Suicide is a major public health problem in the United States. This retrospective exploratory study examined clinician-identified state-related risk factors observed within 30 days prior to death by suicide, comparing 24 decedents with psychosis-related suicide and 133 non-psychosis-related suicide. A secondary descriptive analysis was conducted for 47 patients who were evaluated and denied suicidal ideation within 48 h of death by suicide. Demographic factors being single and unemployed increased risk across both cohorts. While reporting similar SI histories, decedents with psychosis had higher rates of suicide attempts (67% vs. 38%), anxiety and agitation (83% vs. 77%), substance abuse (79% vs. 40%), comorbid diagnosis (71% vs. 54%), social isolation (71% vs. 54%), and treatment non-adherence (58% vs. 4%). In contrast, decedents without psychosis reported sleep problems (80% vs. 54%), and acquired capability for suicide (96% vs. 46%). Among psychotic patients who denied having SI, 83% died by suicide within two days of evaluation. Suicide risk assessment that places strong reliance on verbalized SI as a gateway to determine risk is insufficient in practice. For optimal clinical management and suicide prevention clinicians need a better understanding of near-term risk for suicide and to focus assessment and clinical care accordingly.

In recent years, the prevalence of non-suicidal self-injury (NSSI) and suicidal ideation (SI) has been continuously increasing among adolescents, making it a global public health concern. While previous studies have identified a close relationship between NSSI and SI, few have delved into their reciprocal relationship and the underlying mechanisms. This study aimed to examine the longitudinal relation between NSSI and SI, and the mediating role of irritability in the bidirectional association. This study used the Brief Irritability Test (BIT), the Deliberate Self- Harm Inventory (DSHI), and the Beck Scale for Suicidal Ideation Chinese version (BSICV) in a three-wave longitudinal survey among 1711 Chinese adolescents (MAge = 14.44 years, SD = 1.35; 54.7% females), with 6-month intervals. Data were analyzed by using the random intercept cross-lagged panel model (RI-CLPM). The results revealed that: (1) At the between-person level, NSSI, irritability, and SI were all positively associated with one another. (2) Greater within-person NSSI predicted future greater SI and vice versa. (3) Greater within-person irritability predicted future greater SI and NSSI, and vice versa. (4) Irritability acted as a mediator in the bidirectional relations between NSSI and SI. The study proposed a dynamic and integrative perspective on the longitudinal relation among NSSI, irritability, and SI, emphasizing the evolving nature of these reciprocal relationships. These findings underscore the importance of addressing irritability in adolescents and highlight the need to enhance adolescents' emotional regulation skills to effectively mitigate the risk of NSSI and SI.

ABSTRACTIntroductionSuicide is a leading cause of preventable death worldwide, with approximately 700,000 individuals dying by suicide annually. Recent studies have highlighted the importance of text‐based risk assessments and the use of artificial intelligence technologies such as ChatGPT in suicide prevention. This study examined how intolerable interpersonal situations influence text communication, focusing on the relationship between perceived burdensomeness and the expression of apologetic messages.MethodsA total of 120 university students participated in the Interpersonal Persistence Task (IPT), manipulating levels of perceived burdensomeness and thwarted belongingness (high and low PB–TB conditions) to observe their effects on participants' desire to escape and communication behaviors.ResultsParticipants in the high PB–TB condition reported higher levels of perceived burdensomeness and a stronger desire to escape the task. Regression analyses indicated that perceived burdensomeness predicted the frequency of apology expressions in the high PB–TB condition.ConclusionsThese findings suggest that perceived burdensomeness may influence the expression of apology in digital communication under interpersonal distress. While not directly indicative of suicide risk, apologetic messages could reflect psychological vulnerability in certain contexts.

