Impact of Applied Suicide Intervention Skills Training on the National Suicide Prevention Lifeline

We examined the impact of the implementation of Applied Suicide Intervention Skills Training (ASIST) across the National Suicide Prevention Lifeline's national network of crisis hotlines. Data were derived from 1,507 monitored calls from 1,410 suicidal individuals to 17 Lifeline centers in 2008–2009. Callers were significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful by the end of calls handled by ASIST‐trained counselors. Few significant changes in ASIST‐trained counselors' interventions emerged; however, improvements in callers' outcomes were linked to ASIST‐related counselor interventions, including exploring reasons for living and informal support contacts. ASIST training did not yield more comprehensive suicide risk assessments.     

The Relationship Between Posttraumatic Stress Symptoms and Suicide Ideation Among Child Survivors Following the Wenchuan Earthquake

The association between posttraumatic stress disorder (PTSD) symptoms and suicide ideation was examined in a sample of 2,298 child survivors of the Wenchuan earthquake. Results indicated that intrusion, avoidance, hyperarousal symptom clusters, and PTSD total score were significantly associated with suicide ideation. Except for intrusion, other measures of PTSD remained as statistically significant correlates of suicide ideation even after controlling for age, gender, direct exposure, indirect exposure, and depression. Furthermore, results showed that PTSD symptoms had an indirect influence on suicide ideation that was mediated by depression. The findings suggest that avoidance and hyperarousal symptom clusters of PTSD may be two important indicators of suicide ideation among child survivors of the Wenchuan earthquake. Implications of the results for intervention and prevention of suicide behavior are discussed.     

Association Between Suicidal Ideation and Exposure to Suicide in Social Relationships Among Family,Friend, and Acquaintance Survivors in South Korea

Exposure to suicide in social relationships may be associated with suicidal ideation among survivors. In South Korea, which is known for having the highest suicide rate among OECD countries, exposure to suicide in social relationships can have serious consequences as social relationships are greatly emphasized in the society. The purpose of this study was to examine the association between survivors' suicidal ideation and their exposure to suicide in close relationships. Data collected through a telephone survey of a total of 1,000 men and women selected from across the nation using a stratified sampling method were analyzed. The results show that individuals who lost a family member, friend, or acquaintance in their lifetime are 4.5 times, 3.7 times, 2.2 times, respectively, more likely to have suicidal ideation in the past year compared to those without such experience. These findings suggest that special intervention for suicide survivors should be considered for those who experience suicide in close relationships.     

Who Leaves Suicide Notes? A Six‐Year Population‐Based Study

Popular culture insists on the significance of suicide notes, but research has yielded conflicting results about who leaves notes. Utilizing 6 years of suicides from a comprehensive statewide data surveillance system, differences were examined between cases with suicide notes and those without in terms of demographics, circumstances of the suicide, and precipitating circumstances. Of the 2,936 suicides, 18.25% included a note. Demographics and circumstances did not differ for cases with a note compared to cases with no note. Results have implications for working with people bereaved by suicide in helping understand that the notes are uncommon and not systematic. However, it is also possible that for some individuals, the content of a note is meaningful and can help or hinder their course of bereavement.     

Mental Disorders,Comorbidity, and Pre‐enlistment Suicidal Behavior Among New Soldiers in the U.S. Army: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

We examined the associations between mental disorders and suicidal behavior (ideation, plans, and attempts) among new soldiers using data from the New Soldier Study (NSS) component of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS; N = 38,507). Most new soldiers with a pre‐enlistment history of suicide attempt reported a prior mental disorder (59.0%). Each disorder examined was associated with increased odds of suicidal behavior (ORs = 2.6–8.6). Only PTSD and disorders characterized by irritability and impulsive/aggressive behavior (i.e., bipolar disorder, conduct disorder, oppositional defiant disorder, and attention‐deficit/hyperactivity disorder) predicted unplanned attempts among ideators. Mental disorders are important predictors of pre‐enlistment suicidal behavior among new soldiers and should figure prominently in suicide screening and prevention efforts.     

