Perceived stress and suicidal ideation: The role of dispositional mindfulness.

Individuals with bulimia nervosa often experience suicidal ideation. Identity disturbance, or unstable sense of self, has been connected both to eating disorders and to suicidality. This study sought to test whether identity problems were related to severity of current suicidal ideation in a sample of women with bulimic-spectrum pathology, above and beyond history of suicidal behavior and several symptoms of borderline personality disorder. Women (N = 204; 90.7% Caucasian; Mage = 25.7 years [SD = 8.8]) with bulimic-spectrum pathology completed self-report personality assessments and items evaluating suicidality. A hierarchical linear regression was utilized to examine the association between identity problems and severity of current suicidal ideation, before and after inclusion of relevant clinical features (i.e., suicide attempt history [Step 2], affective lability, stimulus seeking, and rejection [Step 3]). Identity problems were directly associated with severity of current suicidal ideation (β = .481, p < .001). This relationship retained significance after inclusion of suicide attempt history (β = .335, p < .001) as well as borderline personality disorder symptoms (β = .324, p < .001). Identity problems displayed a robust relationship with suicidal ideation severity in women with bulimic-spectrum pathology. Findings suggest that identity problems may be a specifically relevant personality feature regarding presence and severity of suicidal ideation in this high-risk group, even after considering the contributions of history of suicidal behavior and various symptoms of borderline personality disorder. There may be value in attending to identity problems when considering suicidal ideation in this population. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

L’effet modérateur de la pleine conscience dispositionnelle dans la relation entre symptomatologie dépressive, troubles de la personnalité limite et idéations suicidaires chez le jeune adulte

Suicide is a major public health concern accounting for 800 000 deaths globally each year. Although there have been many advances in understanding suicide risk in recent decades, our ability to predict suicide is no better now than it was 50 years ago. There are many potential explanations for this lack of progress, but the absence, until recently, of comprehensive theoretical models that predict the emergence of suicidal ideation distinct from the transition between suicidal ideation and suicide attempts/suicide is key to this lack of progress. The current article presents the integrated motivational–volitional (IMV) model of suicidal behaviour, one such theoretical model. We propose that defeat and entrapment drive the emergence of suicidal ideation and that a group of factors, entitled volitional moderators (VMs), govern the transition from suicidal ideation to suicidal behaviour. According to the IMV model, VMs include access to the means of suicide, exposure to suicidal behaviour, capability for suicide (fearlessness about death and increased physical pain tolerance), planning, impulsivity, mental imagery and past suicidal behaviour. In this article, we describe the theoretical origins of the IMV model, the key premises underpinning the model, empirical tests of the model and future research directions.

Substance use, racial/ethnic identity, and suicidal ideation during COVID-19 lockdown in an international adult sample

Emotional distress can lead to suicidal ideation and potentially suicide completion, yet there is very little literature on suicidal ideation in individuals with a diagnosis of neurofibromatosis (NF; NF1, NF2, and schwannomatosis). To examine the baseline occurrence, severity, and clinical correlates of suicidal ideation in adults with NF. Individuals with NF (N = 220) completed assessments measuring depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), perceived stress (Perceived Stress Scale-10), pain (Graded Chronic Pain Scale and PROMIS Pain Interference Short Form 8a), and general quality of life (World Health Organization Quality of Life-Brief version) before beginning a two-arm, single-blind randomized control trial of a live-video mind-body program for stress management and resiliency. Nineteen percent (n = 42) of the individuals experienced suicidal ideation (ie, >0; ideation present several days or greater). More individuals with NF2 experienced suicidal ideation compared with those with NF1 or schwannomatosis. All of the clinical variables except pain intensity were significantly correlated ( P < 0.01) with greater suicidal ideation. Suicidal ideation in individuals with NF was comparable to or higher than that in other medical populations (eg, cancer, dermatological, neurologic). Depression and poor psychological quality of life significantly increased the risk for suicidal ideation. Suicidal ideation was relatively prevalent in individuals with NF seeking participation in a mind-body randomized controlled trial. NF clinicians should be prepared to discuss these concerns and provide resources when suicidal ideation is present. ClinicalTrials.gov (Identifier NCT03406208).

