Greater Risk For Suicidal Behavior Research Articles

Perceived Family Support Buffers the Impact of PTSD-Depression Symptoms on Suicidal Ideation in College Students.

Students reporting symptoms of posttraumatic stress disorder (PTSD) and depression are at increased risk for suicidal ideation, putting them at greater risk for suicidal behavior and attempts. Perceived social support is a robust protective factor against the impact of PTSD and depression on suicidal ideation in college students, however different forms of social support (family, friends, significant others) may have greater influence on this association. In the current study, the influence of the different types of perceived social support on the relationship between PTSD-depression symptoms and suicidal ideation in college students were examined. College students (N = 928; 71% female) were recruited in part of a cross-sectional survey study examining the role of mental health on education functioning. A hierarchical regression indicated that PTSD-depression symptoms (b = .27, p < .001) and perceived family support (b = -.04, p < .01) were significantly associated with current suicidal ideation, while perceived support from friends (b = -.02, p = .417) and significant others (b = -.01, p = .301) were not. Perceived family support interacted with PTSD-depression symptoms (b = -.03, p < .05) to weaken the positive influence of symptoms on current suicidal ideation. Perceived family support appears to be the significant component of social support that moderates the relationship between PTSD-depression symptoms and suicidal ideation. Future research should focus on strengthening family support as a potential mechanism to mitigate suicide risk among college students who may be away from their families for the first time.

Learning from gain and loss: Links to suicide risk

Despite preliminary evidence that people with suicide attempt histories demonstrate deficits in processing feedback, no studies have examined the interrelations of learning from feedback and emotional state on suicide risk. This study examined the influence of suicide risk and negative emotions on learning accuracy and rates among individuals with a range of borderline personality features (N = 145). Participants completed a reinforcement learning task after neutral and negative emotion inductions. Results revealed interactions between suicide risk and emotion condition, with elevated risk linked to greater increases in loss learning rate (training phase models) and gain learning rate (test phase models) post-negative emotion induction. Emotion-dependent fluctuations in learning performance may be markers of decision-making that are associated with greater suicide risk. This line of work has the potential to identify the contexts that confer greater risk for suicidal behaviors.

Suicide attempts among people with eating disorders and adverse childhood experiences: Results from a nationally representative sample of adults.

People with eating disorders (EDs) have elevated rates of suicide attempts. A need exists to identify factors that help predict which people with EDs might be at greater risk for suicidal behavior. Adverse childhood experiences (ACEs) are associated with both EDs and with suicide attempts. Thus, the current study examined whether having histories of ACEs and EDs augments lifetime risk for suicide attempts. This study included 36,146 adult participants in the National Epidemiologic Survey on Alcohol and Related Conditions-III who completed structured diagnostic interviews and answered questions regarding ACEs and suicide attempts. Weighted means, frequencies, and cross-tabulations were computed for prevalence of ACEs and suicide attempts by ED diagnosis. Multiple logistic regression was used to compare risk of lifetime suicide attempts by ED diagnosis and ACE history. Prevalence of ACEs among people with EDs was 54.1-67.8%. ACE history and ED diagnosis were associated with elevated odds of experiencing a lifetime suicide attempt (AORs = 4.64-6.45 and 3.20-4.06, respectively). There was no ACE history-by-ED interaction on risk of suicide attempt, regardless of forms of EDs. ACEs are common among people with EDs and associated significantly with suicide attempts, but ACEs and EDs do not appear to interact to augment risk for suicide attempts. Considering ACE exposure in theoretical models of suicidal behavior in people with and without EDs and in suicide risk assessment and management with people with EDs may prove useful.

Mokken Scale Analysis of Lifetime Responses on the Columbia Suicide Severity Rating Scale's Severity of Ideation Subscale.

Suicide risk screening assumes that suicidal thoughts and behaviors exist on a continuous, hierarchical spectrum with some suicidal thoughts implicated with greater risk for suicidal behaviors. However, screening measures based on the hierarchical model may not capture the suicide risk construct. This study assessed psychometric properties of the Columbia Suicide Severity Rating Scale (CSSRS) for (a) between- and within-person measurement dimensions, (b) item utility in capturing the suicide risk construct, and (c) tenability of a hierarchical risk model. We found that the CSSRS functions differentially between and within individuals, CSSRS items capture more suicide risk construct, and that CSSRS items in current practice likely appear in the correct order. The current CSSRS reasonably represents within-person suicide risk, but not between-person risk. Scale norms or alternate scoring could facilitate functional equivalence and utility for between- and within-person CSSRS dimensions.