Clarifying the Relationship of Parental Bonding to Suicide Ideation and Attempts

Suicide and suicidal behavior are major public health problems, especially among adolescents and young adults. Previous research has established links between parental bonding and suicidality; however, it remains unclear whether parental bonding is associated with suicide ideation, the progression from suicide ideation to suicide attempts, or both. This study examined the relation of parental bonding to suicide ideation and suicide attempts in adolescents from two settings: (1) acute psychiatric care (n = 172) and (2) high school (n = 426). All participants were administered validated measures of parental bonding, suicide ideation, and suicide attempts, as well as emotion dysregulation, loneliness, and self‐worth. In the psychiatric sample, lower parental care significantly differentiated adolescents with a history of suicide attempts from those with suicide ideation only or without histories of suicidality. This pattern remained even after controlling for other known correlates of suicidality (i.e., emotional dysregulation, loneliness, and low self‐worth). Similar effects were found in the community sample, although these findings failed to reach statistical significance. In both samples, parental overprotection was not associated with suicide ideation or suicide attempts. Results suggest that parental care may be an important risk factor for youth suicidal behavior and may help differentiate suicide attempters from suicide ideators.     

Adolescents' Attitudes About the Role of Mental Illness in Suicide,and Their Association with Suicide Risk

We examined teenagers' attitudes about the role of mental illness in suicidal behavior and the relationship between these attitudes and suicide risk. Serious suicidal ideation or behavior and associated risk factors (gender, depression, substance problems, and first‐hand experience with a suicidal peer) were assessed in 2,419 students at six New York high schools. Less than one fifth of students thought that mental illness was a major contributor to suicide. Suicidal adolescents and those at risk were less likely than their nonsuicidal and low‐risk counterparts to associate suicide with mental illness. Our findings contribute to the debate over whether accepting attitudes toward suicide increase suicide risk.     

Self‐Harm and Conventional Gender Roles in Women

A total of thirty‐two women admitted to a general hospital for medical treatment after self‐harming completed measures of conventional positive and negative masculinity and femininity. Comparisons were made with two control groups with no self‐harm history; 33 women receiving psychiatric outpatient treatment and a nonclinical sample of 206 women. Multinomial logistic regression analyses showed that those with lower scores on Instrumentality and Unmitigated Agency (positive and negative masculinity) and higher scores on Insecurity (negative femininity) had greater odds of self‐harming. Relationships were weaker after accounting for generalized self‐efficacy. Results are discussed in relation to previous findings and suggestions for prevention are made.     

Treatment‐Resistant Depression and Risk of Suicide

We evaluated whether treatment‐resistant depression (TRD) as measured by the Massachusetts General Hospital (MGH) staging method was associated with suicide in a large U.S. health system. Data from the Veterans Health Administration and the National Death Index were used to conduct a case–control study of patients newly diagnosed with depression who received antidepressant treatment between 2003 and 2006. Suicide cases (N = 499) were matched with nonsuicide controls (N = 1994). Conditional logistic regression was used to assess whether MGH stage at time of suicide (or matched date) was associated with case status, adjusting for patient demographic characteristics, comorbidity, and service use. Results indicated 11.6% of suicide cases had MGH stage 3 or greater (indicating at least two antidepressant trials) compared to 6.4% of controls (p < .001). In adjusted analyses, suicide was not significantly more likely among patients with stage 3 or greater (OR 1.52; 95% CI: 0.98, 2.37) or stages 1.5–2.5 (OR 1.19; 95% CI: 0.91, 1.55) compared to patients with stage 1 or less (<10 weeks of antidepressant medication). Staging TRD using MGH criteria is unlikely to substantially improve suicide risk assessment of depressed patients beyond existing measures contained in health system records.