Differentiating Suicide Attempters from Suicide Ideators: The Role of Capability for Suicide

This study examined whether different components of capability for suicide (i.e., fearlessness about death, pain tolerance, pain insensitivity, preparation for suicide, suicide plan, and courage), as well as painful and provocative events, nonsuicidal self-injury, depressive symptoms, and hopelessness, could distinguish between suicide attempters, suicide ideators, and non-suicidal controls. A total of 930 Chinese adolescents completed questionnaires, and a multinomial logistic regression was conducted to identify factors that could distinguish among the 3 groups. We found that higher levels of pain tolerance, more detailed suicide plans, more positive attitudes towards suicide, as well as more painful and provocative experiences and more severe depressive symptoms were positively associated with increased likelihood of the engagement in both suicide ideation and suicide attempts. Only nonsuicidal self-injury increased the likelihood of falling in the suicide attempt group as compared to the suicide ideation group. Findings of this study emphasize the role of nonsuicidal self-injury in intervening suicidality.     

Suicide ideation in Chinese adolescents

Background The suicide rate in China is estimated to be around three times the global average, with women in the 15- to 24-year-old age group particularly vulnerable. Despite this, there is a dearth of information on the prevalence and predictors of depression and suicide ideation in Chinese adolescents. The specific aims of the study were, therefore, to quantify the rates and severity of self-reported depression and suicide ideation in middle-school students, to examine the relationship between depression and attempted suicide, and to identify socio-demographic associations. Methods A cross-sectional survey using self-completion questionnaires was carried out in six middle schools (predominant age range 13–17 years) in an urban and a rural setting in Zhejiang Province in eastern China. Results There were 1,576 completed questionnaires. One–third of the students had suffered symptoms of severe depression, with 16 % admitting to suicide ideation and 9 % to actually having attempted suicide. Factors independently associated with severe depression were female gender, poor self-reported academic performance and rural residence. Similar factors were associated with suicide ideation and attempted suicide. Depression was less common in those without siblings. Patterns of help-seeking showed reliance on friends and parents, with very low levels of professional help-seeking (around 1 %) and 30 % having sought no help from any source for psychological problems. Conclusion The results of the study contributed to service developments and the addition of psychological issues to the school health education curriculum. Accepted: 24 December 2001     

When Doctors Struggle: Current Stressors and Evaluation Recommendations for Physicians Contemplating Suicide

The objective of this study was to document current risk factors associated with physicians’ suicide ideation among a group of doctors enrolled in a Physician Health Program. A retrospective cohort study was drawn from administrative data. The study compared intake information between doctors who reported recent thoughts of suicide (n?=?70) and those who did not (n?=?1,572) using adjusted regression analysis. Current stressors included personal, financial, health, and occupational problems; ideation was more likely with multiple stressors. Physicians endorsing suicidal ideation lacked personal supports and scored differently on Short Form-36 measures. Evaluators treating physicians should assess enduring risks and current stressors, particularly multiple stressors, to help detect suicidal patients. Current stressors should not be viewed as transitory and it is critical to bring in collateral information.     

A Test of the Three-Step Theory of Suicide among Chinese People: A Study Based on the Ideation-to-Action Framework

The aim of this study was to test the Three-Step Theory (3ST) of suicide in a sample of college students in China (N?=?1,097). All participants completed a battery of questionnaires indexing psychological pain, hopelessness, connectedness, suicide capacity, suicide ideation, and suicide attempt. The prevalence of suicide ideation and suicide attempt among the sample were 21.42% and 3.83%, respectively. The hierarchical regression analysis showed that psychological pain and hopelessness interacted to predict suicide ideation, and that connectedness was the most protective against ideation in those high on both pain and hopelessness. Suicide capacity differentiated attempters from ideators above and beyond current suicide ideation. These findings provide preliminary evidence for the validity of 3ST of suicide within Chinese contexts. Implications for suicide prevention and intervention and future research directions are also discussed.     

Suicide attempts among adolescents in Switzerland: prevalence,associated factors and comorbidity

Switzerland has one of the highest rates of adolescent suicide in Europe, but the prevalence of suicidal thoughts and attempts is unknown. The objective of this paper is to assess the prevalence of suicidal ideation and behaviour among Swiss teenagers and to identify the factors associated with suicide attempts. A self-administered anonymous questionnaire was distributed to a representative sample of 9268 15- to 20-year-old adolescents attending school or college. Six items focused on suicidal ideation and conduct. Multivariate analyses were performed to identify the health variables associated with suicide attempts. About 55% of the adolescents had no suicidal concerns; 26% reported suicidal thoughts, 15% reported suicidal plans and 3% reported suicide attempts. Suicide attempters reported significantly more problems in four areas, namely health behaviour, life events, social relationships and mental health. In conclusion, many factors associated with suicide attempts represent detectable behaviours. Thus health professionals could use this knowledge to be more effective in suicide prevention among adolescents.     