While Joiner's Interpersonal Psychological Theory of Suicidal Behavior (IPTSB) has been shown relevant to understanding suicide behaviors among Ghanaian adolescents, the integration of sociocultural factors into the theory is important due to Ghana's diverse cultural setting. This study tests the inclusion of sociocultural variables (traditional beliefs, suicide stigma, and religiosity) in the IPTSB to explain suicidal behaviors among junior high school students in Ghana. A sample of 800 students (mean age 15.5 years) completed self-reported measures of suicide behavior (ideation, plan attempt), the Interpersonal Needs Questionnaire, and sociocultural measures. Model fit indices for the original and socioculturally inclusive IPTSB, as well as associations between predictors (suicide stigma, religiosity, traditional beliefs) and suicide behavior, were assessed for significance. The socioculturally inclusive IPTSB model demonstrated an excellent fit for explaining 12-month suicide behavior (RMSEA = 0.03, CFI = 0.99, TLI = 0.96, SRMR = 0.11) and lifetime suicide behavior (RMSEA = 0.02, CFI = 0.99, TLI = 0.98, SRMR = 0.09). The chi-square difference test (χ2 = 130.97, [df = 7], p < 0.001) indicated the socioculturally inclusive model significantly improved explanatory power. Findings affirm the IPTSB's core components while demonstrating that sociocultural factors, particularly stigma, significantly influence suicidal behaviors among Ghanaian adolescents.

This study examines longitudinal models of self-directed violence among 584 Black people (44% female) in a community-based sample living in areas of concentrated disadvantage. I used data from the Self-Help in Eliminating Life-Threatening Diseases study in Baltimore City, Maryland. Multiple groups factor analyses and generalized structural equations evaluated invariance between observed female and male genders across longitudinal mediation models linking perceived neighborhood disorder to self-directed violence ideations through witnessing and experiencing interpersonal violence. Greater perceived neighborhood disorder was significantly associated with witnessing violence, which correlated significantly with experiencing violence. Experiencing violence was significantly associated with greater rates of active and passive self-directed violence ideations. The model was structurally invariant between genders, but factor loading variance on experiencing violence showed that attacks with weapons loaded significantly more among males, while rape emerged as a distinct form of violence for females. The study supported a multilevel violence risk process. Structural violence among Black people living in areas of concentrated disadvantage becomes internalized through perceived neighborhood disorder that contributes to exposure to interpersonal violence and subsequent active and passive self-directed violent ideations. These results highlight how community-based approaches to multilevel violence risk as a gendered process can inform public health theory and practice.

The Brief Suicide Cognitions Scale (B-SCS) is a self-report measure of suicidogenic cognitions. This study evaluated measurement invariance of the B-SCS among different subgroups. Secondarily, this study sought to evaluate the replicability of the psychometric validity, reliability, and factor structure of the B-SCS. Participants included undergraduate students (N = 2000) recruited between 2022 and 2023. Multigroup Confirmatory Factor Analyses (CFA) were conducted comparing participants by race, ethnicity, gender, and sexuality. Results support the existence of a unidimensional factor structure of the B-SCS. Multigroup CFA analyses yielded all levels of measurement invariance across White and Black, Hispanic and Non-Hispanic, cisgender men and women, and heterosexual and sexual minority individuals. Additionally, the B-SCS was found to have strong internal consistency and good concurrent validity. Finally, the B-SCS was able to discriminate between participants who had a history of suicide attempts and those who did not. These results indicate that the B-SCS is a valid and reliable tool to be used in assessing suicidogenic cognitions. Moreover, results from measurement invariance analyses indicate that this tool may be viable to use within specific sub-populations examined within this study.

The Interpersonal Theory of Suicide (ITS) identifies key dynamic factors, including thwarted belongingness, perceived burdensomeness, and interpersonal hopelessness, that may aid in assessing and preventing suicidal thoughts and behaviors. These constructs can also be understood within the framework of the Five Factor Model (FFM) of personality. This study aimed to examine the relationship between personality profiles, the severity of suicide-related histories, and ITS-related risk factors. Additionally, we sought to determine whether the relationship between ITS-related risk factors and the severity of suicide-related histories was moderated by personality profiles. A nationwide sample of 1367 adults, collected via CloudResearch, completed an online survey. Six distinct personality profiles were identified via latent profile analysis. Elevated levels of neuroticism and low levels of conscientiousness corresponded to the highest levels of suicide-related histories. Lower levels of neuroticism coupled with higher levels of extraversion and conscientiousness were associated with reduced levels of suicide-related histories and ITS-related risk factors. However, personality profiles did not moderate the relationship between ITS-related risk factors and the severity of suicide-related histories. Future research should investigate whether directly targeting personality domains contributes to mitigating suicide risk and alleviating thwarted belongingness, perceived burdensomeness, and interpersonal hopelessness.

