Book Reviews

This study clarified the association of maladaptive, potentially self-damaging behaviors with suicidality. Specifically, we examined whether greater frequency (i.e., how often) or greater versatility (i.e., how many ways) of several self-damaging behaviors, including non-suicidal self-injury (NSSI), substance use, and disordered eating, increased risk for suicide. Participants who engaged in NSSI (N = 142) completed questionnaires assessing suicidal and self-damaging behavior at baseline and engagement in suicidal behaviors (e.g., ideation, attempts, talking about suicide) 3 months later. Results suggest that the versatility rather than frequency of self-damaging behaviors is most robustly associated with suicide risk. Engaging in multiple methods of NSSI and using a greater number of illicit substances were positively associated with suicide risk. Further, versatility of NSSI interacted with depression to predict suicide risk at 3-month follow-up such that highly depressed participants who engaged in more methods of NSSI exhibited highest risk, whereas those who engaged in more methods with low depression exhibited the lowest risk.     

Rumination and Pessimistic Certainty as Mediators of the Relation Between Lifetime Suicide Attempt History and Future Suicidal Ideation

This study examined whether rumination and certainty about pessimistic future-event predictions (P-Certainty) would mediate the relation between lifetime suicide attempt history and future suicidal ideation. Young adults, ages 18–25 (N = 143), with a suicide attempt history (n = 32) or no previous suicide attempt history (n = 111) at baseline, were followed up 2–3 years later and completed measures of rumination, depressive symptoms, hopelessness, suicidal ideation, and pessimistic future-event certainty. Lifetime suicide attempts at baseline were associated with higher suicidal ideation at follow up, and this relation was mediated by rumination and P-Certainty. Suicide attempters may be vulnerable to later ideation due to higher levels of rumination and also certainty in their pessimistic future expectations.     

Frequency and Methods of Nonsuicidal Self-Injury in Relation to Acquired Capability for Suicide Among Adolescents

The objective of this study was to test the Interpersonal Psychological Theory of Suicide (IPTS) proposal that the association of nonsuicidal self-injury (NSSI) with suicide attempt is mediated by acquired capability. Inpatient adolescents (n?=?134) reported on suicide ideation and attempts, NSSI frequency and methods, depressive symptoms, and acquired capability for suicide. Consistent with the IPTS, both measures of NSSI were positively associated with acquired capability after accounting for depressive symptoms and past history of attempts. However, both NSSI measures explained independent variance in number of suicide attempts after controlling for suicide ideation and acquired capability. These findings contradict the IPTS and suggest that the role of NSSI in suicide attempt is mediated by variables external to the IPTS.     

The Relationship of Self-reported Executive Functioning to Suicide Ideation and Attempts: Findings from a Large U.S.-based Online Sample

An increasing number of studies demonstrate that individuals with a history of suicidality exhibit impaired executive functioning abilities. The current study examines whether these differences are linked to suicidal thoughts or suicidal acts—a crucial distinction given that most people who think about suicide will not act on their thoughts. A large online sample of U.S. participants with a history of suicide ideation (n = 197), suicide attempts (n = 166), and no suicidality (n = 180) completed self-report measures assessing executive functioning, suicide ideation and attempts; in addition, depression, self-efficacy, and history of drug abuse and brain injury were assessed as potential covariates. Individuals with recent suicide attempts reported significantly worse executive functioning than ideators. This difference was not accounted for by depression, self-efficacy, history of drug abuse or brain injury. Self-reported executive functioning may represent an important short-term risk factor for suicide attempts.     

The Indirect Effect of Perceived Criticism on Suicide Ideation and Attempts

The effect of perceived criticism from others is one potentially important risk factor for suicide that has received scant attention, despite decades of research on the role of criticism in the treatment and course of mental illnesses such as schizophrenia and mood disorders. This study analyzed the effect of perceived criticism's association with suicidal ideation and attempts as well as its connection with the suicide related constructs thwarted belongingness and perceived burdensomeness as described in the Interpersonal Theory of Suicide. Fifty participants (66% female, M_Age = 18.7), 18 of whom had previously made one or more suicide attempts, completed a battery of self-report assessments as well as two in-person, structured clinical interviews. Analyses demonstrated that perceived parental criticism is a significant indicator of suicide ideation (β = .297, p = .003) and attempts (β = .373, p < .001) and that perceived criticism from close friends is a significant indicator of suicide attempts (β = .297, p = .006). Perceived criticism has a strong indirect effect on suicide ideation and attempts through its effect on thwarted belongingness, but not perceived burdensomeness, while controlling for mental illnesses. Some limitations of this study include the cross-sectional design and the use of a relatively small, restricted age sample. Treatment designed to mitigate perceived criticism and thwarted belongingness may be an important component in combatting suicidal ideation and attempts, particularly among young adults.     

