Beliefs About Suicidal Ideation and Behaviors Among Veterans Thinking About Suicide: A Qualitative Exploration Utilizing the Theory of Planned Behavior.

Background: Driving under the influence of alcohol or other substances (DUI) and suicide are both persistent but potentially preventable public health problems. DUI offenders, particularly those who have repeatedly offended, report elevated risk for many suicide risk factors. However, researchers have not systematically studied associations between repeat DUI and suicide.Methods: Out of a population of 729 repeat DUI offenders, 207 were asked about lifetime suicidal thoughts and behaviors (STB) and lifetime instances of DUI as an attempt at self-harm. We calculated rates of DUI as self-harm and compared lifetime STB rates to rates observed in the National Comorbidity Survey Replication (NCS-R). In addition, we examined associations between known risk factors of STB (e.g. psychiatric disorders, marital status) and lifetime STB outcomes among repeat DUI offenders.Results: Nearly 4% of repeat DUI offenders reported that at least one past experience of DUI was a deliberate attempt to take their own life and an additional 3.4% reported that at least one past experience of DUI was a form of non-suicidal self-injury (NSSI). Rates of lifetime STB all were significantly higher among repeat DUI offenders than NCS-R respondents. For repeat DUI offenders, several risk factors (e.g. race/ethnicity, age, anxiety disorders, NSSI) shared significant relationships with at least one lifetime STB outcome.Conclusion: An exclusive focus on drinking habits and problems is insufficient to address mental health risk among repeat DUI offenders, who might require specialized services designed to address STB.

Multi-method assessment of suicidal thoughts and behaviors among patients in treatment for OCD and related disorders

Autonomic correlates of lifetime suicidal thoughts and behaviors among adolescents with a history of depression.

Interoceptive Accuracy, Sensitivity, and Attention are Associated with Suicidal Thoughts and Behaviors.

Preadolescent Suicidal Thoughts and Behaviors: An Intensive Longitudinal Study of Risk Factors

Maternal mental health conditions, comprising maternal suicide and drug overdose, are currently the leading cause of maternal mortality in the United States. However, the relationship between suicidality and drug use behavior in the perinatal period is not well understood. We examined the association between suicidality and drug use behavior among perinatal individuals. Given the racial disparities in both drug use and suicide rates in the U.S., we also examined any differences in suicidality and drug use behavior by race. Participants were recruited from a High-Risk Obstetric & Gynecological Clinic in the Midwestern U.S that specializes in providing obstetric care to perinatal individuals who have histories or current use of opioids and other illicit drugs. Participants (N = 66) were a sub-sample of a larger cohort enrolled in an mHealth intervention to support recovery from opioid and stimulant use disorders. We performed chi-square tests and t-tests to examine any significant associations between lifetime suicidality and drug use behavior during the perinatal period. The final analytic sample included participants who had responded to the suicidality survey questions (n=43). Nearly 40% (n=16) of our sample endorsed a lifetime history of suicidal thoughts and behaviors (SITB). Of those, 87% (n=15) reported a previous suicide attempt . SITB was significantly associated with cravings for opioids during the perinatal period (p = .01) as well as comorbidities with perinatal anxiety symptoms? ( p < .05), depression symptoms? (p < .05), and bipolar disorder (p < .05). A higher proportion of recent cannabis use was found among mothers with SITB, compared to those without SITB (p=0.04). Mothers with SITB also had a strong positive correlation between preconception and postnatal nicotine use compared to mothers without SITB (p < .01). Finally, while white mothers endorsed more lifetime overdoses (p= 0.01), Black mothers endorsed higher cravings for opioids during pregnancy (p = 0.03). A history of SITB is a distinct risk factor for both illicit and recreational drug use behavior in the perinatal period, and frequently co-occurs with other perinatal mental health conditions. Further research is needed to better understand the directionality of this relationship and the complex interplay between high risk drug use behavior and suicidality.

Suicidal thoughts and behaviors (STBs) are a public health concern, particularly among Veterans, who experience elevated rates of STBs. Social integration is negatively associated with STBs, such that high social integration is correlated with low rates of STBs. Much of the literature has studied marital status as a social relationship that may protect individuals from STBs. Although largely unstudied, it has long been assumed that social integration moderates the link between marital status and STBs. Thus, in a sample of Veterans (N = 1469; Military Health and Well-Being Project), we tested our hypotheses that (1) social integration varies by marital status (single vs. married vs. domestic partnership vs. divorced vs. widowed), (2) social integration is negatively associated with STBs (i.e., lifetime suicidal ideation, past year suicidal ideation, suicidal ideation communication, and likelihood of suicide attempt), (3) STBs vary based on marital status, and (4) social integration moderates the cross-sectional link between marital status and STBs. Results indicated that (1) marital status was associated with social integration, such that married people reported greater social integration than people who were single; (2) social integration was negatively associated with all four STBs (r's < - 0.09, p < 0.001); (3) STBs varied based on marital status such that married people reported fewer STBs than people who were in a domestic partnership, single, widowed, or divorced, and (4) social integration did not moderate the link between marital status and STBs. Findings indicate that factors external to marital status may contribute to the link between social integration and STBs.

