Ambulatory Assessment of Suicidal Desire, Wish to Live, and Wish to Die: A Comparison of Bisexual and Heterosexual College Students.

The Temporal Dynamics of Wish to Live, Wish to Die, and Their Short-Term Prospective Relationships With Suicidal Desire

Suicidal ambivalence is increasingly understood as the result of the interplay of two conflicting motivational orientations, the wish to die (WTD) and wish to live (WTL). However, research is scarce regarding the nature of their relationship, their temporal structure, and their relevance in predicting suicidal desire. Fifty psychosomatic/psychiatric inpatients (17 reporting suicide attempts) took part in an intensive longitudinal design with 10 signal-contingent prompts per day over 10 days; assessing WTD, WTL, and suicidal desire. We calculated mean values and variability of WTD, WTL, suicidal ambivalence, and suicidal desire and tested mixed-effects models of suicidal desire. The mean number of answered prompts was 40.98 (SD = 21.68). Repeated-measures correlation of WTD and WTL was r = -0.60. Patients with a history of suicide attempts reported higher WTD, lower WTL, more suicidal ambivalence, stronger suicidal desire, and showed higher variability in all constructs. At the same assessment, WTD was the strongest statistical predictor of suicidal desire. Only WTL and the interaction of WTD and WTL predicted suicidal desire prospectively. Wish to die and WTL are likely two distinct (although correlated) constructs that should not be reduced to a single ambivalence score. A stronger focus on WTL holds potential for suicide research and practice.

Temporal dynamics of the wish to live and wish to die signal near-term increases in suicidal thinking in a veteran sample.

Readiness to live (RTL) is a protective factor against suicidal thoughts and behaviors. It encompasses one's motivation to live and take steps towards staying alive. It is relatively stable, predicting lower odds of suicidal ideation at one- to 6-month follow-ups. However, little is known about its short-term stability. Research is needed to describe the construct and compare it to similar protective factors, like wish to live (WTL). College undergraduates (N = 51), selectively recruited for endorsing past 2-week suicidal desire, completed surveys (5/day for 10 days) on their smart phones. Descriptive and variability statistics of RTL, WTL, and suicidal desire were conducted. Multi-level models were used to determine if RTL is associated with suicidal desire concurrently and prospectively. 78.4% (n = 40) of participants indicated a change in RTL over the study period and RTL demonstrated greater stability than WTL and suicidal desire. RTL was associated with suicidal desire concurrently, but not prospectively, while WTL remained associated both concurrently and prospectively. The sample included only undergraduate college students, limiting generalizability to more diverse samples. Results demonstrate that RTL remains relatively stable over short time scales. While RTL and WTL are similar, the constructs are not redundant, with each providing unique information that may aid in treatment planning. Future research should replicate these findings in samples with more severe suicidal desire and extend them to suicidal behavior.

The "Internal Struggle Hypothesis" (Kovacs and Beck, ) suggests that suicidal persons may have both a wish to live (WTL) and a wish to die (WTD). The current study investigates whether the three-group typology - "WTL", "ambivalent (AMB)", and "WTD" - is determined by common correlates of suicidality and whether these groups can be ordinally ranked. The sample comprised 113 older inpatients. Discriminant analysis was used to create two functions (combining social, psychiatric, psychological, and somatic variables) to predict the assignment of older inpatients into the groups WTL, AMB, and WTD. The functions "Subjective Well-being" and "Social Support" allowed us to assign patients into these three distinct groups with good accuracy (66.1%). "Subjective Well-being" contrasted the groups WTD and WTL and "Social Support" discriminated between the groups WTD and AMB. "Social Support" was highest in the AMB group. Our results suggest a simultaneous presence of a WTL and a WTD in older inpatients, and also that the balance between them is determined by "Subjective Well-being" and "Social Support". Unexpectedly, the AMB group showed the highest scores on "Social Support". We hypothesize that higher social support might function as an important determinant of a remaining WTL when a WTD is present because of a lower sense of well-being. The study suggests that the groups WTL-AMB-WTD can not situated on a one-dimensional continuum. Copyright © 2016 John Wiley & Sons, Ltd.

