Likelihood Of Future Suicide Attempt Research Articles

Evaluating the Effectiveness of Safety Plans for Mitigating Suicide Risk in Two Samples of Psychiatrically Hospitalized Military Veterans

Although safety plans (SPs), following the Stanley–Brown Safety Planning Intervention protocol, are required for suicidal veterans receiving treatment in the Veterans Health Administration (VHA), prior studies have shown that they are frequently incomplete or are not sufficiently personalized to the unique circumstances of each patient. In two studies, we examined SP completeness, SP quality (i.e., degree to which the SP was clear, actionable, and personalized), and SP fidelity (i.e., sum of completeness and quality). We also examined which SP steps were associated with a reduced likelihood of future psychiatric rehospitalizations (Study 1) and suicide attempts (Study 2) following hospital discharge. Participants were veterans admitted to two VHA acute inpatient psychiatric units for suicide risk (Study 1: N = 78; Study 2: N = 132). SPs were coded by independent raters on completeness, quality, and fidelity; step scores (e.g., Step 1 quality) were summed to create whole-plan scores (e.g., SP quality). In Study 1, 52.5% of participants had an SP and, in Study 2, 93.1% of participants had an SP. In Study 1, whole plan scores were not associated with subsequent psychiatric hospitalization status, but higher Step 2 (internal coping) fidelity scores were associated with decreased likelihood of rehospitalization (AHR = 0.05, 95% CI [0.30, 0.84], p = .008). In Study 2, higher whole-plan quality (AHR = 0.79, 95% CI [0.66, 0.95], p = .012) and fidelity (AHR = 0.84, 95% CI [0.71, 0.99], p = .040) scores were associated with a decreased likelihood of future suicide attempt. Step 1 (warning signs) quality (HR = 0.48, 95% CI [0.30, 0.76], p = .002) and fidelity scores (AHR = 0.57, 95% CI [0.37, 0.90], p = .016) were associated with a decreased likelihood of future suicide attempt. The association of SP characteristics differs by outcome of interest, and fidelity of internal coping strategies may contribute to preventing rehospitalizations, whereas quality and fidelity of warning signs may help prevent future suicide attempts. Overall, results suggest that mandating SPs without training and implementation strategies to ensure quality is not enough.

The impact of different neurobehavioral symptoms on suicidal ideation and perceived likelihood of future suicidality

Existing literature suggests that psychological and functional impairment, independent of head injury severity, can increase suicide risk. This study explores the impacts of self-perceived dysfunction within four neurobehavioral symptom clusters—vestibular (e.g., dizziness, balance), somatosensory (e.g., headaches, nausea, vision), affective (e.g., anxious, irritable mood), and cognitive (e.g., concentration, memory, indecision)—on current suicidal ideation and the perceived likelihood of future suicidal ideation and attempts. Community participants (n = 309; Mage = 36.88; 51.6% female; 79.6% White) completed the Neurobehavioral Symptom Inventory (NSI) and the Self-Injurious Thoughts and Behaviors-Short Form (SITBI-SF). Quantile regression analysis was used to explore the effects of the four neurobehavioral symptom clusters at different levels of suicidal ideation intensity, perceived likelihood of future suicidal ideation, and self-perceived likelihood of future suicide attempt. Controlling for past head injuries and suicide attempts, affective symptoms were significantly associated with a moderate and high average intensity of current suicidal ideation. Somatosensory symptoms were significantly associated with a moderate perceived likelihood of future suicidal ideation. Finally, vestibular symptoms were significantly associated with a moderate perceived likelihood of a future suicide attempt. These findings highlight the critical need to consider a broader spectrum of symptoms, including chronic physical symptoms, when assessing suicide risk. Furthermore, they underscore the need to expand beyond affective symptoms as an explanation for increased suicidality and examine additional mechanisms through which chronic physical symptoms can increase suicide risk.

Spreading pride in all who served: A health education program to improve access and mental health outcomes for sexual and gender minority veterans.

