Passive Suicidal Ideation Research Articles

Special Considerations for Older LGBTQ Adults During the COVID-19 Pandemic: Case and Review

IntroductionThroughout the COVID-19 Pandemic, older adults have been disproportionately impacted by both illness and fatalities. Of the nearly 39 million adults over age 65 in the United States, approximately 2.4 million older adults identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ). LGBTQ older adults face unique challenges due to their intersecting identities and histories, including the effects of heterosexism, ageism, and being more likely to live alone, be single, and not have children. As we implement social distancing as a primary COVID-19 prevention method, older adults have faced increased isolation.MethodsWe present one case of a lesbian older adult patient who has experienced increased depression during the COVID-19 pandemic. A table will be added featuring culturally competent recommendations for LGBTQ older adults from a literature review.ResultsA 77-year-old female with history of major depression, attention deficit disorder, hypertension, xerostomia, and polymyalgia rheumatica. The patient has been on multiple trials of medications for depression as well as ECT treatments. She described being a shy child and felt criticized and often rejected by her mother. She was initially engaged to a man and after some years fell in love with a woman. The patient is currently single and has no children. She typically has a strong support system with her lifelong friend and attends church. She transitioned from independent living to an adult living facility, with the hope of increased social activity and connectedness. However, due to COVID-19, she experienced her move as extremely difficult, and was disappointed that all social activities were canceled. For a period of several months, she was unable to visit her chosen family, was limited to attending church via Zoom, and was restricted from multiple areas of the complex. As a result, she reported increased depression, anxiety, and difficulty sleeping with passive suicidal ideation due to isolation and no direct family support.ConclusionsThe latest research highlights current vulnerabilities and health disparities of the older adult population, as well as ways to increase support and resiliency through the ongoing COVID-19 pandemic. Older LGBTQ populations are at disproportionately higher risk for mental health conditions and with the current social distancing measures in place, social isolation and loneliness has been exacerbated. Connection with accepting family and community are well documented in the literature as key protective factors and sources of resiliency in LGBTQ populations. Culturally competent care is integral to psychiatric treatment of older LGBTQ adults.FundingNot Applicable

Disturbed sleep as a clinical marker of wish to die: A smartphone monitoring study over three months of observation

BackgroundSmartphone monitoring could contribute to the elucidation of the correlates of suicidal thoughts and behaviors (STB). In this study, we employ smartphone monitoring and machine learning techniques to explore the association of wish to die (passive suicidal ideation) with disturbed sleep, altered appetite and negative feelings. MethodsThis is a prospective cohort study carried out among adult psychiatric outpatients with a history of STB. A daily questionnaire was administered through the MEmind smartphone application. Participants were followed-up for a median of 89.8 days, resulting in 9,878 person-days. Data analysis employed a machine learning technique called Indian Buffet Process. Results165 patients were recruited, 139 had the MEmind mobile application installed on their smartphone, and 110 answered questions regularly enough to be included in the final analysis. We found that the combination of wish to die and sleep problems was one of the most relevant latent features found across the sample, showing that these variables tend to be present during the same time frame (96 hours). ConclusionsDisturbed sleep emerges as a potential clinical marker for passive suicidal ideation. Our findings stress the importance of evaluating sleep as part of the screening for suicidal behavior. Compared to previous smartphone monitoring studies on suicidal behavior, this study includes a long follow-up period and a large sample.

Predictors of Suicidal Ideation and Preparatory Behaviors in Individuals With Bipolar Disorder: The Contribution of Chronobiological Dysrhythmicity and Its Association With Hopelessness.