Are Developmental Assets Protective Against Suicidal Behavior? Differential Associations by Sexual Orientation.

Sexual orientation disparities in suicide behavior are well-documented. Yet, few studies have examined how developmental assets - key values, self-perceptions, skills, relationships, and opportunities that have been identified as the building blocks of positive youth development - are associated with suicide behaviors, particularly among sexual minority youth. This study examined concurrent associations between young people's developmental assets and suicidal behavior by sexual orientation using a large sample of 116,925 in-school U.S. adolescents (ages 11 to 19, M = 14.74, SD = 1.78). Most of the sample identified as only heterosexual (90.2%); 5% identified as mostly heterosexual, 3.5% as bisexual, 0.6% as mostly lesbian/gay, and 0.7% as only lesbian/gay. Most participants identified as White, non-Latina/o (62.6%) and as cisgender female (50.3%) or cisgender male (47.8%). Compared to only heterosexual adolescents, youth with all other sexual orientations reported lower levels of internal and external developmental assets except for non-sports extracurricular activity participation and social justice values. Identifying as a racial/ethnic minority, particularly for only heterosexual adolescents, and specifically as Latina/o for sexual minority adolescents was associated with greater risk for suicidal behavior. Further, identifying as a gender minority exacerbated risk for suicidal behavior. Relatedly, when youth reported feeling unsafe with their family, or in their school or neighborhood, they were at greater risk for suicidal behavior, regardless of sexual orientation. Feeling hopeful was associated with lower risk for suicidal behavior for all youth. Regardless of sexual orientation, planning and decision-making skills were associated with lower risk and social-emotional skills were associated with heightened risk for suicidal behavior. School boundaries and social justice values were associated with lower risk for suicidal behavior among bisexual adolescents; there were no additional protective assets for mostly/only lesbian/gay adolescents. In conclusion, sexual orientation disparities exist in the lives of adolescents for several internal and external developmental assets. Disparities in suicidal behavior by sexual orientation, however, were largely unexplained by differential associations between developmental assets and suicidal behavior.

Pain and Suicidal Behavior in Primary Care Patients: Mediating Role of Interpersonal Needs

Individuals experiencing chronic pain are at greater risk for suicidal behavior. The mechanism of action for this association is unexplored, but may involve the influence of pain on interpersonal functioning. We examined the mediating role of unsatisfied interpersonal needs on the relation between pain severity and interference, and suicidal behavior. Low income, uninsured participants completed self-report measures of pain severity and interference, thwarted interpersonal needs and suicidal behavior. Our hypotheses were partially supported; in simple mediation models, an indirect only effect existed for both thwarted belongingness and perceived burdensomeness in the relation between pain severity and pain interference and suicidal behavior. These effects did not persist in multiple mediation analyses. Our findings suggest that, for patients experiencing pain, assessment and improvement of the quantity and quality of interpersonal relationships may reduce risk for suicide ideation and attempts.

Youth, High-Dose Antidepressants, and Self-harm

Children and young adults who start antidepressant therapy at higher than modal doses appear to be at greater risk for suicidal behavior during the first 90 days of treatment, found a cohort study of 162 625 people aged 10 to 64 years with depression (Miller M et al. JAMA Intern Med. 2014;174[6]:899-909). Modal doses for citalopram, sertraline, and fluoxetine were 20 mg/d, 50 mg/d, and 20 mg/d, respectively. The rate of deliberate self-harm among individuals 24 years or younger who started antidepressant therapy at doses higher than modal doses (up to maximum daily doses of 40 mg/d, 200 mg/d, and 80 mg/d for citalopram, sertraline, and fluoxetine, respectively) was about twice as high as that in a matched group of patients who received modal-dose therapy. The authors suggested this corresponds to about 1 additional event of deliberate self-harm for every 150 patients treated with high-dose therapy. For adults 25 to 64 years old, there was no difference in risk for suicidal behavior. Language: en

Symptoms of Attention‐Deficit/Hyperactivity Disorder (ADHD) Moderate Suicidal Behaviors in College Students With Depressed Mood