US Veterans are at higher risk for suicide compared to the general population. Access to evidence-based practices for suicide prevention (EBP-SPs) is limited; however, emerging research supports the delivery of EBP-SPs through telehealth. The Veterans Health Administration's (VHA) Suicide Prevention (SP) 2.0 Clinical Telehealth Program aims to increase nationwide access to EBP-SPs for Veterans with recent suicidal self-directed violence (SSDV). This paper describes initial outcomes of SP 2.0's Cognitive Behavioral Therapy for SP (CBT-SP). From April 2021 to September 2023, SP 2.0 provided EBP-SPs to Veterans via telehealth. Veterans were eligible if they were enrolled in VHA care and engaged in SSDV (suicide attempts and/or preparatory behavior) in the past 12 months. CBT-SP was provided via VHA's telehealth platform, accessible to all 139 VA Health Care Systems in the US. Outcomes were captured via electronic health records and analyzed using logistic regression and generalized linear models. Significance was set at p < 0.003. Veterans (N = 2712) received an average of 8.54 CBT-SP sessions. Models demonstrated improvements in suicide-related coping, depression, suicidal thought intensity, hopelessness, urge and intent to kill self, and self-efficacy. Providing CBT-SP via telehealth is feasible and Veterans demonstrated several improvements. Implications and future research directions are discussed.

ABSTRACTIntroductionEmphasis on medical severity when assessing the lethality of suicide attempts may overlook important contextual factors. We examined if distinguishing between medical severity and chance of rescue improves evaluation and understanding of suicidal mental states.MethodsSeventy adolescent inpatients with a recent suicide attempt were interviewed with the Suicide Intent Scale, and clinicians rated the Risk‐Rescue Rating Scale, which provides separate ratings for medical severity (Risk) and chance of rescue (Rescue). They also completed the Interpersonal Needs Questionnaire and Fearlessness about Death scale.ResultsThe lethality components Risk and Rescue were uncorrelated (r = −0.02). However, Rescue was significantly negatively correlated with suicidal intent (r = −0.46), fearlessness about death (r = −0.29), and unmet interpersonal needs (r = −0.28), while Risk was only correlated with suicidal intent (r = 0.29). In a hierarchical regression model, Rescue was the strongest predictor of suicidal intent.ConclusionRescue factors, more than medical severity factors, were consistently related to our measures of suicidal mental state. Including the rescue component in lethality assessments may improve both the accuracy of clinical evaluations and our understanding of adolescents' mental state during suicidal crisis.

The fearlessness about suicide scale (FSS) was developed in response to evidence suggesting fearlessness about suicide is more relevant to the capability for suicide than fearlessness about death. To extend its psychometric validation, this study provides a cross-sectional comparison of the FSS and the acquired capability for suicide-fearlessness about death (FAD) scale. Pearson correlations and regression analyses examined associations between both scales with suicidal ideation (SI), pain tolerance, non-suicidal self-injury (NSSI), and eating disorder symptoms in 1233 undergraduates. In the full sample, the FSS was positively associated with SI, general pain tolerance, NSSI, restriction, purging, and muscle building, but negatively with NSSI pain tolerance. The FAD was positively associated with SI, general pain tolerance, anti-suicide and sensation-seeking NSSI functions, and muscle building, but negatively with NSSI, binge eating, and eating disorder cognitive symptoms. Differential patterns of associations emerged across individuals with and without recent SI. The FSS appears more strongly associated with painful and frightening experiences hypothesized to contribute to the capability for suicide, whereas the FAD is associated with traits and behaviors associated with unintentional bodily harm. Longitudinal research is needed to examine the FSS's predictive ability for future self-injurious thoughts and behaviors.