Findings on the role of suicide ambivalence, an individual's wish to live (WL), and wish to die (WD) in the development of suicidality have been heterogenous. The main goal of this study was to examine associations of these constructs within the past week with sociodemographic factors and to longitudinally investigate their predictive power for suicidal ideation (SI) and suicide attempts (SA). N = 308 patients (54% female; M = 36.92 years, SD = 14.30), admitted to a psychiatric ward due to suicidality, were assessed for all constructs after admission, after six, nine, and 12 months. Data were analyzed with univariate fixed-effect models and lagged mixed-effect regression models. Decreased, WL increased post-baseline. Gender showed no significant link to ambivalence, WD, and WL. Ambivalence and WD correlated negatively with age and positively with depressiveness. More participants in a relationship showed a WL compared with single/divorced/widowed participants. More single participants or those in a relationship showed ambivalence than divorced/widowed participants. More single participants showed a WD than participants in a relationship/divorced/widowed. Longitudinally, ambivalence and WD predicted SI and SA. The findings underscore the importance of taking suicide ambivalence and WD into account in risk assessment and treatment.

Suicide risk is highly fluctuating. There is a need for predictors of short-term change in suicide risk to optimize risk assessment and treatment, especially among individuals who already attempted suicide. Based on 1776 daily assessments of 16 former psychiatric inpatients with a history of suicide attempts, we examined how suicidal ambivalence and, respectively, wish to die (WTD) and wish to live (WTL) predicted same-day and change in perceived suicide risk (i.e., next-day perceived suicide risk, controlled for same-day perceived suicide risk) in multilevel regression models. Additionally, based on the assumptions of nonlinear dynamics, we examined the associations between levels of fluctuations in the WTD/WTL and perceived suicide risk within the same time period. Suicidal ambivalence, WTD, and a WTL significantly correlated with same-day suicide risk. Suicidal ambivalence and WTD significantly predicted change in suicide risk. Fluctuations in WTD were significantly associated with concurrent suicide risk. The results suggest that suicidal ambivalence and WTD are drivers of suicide risk among individuals who already attempted suicide. The association between fluctuations in WTD and suicide risk was small and warrants further investigation on the practical utility as a warning sign.

Existing suicide risk screening and detection methods are unable to reliably identify who will engage in suicidal behavior (SB), and when. Modeling the "push-pull" among risk and protective processes could be useful for understanding when patients may be at increased risk for transitioning from lower to higher risk states. This study examines if changing temporal dynamics in wish to live (WTL) and wish to die (WTD) ratings, assessed during consecutively scheduled psychiatric outpatient visits, can differentiate patients who will attempt suicide and signal when suicidal behavior is about to occur. 78 adults with past-month suicidal ideation and/or suicidal behaviors who enrolled in a randomized clinical trial comparing two outpatient psychotherapies provided weekly WTL and WTD ratings assessed with the first two items of the Scale for Suicide Ideation and weekly occurrence of suicide attempts assessed with items from the Self-Injurious Thoughts and Behaviors Interview-Revised. Session-to-session changes in WTL and WTD were examined using multilevel regression modeling supplemented by eigenvalue decomposition analysis. Temporal patterns significantly differed over time between patients who attempted suicide versus patients who did not. Temporal patterns remained consistent over time among patients who did not attempt suicide. Among patients who attempted, temporal patterns changed from pre- to post-attempt, consistent with a state transition. Suicidal behaviors represent a state transition that is foreshadowed by unique temporal patterns in self-reported WTL and WTD.

