We investigated predictors of suicide among Add Health longitudinal survey participants with over 20,000 high school students using National Death Index (NDI) mortality records, exploring behavioral, attitudinal, and demographic correlates of suicide risk. We investigated early correlating suicide risk factors when students were in high school and whether they died by suicide during the next 28 years. We used multiple linear regression to distill the most essential correlates of suicide risk for male (n = 58) and female (n = 14) suicide decedents. Findings indicated suicide rates four times higher for males than for females, with males dying at younger ages on average than females. Many risk factors established from previous research were found to be associated with suicide risk. Regression analysis showed only two factors associated with a male's suicide risk: experiencing a friend's death by suicide and running away from home. For females, being expelled from school and having a conflicted relationship with one's father were the most significant correlates. This follow-up provides insights into how risk factors evolve over time, highlighting the importance of early-life psychosocial challenges and gender-specific dynamics in creating suicide risks. Findings underscore the need for differentially targeted interventions to mitigate suicide risk across the lifespan.

Active suicidal ideation and passive suicidal ideation are distinct but related constructs, each carrying significant clinical implications. However, their real-time predictors remain underexplored in intensive longitudinal studies. This ecological momentary assessment (EMA) study investigated the associations of thwarted belongingness (TB), perceived burdensomeness (PB), and hopelessness with changes in both types of ideation at 2-4 h intervals, and whether a history of suicide attempts moderates these relationships. Thirty-one college students (23 females; mean age = 19.83 ± 1.86 years) with current suicidal ideation participated, 17 of whom (54.84%) had a history of suicide attempts. Participants completed EMA assessments five times daily for one week. Data were analyzed using mixed linear models. TB (β = 0.05, p = 0.007) and hopelessness (β = 0.09, p = 0.006) predicted next-moment active ideation, but these associations became insignificant after all covariates were considered. PB was a robust predictor (β = 0.04, p = 0.032) of subsequent passive ideation, even after accounting for TB, hopelessness, and prior ideation. Notably, hopelessness predicted subsequent active ideation (β = 0.12, p = 0.034) only in participants with a history of suicide attempts. These findings underscore the distinct predictive roles of PB, TB, and hopelessness, highlighting the importance of considering suicide attempt history in risk assessment for suicidal ideation.

Suicide stigma is a multifaceted social issue with far-reaching consequences for mental health. While previous research has linked it to suicidal thoughts and behaviors (STBs), the roles of perceived and internalized forms of suicide stigma in influencing STBs remain unclear. This study investigated the potential causal relationships between perceived and internalized suicide stigma, hopelessness, unbearable pain, and thwarted connectedness in relation to STBs among 546 Chinese college students (mean age = 20.92 years). Three-wave longitudinal data with a time gap of roughly 3 months were analyzed by using structural equation modeling. The results showed that the second-wave internalized stigma mediated the relationship between baseline perceived stigma and the third-wave unbearable pain, hopelessness, and thwarted connectedness, which are considered risk factors of STBs. Furthermore, the coexistence of unbearable pain and hopelessness, and the coexistence of unbearable pain and connectedness mediated the influences of perceived and internalized suicide stigma on STBs. These findings demonstrated that the temporal evolution of perceived and internalized suicide stigma contributes to risk factors predicting STBs.

Suicidal ideation and attempts as well as eating disorders (EDs) are common among Iranian individuals. Additionally, ED symptoms are associated with suicidality. According to the interpersonal-psychological theory of suicide (IPTS), factors such as thwarted belongingness, perceived burdensomeness, and capability for suicide must combine for suicidality to occur. The tenets of IPTS have been supported among individuals with ED symptoms from Western countries. However, no study has yet explored how ED symptoms might co-occur with IPTS factors and potentially relate to suicidal ideation and attempts using latent profile analysis (LPA). Participants (N = 773) were Iranian community members who completed a battery of scales assessing ED symptoms, suicide-related risk factors, as well as suicidal ideation and suicide attempts. The LPA revealed that a six-class solution best fit the data. The classes with the highest levels of IPTS and binge/purge related symptoms also had the highest odds of suicide attempts. Our findings suggest that the measurement of thwarted belongingness, perceived burdensomeness, and capability for suicide is particularly important for individuals with binge/purge type eating disorder symptoms. Overall, IPTS factors should be incorporated into assessments of clients presenting with ED symptoms and suicidality.

