To identify firearm behaviors and perceptions that differentiate firearm owners with a history of suicidal thoughts from other firearm owners and from nonfirearm owners with a history of suicidal thoughts. A nationally representative sample (n = 8009) of adults residing in the United States completed a self-report survey May 15-May 28, 2024. Firearm owners with a history of suicidal thoughts were 45% likelier to store firearms loaded and unlocked and reported a stronger belief that home firearm access increases suicide risk. Some subgroups of firearm owners more heavily represented among those with a history of suicidal thoughts (e.g., women) were more likely to store firearms loaded and unlocked if they endorsed a history of suicidal thoughts. Firearm owners with a history of suicidal thoughts are more likely to recognize the link between firearm access and suicide risk, but nonetheless are more likely to store firearms unsecured. Identification of firearm owners with suicidal ideation remains difficult, but findings point toward subgroups and beliefs to target with messages aimed at promoting secure firearm storage.

Suicide among Black youth has become a public health concern. To better understand the rapid increase in Black youth suicide, we aimed to determine whether there had been changes in the risk correlates and their impacts on suicidality among Black youth over the past three decades. We analyzed four suicide-related outcomes-ideation, planning, attempts, and attempt-related injuries-using Black youth's responses from the 1991-2021 Youth Risk Behavior Survey (survey-adjusted n = 31667.12). Potential correlates considered were demographics, sexuality, injury, violence, bullying, diet, physical activity, mental health, substance use, school connectedness, and exposure to community violence. Correlate-by-year interactions were included to allow for time-varying effects of factors. Missing data were imputed five times, and logistic LASSO regressions were used to select important factors. Rates of suicidal ideation decreased from 22% (1991) to 12% (2005), then increased to 22% (2021). Suicide planning and attempts had similar trends, whereas rates of injuries remained stable (ranging from 2% to 4%). Correlates identified for all four outcomes were similar and consistent over time, including violent behaviors, substance use, body image concerns, and sex. All correlates' effects remained unchanged over time. Although trends of suicidality in Black youth changed over time, correlates associated with them remained stable.

The interpersonal theory of suicide presumes that hopelessness about interpersonal conditions of perceived burdensomeness (PB) and thwarted belongingness (TB) precipitate active suicide ideation. However, it was suggested that there is a paucity of research investigating the role of interpersonal hopelessness (IH) in suicide ideation. In Study 1, the objective was to adapt the Interpersonal Hopelessness Scale (IHS) to Turkish. Study 2 aimed to test whether PB, TB, general hopelessness, and IH predict suicide ideation and to investigate how much of the unique variance in suicide ideation was explained by IH. In two studies using cross-sectional design (Study 1: N = 387, 53.2% female; Study 2: N = 407, 70.52% female), the variables of interest were tested through confirmatory factor analysis and a hierarchical regression model. Study measures for both studies were completed via paper-pencil method. The psychometric properties of the IHS were adequate for the sample recruited, and PB, TB, general hopelessness, and IH were significant predictors of suicide ideation, with IH accounting for statistically significant unique variance. Results offer preliminary evidence of the utility of the IHS and contribute to over 10 years of empirical evidence supporting the interpersonal theory of suicide within the context of young adulthood.

With the 988 Suicide and Crisis Lifeline's expanding role in the crisis care continuum in the U.S., assessments of its effectiveness are more important than ever. The current study estimated the extent to which suicidal Lifeline callers perceived their crisis calls as helping them and stopping them from killing themselves, whether their suicidal thoughts recurred after the call, and the caller characteristics and counselor practices associated with these outcomes. Telephone interviews were conducted with 437 adult suicidal callers to 12 Lifeline crisis centers between April 15, 2020 and August 15, 2021. The interview collected callers' demographic and clinical characteristics and their perceptions of counselor practices and call outcomes. A series of logistic regression analyses assessed the association of caller characteristics and counselor practices with call outcomes. The vast majority of suicidal Lifeline callers thought their crisis call helped them (nearly 98%) and stopped them from killing themselves (88.1%). Callers' perceptions of counselor behaviors in the domains of fostering engagement/connection, collaborative problem-solving, and safety assessment/management were strongly associated with callers' perceived effectiveness of the crisis call. Our study offers empirical evidence for the effectiveness of the Lifeline's (now 988 Lifeline's) telephone crisis services from the caller's perspective.