Research is needed to identify the factors that explain the link between prior and future suicidality. This study evaluated possible mediators of the relationship between: (1) the severity of prior suicidality and (2) suicidal ideation severity at 3-month follow-up among a sample of high-risk military personnel. US military service members referred to or seeking care for suicide risk (N = 624) completed self-report psychiatric domain measures and a clinician interview assessing prior suicidality severity at baseline. Three months later, participants completed a self-report measure of suicidal ideation severity. Three separate percentile bootstrap mediation models were used to examine psychiatric factors (i.e. alcohol abuse, anxiety sensitivity, hopelessness, insomnia, posttraumatic stress symptoms, suicidal ideation, and thwarted belongingness) as parallel mediators of the relationship between prior suicidality severity (specifically, suicidal ideation, suicide attempt, and overall suicidality - i.e. ideation/attempt severity combined) at baseline and suicidal ideation severity at follow-up. Hopelessness, specifically, and the total effect of all mediators, each significantly accounted for the relationship between prior suicidality severity and subsequent ideation severity across models. In the models with attempt severity and overall suicidality severity as predictors, thwarted belongingness was also a significant mediator. Hopelessness, thwarted belongingness, and overall severity of psychiatric indices may explain the relationship between prior suicidality severity and future suicidal ideation severity among service members at elevated suicide risk. Research is needed to replicate these findings and examine other possible mediators.

Longitudinal association between stigma and suicidal ideation among patients with major depressive disorder.

Emerging adult college students who binge drink in solitary contexts (i.e., while alone) experience greater depression and suicidal ideation than do students who only binge drink in social contexts, suggesting that they may be at greater risk for suicidal behavior. This study examined the association of a previous suicide attempt, one of the best predictors of future suicide attempts and suicide, and severity of recent suicidal ideation with drinking in solitary and social contexts. Participants were binge drinking, emerging adult (18- to 25-year-old) college students (N=182) drawn from two studies of college drinkers. A logistic regression analysis revealed that both suicide attempt history and severity of suicidal ideation were significantly associated with a greater likelihood of being a solitary binge drinker as opposed to only a social binge drinker. Students with a previous suicide attempt were nearly four times more likely to be solitary binge drinkers. Multiple regression analyses revealed that suicide attempt history was significantly associated with greater frequency and quantity of drinking in solitary, but not social contexts. Suicidal ideation was significantly associated with drinks per solitary drinking day, but not frequency of solitary drinking once suicide attempt history was accounted for. Given the associations found between solitary binge drinking and a history of suicide attempts, as well as greater severity of recent suicidal ideation, it appears that these students are in need of suicide prevention efforts, including treatment efforts aimed at reducing binge drinking.

Teléfono de la Esperanza (TE) is the main Spanish helpline providing telephone listening and support for callers in crisis. Crisis helplines can facilitate the identification of persons at risk for suicide. The main goals of this cross-sectional study were to identify severe suicidal ideation and to explore the differential characteristics between callers with severe and low-moderate suicidal ideation. A sample of 26,032 callers to TE was assessed; 544 callers with suicidal ideation were evaluated through ATENSIS, an assessment tool designed to collect information related to suicidal ideation. Comparisons between severe and low-moderate suicidal ideators in sociodemographics, telephone call timing, risk factors, and suicidality variables were conducted. Sixty-four (11.8%) of the suicidal ideators presented with severe suicidal ideation and 480 (88.2%) with low-moderate severity. Significant differences in several sociodemographic characteristics, risk factors, and suicidality variables between both levels of suicidal ideation severity were found. In the regression analysis, the main variables related to the presence of high suicidal ideation severity were preparatory acts, previous suicide attempts, non-suicidal self-injuries, lack of life sense, age, and hopelessness. It is concluded that helplines can be used to identify suicidal ideation among callers and to provide rapid crisis interventions according to the risk of suicide.

