Nonsuicidal self-injury: relationship to behavioral and self-rating measures of impulsivity and self-aggression

Previous research using self-report measures has shown an association between nonsuicidal self-injurious behavior (NSSI) and impulsive tendencies. However, self-injurers have not been shown to be different from comparison groups on laboratory tasks putatively assessing impulsive behavior. One explanation for these contradictory findings is that self-report and laboratory measures of impulsive behavior tap into distinct but related constructs. Moreover, performance on laboratory measures of impulsive behavior can be influenced by myriad contextual and affective factors not present during past self-reported NSSI events. Accordingly, a relationship between behavioral tasks of impulsivity and self-injurious behavior could emerge if both are assessed relatively close in time under controlled laboratory conditions. To test this possibility, both self-ratings and laboratory task measures of self-injurious and impulsive behavior were employed in the current study. This multi-modal assessment approach revealed that self-rated impulsivity was associated with both self-report and behavioral measures of self-injurious behavior. Moreover, behavioral measures of impulsivity were associated with self-injurious behavior, but not NSSI history. These results provide support for the notion that a multi-modal approach to assessing self-injurious behavior is important for better understanding the correlates of nonsuicidal self-injury.     

Technological Advances and the Future of Suicide Prevention: Ethical,Legal, and Empirical Challenges

Technological advancements have brought multiple and diverse benefits to our human existence. In suicide prevention, new technologies have spurred great interest in and reports of the applicability to assessing, monitoring, and intervening in various community and clinical populations. We argue in this article that we need to better understand the complexities of implementation of technological advances; especially the accuracy, effectiveness, safety, ethical, and legal issues, even as implementation occurs at individual, clinical, and population levels, in order to achieve that measure of public health impact we all desire (i.e., greater benefit than harm).     

Perceived control and posttraumatic stress: A temporal model

In this article we present a temporal model for understanding the relations between perceived control and posttraumatic distress. Although perceived control generally is seen as adaptive, a review of the research using a temporal framework reveals that the relations between different types of control and distress vary greatly. Specifically, present and future control tend to be associated with better adjustment and fewer posttraumatic stress disoorder (PTSD) symptoms, whereas past control tends to be unrelated to distress or associated with more distress. Following this review, we outline an agenda for future research on past, future, and present control and posttraumatic distress using our temporal framework and discuss general methodological issues that need to be addressed in future research.     

1. The Adolescent: The Individual in Cultural Perspective

Case vignettes are presented to highlight the idiosyncratic dynamics and special cultural influences that describe adolescent suicides. Extrapolated from these cases are a series of aphorisms about the study of adolescent suicide and about adolescence, meant to inform both clinicians and researchers on the need to better attend to the individual in context of his or her cultural influences.     

Suicide Risk Assessment and Risk Formulation Part I: A Focus on Suicide Ideation in Assessing Suicide Risk

The main procedure used by clinicians to determine whether an individual may be at risk of suicidal behaviors is the suicide risk assessment (SRA). The purpose of the SRA is to identify risk and protective factors that then provide the data for the formulation of suicide risk. The suicide risk formulation (SRF) assigns a level of suicide risk that ideally leads to triage and treatment deemed appropriate for that level of risk. Some of the problems with the SRA are explored here, with an emphasis on addressing the over reliance on communicated suicide ideation, and recommendations are made for improvements. Part II of this article (Berman & Silverman, 2013, also appears in this issue of STLB) examines the process of an SRF and, similarly, makes recommendations to improve clinical practice toward the desired end of saving lives.     

Suicide on Railroad Rights‐of‐Way: A Psychological Autopsy Study

Findings from 55 psychological autopsies of decedents who perished on U.S. railroad rights‐of‐way between October 1, 2007, and September 30, 2010 are reported. Described are distal, proximal, and contextual factors of risk; understandings of why these suicides occurred on railroad rights‐of‐way; and opportunities for prevention of similar suicides. International comparisons of suicides on railroad rights‐of‐way are made to highlight distinct findings regarding U.S. cases. Decedents studied exhibited considerable predisposing risk for suicide, with a high prevalence of severe mental disorders and substance abuse. In addition, a number of acute risk factors were commonly observed, notably suicide ideation, hopelessness, anxiety, and anger. In the context of that acute risk, associated situational variables and a relative absence of protective factors are described.     

Suicide Prevention in Adolescents (Age 12–18)

The epidemiology of adolescent suicide is summarized with particular emphasis on temporal trends by age and gender. “First-generation” prevention programs, as reviewed and critiqued by the Centers for Disease Control and Prevention, are then examined. In the absence of compelling empirically based behavioral outcome data, selective targeted “second-generation” prevention efforts are then described across the primary-secondary-tertiary continuum. These efforts are focused toward targets of individual predisposition, the social milieu, or proximal agents associated with high risk for suicidal behaviors. Finally, with an eye toward the future, current obstacles and unanswered questions are explored as they relate to opportunities and hopes for change in effecting reduced rates of these behaviors.