To examine the role of chronobiological dysrhythmicity in suicidal ideation and behaviors and its relation with hopelessness. One hundred twenty-seven patients (77 females, mean age of 47.4 ± 12.5 years) with a major depressive episode and bipolar disorder (BD) type I or II (according to Structured Clinical Interview for DSM-5 assessment) were recruited in 2019 and assessed for depressive and manic symptoms (Beck Depression Inventory-II, Young Mania Rating Scale) and with the Biological Rhythms Interview of Assessment in Neuropsychiatry, Beck Hopelessness Scale, and Scale for Suicide Ideation. Univariate regression and mediation analyses were performed. Forty-one patients (32.3%) showed clinically significant suicidal ideation and were more frequently affected by BD type I (P = .029) with mixed features (P = .022). Compared to nonsuicidal individuals, they had significantly more depressive symptoms (P = .019), higher emotional component of hopelessness (P = .037), and higher dysrhythmicity of sleep (P = .009), activities (P = .048), and social life (P = .019). Passive and active suicidal ideation and suicidal plans were best predicted by dysrhythmicity of sleep and social life. Dysrhythmicity of sleep and social life mediated the direct effect of depressive symptoms on passive and active suicidal ideation and also of active ideation on suicidal plans. The emotional component of hopelessness was related to dysrhythmicity of social life and mediated its effect on suicidal plans (P = .010). Chronobiological alterations directly contributed to passive and active suicidal ideation and to suicidal preparation, with a key role of dysrhythmicity of sleep, activities, and social life. Chronobiological alterations also impacted the emotional component of hopelessness, hence indirectly contributing to suicidal ideations and plans. These findings call for the systematic screening of these dysrhythmicity dimensions when considering suicidal risk in individuals with BD.

Assessing Suicidal Ideation Using a Brief Self-Report Measure

Accurate assessment of suicidal thoughts is a challenge for researchers and clinicians. There is evidence that self-report and clinical interview assessment methods can result in different endorsement numbers when used to assess suicidal ideation. This study investigates endorsement rates and psychometric properties of a two-item self-report measure of suicidal ideation that distinguishes active from passive suicidal ideation, when compared with a clinical interview. Individuals presenting at an outpatient psychiatry clinic completed a measure of depression severity containing two items assessing passive and active suicidal ideation before undergoing a structured clinical interview. Self-report and clinical interview items demonstrated a low level of agreement. Self-report items were more strongly correlated with same-domain clinical interviewer ratings than different-domain ratings. These items demonstrated high negative predictive value and moderate-to-low positive predictive value for interviewer ratings. A two-item measure of suicidal ideation did not highly align with corresponding interviewer ratings, though such a measure may be useful in determining the absence of suicidal ideation, as well as distinguishing between passive and active suicidal ideation.

A meta-analysis of the association between the Children's Depression Inventory (CDI) and suicidality

A number of factors are associated with adolescent suicidal behaviors. One such factor is depressive symptoms, and there are multiple measures designed to assess youth depressive symptoms. One of the most commonly used instruments to assess depressive symptoms in youth is the Children's Depression Inventory (CDI). The aim of this meta-analysis was to evaluate the association between the CDI total score and adolescent suicidality (e.g., suicidal ideation, suicide attempts). Research reports were located through searching databases (e.g., PsycINFO) and reviewing reference lists. A total of 56 research reports ( N = 24,369) were identified as meeting inclusion criteria. Due to non-overlapping subgroups, 66 correlations were included in a random-effects model. The overall correlation between the CDI total score and suicidality was found to be 0.36, 95% confidence interval (CI) [0.32, 0.41], 80% credibility interval (CrI) [0.13, 0.60], I 2 = 94.15. Two coded study characteristics were found to significantly moderate effect sizes: when passive suicidal ideation was incorporated into the measurement of suicidality and sample type (i.e., clinical, school, community, forensic, mixed). Based on the results of this meta-analysis, CDI total scores could be used as a tool for evaluating adolescents' suicide risk. However, a determination of adolescents' suicide risk should never be based on CDI results alone, and the limitations of this meta-analysis should be considered when evaluating the strength of the findings.

Compassion-Focused Therapy: Proof of Concept Trial on Suicidal Ideation and Cognitive Distortions in Female Survivors of Intimate Partner Violence With PTSD.