Predictors of Suicide Attempt Status: Acquired Capability,Ideation, and Reasons

The present study compared Non-Attempters, Recent Attempters, and Distant Attempters on the following three constructs: Acquired capability for suicide, reasons for attempting suicide (internal perturbation based reasons vs. extrapunitive/manipulative reasons), and suicidal ideation. Participants were 40 Non-Attempters, 28 Recent Attempters, and 32 Distant Attempters at three state psychiatric hospitals. The sample consisted of 63 males and 37 females ranging in age from 18 to 63 years (M = 35.84, SD = 11.44). All patients completed the self-report measures. There were significant differences between the groups on suicidal ideation and acquired capability for suicide. The results of the present study indicate that acquired capability and reasons for attempting suicide have considerable importance for understanding suicide risk. Integration of acquired capability for suicide and reasons for attempting suicide into assessment and treatment is warranted.     

The Influence of Death Exposure on Suicidal Thoughts and Behaviors

The present study investigated the relationship between exposure to both suicidal and non-suicidal deaths and current suicidal ideation and suicide attempt history among urban college students. Three hundred and ninety-six (n = 396) undergraduate students attending an urban university completed a series of questionnaires assessing their exposure to death (including suicide), suicide attempt history, and current level of suicidal ideation. Exposure to suicide and non-suicidal death were not related to current suicidal ideation; however, students who had made a suicide attempt were more likely to have been exposed to a death by suicide or acute disease. The findings of this study suggest that exposure to death by suicide or acute disease increased the likelihood a student made a past suicide attempt.     

Active and Passive Problem Solving as Moderators of the Relation Between Negative Life Event Stress and Suicidal Ideation Among Suicide Attempters and Non-Attempters

This study examined whether active problem solving would buffer against, whereas passive problem solving would exacerbate, the association of negative life stress with suicidal ideation. Young adult college students (73 females, M_age = 19.0) from a diverse urban public university, with (n = 37) and without (n = 59) a suicide attempt history completed measures of life stress, problem solving, hopelessness, depression, and suicidal ideation. Hierarchical linear regressions were conducted to test moderating roles of active and passive problem solving, along with suicide attempt history, on the relation between negative life event stress and suicidal ideation. There was a weaker relation between life stress and suicidal ideation at high and average levels of relevant problem solving than at low levels, and this was the case primarily for suicide attempters but not for non-attempters. Individuals with a past attempt produced more passive solutions than non-attempters, but among attempters, even passive problem solving buffered the association of life stress with suicidal ideation. Relevant problem solving in the face of life stress may be especially important for individuals vulnerable to suicidal ideation due to an attempt history. Among such at-risk individuals, generating even passive solutions in the face of life stress may be more adaptive than generating few solutions. Thus, clinical interventions with suicide attempters that focus on generating solutions to problems, even if these are initially passive, may help mitigate the effect of life stress on suicidal ideation.     

Non-suicidal self-injury and suicidal ideation as predictors of suicide attempts in adolescent girls: A multi-wave prospective study

Although both suicide ideation (SI) and non-suicidal self-injury (NSSI) are known risk factors for suicidal behavior, few longitudinal studies have examined whether having a history of one or both of these factors prospectively predicts increased risk for suicide attempts. According to the theory of acquired capability for suicide, engagement in NSSI may reduce inhibitions around self-inflicted violence, imparting greater risk for suicide attempts among those with SI than would be observed in those with SI who do not have a history of NSSI. We used prospective data from the Pittsburgh Girls Study, a large community sample, to compare groups of girls reporting no SI or NSSI, SI only, or both NSSI and SI between early to late adolescence on any lifetime or recent suicide attempts in late adolescence and early adulthood. As compared to girls with no SI or NSSI history and those with only an SI history, girls with a history of both NSSI and SI were significantly more likely to subsequently report both lifetime and recent suicide attempts. Results are consistent with the acquired capability theory for suicide and suggest that adolescent girls who have engaged in NSSI and also report SI represent a particularly high-risk group in need of prevention and intervention efforts.     