ABSTRACTBackgroundFew studies investigate cause‐specific mortality in individuals with tic disorders. We aimed to examine all‐cause, natural‐cause, and unnatural‐cause mortality in individuals with tic disorders.MethodsUsing the nationwide database of Taiwan from 2003 to 2017, we identified 50,018 patients with tic disorders and, using a ratio of 1:4, matched unaffected controls based on birth year and sex. Cause‐specific mortality (i.e., natural cause, accident, and suicide mortality) and all‐cause mortality were assessed between the two cohorts using time‐dependent Cox regression models.ResultsAfter adjusting for demographics, individuals with tic disorders had increased likelihoods (reported as adjusted hazard ratio [aHR] with 95% confidence interval [CI]) of all‐cause (1.14, 1.03–1.26), unnatural‐cause (including accidents and suicides; 1.78, 1.43–2.23), and suicide mortality (3.09, 2.07–4.59) compared to controls. With additional adjustments for psychiatric comorbidities, the likelihood of all‐cause, unnatural‐cause, and suicide mortality remained significant. However, we did not find a higher natural cause mortality in patients with tic disorders compared to controls (1.02, 0.91–1.15).ConclusionIndividuals with tic disorders have a higher likelihood of unnatural causes and suicide mortality after adjusting for demographics, clinical characteristics, and psychiatric comorbidities. Our findings suggest that clinicians should routinely monitor both the physical and mental conditions of patients with tic disorders.

ABSTRACTIntroductionSuicide ideation (SI) may provide relief from negative affect (NA), thereby making future SI more likely through reinforcement processes. Though some studies suggest that SI reduces NA, this evidence is limited and inconclusive.MethodsWe used dynamic structural equation models to test whether bidirectional associations between SI and both NA and positive affect (PA) over 2‐h intervals support an affect regulation model of SI. Participants were 140 young adults with SI or suicidal behaviors in the past 4 months who completed a 21‐day ecological momentary assessment with seven daily assessments.ResultsResults demonstrated reciprocal effects over 2‐h intervals, such that within‐person increases in NA and decreases in PA were associated with subsequent increases in SI, and increases in SI were associated with subsequent increases in NA and decreases in PA. The occurrence of SI did not significantly moderate the persistence of NA or PA over 2‐h intervals. However, we replicated prior findings of decreases in affective distress following SI when analysis was restricted to occasions when SI occurred and resolved by the next occasion.ConclusionsResults suggest that distinct analytic and sampling methods can lead to divergent conclusions regarding whether SI provides relief from affective distress.

ABSTRACTBackgroundCrisis Stabilization Centers (CSCs) are a critical component of the crisis response system and the 988 Lifeline expansion that may promote ED diversion. To maximize CSC care quality and effectiveness, brief psychotherapy interventions that focus on recovery, match CSC workflows, and have the potency to reduce suicide attempts and deaths are needed but do not exist. The purpose of this study was to establish the feasibility, acceptability, appropriateness, and social validity of a novel, ultra‐brief, 60‐min psychotherapy intervention—Toward Hope, Recovery, Interpersonal Connection, Values, and Engagement for Crisis (THRIVE‐C).MethodsWe recruited CSC stakeholders (n = 15) and CSC study therapists (n = 5) to complete surveys, followed by a pilot study of THRIVE‐C with CSC guests (n = 54).ResultsCSC stakeholders, study therapists, and guests found THRIVE feasible, acceptable, appropriate, and socially valid. CSC guests experienced THRIVE‐C as satisfactory, established a positive therapeutic alliance (bond), and 91% of guests endorsed behavioral intentions to attend outpatient psychotherapy appointments after discharge. Further, 94% of guests completed all phases of THRIVE, demonstrating clinical readiness to work on suicide recovery beyond physical safety or stabilization from suicide alone.ConclusionPreliminary findings suggest that further development and testing of THRIVE are needed.Trial RegistrationThis study was registered with ClinicalTrials.gov (Identifier NCT05558891)