This proof of concept trial aimed to assess the pre-post differences in suicidal ideation and cognitive distortions in the compassion-focused therapy (CFT), and to compare the psychological improvement in the experimental group to a control group. A total of 42 women suffering from PTSD due to exposure to intimate partner violence (IPV) were randomized to the experimental and control groups (21 per group). All participants completed the questionnaires of suicidal ideation and cognitive distortions as pretest measures. Subjects of the experimental group received 8 CFT sessions, while the controls did not receive any therapy. Then, all subjects responded to the questionnaires of suicidal ideation and cognitive distortions as the posttest measures. Data were analyzed using one-way repeated measures MANOVA. Subjects of the experimental group indicated a greater reduction in post-test scores of suicidal ideation and its subscales including passive suicidal ideation, preparation for suicide, and active suicidal ideation when compared to the controls. Moreover, the subjects of the experimental group indicated a greater reduction in the post-test scores of cognitive distortions than controls. These results provide support for a larger trial focusing on the efficacy of CFT on psychological outcomes of PTSD following exposure to IPV. This intervention has the potential to be deployed at higher scales for IPV-affected women with PTSD.

Examining the relations between hopelessness, thwarted interpersonal needs, and passive suicide ideation among older adults: does meaning in life matter?

Older adults are at an elevated risk for passive suicide ideation. The interpersonal theory of suicide and the 3-step theory may provide a framework to better understand factors that contribute to passive suicide ideation among older adults. Specifically, this study aimed to test components of prominent suicide theories and examine the role of meaning in life in the associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation among older adults. Participants were 243 adults aged 60 and older recruited from primary care settings in the southwest United States. We hypothesized that high meaning in life would weaken the associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation. Results from moderation analyses indicate that meaning in life was a significant moderator of the associations between hopelessness and passive suicide ideation, thwarted belongingness and passive suicide ideation, and perceived burdensomeness and passive suicide ideation. These findings suggest that when meaning in life is low there are significant negative associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation among older adults. Implications, limitations, and future directions are discussed.

Predictors of Passive and Active Suicidal Ideation and Suicide Attempt Among Older People: A Study in Tertiary Care Settings in Thailand.

PurposeThis study compared predictors of passive suicidal ideation (SI), active SI, and suicide attempt (SA) among elderly Thai patients in tertiary care settings.Patients and MethodsPsychiatric diagnoses and suicidality of 803 older people were assessed using the Mini-International Neuropsychiatric Interview and the Structured Clinical Interview for DSM-IV-TR. All participants completed the Montreal Cognitive Assessment, multidimensional scale of perceived social support (MSPSS), 15-item Thai geriatric depression scale (TGDS-15), 10-item perceived social scale and the Core Symptoms Index. The chi-square test, t-test and ANOVA were used for bivariate analysis of predictors of specific suicidality types. Multiple logistic regression was used to determine the predictors for each type of suicidality.ResultsThe patients’ mean age was 69.24 ± 6.90 years, and the majority were female (69.74%). Passive SI, active SI and SA were found among 20.42%, 3.74% and 2.37%, respectively, of the patients. Major depressive disorder (MDD) was a predictor of both passive and active SI (OR = 2.06 and 3.74, respectively). Other predictors of passive SI included hypomania (OR = 8.27) and positive score on the TGDS-15 (OR = 1.29). Predictors of active SI included agoraphobia (OR = 6.84) and hypomania (OR = 7.10). Predictors of SA included a family history of alcohol dependence (OR = 14.16), a history of depression (OR = 4.78) and agoraphobia (OR = 19.89). Surprisingly, hypertension and self-reported anxiety symptoms were protective factors for passive SI (OR = 0.51 and 0.85, respectively). Likewise, MSPSS was a protective factor for SA (OR = 0.90).ConclusionPredictors of each type of suicidality differed. MDD was the main predictor for SI; however, agoraphobia and poor perceived social support were more pronounced among individuals with SA. Further investigation, especially in longitudinal fashion, should be warranted.