An Aspect of the Capability for Suicide—Fearlessness of the Pain Involved in Dying—Amplifies the Association Between Suicide Ideation and Attempts

The interpersonal theory of suicide posits that individuals who experience suicide ideation will only develop suicidal intent, and subsequently engage in suicidal behavior when they have concomitant fearlessness about death and tolerance for physical pain (i.e., the capability for suicide). The current studies examined the hypothesis that one aspect of the capability for suicide—fearlessness of the pain involved in dying—would amplify the positive association between current suicide ideation and a previous suicide attempt in two samples at high risk for experiencing suicide ideation and suicide attempts. Study 1 examined this relation using self-report methods in a sample of adults entering treatment in a mental health outpatient clinic. Study 2 utilized similar methods in a sample of adults admitted to inpatient psychiatry. Both studies indicated that those individuals who reported suicide ideation were more likely than non-ideators to report having attempted suicide only if they also reported greater fearlessness of the pain involved in dying. The current findings support the theorized role of the capability for suicide in the transition from ideation to attempt and also support assessing the capability for suicide in risk assessment.     

Borderline Personality Disorder Diagnostic Criteria as Risk Factors for Suicidal Behavior Through the Lens of the Interpersonal Theory of Suicide

Borderline personality disorder diagnostic criteria, particularly affective dysregulation and behavioral dysregulation, are avenues through which suicide risk is conferred, though pathways are not well understood. The interpersonal theory of suicide may help elucidate these associations. The current study examined indirect relationships between affective and behavioral dysregulation and suicidal ideation through perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide. 169 outpatients completed measures prior to their intake assessment. Perceived burdensomeness accounted for the relationship between affective dysregulation and suicidal ideation. The acquired capability did not explain the association between behavioral dysregulation and suicide attempt history. Affective and behavioral dysregulation may be key targets in treatment for reducing suicide risk.     

Does cannabis use lead to depression and suicidal behaviours? A population‐based longitudinal study

Objective: This study investigates the relationship between cannabis use and later depression, suicidal ideation and suicide attempts in a cohort of young Norwegians. Method: Data were gathered through the Young in Norway longitudinal study, in which a population‐based sample of 2033 Norwegians were followed up over a 13‐year period, from their early teens to their late twenties. Data were gathered on: (a) exposure to cannabis use; and (b) depression, suicide ideation and suicide attempts. In addition, information about possible confounding factors was included. Results: In early adolescence, no associations with later depression or suicidal behaviours were observed. In the sample’s twenties, we observed highly significant associations with suicide ideation and suicide attempts. When adjusting for confounders, the OR was 2.9 (95% CI 1.3–6.1) for later suicide attempts in the group who had used cannabis 11+ times during the past 12 months. Conclusion: The findings suggest that exposure to cannabis by itself does not lead to depression but that it may be associated with later suicidal thoughts and attempts.     

The Epidemiology and Phenomenology of Non-Suicidal Self-Injurious Behavior Among Adolescents: A Critical Review of the Literature

This article critically reviewed the research addressing the epidemiology and phenomenology of non-suicidal self-injury (NSSI) among adolescents. Articles were identified through a search of Medline and Psychinfo. Findings indicate a lifetime prevalence of NSSI ranging from 13.0% to 23.2%. Reasons for engaging in NSSI include to regulate emotion and to elicit attention. Correlates of NSSI include a history of sexual abuse, depression, anxiety, alexithymia, hostility, smoking, dissociation, suicidal ideation, and suicidal behaviors. Suggested areas of future research include identifying the psychiatric diagnoses associated with NSSI among adolescents, determining the temporal link between NSSI and suicide attempts, learning more about the course of NSSI, understanding the biological underpinnings of NSSI, and identifying effective treatments for NSSI in adolescents.     

