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.

Increases in suicide attempts in preadolescents represent a serious public health concern. This study aimed to identify prospective and concurrent risk factors that differentiate children with suicidal ideation (SI) from those with a suicide attempt (SA) across childhood. 195 participants comprised of 8-12-year-olds from the Pediatric Suicidality Study, which followed a sample of preschoolers enriched for depression into preadolescence. Clinical diagnostic interviews and surveys to assess children's thoughts, behaviors, and experiences were administered to caregivers (preschool, preadolescence) and children (preadolescence). Three groups were created based on preadolescents' lifetime history of SI/SA: Suicide Attempt (SA; n = 25), Suicide Ideation without Attempt (SI-only; n = 102), and No SI/SA (n = 68). Compared to preadolescents with SI-only, preadolescents with SA exhibited increased depression (OR = 1.52), anxiety (OR = 1.32), maladaptive guilt (OR = 3.31), catastrophizing (OR = 1.24), stressful (OR = 1.20) and traumatic events (OR = 1.82) by preadolescence. Preadolescents with SA also exhibited increased anxiety (OR = 1.07) and maladaptive guilt during preschool (OR = 4.10). Family SA and social relationships did not differentiate groups. Findings demonstrate unique and separable risk factors for SI and SA in children under age 13 with clinical implications for assessing suicide risk. Alongside depression and anxiety, assessments of maladaptive guilt may be important to identify at-risk children for increased monitoring and intervention.

Nondisclosure of suicidal ideation (SI) presents a challenge to assessing suicide risk, as assessments often rely on self-reported SI. Cross-national comparisons of rates of, and reasons for, SI nondisclosure remain understudied. The present study examined whether rates of SI nondisclosure from clinicians differed, and if there were differences in rates of reasons for SI nondisclosure, across 12 countries. A subset of adult participants (n = 6770) who reported a lifetime history of SI from 12 countries responded to the question: "Have you ever denied or concealed thinking about suicide from a doctor or clinician?" Those who selected "Yes" provided reason(s) for SI nondisclosure. Responses were coded according to inductively and deductively derived reasons for SI nondisclosure. Rates of nondisclosure among participants who reported lifetime SI ranged from 7.2% (Taiwan) to 48.2% (United States). Among those participants, rates of reasons for SI nondisclosure ranged from 2.0% (participant was unsure/did not know why they concealed SI) to 35.6% (negative internal experiences). Findings provide insight into the frequency of and reasons for SI nondisclosure from clinicians at a country-specific level. Results could serve as a rationale for clinicians to incorporate indirect suicide risk factors into risk assessments.

As the Army continues to modernize in the domains of technology, strategy, and training, there remains a need for research that intersects across research fields to promote the identification of transdiagnostic mechanisms that impact both psychological health and performance by designing more efficient and effective interventions. Bodily awareness (i.e., interoception and exteroception) has significant implications in military contexts, whereby both psychological health (e.g., suicide) and physical performance are key components to training, readiness, and wellbeing. However, although promising research exists focused on the etiological impacts of interoception on suicide, no work has directly examined exteroception-awareness of the body with respect to space and movement-within a military sample. The current study aimed to address this gap by examining the impact of bodily awareness on measures of suicide and military performance. A total of 1462 ADSM completed surveys assessing exteroception, suicidal ideation, readiness, and specific job related performance indicators. Awareness of one's body in space (i.e., exteroception) was associated with suicidal ideation, over and above thwarted belongingness and perceived burdensomeness. Notably, exteroception was significantly associated with all measures of military performance. The results of this study suggest that improving exteroception may be an appropriate transdiagnostic target for interventions designed to improve mental health while simultaneously optimizing performance among ADSM.

Although perceived burdensomeness and suicidal ideation are intended to be distinct constructs, they are often overlapping in both research and clinical settings. Such overlap provides room for error during assessment and analysis, with uncertainty in the degree to which PB and SI represent unique constructs. The present study evaluated what is represented in a SI variable with PB covaried out, and vice versa. 312 students with lifetime suicidal ideation (Mage = 19.10, 79.8% cisgender women, 75.6% White) completed self-report measures. We computed two variables-PB with SI covaried out and SI with PB covaried out-and examined relationships between these residuals and other suicide-related risk factors. When SI was covaried out of PB, the PB residual remained significantly associated with nearly all risk factors. However, when PB was covaried out of SI, more than half of these suicide risk factors were no longer significantly associated with the SI residual. Our findings could hold relevance for advancing both clinical and research efforts, as most risk factors were uniquely associated with PB, as opposed to SI. Specifically, PB may act as a mediator between a plethora of suicide risk factors and SI, while also holding relevancy in other domains.

National Guard members face unique challenges of psychological trauma and rapid transitions between military and civilian life. These challenges may partially explain Guard members' increased likelihood of developing Posttraumatic Stress Disorder (PTSD) and higher suicide rates compared to other military and civilian populations. These challenges may prompt the use of dissociation and alcohol to cope, which can exacerbate PTSD symptoms and increase tolerance of painful experiences, such as suicide. Despite these connections, the interplay among dissociation, alcohol, PTSD symptoms, and suicide capability in Guard members remains unknown. This study assessed how dissociation and alcohol use may indirectly explain the relationship between PTSD symptoms and acquired suicide capability in 144 Guard members. Two alternative models, including psychological reactance and depression, were tested to assess model fit. Using Structural Equation Modeling, we found that PTSD severity related to acquired suicide capability through dissociation and alcohol use. The base model had a significantly better fit than the alternative models. This work could contribute to necessary research on why Guard members are disproportionately affected by suicide. The results of this study may have implications for suicide prevention and intervention strategies among Guard members with PTSD symptoms, alcohol use, and dissociation.