Suicide risk is an issue of increasing concern among military personnel. To date, most studies have focused on identifying risk factors for suicide in military personnel, but have by and large overlooked possible protective factors that reduce suicide risk, such as optimism. In a clinical sample of 97 treatment-seeking active duty Air Force personnel, the protective effects of optimism on suicidal ideation was investigated by considering the direct effect of optimism on suicidal ideation as well as the possible moderating effects of optimism on several suicide risk factors: depression, posttraumatic stress, and hopelessness. When adjusting for demographic and clinical covariates, results of multiple regression indicated that optimism was significantly associated with less severe depression, hopelessness, and suicidal ideation, but not posttraumatic stress symptoms. The interaction of optimism with hopelessness was also significant, and indicated that severe hopelessness contributed to more severe suicidal ideation only among participants with low levels of optimism. Results suggest that optimism is associated with less severe suicidal ideation, and buffer the effects of hopelessness among military patients.

BackgroundSuicidal ideation is a major risk for a suicide attempt in younger people, such that reducing severity of ideation is an important target for suicide prevention. Smartphone applications present a new opportunity for managing ideation in young adults; however, confirmatory evidence for efficacy from randomized trials is lacking. The objective of this study was to assess whether a therapeutic smartphone application (“LifeBuoy”) was superior to an attention-matched control application at reducing the severity of suicidal ideation.Methods and findingsIn this 2-arm parallel, double-blind, randomized controlled trial, 455 young adults from Australia experiencing recent suicidal ideation and aged 18 to 25 years were randomly assigned in a 2:2 ratio to use a smartphone application for 6 weeks in May 2020, with the final follow-up in October 2020. The primary outcome was change in suicidal ideation symptom severity scores from baseline (T0) to postintervention (T1) and 3-month postintervention follow-up (T2), measured using the Suicidal Ideation Attributes Scale (SIDAS). Secondary outcomes were symptom changes in depression (Patient Health Questionnaire-9, PHQ-9), generalized anxiety (Generalized Anxiety Disorder-7, GAD-7), distress (Distress Questionnaire-5, DQ5), and well-being (Short Warwick–Edinburgh Mental Well-Being Scale, SWEMWBS). This trial was conducted online, using a targeted social media recruitment strategy. The intervention groups were provided with a self-guided smartphone application based on dialectical behavior therapy (DBT; “LifeBuoy”) to improve emotion regulation and distress tolerance. The control group were provided a smartphone application that looked like LifeBuoy (“LifeBuoy-C”), but delivered general (nontherapeutic) information on a range of health and lifestyle topics. Among 228 participants randomized to LifeBuoy, 110 did not complete the final survey; among 227 participants randomized to the control condition, 91 did not complete the final survey. All randomized participants were included in the intent-to-treat analysis for the primary and secondary outcomes. There was a significant time × condition effect for suicidal ideation scores in favor of LifeBuoy at T1 (p < 0.001, d = 0.45) and T2 (p = 0.007, d = 0.34). There were no superior intervention effects for LifeBuoy on any secondary mental health outcomes from baseline to T1 or T2 [p-values: 0.069 to 0.896]. No serious adverse events (suicide attempts requiring medical care) were reported.The main limitations of the study are the lack of sample size calculations supporting the study to be powered to detect changes in secondary outcomes and a high attrition rate at T2, which may lead efficacy to be overestimated.ConclusionsLifeBuoy was associated with superior improvements in suicidal ideation severity, but not secondary mental health outcomes, compared to the control application, LifeBuoy-C. Digital therapeutics may need to be purposefully designed to target a specific health outcome to have efficacy.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12619001671156

Young adults are at elevated risks of hikikomori (severe social withdrawal) under the COVID-19 pandemic, which could lead to psychological distress and suicidal ideation. The present study aimed to examine the associations among hikikomori, suicide stigma, suicidal ideation, and help-seeking behaviors among young adults in Hong Kong. This study recruited a large sample of 2,022 young adults in Hong Kong via an online survey at the end of 2021. The participants completed the Hikikomori Questionnaire and validated measures on psychological distress, suicide stigma, and suicidal ideation severity and report their help-seeking behaviors. Multivariate analysis of variance was conducted to compare the profiles of the hikikomori groups. Path analysis evaluated the effects of hikikomori and suicide stigma on occurrence and severity of suicidal ideation and their associations with help-seeking behaviors. Hikikomori showed significant and positive indirect effects on prevalence and severity of suicidal ideation via psychological distress. Glorification positively predicted hikikomori and suicidal ideation severity among suicidal persons. Hikikomori was associated with reduced help-seeking. Isolation and suicidal ideation were associated with greater barriers to seek help among the non-help-seekers. Perceived helpfulness of sought help was negatively associated with hikikomori and suicidal ideation among the help-seekers. The present findings demonstrated greater prevalence and severity of suicidal ideation and less help-seeking in young adults with hikikomori. Suicide stigma showed differential associations with hikikomori, suicidal ideation, and help-seeking behaviors.