College students with attention-deficit/hyperactivity disorder-related hyperactive/impulsive (HI) and/or inattentive (IA) symptoms may be at greater risk for suicidal behavior due to core and secondary symptoms that increase their potential to engage in behaviors that put them at risk for suicidal behavior. Consequently, the current study examined the moderating effect of combined HI/IA symptoms, in addition to independent HI and IA symptoms on the relationship between depressed mood and suicidal thoughts and behavior. A sample of 1,056 undergraduate students (61.5% female, 96.4% aged 18-24 years) provided self-report ratings of mood, suicidal behavior (thoughts, self-harm, attempts, and need for medical attention), and current HI/IA symptoms. Significant moderation effects were detected, such that greater HI/IA symptoms were associated with a stronger relationship between depressed mood and suicidal ideation and attempts, but not self-harm. Current HI and IA symptoms significantly moderated the relationship between depressed mood and suicidal thoughts and suicide attempts, but did not moderate the relationship between depressed mood and self-harm and need for medical attention. The current findings suggest that the presence of combined HI/IA symptoms conveys increased suicide risk for depressed college students. Additionally, results suggest a complex relationship between independent HI and IA symptoms and severe suicidal outcomes.

Association of solitary binge drinking and suicidal behavior among emerging adult college students.

Emerging adult college students who binge drink in solitary contexts (i.e., while alone) experience greater depression and suicidal ideation than do students who only binge drink in social contexts, suggesting that they may be at greater risk for suicidal behavior. This study examined the association of a previous suicide attempt, one of the best predictors of future suicide attempts and suicide, and severity of recent suicidal ideation with drinking in solitary and social contexts. Participants were binge drinking, emerging adult (18- to 25-year-old) college students (N=182) drawn from two studies of college drinkers. A logistic regression analysis revealed that both suicide attempt history and severity of suicidal ideation were significantly associated with a greater likelihood of being a solitary binge drinker as opposed to only a social binge drinker. Students with a previous suicide attempt were nearly four times more likely to be solitary binge drinkers. Multiple regression analyses revealed that suicide attempt history was significantly associated with greater frequency and quantity of drinking in solitary, but not social contexts. Suicidal ideation was significantly associated with drinks per solitary drinking day, but not frequency of solitary drinking once suicide attempt history was accounted for. Given the associations found between solitary binge drinking and a history of suicide attempts, as well as greater severity of recent suicidal ideation, it appears that these students are in need of suicide prevention efforts, including treatment efforts aimed at reducing binge drinking.

The Moderating Role of Distress Tolerance in the Relationship Between Posttraumatic Stress Disorder Symptom Clusters and Suicidal Behavior Among Trauma Exposed Substance Users in Residential Treatment

The co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) is associated with greater risk for suicidal behavior than either disorder alone. Research highlights the relevance of PTSD symptoms in particular to suicide risk within this population. Research has also provided support for an association between distress tolerance (DT) and both PTSD symptoms and suicidal behavior. This study examined the role of DT in the relationship between PTSD symptom severity and suicidal behavior in a sample of 164 SUD inpatients with a history of Criterion A traumatic exposure. Results indicated that DT moderated the relationship between PTSD symptoms (overall, re-experiencing, and hyperarousal) and medically attended suicide attempts, with the magnitude of the relationship increasing at higher levels of DT.

Panic Disorder and Suicidal Behavior

Previous research has suggested that patients with panic disorder but no comorbid disorder are not at greater risk for suicidal behavior. The present study followed up patients with panic disorder in order to assess the frequency of their suicidal behavior. A sample of 281 outpatients with panic disorder, but without a comorbid psychiatric disorder, was followed up for an average of 5 years. The patients were given 6-8 weeks of cognitive therapy, and 65% were prescribed SSRIs. At the time of first admission, 5 patients (1.7%) reported a previous (lifetime) suicide attempt, and 53 patients (18.2%) reported previous (lifetime) suicidal ideation (both thoughts and plans), not greatly different from the Hungarian population in general. During the follow-up period, no patient committed suicide, 2 patients attempted suicide (0.7%), and 4 patients (1.4%) reported suicidal ideation. This study indicates that people with panic disorders without comorbid disorders have no higher suicidal risk than the general population in Hungary. After treatment with cognitive therapy and SSRIs, 38.5% were symptom-free, and only 7.8% required continued close therapeutic contact after the follow-up period.

