The aim of this study is to conduct a longitudinal evaluation of the effectiveness of Dialectical Behavior Therapy (DBT) based on the "Internet Plus" model on adolescents with Non-Suicidal Self-Injury (NSSI). Seventy-four NSSI patients were randomly divided into an intervention group (36 cases) and a control group (38 cases). The intervention group underwent a 3-month "Internet Plus" DBT intervention, whereas the control group received standard psychological intervention. The Adolescent Non-suicidal Self-injury Assessment Questionnaire (ANSAQ), the Hamilton Depression Rating Scale (17 items, HAMD-17), and the Simplified Coping Style Questionnaire (SCSQ) were administered to assess NSSI behavior, depressive symptoms, and coping strategies at baseline and at 1, 2, and 3 months post-intervention. The intervention group demonstrated significant improvements in the frequency of self-injury, depressive symptoms, and coping strategies (p < 0.05), with notable differences compared to the control group. The "Internet Plus" DBT intervention model has a positive effect on improving the symptoms of adolescents with NSSI.

Sleep disturbances are established risk factors for suicidal thoughts and behaviors (STB) in adolescents. Nightmares are understudied in this context. The Interpersonal Psychological Theory of Suicide (IPTS) proposes that suicide ideation (SI) alone is not a risk factor for suicide attempt (SA); instead, high levels of SI interact with capability (i.e., factors that enable ideators to make attempts). Through the lens of the IPTS, this study explored the role of nightmares as correlates of variables associated with STB and as potential indicators of capability. We assessed nightmare frequency and severity in 340 adolescents at entry into intensive treatment for STB. For the group at large, nightmares did not have direct relationships with SI and SA but were correlated with variables associated with these outcomes. The pattern of associations suggested that nightmares are distal risk factors for SI mediated by insomnia, depression, and emotional dysregulation. In the presence of high SI, nightmares were associated with SA, even after controlling for STB-related variables. Nightmares may be an indicator of capability potentiating SA in youth with high SI. Our findings highlight the importance of assessing nightmares in the management of suicidal youth and exploring interventions that decrease nightmares as a suicide prevention strategy.

In 1997, the Heaven's Gate religious group died by mass suicide. Before their deaths, many members left videotaped final messages ("exit statements"), recording a functional equivalent to a suicide note. This study used natural language processing to compare the proportion of emotion keywords present in these statements to a collection of traditional suicide notes to examine whether the psychological state of individuals differs from more traditional cases of suicide. Heaven's Gate exit statements were transcribed and compared to a collection of traditional suicide notes collected from Leenaars (1988). Text was analyzed using Linguistic Inquiry and Word Count-22 (LIWC-22). Emotion scores between the two groups were compared using Welch's t-test. Overall, Heaven's Gate exit statements contained significantly fewer emotion keywords than traditional suicide notes. Post hoc analysis likewise found Heaven's Gate exit statements to contain significantly fewer positive emotion words and negative emotion words. These results suggest Heaven's Gate members had less emotion surrounding dying by suicide than nonmembers. This result demonstrates that cases like Heaven's Gate (i.e., religious and mass suicide events) may not be well represented by prevailing theories of suicide.

ABSTRACTIntroductionPersistent suicidal ideation (PSI) represents a clinically relevant phenomenon that remains insufficiently understood. The aim of this scoping review was to provide an overview of empirical studies investigating PSI, with a focus on definitions, operationalizations, and associations with indicators of mental health, suicidal behaviors, and treatment approaches.Materials and MethodsFollowing established guidelines for conducting scoping reviews, a systematic search of the literature was conducted, and studies were screened according to predefined inclusion criteria.ResultsN = 44 articles reporting on n = 40 individual studies were included in this review. The results indicate that several empirical studies have addressed PSI, most commonly using longitudinal designs. However, the absence of a consistent conceptualization across studies led to diverse and heterogeneous operationalizations and partly contradictory findings, making synthesis difficult.DiscussionA major limitation of this review lies in the inconsistent terminology across publications, which may have resulted in missed studies. Furthermore, case studies and theoretical works were excluded, narrowing the scope of the findings.ConclusionThe clinical relevance of PSI contrasts with the lack of empirical findings addressing its epidemiological and phenomenological characteristics. Future research should establish a common definition and operational criteria for PSI.