Access to effective, replicable services is critical to reduce known mental health disparities for sexual and gender minority or LGBTQ+ veterans (lesbian, gay, bisexual, transgender, queer, questioning, and related identities). This paper examines the impact of a manualized 10-week health education group, called PRIDE in All Who Served on veteran patient experience, protective factors (e.g., identity acceptance), and mental health outcomes (e.g., suicide risk) at 10 Department of Veterans Affairs (VA) facilities. Implementation facilitation strategies (e.g., consultation, staff training) supported adoption at new sites and initial facilitators and barriers are described. Forty-four veterans (M = 47.21 years old) completed outcome surveys before and after the group. Significant improvement in acceptance concerns, identity uncertainty, community involvement, and likelihood of future suicide attempts were observed; other changes in mental health symptoms were not replicated in this sample (e.g., depression, anxiety). Open-ended veteran feedback reflected improved social support and engagement and increased self-understanding as the most frequent themes. At the facility level, Healthcare Equality Index scores (a Human Rights Campaign measure of affirmative care climate) improved from 30% to 90% achieving top-performer/leader status from pre- to postimplementation. Manualized approaches, like PRIDE in All Who Served, that are based on established minority stress models and can be spread for use with diverse LGBTQ+ veterans (e.g., age, race, gender identity, sexual orientation, rurality, housing) are needed. The PRIDE in All Who Served program is an increasingly available resource to VA clinicians advocating for greater health equity within a national healthcare setting. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Internal entrapment and fearlessness about death as precipitants of suicidal thoughts and planning in the context of post-traumatic stress disorder.

The relationship between post-traumatic stress disorder (PTSD) and suicidal thoughts and behaviors (STB) has been extensively studied but explanatory mechanisms remain inconclusive. Entrapment is one variable that evinces a mechanistic relationship with PTSD and STB. The current study examined the indirect effect of PTSD screen on suicide ideation (SI), planning, and likelihood of future suicide attempt through internal (IE) and external entrapment (EE), moderated by levels of fearlessness about death (FAD). The cross-sectional sample consisted of military service members and civilians recruited from primary care clinics across the United States (N=2690). Moderated mediation models indicated an indirect relationship between a positive PTSD screen, past-month SI, and past-month suicide planning through IE but not EE at low, moderate, and high levels of FAD. These relationships were replicated for the association between positive PTSD screen and concurrent self-rated likelihood of a future suicide attempt through both IE and EE at moderate and high levels of FAD. Phenomenological implications are discussed, including IE as a mechanism of action in the PTSD/SI pathway and FAD as necessary to potentiate suicidal planning for those experiencing IE.

Raising doubt about the anticipated consequences of suicidal behavior: Evidence for a new approach from laboratory and real-world experiments

ObjectiveConverging evidence from basic science and experimental suicide research suggest that the anticipated consequences of suicide may have direct causal effects on suicidal behavior and accordingly represent a promising intervention target. Raising doubt about individuals’ desirable anticipated consequences of suicide may be one means of disrupting this target. We tested this possibility across two complementary experimental studies. MethodStudy 1 tested the effects of raising doubt about desirable anticipated consequences on virtual reality (VR) suicide in the lab, randomizing 413 participants across four conditions. In Study 2, 226 suicidal adults were randomized to an anticipated consequence manipulation or control condition then re-assessed at 2- and 8-weeks post-baseline. ResultsIn Study 1, anticipating that engaging in VR suicide would guarantee a desirable outcome significantly increased the VR suicide rate; conversely, raising doubt about the desirable anticipated consequences significantly reduced the VR suicide rate. In Study 2, raising doubt about the anticipated consequences of attempting suicide by firearm significantly reduced the perceived lethality of firearms as well as self-predicted likelihood of future suicide attempts, with effects sustained at 2-week follow-up. ConclusionsFindings suggest that raising doubt about desirable anticipated consequences of suicide merits further research as one potential approach to inhibit suicidal behavior.

Impulsivity facets and perceived likelihood of future suicide attempt among patients who recently attempted suicide

BackgroundGiven the substantial heterogeneity of both impulsivity and suicidality, increased specificity in studying relations between these variables is needed. One aspect of suicidality that may be especially important for predicting future risk among those with a recent suicide attempt is self-perceived likelihood of making a future attempt (suicide likelihood). Presently, little is known about the extent to which impulsivity is related to this important aspect of suicidality. We examined whether three distinct impulsivity facets (i.e., deficits in conscientiousness, negative urgency, and sensation seeking) would differentially predict suicide likelihood. MethodsParticipants included 155 psychiatric inpatients who presented to a Level-1 trauma hospital after a recent suicide attempt. Structural Equation Modeling (SEM), in which demographic and clinical covariates were controlled, was conducted to examine whether each impulsivity facet would uniquely predict suicide likelihood. ResultsDeficits in conscientiousness was the only robust predictor of suicide likelihood, with an association that persisted after accounting for demographic and clinical covariates. LimitationsThe cross-sectional design and unknown predictive validity of suicide likelihood are study limitations. ConclusionThis was a preliminary investigation of impulsivity facets with suicide likelihood. Clinical implications of this study suggest that deficits in conscientiousness and suicide likelihood may be important factors to consider when identifying and intervening with patients at high-risk for suicide.