Objectives:To evaluate long-term outcomes after an 8-week mindfulness intervention, Mindfulness for Interdisciplinary Health Care Professionals (MIHP), and investigate relationships between outcomes overtime.Design/Methods:In this single-arm study, 35 participants received MIHP and completed measures of burnout, perceived stress, activity impairment, and dispositional mindfulness at baseline, post-MIHP, and a 3-month follow-up. Changes over time were evaluated using repeated-measures analysis of variance (ANOVA) and reliable change indices (RCIs). Then, correlations between dispositional mindfulness and distress/impairment outcomes were evaluated.Results:At follow-up, aspects of burnout and several mindfulness skills demonstrated maintained improvements. RCIs showed that a higher percentage of participants improved on all outcomes at each time period than declined—all outcomes showed little to no deterioration. However, most participants did not reliably change, and this was more pronounced at the follow-up. Changes in two mindfulness skills (acting with awareness and nonjudging of inner experience) were consistently negatively correlated with distress and impairment outcomes.Conclusions:Acquired mindfulness skills during MIHP were maintained at the follow-up. RCI analyses demonstrated that MIHP may protect against worsening stress and burnout during training. Two mindfulness skills, acting with awareness and nonjudging of inner experience, showed potential mechanistic effects on work-relevant outcomes. Booster sessions to encourage maintained mindfulness practices and skills should be investigated in future trials. This study was registered on clinicaltrials.gov (#NCT03403335) on January 11, 2018.

Veterans with combat exposure experience high rates of posttraumatic stress symptoms (PTSS) and associated suicidal ideation. The current study examined whether social support (i.e., social connectedness and social engagement) and protective psychological factors (i.e., resilience and altruism) moderated the relation between PTSS and suicidal ideation severity in a sample of 149 U.S. military combat veterans who served in the Vietnam War or Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND). Consistent with expectations, initial PTSS were positively associated with concurrent and three-year follow-up severity of suicidal ideation. Moderation analyses revealed the relation between initial PTSS and concurrent suicidal ideation severity was no longer significant at above average levels of social connectedness, social engagement, and psychological resilience. Further, the relation between initial PTSS and suicidal ideation severity three years later continued to be buffered by above average levels of social engagement. Results suggest social connectedness, psychological resilience, and social engagement help moderate initial severe thoughts of suicide linked to PTSS, while social engagement might be the strongest protective factor against severe suicidal ideation over time. Empirically-supported prevention and treatment efforts enhancing social engagement may help promote resilience to severe PTSS-related suicidal ideation among veterans from Vietnam and OEF/OIF/OND combat eras.

There is a dearth of research on mental health in transgender military service members, despite 21.4% of eligible transgender United States citizens having served in the military. The aim of this study was to examine differences in suicide risk and ideation based on gender identity in elevated risk service members over a 3-month period. Participants included 1,041 military service members identified as at risk of suicide by military treatment providers. Of these participants, 1,027 provided baseline data and 726 provided follow-up data. Baseline suicide risk was measured using the Suicidal Behaviors Questionnaire—Revised, and baseline suicidal ideation was derived from the Self Harm Behaviors Questionnaire. Follow-up data on suicidal ideation were collected using the Adult Suicidal Ideation Questionnaire. At baseline, differences in suicide risk and ideation between transgender and cisgender military members were not significant. However, at the 3-month follow-up, transgender service members had significantly higher levels of suicidal ideation than cisgender service members. In our sample, at-risk transgender service members do not differ from their at-risk cisgender counterparts in severity of suicidal risk or ideation. These findings have implications for future research to inform military policy and mental health services.