Conformity to the masculine norms of self-reliance and emotional control is linked to suicidal ideation. Risk factors for suicidal ideation, such as perceived burdensomeness and thwarted belongingness, may explain the relationship between conformity to the masculine norms of self-reliance/emotional control and suicidal ideation. The current study expanded on past cross-sectional research by testing if perceived burdensomeness and/or thwarted belongingness mediated longitudinal relationships between conformity to self-reliance/emotional control and suicidal ideation. Two hundred and sixty-nine US men completed self-report measures at three timepoints spaced 1 month apart. An adapted version of a longitudinal autoregressive three-wave mediation model was used to test study hypotheses. Conformity to self-reliance longitudinally predicted perceived burdensomeness, which in turn longitudinally predicted suicidal ideation. Thwarted belongingness had nonsignificant longitudinal relationships with conformity to masculine norms or suicidal ideation. Results suggest that perceived burdensomeness links relationships between self-reliance and suicidal ideation. Clinicians working with male-identified clients may consider assessing and targeting extreme self-reliance or perceived burdensomeness by helping clients to flexibly negotiate certain standards of masculinity.

The suicide Implicit Association Test (S-IAT) captures the strength of the implicit identification between self and death and is one of the few suicide-specific behavioral tasks that uniquely predicts future suicide risk. Thus, identifying brain regions associated with the S-IAT provides insights into the neural mechanisms underlying suicidality. This study measured brain activation during the S-IAT with concurrent fMRI in a post-9/11 trauma-exposed veteran sample. In total, 37 post-9/11 veterans at low risk for suicide participated in this study as part of an ongoing longitudinal study. Behaviorally, participants were slower to categorize words during incongruent (death-me) contexts relative to congruent (life-me) contexts (p < 0.001). Whole-brain voxelwise fMRI contrasts revealed a brain network that was significantly more active during incongruent trials than congruent trials that included the bilateral occipital, posterior parietal, and cerebellum (corrected p < 0.05). This increased brain activation corresponded with task performance, suggesting that more brain resources are needed to complete death-me identifications. These results suggest that death-me implicit identifications involve resolving conflict between self and death representations in the brain and mark an important step towards characterizing neural mechanisms contributing to suicidality.

Patient navigation (PN), paired with the safety planning intervention (SPI), may allay mechanisms that theoretically underlie suicide among sexual and gender minorities (SGM). This paper describes (a) the iterative development of a theory-informed PN + SPI intervention (QueerCare) to prevent suicide among at-risk SGM youth and young adults and (b) a case series examining the feasibility and acceptability of study procedures, measures, and QueerCare. Seven initial QueerCare modules and a glossary of terms were drafted. Seven participants completed the case series. Feasibility and acceptability over 3 months were examined by triangulating multi-method data. The study procedures and measures in the at-risk population were feasible and sensitive, provided that remote safety monitoring and parental consent waivers were in place. QueerCare was feasible, helpful, and appropriate based on satisfaction ratings and four emerging themes: matched identity care, internalized barriers, support, and flexibility valued. Two additional modules and guardian materials were created. Suicidal crisis management protocols were continuously refined. QueerCare was developed as a highly flexible modular intervention to meet the needs of SGM youth and young adults and prevent repeat suicide attempts in this population. Findings indicate study procedures, measures, and QueerCare were feasible and acceptable based on triangulated data. This study was registered under ClinicalTrials.gov identifier NCT04757649.