Pathways to Late-Life Suicidal Behavior: Cluster Analysis and Predictive Validation of Suicidal Behavior in a Sample of Older Adults With Major Depression.

Clinical heterogeneity is a key challenge to understanding suicidal risk, as different pathways to suicidal behavior are likely to exist. We aimed to identify such pathways by uncovering latent classes of late-life depression cases and relating them to prior and future suicidal behavior. Data were collected from June 2010 to September 2015. In this longitudinal study we examined distinct associations of clinical and cognitive/decision-making factors with suicidal behavior in 194 older (50+ years) nondemented, depressed patients; 57 nonpsychiatric healthy controls provided benchmark data. The DSM-IV was used to establish diagnostic criteria. We identified multivariate patterns of risk factors, defining clusters based on personality traits, perceived social support, cognitive performance, and decision-making in an analysis blinded to participants' history of suicidal behavior. We validated these clusters using past and prospective suicidal ideation and behavior. Of 5 clusters identified, 3 were associated with high risk for suicidal behavior: (1) cognitive deficits, dysfunctional personality, low social support, high willingness to delay future rewards, and overrepresentation of high-lethality attempters; (2) high-personality pathology (ie, low self-esteem), minimal or no cognitive deficits, and overrepresentation of low-lethality attempters and ideators; (3) cognitive deficits, inability to delay future rewards, and similar distribution of high- and low-lethality attempters. There were significant between-cluster differences in number (P < .001) and lethality (P = .002) of past suicide attempts and in the likelihood of future suicide attempts (P = .010, 30 attempts by 22 patients, 2 fatal) and emergency psychiatric hospitalizations to prevent suicide (P = .005, 31 participants). Three pathways to suicidal behavior in older patients were found, marked by (1) very high levels of cognitive and dispositional risk factors suggesting a dementia prodrome, (2) dysfunctional personality traits, and (3) impulsive decision-making and cognitive deficits.

Posttraumatic Stress and Suicidality Among Firefighters: The Moderating Role of Distress Tolerance

Firefighters report high rates of suicidality and posttraumatic stress disorder (PTSD). This investigation explored the moderating role of distress tolerance (DT) in the association between PTSD symptomatology and suicidality in firefighters. Covariates included trauma load, depressive symptom severity, gender, race, age, and education. The sample was comprised of 765 (94.0% male; Mage = 38.8, SD = 8.6) trauma-exposed firefighters who completed a questionnaire battery. Structural equation modeling was employed. PTSD symptom severity was significantly, positively associated with global suicide risk, suicidal ideation/attempt, frequency of suicidal ideation, lifetime threat of suicide, and perceived likelihood of future suicide attempts. Lower levels of DT were significantly associated with higher frequency of past-year suicidal ideation. Significant interactive effects were noted; firefighters with higher levels of PTSD symptom severity and low levels of DT had the highest levels of global suicide risk and perceived likelihood of future suicide attempt. Clinical and research implications are discussed.

Comparing the Internal Consistency, Overall Scores, and Response Patterns on the Suicidal Behavior Questionnaire–Revised in People With and Without Disabilities

This study examined the internal consistency, overall mean scores, and response patterns of 485 American adults, including 92 who identified as people with disabilities, on the Suicidal Behavior Questionnaire–Revised (SBQ-R). The measure demonstrated acceptable internal consistency in both groups. Participants with disabilities had higher mean total scores as well as more concerning response patterns on SBQ-R items assessing suicide attempts, plans, recent suicidal ideation, and perceived likelihood of future suicide attempts.

An exploratory randomised trial of a simple, brief psychological intervention to reduce subsequent suicidal ideation and behaviour in patients admitted to hospital for self-harm.