The Assessment of Chronic Risk in Youth (ACRY): Development and Initial Validation in a Clinical Sample

ABSTRACT Assessment and monitoring of chronic suicidal and homicidal risk are necessary components of care within youth behavioral health clinics. Few standardized assessments or guidelines exist to help clinicians designate youth chronic risk status. The current study presents the Assessment of Chronic Risk in Youth (ACRY), a newly developed instrument that contains empirically supported risk and protective factors and guides clinicians in assessing chronic risk status over time. This study aimed to (a) examine the instrument’s validity against an expert consensus, (b) measure interrater reliability, and (c) examine associations between each risk and protective factor and risk classification. The ACRY was completed on 111 youth (ages 6–20 years, 67% female) within an outpatient clinic. The ACRY achieved excellent interrater reliability and high sensitivity and specificity against expert consensus ratings. Significant associations between several risk factors and total number of risk factors with higher-risk classifications were found. Active suicidal ideation, intent, and plan were significantly associated with high risk classification. Passive suicidal ideation, hospitalization, emergency room visits, nonsuicidal self-injury, perceived burdensomeness, high-risk behaviors, impulsivity, and substance use differentiated high from low, and moderate from low-risk classification. Greater number of risk factors was associated with higher risk categorization. Self-esteem and connection to family were significantly more likely in low-risk versus moderate-risk individuals. The ACRY is a promising new clinical and administrative tool that systematically and reliably documents chronic risk in youth.

Neurocognitive markers of passive suicidal ideation in late-life depression.

(1) To delineate whether cognitive flexibility and inhibitory ability are neurocognitive markers of passive suicidal ideation (PSI), an early stage of suicide risk in depression and (2) to determine whether PSI is associated with volumetric differences in regions of the prefrontal cortex (PFC) in middle-aged and older adults with depression. Cross-sectional study. University medical school. Forty community-dwelling middle-aged and older adults with depression from a larger study of depression and anxiety (NIMH R01 MH091342-05 PI: O'Hara). Psychiatric measures were assessed for the presence of a DSM-5 depressive disorder and PSI. A neurocognitive battery assessed cognitive flexibility, inhibitory ability, as well as other neurocognitive domains. The PSI group (n = 18) performed significantly worse on cognitive flexibility and inhibitory ability, but not on other neurocognitive tasks, compared to the group without PSI (n = 22). The group with PSI had larger left mid-frontal gyri (MFG) than the no-PSI group. There was no association between cognitive flexibility/inhibitory ability and left MFG volume. Findings implicate a neurocognitive signature of PSI: poorer cognitive flexibility and poor inhibitory ability not better accounted for by other domains of cognitive dysfunction and not associated with volumetric differences in the left MFG. This suggests that there are two specific but independent risk factors of PSI in middle- and older-aged adults.

Psychotic Experiences and Schizotypy in Early Adolescence Predict Subsequent Suicidal Ideation Trajectories and Suicide Attempt Outcomes From Age 18 to 38 Years.

Subclinical risk markers for schizophrenia predict suicidality, but little is known about the nature of the relationship. Suicidal ideation is often considered homogenous, but distinguishing passive from active ideation (ie, thoughts of death vs thoughts of killing oneself) and different temporal patterns may further the understanding of risk factors. We tested whether schizotypy and psychotic experiences (PEs) in early adolescence predict subsequent growth trajectories of suicidal ideation and suicide attempt outcomes. Participants were 1037 members of the population-representative Dunedin Study cohort. PE was measured at 11 years and schizotypy at 13 and 15 years. Outcomes were passive and active suicidal ideation, and suicide attempt, measured at 18, 21, 26, 32, and 38 years. Passive ideation was best represented by 2 trajectories, including persistent and transient ideation classes. Schizotypy predicted membership in the smaller persistent class (odds ratio [OR] = 1.21, P = .041), whereas PE was not associated with class membership. The probability of suicide attempts was 13.8% in the persistent ideation class, compared with 1.8% in the transient class. Active ideation was best represented by a 1-class model, the intercept of which was predicted by schizotypy (OR = 1.23, P = .015). Suicide attempts were predicted by schizotypy (OR = 1.53, P = .040) and PE (OR = 3.42, P = .046), and this was partially mediated by indirect effects via the active ideation trajectory. Findings indicate that adolescent schizotypy and PE are related to subsequent suicidal ideation and attempts. Suicidal ideation is heterogeneous, and schizotypy is specifically related to a persistent passive ideation subgroup.