Antecedents and Patterns of Suicide Behavior in First-Admission Psychosis

Background: Persons with psychotic illnesses have an increased risk for suicide, especially early in the illness. Sufficient knowledge allowing for early recognition is lacking. Objectives: To describe suicide behaviors before and during the 4 years following first psychiatric hospitalization, examine associations of demographic and psychiatric risk factors, and develop a suicide risk index. Method: Data came from the Suffolk County Mental Health Project, a first-admission cohort (n = 529). Cox regression was used to study associations of risk factors to suicide behaviors; a summary suicide behavior risk index was also tested. Results: Prior to first admission, 28.0% (n = 148) of the cohort had attempted suicide. During the 4-year follow-up, 13.6% (n = 72) of the cohort attempted suicide (29.7% of those with previous attempts and 7.3% making their first attempt) and 3 respondents died of suicide. The significant predictors at index admission of subsequent attempts were prior attempts or ideation, severity of depressive symptoms and thought disorder, lifetime substance abuse, and younger age. Suicide ideation was predicted by the same variables with the addition of insight into illness and with the exception of age at admission. A 3-category risk index was created; 61.1% of those who made a suicide attempt were in the highest risk group (n = 44/72). Conclusion: The current study confirms and extends previous research showing that risk factors early in the course of illness are predictive of subsequent ideation and attempts. The risk index may be a useful adjunct in identifying individuals likely to benefit from preventive interventions.     

Isolating the Association of Sleep,Depressive State,and Other Independent Indicators for Suicide Ideation in United States Teenagers

According to the Centers for Disease Control and Prevention, suicide is the second leading cause of death in American teenagers, and is a growing public health concern. This study uses multivariable logistic regression to investigate the independent relationship between suicide ideation and sleep duration in teenagers using the 2015 Youth Behavior Risk Surveillance Study, controlling for demographic, behavioral, and other factors found to be associated. Sleep durations of 4–5 hours and 6–7 hours per night were associated with approximately 75–80% and 20–40% increased adjusted odds of suicide ideation, as compared to teens sleeping the recommended 8 hours or more, and should be considered as a potential important indicator for adolescent suicidal ideation in primary-care screens.     

Clinical Features Associated with Suicide Attempts versus Suicide Gestures in an Inpatient Sample

The objective of this study was to test whether suicide attempters and suicide gesturers can be clinically differentiated. A total of 150 subjects who had attempted suicide at least once, had made a suicide gesture, had suicidal ideation, and/or had engaged in non-suicidal self-injury were recruited from the inpatient service of the Jiménez Díaz Foundation (Madrid, Spain). A multinomial regression analysis was conducted. Histrionic and antisocial personality disorders were risk factors specific to suicide gestures. Narcissistic personality disorder was specifically associated with suicide attempts. Borderline personality disorder was associated with both suicide gestures and attempts. A high level of impulsiveness was a risk factor specific to suicide attempts. Conclusion: Suicide attempters and suicide gesturers are two distinct, although partially overlapping, populations.     

Suicide attempts among Inuit youth: a community survey of prevalence and risk factors

The prevalence of and risk factors for attempted suicide and suicidal ideation were examined with a survey of 99 Inuit, aged 14–25 years, residing in a community in Northern Québec. A total of 34% of survey respondents reported a previous suicide attempt, and 20% had attempted suicide more than once. A suicide attempt had resulted in injury in about 11 % of those surveyed. The prevalence of suicidal ideation was also very high: 43% of subjects reported past thoughts of suicide, and 26% had had suicidal thoughts during the month before the survey. Risk factors for suicide attempts included male gender, having a friend who had attempted or committed suicide, a history of being physically abused, a history of solvent abuse, and having a parent with an alcohol or drug problem. Protective factors included a family history of having received treatment for a psychiatric problem, more frequent church attendance, and a high level of academic achievement. While individuals in the community who are at high risk for suicide can be targeted for preventive measures, the high prevalence and effect of family problems on likelihood of suicide attempts indicate the need for family- and community-based approaches.     