Implementation intentions link triggers for self-harm with coping skills and appear to create an automatic tendency to invoke coping responses when faced with a triggering situation. To test the effectiveness of implementation intentions in reducing suicidal ideation and behaviour in a high-risk group. Two hundred and twenty-six patients who had self-harmed were randomised to: (a) forming implementation intentions with a 'volitional help sheet'; (b) self-generating implementation intentions without help; or (c) thinking about triggers and coping, but not forming implementation intentions. We measured self-reported suicidal ideation and behaviour, threats of suicide and likelihood of future suicide attempt at baseline and then again at the 3-month follow-up. All suicide-related outcome measures were significantly lower at follow-up among patients forming implementation intentions compared with those in the control condition (ds>0.35). The volitional help sheet resulted in fewer suicide threats (d = 0.59) and lowered the likelihood of future suicide attempts (d = 0.29) compared with patients who self-generated implementation intentions. Implementation intention-based interventions, particularly when supported by a volitional help sheet, show promise in reducing future suicidal ideation and behaviour.

Grief cognitions and cognitive-emotional regulation associated with romantic breakup distress among college students

IntroductionIndividuals manage differently the experience of a romantic breakup [RB]. These differences may in part be related to the use of different cognitive-emotional regulation strategies [CERS]. Also, global negative beliefs and catastrophic misinterpretations regarding the RB may contribute to the emotional distress (Boelen and Reijntjes, 2009).ObjectivesTo explore the associations between CERS, grief cognitions related to RBs, and depression and suicidal ideation/behaviors in a sample of college students.AimsTo conduct regression analyses to predict depression, anxiety, hostility, and suicide behaviors from CERS and grief cognitions (as independent variables).MethodsCross-sectional, self-report data was collected from 359 college students who experienced a RB. The assessments used were: Cognitive-Emotional Regulation Questionnaire- Short Form (Garnefski et al., 2002); the Grief Cognitions Questionnaire adjusted to grief after RBs (Boelen et al., 2003); the subscales of Depression, Anxiety, and Hostility of the Counseling Center Assessment of Psychological Symptoms-62; and the Suicide Behaviors Questionnaire-Revised, Osman et al., 2001).ResultsPast suicide thoughts or attempts were predicted by Other-Blame; self-reported likelihood of future suicide attempt was predicted by Self-Blame, Other-Blame, and Positive Reappraisal, Grief Cognitions-Future, and Grief Cognitions-Appropriateness. Depression was predicted by all cognitive-emotional regulation subscales except Acceptance and Perspective, and by RB grief cognitions (self, future, self-blame, others, and perceived appropriateness of own grief reaction).ConclusionsClinical assessment to evaluate at-risk young adults after RBs could incorporate evaluations of cognitions regarding the RB and self-blaming, appropriateness of one's own grief reaction, and thoughts about the future.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Firearms Matter: The Moderating Role of Firearm Storage in the Association Between Current Suicidal Ideation and Likelihood of Future Suicide Attempts Among United States Military Personnel

The relationship between firearm ownership and suicide is well documented. This study hypothesized that how soldiers store their firearms would moderate the relationship between suicidal ideation and the self-reported likelihood of engaging in a future suicide attempt, and that this relationship would be explained by fearlessness about death. There were 432 military personnel (91.3% men, 74.2% White, Mage = 27.60) who endorsed current ownership of a private firearm and who were recruited from a military base in the southeastern United States (94.5% National Guard). Firearm storage moderated the relationship between suicidal ideation and the self-reported likelihood of engaging in a future suicide attempt, but this relationship was not explained by fearlessness about death. Individuals who reported keeping their firearms loaded and stored in an unsecure location exhibited higher mean levels of fearlessness about death. Findings highlight the need for research examining contributors to suicide risk in the context of firearm storage, and provide support for suicide prevention efforts involving restricting means.

Religious Commitment, Attitudes Toward Suicide, and Suicidal Behaviors Among College Students of Different Ethnic and Religious Groups in Malaysia

The variation in suicide patterns across ethnic groups with different religious background is a puzzling social phenomenon. This study sought to examine the impact of religious commitment and attitudes toward suicide on suicidal behaviors of college students across major ethnic and religious groups in a multicultural society of Malaysia. A total of 139 college students completed Religious Commitment Inventory-10, Attitudes Toward Suicide Scale, and Suicidal Behavior Questionnaire-Revised. Findings showed significant discrepancies in attitudes toward suicide, but not suicidal behaviors across ethnic and religious groups. Suicide acceptance significantly affected suicidal behaviors as well. Although religious commitment is not associated with suicidal behaviors, its deviation is reflected in students' acceptance of suicide. Additionally, college students' suicide risk, lifetime, and recent suicide ideation, as well as their likelihood of future suicide attempt can be associated with their acceptance of suicide. The influence of attitudes toward suicide and religion, therefore, should be taken into consideration while implementing suicide prevention programs as it helps shape the norms about suicide among youths.