Investigation of Serotonin Transporter Gene Promoter (5-HTTLPR) and Intron 2 (Variable Number of Tandem Repeats) Polymorphisms with Suicidal Behavior in a Turkish Population

The serotonin (5-hydroxytryptamine) transporter (5HTt) gene has been reported to be associated with suicidal behavior. In this study, we have investigated the 5' promoter region (i.e., 5HTt gene-linked polymorphic region [5-HTTLPR]) and a 17-base pair variable number of tandem repeats polymorphism in the 5HTt gene for potential association with suicidal behavior in a Turkish population. Genotypes were determined for 182 subjects of suicide (86 attempted suicide and 96 completed suicide) and 181 healthy control subjects. Our results showed that allele frequencies at individual loci were not significantly different in the two groups. This absence of altered individual locus haplotype (allele) frequency suggests the lack of a significant genetic contribution by the 5-HTTLPR or variable number of tandem repeats variations to the expression of suicidal tendencies. However, our linkage disequilibrium analyses indicated that there may be a greater risk for suicidal behavior in carriers of the S10 and L12 alleles of 5-HTTLPR.

‘Bad’ Boys and ‘Sad’ Girls? Examining Internalizing and Externalizing Effects on Parasuicides Among Youth

Suicide and parasuicides (i.e. suicidal ideation and suicidal attempt) have long been recognized as serious social problems, especially among youth. A series of logistic regression models were developed incorporating various internalizing and externalizing risk factors experienced by young people with the goal of predicting parasuicides among Canadian youth. The main objective of the research is to determine whether or not there are significant sex differences between these internalizing and externalizing influences on suicidal behavior. Data were used from the National Longitudinal Study of Children and Youth-Waves 3 through 6, for a total sample of 2,499 15-year olds (48.9% male). Results show that both suicidal ideation and attempt are more frequent for girls compared to boys. Contrary to expectations, externalizing problems had a greater impact on girls and internalizing problems had a marginally greater impact on boys. This casts doubt on the notion that "bad boys" and "sad girls" are at greater risk for suicidal behavior. These results are discussed in light of their substantive importance, policy implications, and suggestions for future research.

Early Initiation of Alcohol Drinking, Cigarette Smoking, and Sexual Intercourse Linked to Suicidal Ideation and Attempts: Findings from the 2006 Korean Youth Risk Behavior Survey

PurposeThis study examined the association between early initiation of problem behaviors (alcohol drinking, cigarette smoking, and sexual intercourse) and suicidal behaviors (suicidal ideation and suicide attempts), and explored the effect of concurrent participation in these problem behaviors on suicidal behaviors among Korean adolescent males and females.Materials and MethodsData were obtained from the 2006 Korean Youth Risk Behavior Survey, a nationally representative sample of middle and high school students (32,417 males and 31,467 females) in grades seven through twelve. Bivariate and multivariate logistic analyses were conducted. Several important covariates, such as age, family living structure, household economic status, academic performance, current alcohol drinking, current cigarette smoking, current butane gas or glue sniffing, perceived body weight, unhealthy weight control behaviors, subjective sleep evaluation, and depressed mood were included in the analyses.ResultsBoth male and female preteen initiators of each problem behavior were at greater risk for suicidal behaviors than non-initiators, even after controlling for covariates. More numerous concurrent problematic behaviors were correlated with greater likelihood of seriously considering or attempting suicide among both males and females. This pattern was more clearly observed in preteen than in teen initiators although the former and latter were engaged in the same frequency of problem behavior.ConclusionEarly initiation of alcohol drinking, cigarette smoking, and sexual intercourse, particularly among preteens, represented an important predictor of later suicidal ideation and suicide attempts in both genders. Thus, early preventive intervention programs should be developed and may reduce the potential risks for subsequent suicidal behaviors.

Clinical features of depressed patients with or without a family history of alcoholism

To compare clinical features of depressed subjects without alcoholism but with a family history of alcoholism to a depressed group without alcoholism and without a family history of alcoholism. Clinical and demographic data of 209 depressed subjects without a history of alcoholism in first-degree relatives and 73 depressed individuals with a history of alcoholism in first-degree relatives were compared. Subjects with a personal history of alcoholism were excluded. Depressed subjects with a family history of alcoholism have a significantly higher prevalence of reported childhood physical and sexual abuse and post-traumatic stress disorder (PTSD), make more suicide attempts, and have greater intent to die at the time of their most lethal suicide attempt, compared to depressed subjects without a family history of alcoholism. Depressed patients with a family history of alcoholism are at greater risk for suicidal behavior and PTSD and may require more careful management.