Predicting Risk for Suicide: A Preliminary Examination of Non-Suicidal Self-Injury and the Acquired Capability Construct in a College Sample

The interpersonal psychological theory of suicide provides a useful framework for considering the relationship between non-suicidal self-injury and suicide. Researchers propose that NSSI increases acquired capability for suicide. We predicted that both NSSI frequency and the IPTS acquired capability construct (decreased fear of death and increased pain tolerance) would separately interact with suicidal ideation to predict suicide attempts. Undergraduate students (N = 113) completed self-report questionnaires, and a subsample (n = 66) also completed a pain sensitivity task. NSSI frequency significantly moderated the association between suicidal ideation and suicide attempts. However, in a separate model, acquired capability did not moderate this relationship. Our understanding of the relationship between suicidal ideation and suicidal behavior can be enhanced by factors associated with NSSI that are distinct from the acquired capability construct.     

Suicide risk in civilian PTSD patients

Abstract Background There appears to be a strong connection between suicidality and the experience of trauma. The study investigated suicidality in chronic civilian post–traumatic stress disorder (PTSD). Method Ninety–four participants suffering from chronic PTSD were assessed for suicidal ideation, plans and attempts since the index trauma as part of a comprehensive assessment. The prevalence of these was assessed and characteristics of those reporting suicide–related thoughts and behaviour were investigated through logistic and multinominal regression analyses. Results Over half of the sample (56.4%) reported some aspect of suicidality with 38.3% reporting ideation, 8.5% reporting suicide plans and 9.6% having made suicide attempts since the trauma. Of the nine participants who reported suicide attempts, six had made more than one attempt. The proportions of participants who reported suicidality in this sample were significantly greater than reported within the general population, when comparisons were made with an epidemiological study. Logistic regression analysis indicated that a unit increase in life impairment (OR = 3.1) and depression (OR = 1.14) scores were independently and significantly associated with suicidality. Multinominal regression indicated that life impairment (OR = 2.71) and depression (OR = 1.13) scores were associated with the presence of suicidal ideation compared to no ideation, and life impairment (OR = 5.75), depression (OR = 1.2) scores and receiving psychotropic medication (OR = 10.6) were associated with the presence of plans and attempts compared to no suicidal behaviour. Conclusions Suicide risk is elevated in those suffering from chronic PTSD and is associated with impaired functioning in combination with depression.     

Prevalence of Suicide Ideation in Two Districts of Uganda

ABSTRACT

Suicide ideation is common in all communities but research on suicidal behavior in Sub-Saharan Africa is scarce. The aim of this study was to determine the prevalence of self-reported suicidal ideation in two contrasting districts of Uganda. The method employed was a systematic sample of 939 respondents residing in Adjumani and Bugiri districts, using the Beck Scale for Suicide Ideation (BSS). Results indicated a higher rate of suicidal ideation in females, the unemployed and in Adjumani district. Consistent with other international studies, high rates of suicidal ideation were found in the Ugandan population. The higher prevalence of suicide ideation in the Adjumani District appears to be a symptom of psychosocial distress related to many years of social and political turmoil and the poor socio-economic conditions. In-depth observational studies are needed to fully understand the process of suicide ideation in Uganda.     

Suicide among the elderly and associated factors in South Korea

With the population of the elderly increasing, suicides among elderly people present a serious problem for global societies. However, there are few studies on suicide among elderly subjects, especially in Asia. The study aimed to determine the relationship between physical health, mental health, social environmental condition, and the suicide behavior among elderly subjects in the city of Suwon, located southeast of Seoul. We analyzed 1548 Korean aged over 60 years from baseline data of a larger prospective study called the Suwon Project. The study protocol included sociodemographic variables, mental health factors, and physical health factors. In the interview, the subjects were asked about suicide ideation and history of suicide attempt. Of the total subjects, 7.42% reported suicide ideation and 1.42% reported a history of suicide attempt. A logistic regression analysis showed that physical illness, five stroke warning signs, anxiety and depression associated with suicide ideation, and depression strongly corresponded to the suicide ideation. Anxiety, depression, and stroke warning signs were associated with history of suicide attempt among the elderly. Additionally, stroke warning signs and depression are independently associated with history of suicide attempt. This study revealed that stroke warning signs have a high correlation with history of suicide attempt in the elderly, independent from the depression factors. This study suggests that there is an independent relationship between physical health status and suicide behavior in the case of elders.     

The Association between Anhedonia,Suicidal Ideation,and Suicide Attempts in a Large Student Sample

Depression is a significant risk factor for suicide. Evidence suggests that anhedonia may be a symptom of depression that is uniquely associated with suicidality. However, exactly how anhedonia is related to suicide is unclear. To provide more specific evidence regarding this association, we investigated relationships between anhedonia, suicidal ideation, and suicide attempts. A large combined undergraduate sample completed the novel Specific Loss of Interest and Pleasure Scale (SLIPS), the Center of Epidemiological Studies Depression Scale (CES-D), and the Suicidal Behaviors Questionnaire—Revised (SBQ-R). Anhedonia was associated with suicidal ideation, even when accounting for depressive symptoms. Additionally, anhedonia was not associated with suicide attempts when symptoms of depression were held constant. The current study provides novel evidence regarding the relationship between anhedonia and risk of attempting suicide. Future research can examine the role anhedonia plays in the unfolding of suicidal behavior over time.     