Common Pathways to NSSI and Suicide Ideation: The Roles of Rumination and Self-Compassion

We investigated whether rumination and self-compassion moderate and/or mediate the relationships between negative affect and both non-suicidal self-injury (NSSI) and suicide ideation. Undergraduate university students (n?=?415) completed well-validated measures of negative affect, rumination, self-compassion, NSSI, and suicide ideation. Neither rumination nor self-compassion moderated associations between negative affect and NSSI and suicide ideation. However, both rumination and self-compassion mediated associations between negative affect and lifetime history of NSSI and suicide ideation. Self-compassion additionally mediated the association between negative affect and both 12-month NSSI and suicide ideation. The salience of self-compassion, particularly in predicting recent NSSI and suicide ideation, offers promise for early intervention initiatives focusing on less judgmental or self-critical means of self-relation.     

Characteristics of Soldiers with Self-Harm in the Israeli Defense Forces

Suicide is the leading cause of soldier death in the Israeli Defense Forces (IDF) in peace time. Suicide attempt (SA) and non-suicidal self-injury (NSSI) are risk factors for death by suicide in civilian studies and therefore their predictive value needs to be determined in the military. All army screening, psychometric and demographic data on consecutive cases of IDF soldier self-harm during the years 2010–2011 were analyzed. The Columbia Suicide Severity Rating Scale was used retrospectively to classify self-harm as suicidal or NSSI. The Suicide Ideation Scale and the Suicide Intent Scale were scored retrospectively by trained clinical psychologists. A total of 107 soldiers reported self-harm during the study period, comprising 70 SA and 37 with NSSI. The most prevalent diagnosis was personality disorder (n = 48). Soldiers with any mood/anxiety disorders comprised the smallest group (n = 21) and included major depression, dysthymia, anxiety, and posttraumatic stress disorder. Soldiers with NSSI (n = 37) did not differ in any of the characteristics from those who attempted suicide (n = 70). Unlike the well-known female dominance in both SA and NSSI patients in other settings, males dominated this army sample in both groups. Soldiers with self-harm (both SA and NSSI) cannot be easily distinguished by any demographics or specific psychological attributes detectable at induction, and the scales used in suicide research cannot predict an attempt or NSSI. Unlike civilian samples, males dominated attempter and NSSI groups and the reason for this may be multifactorial. These retrospective findings, if replicated, indicate the need for different screening strategies at induction into the military.     

Hopelessness,depression, substance disorder,and suicidality

Abstract. Background: Most earlier studies of hopelessness as a risk factor for suicidal behavior were based on either clinical or restricted samples. Using a longitudinal study design with a community sample of more than 3,000 participants, we aimed to examine if hopelessness was a long-term predictor of suicidal behaviors. Methods: Using longitudinal data from the Baltimore Epidemiologic Catchment Area (ECA) Program, we assessed the association of hopelessness at baseline and incident suicidal behaviors in the 13-year follow-up period, adjusting for the presence of depression and substance use disorders. Suicide behaviors studied included completed suicide, self-reported attempted suicide, and suicide ideation. Results: Hopelessness was predictive of all three types of suicidal behaviors in the follow-up period, even after adjustment. Persons who expressed hopelessness in 1981 were 11.2 times as likely to have completed suicide over the 13-year follow-up interval (95% confidence interval [1.8, 69.1]). The association between suicidality and hopelessness was stronger and more stable than the association of suicidality with the presence of depression and substance use disorders. Conclusion: Hopelessness was an independent risk factor for completed suicide, suicide attempts, and suicidal ideation. Intervention strategies that lower hopelessness may be effective for suicide prevention.Dr. Kuo is currently with Medical and Health Research Association (MHRA) and National Development and Research Institute, Inc (NDRI), New York, NY, USA. Dr. Gallo is currently with the Department of Family Practice and Community Medicine, University of Pennsylvania, Philadelphia, PA, USA.     

Sex and Emotion in the Acquired Capability for Suicide

This article examined the impact of distress tolerance on sex differences in the acquired capability for suicide. Two hundred undergraduate participants filled out a series of questionnaires related to emotions and suicide risk. Males exhibited higher mean levels of the acquired capability than did women and distress tolerance interacted with sex to predict the acquired capability (β = ?.70, p < .02), such that males with high distress tolerance were at the greatest risk. These results indicate that the degree to which an individual can tolerate negative emotions impacts the strength of the relationship between sex and the acquired capability for suicide.     