Caring Cards is a novel adaptation of caring contacts, where Veterans with a history of suicidality (card makers) create cards for Veterans with active suicidality (recipients). Aims included (1) establishing Caring Cards' feasibility and acceptability, including an optional meetup group, and (2) evaluating pre-/postchanges in thwarted belongingness, perceived burdensomeness, social connectedness, and suicide ideation. Participants included 30 card makers and 50 recipients receiving care at a Veterans Affairs Center. Groups of 5-10 card makers met weekly for 3-6 months to create cards; recipients received cards monthly for 6 months. Outcomes were collected at baseline and follow-up (one month postparticipation completion). Card makers demonstrated marginal feasibility (69.4% average attendance). Card maker attrition was greater than expected (60%). These rates may have been impacted by COVID-19. Card maker follow-up was feasible (70%). There was 0% attrition for recipients; however, follow-up was marginally feasible (68%). The optional meetup group was not feasible (36.4% attendance). All participants found the intervention acceptable (> 75% average satisfaction). There were no significant pre-/postdifferences across card maker outcomes. Recipients reported significant reductions in thwarted belongingness (d = 0.27) and perceived rejection (d = 0.41). Results highlight the promise of Caring Cards as a low-cost, highly scalable intervention.

Little is known about the prevalence of self-injurious thoughts and behaviors, including suicidal ideation (SI), suicide attempts (SA), and non-suicidal self-injury (NSSI) for transgender and gender-diverse (TGD) deaf adults. This project used data collected as part of the 2017 TransLifeline Mental Health Survey. Study participants include N = 4245, self-identified TGD adults ages 18-87 that currently live in the United States. Chi-square analyses compared endorsement of lifetime and recent SI, SAs, and NSSI between TGD deaf and TGD hearing adults. Compared to their TGD hearing peers, TGD deaf participants, regardless of gender identity, were more likely to endorse hospitalization for SI, despite equivalent endorsement of past-year and lifetime SI compared to their TGD hearing peers. Similarly, TGD deaf participants, regardless of gender or racial/ethnic identity, were more likely to endorse a lifetime hospitalization for a SA. Lastly, although TGD deaf participants were equally likely as their TGD hearing peers to endorse lifetime experiences of NSSI, TGD deaf participants were more likely to report hospitalization for NSSI. TGD deaf adults are at an increased risk of making a SA in their lifetime and at an increased risk for hospitalization for SI, SAs, and NSSI.

Among patients with substance-related disorders (SRDs) and suicide attempts in 2014-2021, we identified care trajectories within a 3-year period preceding their last suicide attempt (index date). We also determined associations between care trajectories and patients sociodemographic and clinical characteristics, quality of care received, and risk of death in the following year. Using Quebec (Canada) medical databases, we produced Group-based Multi-Trajectory Modeling, Multinomial Logistic Regression, and Cox Proportional Hazards models. We identified five care trajectories (profiles) among the 2297 study patients. Profile 1 (31%, reference profile) had low outpatient care with late increase in acute care use. It included more men, younger patients and individuals with overall better conditions. Profile 2 (22%) received high physical healthcare and had more chronic physical illnesses. Profile 3 (19%), with more serious mental disorders, and Profile 4 (16%), with more polysubstance-related disorders, used more outpatient mental health (MH) or SRD care, decreasing before index date. Profiles 2, 3 and 4 increasingly used acute care before index date. Profile 5 patients (12%) had more health problems, and so showed the highest overall care use and highest risk of death. Tailored interventions are suggested for all profiles, with improved screening and SRD-MH care.