Previous literature suggests that adolescent psychotic-like experiences (PLEs) are associated with depressive symptoms and suicidal ideation. This study aimed to explore these prospective relationships between PLEs, depressive symptoms, and suicidal ideation among adolescents. A large-scale web-based survey was conducted using repeated measures at three time points: from 21 April to 12 May 2021 (T1), from 17 to 26 December 2021 (T2), and from 17 May to 6 June 2022 (T3). A total of 17,722 adolescents were assessed at both T1 and T2, and 15,694 adolescents also provided complete responses at both T1 and T3. Self-reported scales were used to assess PLEs and depressive symptoms, and suicidal ideation was assessed. PLEs at baseline were significantly associated with increased odds of depressive symptoms and suicidal ideation at both follow-up intervals after adjusting for covariates (all p < 0.001). Moreover, baseline depressive symptoms and suicidal ideation were significantly associated with increased likelihoods of subsequent PLEs (all p < 0.001). This study underscores bidirectional prospective associations between PLEs, depressive symptoms, and suicidal ideation among adolescents, and its findings underscore the critical educational and clinical importance of screening for PLEs while treating depressive symptoms and suicidal ideation.

The Family Check-Up (FCU) is a family-focused prevention program originally developed to reduce externalizing behaviors, which has demonstrated improvements in internalizing behaviors and suicide. The present study attempted a conceptual replication of previous results from a separate trial of the FCU, initiated in early childhood, that found that the FCU predicts reductions in suicide risk via improvements in youth self-regulation. The current study examined whether the FCU would predict reductions in youth suicidality via improvements in self-regulatory ability, in an independent trial of the FCU, initiated in early adolescence. The sample included 782 families, youth were 50.7% female, and 11 years old at baseline. Findings from previous trials were partially replicated, suggesting that improvements in self-regulatory skills in early adolescence support long-term reductions in suicide risk into early adulthood. However, the indirect effect of the FCU on suicide-related outcomes was only observed at the level of statistical trend in the current trial. Findings are discussed in the context of broader suicide treatments for youth involving family members and targeting important mechanisms of risk. NCT01490307.

ABSTRACTObjectiveSuicide is a leading cause of mortality among perinatal populations. Despite increasing rates, research on this topic remains limited. This paper examined (1) change in self‐injurious thoughts and behaviors (SITBs) from pregnancy to postpartum, (2) associations between risk factors and SITBs, and (3) whether risk factors moderated change in SITBs.MethodsParticipants (N = 223) reported on SITBs, emotion dysregulation, and partner stress at the third trimester and 7 months postpartum, and childhood trauma at the third trimester. We tested study aims with generalized linear models.ResultWhile self‐injurious thoughts did not change from pregnancy to postpartum, the odds of self‐injurious behaviors were 3.56 times higher postpartum (OR = 3.56, p = 0.011), even while accounting for risk factors. Higher concurrent emotion dysregulation was associated with self‐injurious thoughts during pregnancy and postpartum (OR = 1.04, p < 0.001; OR = 1.05, p < 0.001) and with behaviors postpartum (OR = 1.05, p = 0.002). Childhood trauma was associated with self‐injurious thoughts during pregnancy (OR = 2.54, p = 0.004) and postpartum (OR = 2.05, p = 0.028) and with behaviors postpartum (OR = 3.25, p = 0.009). Partner relationship conflict was not associated with self‐injurious thoughts or behaviors at either time point. Higher rates of prenatal risk factors increased the odds of SITBs in the postpartum period.ConclusionFindings support interventions addressing childhood trauma and emotion dysregulation for prevention of SITBs before postpartum, when risk is higher.

Given the high frequency and persistence of suicidal thoughts and behaviors among individuals with borderline personality disorder (BPD), characterizing mitigating factors of risk is critical. Suicide-related coping (SRC; knowledge and confidence in using internal coping strategies and external supports to manage suicidal thoughts and urges) is beneficial for suicide risk management. However, SRC has not been characterized longitudinally in suicidal individuals with BPD. A clinical sample of 98 high-risk veterans (83% male; 21-73 years old [M = 44.7]) with BPD features was assessed in up to four waves over 1 year. Multilevel models evaluated between- and within-person relationships of SRC with thwarted interpersonal needs, depressive symptoms, hopelessness, and reasons for living. Results found significant (p < 0.001) between- and within-person relationships between SRC and suicide risk and protective factors. Within-person heterogeneity accounted for ≥ 50% variance (between-person ≤ 50% variance). SRC's relationships with all outcomes were maintained when considering suicidal characteristics besides between-person SRC with depressive symptoms. These findings suggest that SRC tracks with fluctuations in suicide risk and protective profiles over time in veterans with clinically meaningful BPD features, positioning it as a promising protective factor for suicidal thoughts and behaviors in this population.