Bisexual individuals face elevated suicide risk, yet relatively little is known about short-term fluctuations in suicidal ideation (SI) and related constructs within this population. This study compared the frequency and variability of SI facets among bisexual and heterosexual college students. Sixty-two students (38 heterosexual; 24 bisexual) completed ambulatory assessments five times daily for 10 days, rating suicidal desire, wish to live (WTL), and wish to die (WTD). Analyses included generalized linear models and descriptive and variability statistics. Bisexual participants reported lower WTL and higher suicide desire and WTD than heterosexual peers, with the most robust effects observed for WTD. Bisexual participants were also more likely to endorse non-zero suicidal desire and WTD and experienced more frequent large moment-to-moment changes in these constructs. Models revealed similar variability in suicidal desire and WTD across groups, whereas bisexual individuals exhibited modestly higher variability in WTL. Findings suggested that bisexual individuals not only reported higher levels of suicidal desire and WTD but also experienced these states more frequently, with more frequent acute shifts over time. These results highlighted the importance of monitoring short-term fluctuations in suicidal thoughts and behaviors when assessing suicide risk in bisexual populations.

Youth experiencing high levels of functional impairment may be at risk for suicidal ideation, but variables contributing to this risk remain unclear. The present study investigates the role of perceived burdensomeness toward others as an explanatory variable in the association between functional impairment and suicidal ideation in a sample of clinically referred youth, and whether this relationship differs by age. N = 383 clinically-referred youth aged 6 to 17 (Mage = 10.17, SDage = 2.96; 81.8% Hispanic) completed measures of impairment, perceived burdensomeness, suicidal ideation, and depressive symptoms. Functional impairment was significantly associated with perceived burdensomeness (B = 0.39, p < 0.001), and perceived burdensomeness was significantly associated with suicidal ideation (B = 0.02, p < 0.001). The indirect effect of impairment on suicidal ideation through perceived burdensomeness was statistically significant (B = 0.005, SE = 0.002). The conditional indirect effect was significant and strengthened as a function of age. These findings provide novel evidence that perceived burdensomeness may explain the link between impairment and suicidal ideation in youth, and that this explanatory link strengthens with increasing age. Clinically, results underscore the need for developmentally tailored interventions that target perceptions of burdensomeness to mitigate suicidal thoughts in at-risk youth.

Nonsuicidal self-injury (NSSI) is recognized as a global public health concern among adolescents. Although some studies have explored the relationship between self-disgust and NSSI, the discussion remains limited, and the underlying mechanisms have yet to be fully elucidated. This study examined the longitudinal effects of self-disgust on NSSI, as well as the potential indirect effects of depression and psychache on this relationship. A total of 832 Chinese adolescents participated in a two-wave longitudinal study with a six-month interval. The structural equation model was used to investigate the chain mediating roles of depression and psychache in the relationship between self-disgust and NSSI. The findings indicated that higher levels of self-disgust were predictive of NSSI 6 months later. The higher levels of depression were predictive of psychache 6 months later. Additionally, depression and psychache played chain mediating roles in the relationship between self-disgust and NSSI. This longitudinal study provides evidence that self-disgust may contribute to adolescent NSSI by promoting depression and exacerbating psychache. These findings highlight the importance of addressing self-disgust in prevention and intervention strategies aimed at reducing NSSI risk among adolescents.

Suicide is a leading cause of death among young males in Australia. Tomorrow Man's "Breaking the Man Code" workshops aim to challenge potentially harmful masculine norms and promote positive attitudes towards help-seeking among adolescent boys in schools. Our stratified cluster randomized trial was undertaken with 1225 boys (mean (SD) age = 15.04 (0.74) years) across 24 Australian secondary schools: 13 randomized to intervention, 11 to waitlist control. Primary outcome was mean change in intentions to seek help for personal or emotional problems 4 to 8 weeks from baseline. Secondary outcomes included conformity to masculine norms, depression risk, perceived social support, and quality of life. Purpose-designed closed-ended questions captured other behavioral and attitudinal changes. The trial was prospectively registered with ANZCTR. Estimated mean change in scores from baseline between the two groups on the primary outcome was -0.07 (95% confidence interval: -1.75, 1.62; p = 0.937). Purpose-designed questions revealed increased help-offering, connection with friends, and some potential barriers to change. Further research is needed to understand the impacts of school-based interventions for boys. Prospectively registered with ANZCTR: ACTRN12620001134910.

This study aims to examine the five-year evolution of NSSI and identify the predictive factors associated with its persistence. Adolescents aged 12-18 years who attended a CAP outpatient clinic between 2014 and 2016 were retrospectively reviewed. Those with a history of NSSI formed the study group, while those without NSSI comprised the control group. Of 126 adolescents with NSSI, 51 were successfully re-evaluated five years later. The participants' mean age at T1 was M = 15.5 years, and at T2 it was M = 22.0 years. Adolescents who continued to engage in NSSI showed significantly greater difficulties in impulse control, body effectiveness, and identity diffusion compared to those who discontinued the behavior. In logistic regression analysis, identity diffusion and body effectiveness were significant predictors of persistence. Higher identity diffusion had nearly 18 times higher odds of maintaining NSSI (OR 17.99 95% CI [2.195, 147.418]), and those with higher body effectiveness had 1.4 times higher odds of persistence (OR 1.40 95% CI [1.115, 1.774]). Identity diffusion showed the strongest association with persistent NSSI, whereas higher body effectiveness was modestly related to its continuation. These findings point to potential links between identity- and body-related processes and the long-term continuation of NSSI.

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.