Emotion Dysregulation and Affective Intensity Mediate the Relationship Between Childhood Abuse and Suicide‐Related Behaviors Among Women with Bulimia Nervosa

Self‐harm and suicide attempts occur at elevated rates among individuals with bulimia nervosa, particularly among those who have experienced childhood abuse. This study investigated the potential mediating roles of emotion dysregulation and affective intensity in the relationship between these variables in 125 women with bulimia nervosa. Analyses revealed that emotion dysregulation mediated the relationship between sexual and emotional abuse with both self‐harm and suicide attempts. Negative affective intensity mediated the relationship between abuse and suicide attempts. The findings may advance the understanding of mechanisms underlying suicide‐related behaviors in women with bulimia nervosa who experienced abuse and suggest potential clinical targets.     

Assessing the Adherence to Guidelines of Media Reporting of Suicide Using a Novel Instrument—the “Risk of Imitative Suicide Scale” (RISc)

Media guidelines for reporting of suicide are considered important in suicide prevention because of the risk of “imitative” suicide. There are currently no established tools for the quantification of quality of reporting. We sought to develop and validate a quality assessment instrument—the Risk of Imitative Suicide Scale (RISc). The RISc appears capable of discriminating reliably between adherent and nonadherent articles. Our data suggest that adherence to guidelines is inconsistent, and there are major differences between web‐based and print media. The RISc could be used to evaluate effectiveness and consistency of media engagement with suicide prevention strategies.     

Causal and noncausal conditionals: An integrated model of interpretation and reasoning

We present an integrated model for the understanding of and the reasoning from conditional statements. Central assumptions from several approaches are integrated into a causal path model. According to the model, the cognitive availability of exceptions to a conditional reduces the subjective conditional probability of the consequent, given the antecedent. This conditional probability determines people's degree of belief in the conditional, which in turn affects their willingness to accept logically valid inferences. In addition to this indirect pathway, the model contains a direct pathway: Availability of exceptional situations directly reduces the endorsement of valid inferences. We tested the integrated model with three experiments using conditional statements embedded in pseudonaturalistic cover stories. An explicitly mentioned causal link between antecedent and consequent was either present (causal conditionals) or absent (arbitrary conditionals). The model was supported for the causal but not for the arbitrary conditional statements.     

Screening for Suicidal Ideation and Attempts among Emergency Department Medical Patients: Instrument and Results from the Psychiatric Emergency Research Collaboration

Joint Commission National Patient Safety Goal 15 calls for organizations “to identify patients at risk for suicide.” Overt suicidal behavior accounts for 0.6% of emergency department (ED) visits, but incidental suicidal ideation is found in 3%–11.6%. This is the first multicenter study of suicide screening in EDs. Of 2,243 patients in six diverse emergency settings, 1,068 (47.7%) were screened with a brief instrument. Depression was endorsed by 369 (34.5%); passive suicidal ideation by 79 (7.3%); and active suicidal ideation by 24 (2.3%). One hundred thirty‐seven (12.8%) reported prior attempts, including 35 (3.3%) with current suicidal ideation. Almost half of those with current ideation had a prior attempt (43.8%) versus those without current ideation, 10.3%, χ² (1) = 75.59, p < .001. Twenty cases (25%) were admitted to medical services, but only 10 (12.5%) received mental health assessment; none were admitted directly to a psychiatry service. The prevalence of suicidal ideation here is similar to previous studies but the frequency of prior attempts has not been reported. The 35 cases with current ideation and prior attempt are at risk. As they did not present psychiatrically, they would likely have gone undetected. Despite reporting these cases to clinical staff, few received risk assessment.     

Suicidal Behavior in Relatives or Associates Moderates the Strength of Common Risk Factors for Suicide

The prevalence and odds ratios of different suicide risk factors were compared in three pairs of decedents: 80 suicides and 25 injury decedents with blood relatives with suicidal behavior history (biologically exposed); 259 suicides and 126 injury decedents with unrelated acquaintances with suicidal behavior history (socially exposed); and 471 suicides and 523 injury decedents with neither relatives nor acquaintances with suicidal behavior history (unexposed). Negative life events and high psychological stress were more common in socially exposed suicides than in other suicides. The adjusted odds ratios of most established suicide risk factors were higher in unexposed decedents than in biologically or socially exposed decedents, suggesting that the predictive value of established risk factors wanes in individuals who have been exposed to suicidal behavior in family or friends.     

Looking Back on Self‐Poisoning: The Relationship between Depressed Mood and Reporting of Suicidal Intent in People Who Deliberately Self‐Poison

Lifetime worst‐point suicidality is associated with risk of subsequent death by suicide. Yet little is known about how people who deliberately self‐poison (DSP) change their appraisal of suicidal intent of a single DSP episode over time. We assessed whether suicidal intent for a single index episode of DSP changed over time and factors associated with such change. We studied 202 patients admitted for DSP (66.3% female, all Caucasian), 18–85 years old (M = 37.8, SD = 14.8), using a longitudinal design (0, 3, and 12 months). The primary outcome measure was change in suicidal intent for a single index DSP episode, analyzed using multilevel modeling. Wish to die and whether the episode was considered a suicide attempt increased significantly with depressed mood. Wish to die associated with the index episode also increased over time independently of depressed mood. No association with time or depressed mood was found for perceived likelihood of dying. Depressed mood was strongly associated with appraisal of suicidal intent associated with a DSP episode. In suicide risk assessment, reports of the nature and severity of past DSP should be interpreted in light of current mood.