ABSTRACTIntroductionGendered racism, which emasculates and denigrates the masculinity self‐concept and the desirability of Asian American men, has been associated with greater endorsement of suicide ideation. However, no research has examined culturally informed gendered racial factors that could moderate the risk of suicide ideation associated with gendered racism. Based on the potential of affirming gendered racial experiences that can validate and empower Asian American men to resist internalizing the harms of gendered racism, we examined whether affirmative body positive and positive intimacy experiences could moderate the link between gendered racism and suicide ideation.MethodsWe conducted latent moderated structural equation modeling to analyze online convenience data from 876 Asian American men (Mage = 30.78; SD = 9.43).ResultsGendered racism was significantly associated with suicide ideation. Affirmative body positive experience was a buffer at low to mean levels of gendered racism but was an exacerbator at mean to high levels of gendered racism. Affirmative positive intimacy experiences were a buffer at low and mean levels of gendered racism but not at high levels of gendered racism.ConclusionImplications include translating these findings into a more nuanced affirmative support system and gendered racial socialization strategies to help Asian American men engage in healthier and flourishing outcomes.

ABSTRACTBackgroundSuicidal crises can occur when a clinician is not available to intervene. Safety planning‐type interventions, such as the Crisis Response Plan (CRP) and the self‐guided Safety Plan (SP), were developed to provide patients with skills to manage their suicide risk in daily life. These plans are similar in makeup, but differ in terms of how they are created. This study examined whether plan type moderated associations between frequency of plan use and suicide ideation and affect.MethodParticipants were 115 military personnel in a randomized clinical trial comparing the effectiveness of CRP versus a self‐guided SP who completed an ecological momentary assessment battery. Generalized linear mixed‐effects models examined whether plan type moderated the association between daily plan use frequency and clinical outcomes.ResultsTreatment group moderated the relationship between plan use frequency and the odds of suicidal ideation. When participants used plans more frequently than their average, they reported lower suicidal ideation and higher positive affect for CRP versus self‐guided SP.ConclusionsMore frequent CRP use was linked with lower risk of suicidal ideation and greater positive affect. This may reflect better plan use due to clinician guidance. Results have critical implications for the implementation of safety planning‐type interventions.

Assessing suicide risk in clinical settings is challenging, as conventional self-report scales have limited predictive validity. The Death Implicit Association Test (D-IAT) was developed to explore implicit associations related to death and the self-concept. However, it omits the emotional association with death that may be crucial in suicide risk assessment. This cross-sectional study on individuals with current suicidal ideation integrates the implicit emotional association with death into the conventional D-IAT. We aimed to explore whether patients with current suicidal ideation exhibit more positive implicit emotional associations with death compared to a clinical control group without current suicidal ideation and lifetime suicidal behavior (total N = 182). We employed the standard identity D-IAT (D-IATme/not me) and two novel attitude D-IAT versions (D-IATI like/I don't like, D-IATpleasant/unpleasant). Furthermore, we compared all versions regarding their predictive and discriminative validity and analyzed correlations between implicit associations and self-reported suicidal ideation. In the D-IATme/not me and D-IATI like/I don't like version, patients with current suicidal ideation exhibited weaker negative associations with death compared to clinical controls. The D-IATpleasant/unpleasant did not yield a group difference. The D-IATme/not me showed superior performance in predictive validity and a similar performance in discriminative validity as the D-IATI like/I don't like. These two versions correlated positively with self-reported current suicidal ideation. In the D-IATpleasant/unpleasant, no such correlation was found. Our findings substantiate the validity and reliability of the identity D-IAT and suggest the D-IATI like/I don't like as a potential complementary attitude variant with personalized categories. Incorporating implicit emotional associations when working with suicidal patients could enhance the evaluation and treatment of individuals at risk of suicide. Further investigation is warranted to gain a more comprehensive understanding of these relationships.

