing suicide. The group developed and mailed materials for (1) firearm retailers on avoiding sales to suicidal customers and (2) their customers on suicide and firearm safety. All storefront retailers were identified (n = 65), visited unannounced 6 months after receiving materials, and asked to complete a survey. Nearly half (48%) had at least one campaign product on display. Belief that reducing a suicidal person's access to firearms might save a life was associated with displaying materials (69% vs. 41%, p = .06). Public health and gun groups can successfully collaborate on suicide prevention activities.     

The Role of Hope and Optimism in Suicide Risk for American Indians/Alaska Natives

There are some American Indian/Alaska Native communities that exhibit high rates of suicide. The interpersonal theory of suicide (Joiner, 2005) posits that lethal suicidal behavior is likely preceded by the simultaneous presence of thwarted belongingness, perceived burdensomeness, and acquired capability. Past research has shown that hope and optimism are negatively related to suicidal ideation, some of the constructs in the interpersonal theory of suicide, and suicide risk for the general population. This is the first study to investigate hope and optimism in relation to suicidal ideation, thwarted belongingness, perceived burdensomeness, and acquired capability for American Indians/Alaska Natives. Results showed that hope and optimism negatively predicted thwarted belongingness, perceived burdensomeness, and suicidal ideation. However, these results were not found for acquired capability. Overall, this study suggests that higher levels of hope and optimism are associated with lower levels of suicidal ideation, thwarted belongingness, and perceived burdensomeness in this American Indian/Alaska Native sample.     

Predicting Suicide Attempts among Treatment‐Seeking Male Alcoholics: An Exploratory Study

Documented risk factors for suicide among alcohol‐dependent patients are sensitive but insufficiently specific to effectively identify individuals who are prone to future suicide attempt. As a first step to assess factors not previously considered, this pilot study involved a group of male alcohol‐dependent patients (N = 175) coming to detoxification to examine the potential utility of adverse childhood experiences (ACE) along with other documented events to discriminate individuals with a history of attempted suicide from their detoxifying peers. Family health history questionnaires were used to evaluate their ACEs. Receiver operating characteristic (ROC) analysis was applied to examine the predictive power of ACEs, alone or in combination with documented risk factors, to lifetime history of attempted suicide. Among our participants, 48 (27.4%) had a history of a suicide attempt and 156 (89.1%) reported at least one out of the nine categories of ACEs. Modeling by ROC analysis, we found that a cutoff of four or more ACEs plus a history of personal violence achieved the best predictive power to a history of any suicide attempt, producing a sensitivity of 0.7, specificity of 0.81, and area under curve of 0.75. A prospective study to replicate and extend our findings is necessary.     

A Systematic Review of Suicide Prevention Programs for Military or Veterans

Military personnel and veterans have important suicide risk factors. After a systematic review of the literature on suicide prevention, seven (five in the U.S.) studies of military personnel were identified containing interventions that may reduce the risk of suicide. The effectiveness of the individual components was not assessed, and problems in methodology or reporting of data were common. Overall, multifaceted interventions for active duty military personnel are supported by consistent evidence, although of very mixed quality, and in some cases during intervals of declines in suicide rates in the general population. There were insufficient studies of U.S. Veterans to reach conclusions.     

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.     

Risk Factors,Warning Signs,and Drivers of Suicide: What Are They,How Do They Differ,and Why Does It Matter?

Research investigating suicide attempts and deaths by suicide has yielded many specific risk factors and warning signs for future suicidal behaviors. Yet, even though these variables are each valuable for suicide prevention efforts, they may be limited in their applicability to clinical practice. The differences among risk factors, warning signs, and “drivers,” which are person‐specific variables that lead individuals to desire death by suicide, are highlighted. The scarce evidence on drivers is described and specific recommendations for conducting future drivers‐focused research and targeting them in clinical practice are suggested.     

The Media and Suicide: Evidence‐Based on Population Data over 9 Years in Taiwan

The relationship between the regional distribution densities of different media and the suicide death rate was explored by analyzing the annual total, male, and female suicide rates and media densities from 23 cities/counties in Taiwan during 1998–2006 by univariate and multivariate regression adjusted for five socioeconomic factors. The regional density of newspapers was significantly inversely related to the total, male, and female suicide rates, while that of television sets was not. The density of in‐home personal computers was significantly positively related to the total and male suicide rates, but not the female suicide rate. The results indicate that media reporting on suicide can be beneficial, instead of harmful, depending on the content.     

Positive‐Themed Suicide Prevention Messages Delivered by Adolescent Peer Leaders: Proximal Impact on Classmates' Coping Attitudes and Perceptions of Adult Support

Developing science‐based communication guidance and positive‐themed messages for suicide prevention are important priorities. Drawing on social learning and elaboration likelihood models, we designed and tested two positive‐focused presentations by high school peer leaders delivered in the context of a suicide prevention program (Sources of Strength). Thirty‐six classrooms in four schools (N = 706 students) were randomized to (1) peer leader modeling of healthy coping, (2) peer leader modeling plus audience involvement to identify trusted adults, or (3) control condition. Students' attitudes and norms were assessed by immediate post‐only assessments. Exposure to either presentation enhanced positive coping attitudes and perceptions of adult support. Students who reported suicide ideation in the past 12 months benefited more than nonsuicidal students. Beyond modeling alone, audience involvement modestly enhanced expectations of adult support, congruent with the elaboration likelihood model. Positive peer modeling is a promising alternative to communications focused on negative consequences and directives and may enhance social–interpersonal factors linked to reduced suicidal behaviors.