ABSTRACTIntroductionIn the past two decades, suicide attempts and deaths involving prescription opioids have sharply increased. Research is needed to understand how prescription opioid misuse may increase suicide risk. Contemporary suicide theories suggest opioid use may increase suicide capability by increasing pain tolerance, altering fears related to death, or increasing one's understanding of lethal doses and/or access to means. This study examined the role of these dimensions of suicide capability in the association between prescription opioid misuse and self‐reported likelihood of future suicidal behaviors.MethodsIndividuals with chronic pain, past year depression, and a current prescription of opioids for pain (N = 166) completed assessments of opioid misuse, suicide capability (i.e., fearlessness about death, pain tolerance, and suicide preparation and rehearsal), and suicidal behaviors.ResultsAnalyses demonstrated significant indirect relations of prescription opioid misuse to the perceived future likelihood of suicide planning and attempts (both in general and involving opioids specifically) through suicide capability in the form of suicide preparation and rehearsal, controlling for suicide attempt history.ConclusionFindings suggest that prescription opioid misuse may increase suicide risk by increasing familiarity with a potential suicide method, consistent with extant literature highlighting the role of practical suicide capability in suicide risk.

ABSTRACTIntroductionSuicide is the second leading cause of death in adolescents in the United States. There is an urgent need to advance understanding of risk mechanisms in adolescents to guide early interventions. While prior research has implicated cognition, neural connectivity, and psychopathology in relation to adolescent suicidal ideation (SI) and nonsuicidal self‐injury (NSSI), there is a relative lack of clarity regarding the causal structure of these factors, particularly in early adolescence.MethodsCausal discovery analysis was applied to neuroimaging, neurocognition, and clinical assessment data from the baseline visit of the Adolescent Brain Cognitive Development Study when the participants were 9–10 years old (N = 8937; 49.6% female) to produce models of causal relationships.ResultsIn the discovered model, causal pathways from resting state functional connectivity to externalizing and internalizing psychopathology were observed. Greater externalizing psychopathology increased SI and NSSI. Cognitive performance indirectly increased SI and NSSI via its negative relationship with externalizing psychopathology. Finally, more SI increased NSSI.ConclusionsIn this developmental window prior to when the risk of suicide accelerates, it is critical to begin to advance our understanding of the processes that may undergird suicide risk (neural, cognitive performance), features of psychopathology and the potential progression of SI and NSSI (both risk factors for suicide). Future research should incorporate other factors related to SI and NSSI to produce a more comprehensive understanding of the mechanisms of risk. This line of research has the potential for a more comprehensive understanding of risk and provides avenues for prevention.

ABSTRACTIntroductionThe 15%–20% of adolescents worldwide who engage in nonsuicidal self‐injury (NSSI) face an increased risk of transitioning from suicidal ideation to suicide attempt. To resist NSSI urges, young people often seek peer support online. We examined adolescent help‐seeking on a purpose‐built online mental health peer support platform, which is a critically understudied help‐seeking venue.MethodsAdolescents' help‐seeking posts in the “Self Harm” category on a large online peer support platform (575,261 posts from 114,937 users) were analyzed using topic modeling. We assessed the prevalence of NSSI‐related topics versus morbid/suicidal topics.ResultsOur 12‐topic model produced interpretable themes. Three main findings emerged: posts included little information about the context of self‐harm behavior; there was minimal evidence of pro‐self‐harm content in posts; and the primary topics of the posts were evenly split between NSSI‐related topics and morbid/suicidal topics.ConclusionOur findings have important implications for online mental health communities: requiring users to select a narrow category for their post may limit contextual information; moderation of pro‐self‐harm content may reduce its prevalence; and the absence of dedicated spaces for suicidal users may funnel those users into NSSI‐focused spaces, potentially increasing risk for all users.