Both daily stressful events and suicidal ideation (SI) are common experiences in adolescence. Different sources of stress have been associated with SI, but few studies have compared how they might differentially predict short-term SI. The current study examined whether daily stressful events, both by perceived stress level and by stressor type, predict short-term SI and whether positive events have moderating effects. A sample of 47 suicidal adolescents participated in a 14-day EMA protocol assessing the most stressful and positive events from the day and current SI levels. Over 70% of the stressful events reported were interpersonal or school-related. Multilevel analyses revealed a shorter prediction time frame than expected: while perceived stress of daily stressful events did not predict next-day SI, it did predict end-of-day (EOD) SI. Further, perceived stress from interpersonal exchanges was especially predictive of EOD SI. Positive events did not moderate the relationship between perceived stress and SI. Stress may have even shorter-term effects on SI than previously thought. Additionally, experiencing positive events may not be enough to buffer the negative effects of stressful events on SI. Specific intervention focus should be on interpersonal forms of stress, as they are highly frequent and predictive of SI.

ABSTRACTIntroductionBrief contact interventions (BCI) refer to short messages delivered proactively to a specific target population. The aim of this study was to test the effectiveness of a mobile phone short‐message service (SMS) BCI for people bereaved by suicide.MethodsParticipants were randomly allocated. The BCI group received text messages over a 6‐week period. The active control group received the intervention website. Pre‐ and post‐intervention surveys assessed demographic, suicide exposure and five key outcomes (psychological distress, suicidal ideation, complicated grief, resilience, and professional help‐seeking intentions). BCI participants were also invited to participate in an interview post‐intervention.ResultsOf 99 participants randomized, 52 BCI and 47 control completed pre‐intervention surveys. Post‐intervention response rates were low (BCI: n = 15; 28.85%; active control: n = 16; 34.04%), with no statistically significant changes in key outcome measures. Eight BCI participants completed follow‐up interviews. Relevance, timing of support, benefit to bereavement, and recommendations for scaling were identified.ConclusionsRecruitment and retention challenges meant the effectiveness of the BCI could not be statistically determined. Qualitative evidence supported BCI acceptability for people bereaved by suicide. Recommendations to improve the intervention include embedding the BCI within existing postvention services offered soon after a death occurs and tailoring of messages to individuals' needs.Trial RegistrationThis trial was registered with the Australian New Zealand Clinical Trial Register (ACTRN12621001430820)

ABSTRACTBackgroundMajor depressive disorder (MDD) is associated with maladaptive self‐reported interoception, that is, abnormal bodily self‐experience. Although diminished body trust predicts suicidal ideation, interoceptive measures have not been considered in depressed inpatients, whose suicide risk regularly peaks post‐discharge. This study aims to explore interoceptive characteristics at admission that help identify inpatients at risk for suicidal ideation at discharge.MethodsThe observational study included 87 depressed inpatients providing self‐ratings at both hospital admission (T0) and discharge (T1) on the BDI‐II and MAIA‐2. The statistical analysis included hierarchical logistic regression models and used ROC curve analysis to establish optimal cutpoints.ResultsSuicidal ideation was found in 17.24% of patients at discharge, who reported lower baseline MAIA‐2 Trusting scores than non‐ideators (p = 0.01). Diminished Trusting (OR = 0.19), somatic comorbidity (OR = 16.77), and baseline suicidal ideation (OR = 24.01) significantly predicted suicidal ideation (T1). For Trusting, we estimated an optimal classification of subsequent suicidal ideation for the cutpoint ≤ 2.33 (AUC = 0.70 [95% CI 0.57, 0.83], sensitivity = 0.87, specificity = 0.44, positive predictive value = 0.25, negative predictive value = 0.94).ConclusionsDiminished body trust is a significant predictor for post‐treatment suicidal ideation in depressed inpatients. This finding emphasizes the importance of incorporating body‐centered approaches into multimodal treatment strategies, especially in inpatients under risk to prevent suicidal incidents.