Data from high-income countries (HICs) show a high risk of suicidal thoughts and behaviors (STBs) in first-episode psychosis (FEP). It is unknown, however, whether rates and associated factors differ in low- and middle-income countries (LMICs). We therefore aimed to compare the 2-year course of STBs and associated factors in persons with FEP treated in two similarly structured early intervention services in Chennai, India and Montreal, Canada. To ensure fit to the data that included persons without STBs and with varying STBs' severity, a hurdle model was conducted by site, including known predictors of STBs. The 2-year evolution of STBs was compared by site with mixed-effects ordered logistic regression. The study included 333 FEP patients (168 in Chennai, 165 in Montreal). A significant decrease in STBs was observed at both sites (OR = 0.87; 95% CI [0.84, 0.90]), with the greatest decline in the first 2 months of follow-up. Although three Chennai women died by suicide in the first 4 months (none in Montreal), Chennai patients had a lower risk of STBs over follow-up (OR = 0.44; 95% CI [0.23, 0.81]). Some factors (depression, history of suicide attempts) were consistently associated with STBs across contexts, while others (gender, history of suicidal ideation, relationship status) were associated at only one of the two sites. This is the first study to compare STBs in FEP between two distinct geo-sociocultural contexts (an HIC and an LMIC). At both sites, STBs reduced after treatment initiation, suggesting that early intervention reduces STBs across contexts. At both sites, for some patients, STBs persisted or first appeared during follow-up, indicating need for suicide prevention throughout follow-up. Our study demonstrates contextual variations in rates and factors associated with STBs. This has implications for tailoring suicide prevention and makes the case for more research on STBs in FEP in diverse contexts.

Trajectories of Suicidal Thoughts and Behaviors From Preschool Through Late Adolescence.

Neural signatures of suicide risk likely reflect a combination of specific and non-specific factors, and clarifying specific factors may facilitate development of novel treatments. Previously, we demonstrated an altered pattern of resting state connectivity between the dorsal and ventral posterior cingulate cortex (d/vPCC) and the dorsal anterior cingulate cortex (dACC), as well as altered low frequency oscillations in these regions, in individuals with a history of suicidal thoughts and behaviors (STBs) compared to healthy controls. It remains uncertain, however, whether these markers were directly related to STBs or, more generally, reflect a trait-level risk factor for depression. Here, we examined data from a 3-generational longitudinal study of depression where resting state fMRI data were analyzed from 2nd and 3rd generation offspring of probands with (FH+ = 44: STB+ = 32, STB- = 12) and without (FH- = 25: STB+ = 15, STB- = 10) a family history of major depressive disorder (MDD). Standard seed-based methods and a frequency-based analysis of intrinsic neural activity (ALFF/fALFF) were employed. FH of MDD, but not a personal history of STBs or MDD, was associated with relatively reduced dPCC-dACC, and enhanced vPCC-dACC functional connectivity. FH of MDD showed a pattern of reduced ALFF in the dPCC whereas an STB history was associated with an increase. All findings were invariant to confounding by lifetime MDD and current depression severity. Overall, contrary to predictions, resting state functional connectivity within the default mode network (DMN) was associated with FH of depression rather than STBs. These findings confirm the relevance of DMN functional connectivity for mood disorders and underscore the importance of disambiguating biological factors that differentially relate to mental disorders versus STBs.

Preschool-Onset Major Depressive Disorder as a Strong Predictor of Suicidal Ideation and Behaviors Into Preadolescence

A Suicide-Specific Diagnosis – The Case Against

The Modular Assessment of Risk for Imminent Suicide (MARIS): A validation study of a novel tool for suicide risk assessment

Suicidal thoughts and behaviors (STBs) are among the most common reasons for admission to psychiatric inpatient units and a large percentage of these patients also engage in substance misuse. Yet, no known studies have examined whether patients with STBs admitted to inpatient psychiatry units are motivated to change their substance misuse and, if so, whether they benefit from MET-CBT for substance misuse while on the inpatient unit. This study assesses the relationship between STB and motivation to improve substance misuse among 321 (61.1% male, Mage = 35.3 years, 59.8% non-Hispanic/Latin White) patients admitted to an inpatient psychiatric unit with a substance use disorder (SUD) or substance misuse who attended at least one group MET-CBT session, 50.2% of whom were admitted to an inpatient unit for STBs. Patients admitted for STBs reported greater motivation to reduce substance misuse than patients admitted without documented STB, and they did not differ from patients without documented STBs on the number of MET-CBT sessions attended, or ratings of session helpfulness (which were high). Patients admitted for STBs reported significantly increased motivation to change substance misuse after attending MET-CBT for SUD. These findings indicate that psychiatric inpatients with STBs report motivation to change substance misuse as well as willingness to attend MET-CBT for their SUD.

Background: Perceived discrimination (PD) is a risk factor of suicidal thoughts and behaviors (STB) for children, youth, and adults. However, it is unknown whether the association between PD and STB frequency differs between African American (AA) and Non-Hispanic White children. Objectives: In this study, we compared AA and non-Latino White children for the association between PD and STB frequency in a national sample of 9-10-year-old American children. Methods: This cross-sectional study used data from the Adolescent Brain Cognitive Development (ABCD) study, which included 7883 non-Latino White or AA children between the ages of 9 and 10. The predictor variable was frequency of PDs. Race was the moderator. The outcome variable was STB frequency, treated as a count variable, reflecting positive STB items endorsed over the life-course. Covariates included sex, age, marital status, household income, parental education, parental employment, trauma, and economic difficulties. Poisson regression was used for data analysis. Results: Of all the participants, 5994 were non-Latino Whites, and 1889 were AAs. Overall, PD frequency was positively associated with STB frequency. A statistically significant interaction was found between race and PD, suggesting that the association between PD and STB frequency is weaker in AA than non-Latino White children. Conclusion: The observed weaker association between PDs frequency and STB frequency in AA than non-Latino White children suggests that PD may be a less salient risk factor of STB frequency for AA than non-Latino White children. Researchers should explore factors other than PD for suicide prevention of AA children in the US.