Suicide Ideation Among College Students: A Multivariate Analysis

The goal of this study was to develop a multi-dimensional model that might explain suicide ideation among college students. Face-to-face interviews were conducted with 1,249 first-year college students. An estimated 6%_wt of first-year students at this university had current suicide ideation. Depressive symptoms, low social support, affective dysregulation, and father-child conflict were each independently associated with suicide ideation. Only 40%_wt of individuals with suicide ideation were classified as depressed according to standard criteria. In the group who reported low levels of depressive symptoms, low social support and affective dysregulation were important predictors of suicide ideation. Alcohol use disorder was also independently associated with suicide ideation, while parental conflict was not. Results highlight potential targets for early intervention among college students.     

Mechanisms of Action Contributing to Reductions in Suicide Attempts Following Brief Cognitive Behavioral Therapy for Military Personnel: A Test of the Interpersonal-Psychological Theory of Suicide

Brief cognitive behavioral therapy (BCBT) is associated with significant reductions in suicide attempts among military personnel. However, the underlying mechanisms of action contributing to reductions in suicide attempts in effective psychological treatments remain largely unknown. The present study conducted a secondary analysis of a randomized controlled trial of BCBT versus treatment as usual (TAU) to examine the mechanisms of action hypothesized by the interpersonal-psychological theory of suicide (IPT): perceived burdensomeness, thwarted belongingness, and fearlessness about death. In a sample of 152 active duty U.S. Army personnel with recent suicide ideation or attempts, there were significantly fewer suicide attempts in BCBT, but there were no differences between treatment groups from baseline to 6 months postbaseline on any of the 3 IPT constructs or their interactions. Tests of the moderated mediation failed to support an indirect effect for the IPT model, regardless of which IPT variables were specified as mediators or moderators. Results suggest that the IPT’s hypothesized mechanisms of action do not account for reductions in suicide attempts in BCBT. Implications for clinical practice and research are discussed.     

Religious Coping Style and Cultural Worldview are Associated with Suicide Ideation Among African American Adults

The purpose of this study was to examine whether specific religious coping styles and cultural worldview would be associated with thoughts of suicide given higher levels of stress in a community-based sample of African American adults. African American men and women (n?=?134) completed measures of religious coping, cultural worldview, stressful life events, depression symptoms, and suicide ideation. Higher ratings of suicide ideation were observed for African Americans who endorsed a more self-directing religious coping style. The self-directing religious coping was more frequently endorsed by participants who identified with a more Eurocentric cultural worldview that espouses an individualist philosophy. Together, these findings provide some insight to how religious coping and culture are related to suicide vulnerability for African Americans who are not in clinical care.     

Suicide Ideation Is Related to Therapeutic Alliance in a Brief Therapy for Attempted Suicide

The objective of this study was to investigate the role of therapeutic alliance on suicide ideation as outcome measure in a brief therapy for patients who attempted suicide. Sixty patients received the 3-session therapy supplemented by follow-up contact through regular letters. Therapeutic alliance was measured with the Helping Alliance Questionnaire (HAQ). Outcome at 6 and 12 months was measured with the Beck Scale for Suicide Ideation (BSS). Therapeutic alliance increased from session 1 to session 3. Higher alliance measures correlated with lower suicidal ideation at 12 months follow-up. A history of previous attempts and depression had a negative affect on therapeutic alliance. The results suggest that in the treatment of suicidal patients therapeutic alliance may be a moderating factor for reducing suicide ideation.     

A Shortened Screener Version of the Cultural Assessment of Risk for Suicide

The current study aimed to establish a shortened version of the Cultural Assessment of Risk for Suicide (CARS) measure that can be more widely utilized under time constraints in clinical and applied settings. Based on a sample of 485 adults, confirmatory factor analysis, bivariate correlations, and Receiver-Operating Characteristic analyses were employed to determine the most psychometrically valid shortened version. The 14-item, 8-factor CARS screener (CARS-S) evidenced high reliability, high correlation with the original full version of the CARS questionnaire, and high convergent validity with measures of other suicide-related constructs of depression, hopelessness, suicidal ideation, and lifetime suicide attempts. The suggested clinical cut-off is 38.5. The shortened CARS-S offers a time-efficient assessment of cultural suicide risk factors.     

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.