Predictive Validity of the Columbia-Suicide Severity Rating Scale for Short-Term Suicidal Behavior: A Danish Study of Adolescents at a High Risk of Suicide

Using the Columbia-Suicide Severity Rating Scale (C-SSRS), we examined the predictive and incremental predictive validity of past-month suicidal behavior and ideation for short-term suicidal behavior among adolescents at high risk of suicide. The study was conducted in 2014 on a sample of 85 adolescents (90.6% females) who participated at follow-up (85.9%) out of the 99 (49.7%) baseline respondents. All adolescents were recruited from a specialized suicide-prevention clinic in Denmark. Through multivariate logistic regression analyses, we examined whether baseline suicidal behavior predicted subsequent suicidal behavior (actual attempts and suicidal behavior of any type, including preparatory acts, aborted, interrupted and actual attempts; mean follow-up of 80.8 days, SD = 52.4). Furthermore, we examined whether suicidal ideation severity and intensity incrementally predicted suicidal behavior at follow-up over and above suicidal behavior at baseline. Actual suicide attempts at baseline strongly predicted suicide attempts at follow-up. Baseline suicidal ideation severity and intensity did not significantly predict future actual attempts over and above baseline attempts. The suicidal ideation intensity items deterrents and duration were significant predictors of subsequent actual attempts after adjustment for baseline suicide attempts and suicidal behavior of any type, respectively. Suicidal ideation severity and intensity, and the intensity items frequency, duration and deterrents, all significantly predicted any type of suicidal behavior at follow-up, also after adjusting for baseline suicidal behavior. The present study points to an incremental predictive validity of the C-SSRS suicidal ideation scales for short-term suicidal behavior of any type among high-risk adolescents.     

The acquired capability for suicide: A comparison of suicide attempters,suicide ideators,and non‐suicidal controls

Background: The Interpersonal Theory of Suicide states that to make a serious or lethal suicide attempt, a person must experience reductions in fear and pain sensitivity sufficient to overcome self preservation reflexes (i.e., the acquired capability for suicide). The purpose of this study was to examine the fearlessness component of the acquired capability for suicide using self‐report assessment instruments and an objective measure of aversion (the affectively modulated startle reflex task). Methods: Depressed suicide ideators (n=15), depressed suicide attempters (n=15), and a group of control participants (n=14) were compared on their self‐report of acquired capability and painful and provocative life events, and completed the affectively modulated startle reflex task. This task compared electromyography recordings of participants' eye‐blink response to a startle probe while viewing pictures of varying hedonic valence (neutral, positive, negative, and suicide‐related). Results: Suicide attempters reported the highest levels of fearlessness and pain insensitivity and a greater history of painful and provocative life events. Although no group differences were found on the psychophysiology data, participants reacted to suicide‐related images with less aversion compared to neutral images with no differences between suicide‐related and positive images. Conclusions: Self‐reported fearlessness and pain insensitivity can differentiate suicide attempters and suicide ideators. Results suggest that one's self‐perception (i.e., cognitions regarding fear and pain tolerance) are more functionally related to suicide attempts than psychophysiological reactivity to suicide‐related stimuli. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

A Trait-Interpersonal Perspective on Suicide Risk in Criminal Offenders

Despite elevated rates of suicide among offenders, research has yet to adequately address theoretically driven risk models in this population. The present study addresses such a gap by investigating a synthesized framework using 2 well-developed theoretical models, the Five-Factor Model (FFM) of personality and the interpersonal-psychological theory of suicide (IPTS). Archival data from mitigation evaluations for pre-sentenced criminal offenders (n = 307) were analyzed using structural equation modeling (SEM). Results supported a hypothesized personality-IPTS-suicide framework in which neuroticism and extraversion predict IPTS components, namely perceived burdensomeness, thwarted belongingness, and acquired capability. IPTS constructs subsequently directly and indirectly (via suicidal ideation) predicted suicide potential. Findings have important implications for suicide theory, research, and risk assessment with offenders.