Identification,Response, and Referral of Suicidal Youth Following Applied Suicide Intervention Skills Training

Gatekeeper training is a public health approach to suicide prevention that encourages community members to identify those at risk for suicide, respond appropriately, and refer for clinical services. Despite widespread use, few studies have examined whether training results in behavior change in participants. This study employed a naturalistic pre–post design to follow 434 participants in Applied Suicide Intervention Skills Training, finding small but significant increases in self‐reported identification of at‐risk youth, some helpful responses to youth, and numbers of youth referred to treatment from pre‐test to 6‐ to 9‐month follow‐up. Changes in active listening and helping behaviors meant to support treatment referrals (such as convincing a youth to seek treatment) were not observed over time. Additional analyses explored predictors of self‐reported skill utilization including identification as a “natural helper” and attitudes about suicide prevention.     

Is There a Relationship between Suicidal Intent and Lethality in Deliberate Self‐Poisoning?

The relationship between suicidal intent and lethality of deliberate self‐poisoning (DSP) episodes and their associations with suicide have yielded contradictory findings. The aims of this study were to investigate the association between patients’ suicidal intent and independently rated lethality of DSP episodes, and whether the association changes over time. Eighty‐nine DSP patients were investigated longitudinally. Self‐reported suicidal intent, including perceived likelihood of dying, wish to die, and whether or not the DSP was considered a suicide attempt, was measured at the time of the index episode (t1), 3 months (t2), and 12 months (t3) later. Lethality was assessed independently by three clinical toxicologists. Lethality was significantly associated with patients’ reported wish to die (p = .01) and perceived likelihood of dying (p = .04) at t1, but not at t2 and t3. No association was found between whether the episode was considered a suicide attempt or not and lethality at t1, t2, or t3. Lethality and suicidal intent should be considered as largely separate dimensions of self‐harm. Clinicians should bear this in mind during clinical assessment, especially regarding historical information.     

“I've Been a Long Time Leaving”: The Role of Limited Skill Transferability in Increasing Suicide‐Related Cognitions and Behavior in Veterinarians

Barriers to occupational mobility were investigated to determine whether they increased reported suicide‐related cognitions and behavior over 12 months. This was explored in a two‐wave longitudinal study. Intention to leave, depression, perceived skill transferability, and suicide‐related cognitions and behavior was measured at both time points approximately 12 months apart. Results indicated that when there was a high intention to leave at T1, reported suicide‐related cognitions and behavior increased over 12 months only when skill transferability to other professions was perceived to be limited. Findings support the role of limited occupational mobility in suicide‐related cognitions and behavior.     

Investigating the Interaction Between Sleep Symptoms of Arousal and Acquired Capability in Predicting Suicidality

Heightened arousal significantly interacts with acquired capability to predict suicidality. We explore this interaction with insomnia and nightmares independently of waking state arousal symptoms, and test predictions of the Interpersonal Theory of Suicide (IPTS) and Escape Theory in relation to these sleep arousal symptoms. Findings from our e‐survey (n = 540) supported the IPTS over models of Suicide as Escape. Sleep‐specific measurements of arousal (insomnia and nightmares) showed no main effect, yet interacted with acquired capability to predict increased suicidality. The explained variance in suicidality by the interaction (1%–2%) using sleep‐specific measures was comparable to variance explained by interactions previously reported in the literature using measurements composed of a mix of waking and sleep state arousal symptoms. Similarly, when entrapment (inability to escape) was included in models, main effects of sleep symptoms arousal were not detected yet interacted with entrapment to predict suicidality. We discuss findings in relation to treatment options suggesting that sleep‐specific interventions be considered for the long‐term management of at‐risk individuals.     

Modeling the Longitudinal Direct and Indirect Effects of Attitudes,Self‐Efficacy,and Behavioral Intentions on Practice Behavior Outcomes of Suicide Intervention Training

The purpose of this study was to use a longitudinal path analysis to test attitudes toward suicide prevention, self‐efficacy, and behavioral intentions as mediators/moderators of clinical skill development over time following suicide intervention training. Results support a direct effect of attitudes on practice behaviors and self‐efficacy, but no moderating effect. Self‐efficacy performed as a mediator of practice behaviors over time. Behavioral intention had a direct effect on practice behaviors and mediated the relationship between attitudes and practice behaviors. Implications for research and practice are discussed.     

Demographic,Clinical, and Service Utilization Factors Associated with Suicide‐Related Visits among Alaska Native and American Indian Adults

Alaska Native and American Indian people (AN/AIs) are disproportionately affected by suicide. Within a large AN/AI health service organization, demographic, clinical, and service utilization factors were compared between those with a suicide‐related health visit and those without. Cases had higher odds of a behavioral health diagnosis, treatment for an injury, behavioral health specialty care visits, and opioid medication dispensation in the year prior to a suicide‐related visit compared to gender‐, age‐, and residence‐ (urban versus rural) matched controls. Odds of a suicide‐related visit were lower among those with private insurance and those with non‐primary care ambulatory clinic visits.     

Posttraumatic Stress Disorder Symptom Clusters and the Interpersonal Theory of Suicide in a Large Military Sample

Prior studies examining posttraumatic stress disorder (PTSD) symptom clusters and the components of the interpersonal theory of suicide (ITS) have yielded mixed results, likely stemming in part from the use of divergent samples and measurement techniques. This study aimed to expand on these findings by utilizing a large military sample, gold standard ITS measures, and multiple PTSD factor structures. Utilizing a sample of 935 military personnel, hierarchical multiple regression analyses were used to test the association between PTSD symptom clusters and the ITS variables. Additionally, we tested for indirect effects of PTSD symptom clusters on suicidal ideation through thwarted belongingness, conditional on levels of perceived burdensomeness. Results indicated that numbing symptoms are positively associated with both perceived burdensomeness and thwarted belongingness and hyperarousal symptoms (dysphoric arousal in the 5‐factor model) are positively associated with thwarted belongingness. Results also indicated that hyperarousal symptoms (anxious arousal in the 5‐factor model) were positively associated with fearlessness about death. The positive association between PTSD symptom clusters and suicidal ideation was inconsistent and modest, with mixed support for the ITS model. Overall, these results provide further clarity regarding the association between specific PTSD symptom clusters and suicide risk factors.