Beyond the Unidimensional Account of Suicidal Desire: Examining the Dynamic Balance of the Wish to Live and the Wish to Die in Clinical and Non-Clinical Settings

BackgroundWorldwide, the elderly are at a greater risk of suicide than other age groups. There is a paucity of research exploring risk factors for suicide in hospitalized elderly patients. Therefore, a study designed to explore the prevalence and characteristic of suicidal ideation (SI), such as QOL (quality of life), a wish to die (WTD), and other factors in elderly inpatients with medical or surgical conditions in Taiwan was warranted.MethodsA total of 2199 hospitalized elderly patients over age 65 were enrolled. Demographic data, 5-item Brief Symptom Rating Scale (BSRS-5), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) data were collected. Logistic regression models were used to find the SI-related factors for all participants and to investigate the covariates correlated with WTD in patients with SI. Receiver operating characteristic (ROC) curve analysis was used to find the most important items of the BSRS-5 predictive of SI in this population.ResultsSI was found in 3.1% (68/2199) of the elderly. The statistically significantly factors associated with SI were: BSRS-5 item 2 (depression) (odds ratio [OR] = 2.15, 95% confidence interval [CI] = 1.56–2.98), item 4 (inferiority) (OR = 1.62, 1.23–2.13), item 5 (insomnia) (OR = 1.52, 1.13–2.05), and physical domain of WHOQOL (OR = 0.84, 0.72–0.99). QOL15 (mobility) (OR = 0.64, 0.46–0.90) and QOL 16 (satisfaction with sleep) (OR = 0.62, 0.44–0.88) were also significantly associated with SI. The status of living alone (OR = 4.44, 1.24–15.87), QOL 26 (absence of negative feeling) (OR = 0.38, 0.15–0.98), and QOL 27 (being respected/accepted) (OR = 0.43, 0.20–0.92) were significantly associated with WTD among inpatients with SI. The ROC curve analysis revealed that depression, inferiority, and insomnia were the most important items in the BSRS-5 significantly associated with SI among the elderly inpatients.ConclusionTo provide physical recovery and maintain mental health for physically ill elderly inpatients, setting up a multi-faceted approach targeting the aforementioned determinants of SI and WTD for reducing the risk of suicide attempt, and exploring other factors correlated with suicidal behaviors, are important topics and directions for clinical practice and further research.

The Role of a Telephone Helpline in the Prevention of Suicide Between 2012 and 2014 in Italy

CAMS-4Teens, Suicide Index Score typologies, and family factors.

To reduce suicides among Veterans, the Department of Veterans Affairs (VA) has designated suicide risk assessments for Veterans who screen positive for depression or post-traumatic stress disorder as a national performance goal. Many VA Medical Centers (VAMCs) are using brief suicidal ideation screens, administered in non-mental health ambulatory care settings, as the first step in the assessment process. To explore Veterans' perceptions of the suicide screening and risk assessment process, the barriers and facilitators to disclosing suicidal thoughts, and perceptions of possible consequences of revealing suicidal thoughts. Investigators recorded one semi-structured interview with each Veteran. Transcripts were analyzed using a modified grounded theory approach. Thirty-four Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans who screened positive for suicidal ideation in non-mental health ambulatory care settings in 2009 and 2010. Veterans accepted the need to assess suicide risk. They increasingly experienced attempts to suppress and avoid thoughts of suicide as burdensome and exhausting. Despite this, Veterans often failed to disclose severe and pervasive suicidal thoughts when screened because: (1) they considered suicidal thoughts as shameful and a sign of weakness; (2) they believed suicidal thoughts were private and not to be divulged to strangers; (3) they worried that disclosure would lead to unwanted hospitalization or medication recommendations; and (4) the templated computer reminder process was perceived as perfunctory and disrespectful. In contrast, admitting and discussing thoughts of suicide with a health provider who focused on building a relationship, demonstrated genuineness and empathy, offered information on the rationale for suicide risk assessment, and used straightforward and understandable language, all promoted trust that resulted in more honest disclosure of suicidal thoughts. In ambulatory care settings, both provider behaviors and system modifications may lead to more honest disclosure of suicidal thoughts.

Suicide Risk: Navigating the Failure Modes

A Suicide-Specific Diagnosis – The Case Against