Prevalence of Passive Suicidal Ideation in the Early Stage of the Coronavirus Disease 2019 (COVID-19) Pandemic and Lockdown in a Large Spanish Sample.

This work was partly supported by the Government of the Principality of Asturias PCTI-2018-2022 IDI/2018/235, the CIBERSAM, and Fondos Europeos de Desarrollo Regional (FEDER), and Fundacion para la Investigacion e Innovacion Biosanitaria del Principado de Asturias (FINBA).

442 - Neurocognitive markers of passive suicidal ideation in late life depression

Aims:Late life suicide is an international public health crisis, yet the mechanisms underlying late life suicide risk are far less understood compared to younger age groups. Executive dysfunction is widely documented in late life depression (LLD), and cognitive flexibility and inhibition are specifically hypothesized as vulnerabilities for suicide risk. There is some evidence that LLD patients with suicidal ideation or attempt suicide have worse executive dysfunction than LLD patients that do not; however, it is unknown whether these differences exist in Passive Suicidal Ideation (PSI), which may be an important early stage of suicide risk. Delineating the mechanisms of risk for PSI in LLD is a crucial direction for late life suicide research. The purpose of our study was to examine whether cognitive flexibility and inhibitory ability are neurocognitive markers of PSI. The secondary purpose of our study was to determine if neurocognitive differences due to PSI are mediated by volumetric differences in the prefrontal cortex.Methods:Forty community-dwelling middle- and older-aged adults with LLD (18 with PSI, 22 without) completed a neurocognitive battery that assessed cognitive flexibility, inhibitory ability, as well as other neurocognitive domains, and underwent structural neuroimaging.Results:The PSI group performed significantly worse on cognitive flexibility and inhibitory ability, but not on other neurocognitive tasks which included other measures of executive function. The PSI group had a larger left mid-frontal gyrus (LMFG) than those without PSI, but there was no association between LMFG and cognitive flexibility or inhibitory ability, nor was there statistical evidence of mediation.Conclusions:Our findings implicate a unique neurocognitive signature in LLD with PSI: poorer cognitive flexibility and poorer inhibitory ability not better accounted for by other domains of cognitive dysfunction and not mediated by volumetric differences in the prefrontal cortex. Volumetric brain differences in the LMFG appear unrelated to differences in cognitive flexibility and inhibitory ability, which suggests two specific but independent risk factors for PSI in middle- and older-aged adults.

Passive suicidal ideation in older adults from 12 European countries

Abstract Background Highest rates of suicide in older adults are a major public health hazard in many industrialized societies. The current study aims to provide an overview of demographic, psycho-social, and health-related risks for suicidal ideation among European older adults. Methods Study builds on secondary data analysis using data drawn from the Survey of Health, Aging and Retirement in Europe (SHARE) wave 7.0. A total sample of 33,719 older adults, aged 65+, were analyzed. Risk factors included socio-demographic variables, psychological distress, and health conditions. Descriptive statistics and ANOVA were used to provide information about prevalence and demographic correlates of passive suicidal ideation. Standardized significant path coefficients were examined between predicting variables and suicidal ideation. Results Suicide ideation was at its highest level among older adults from France, Poland, Spain, Germany, Italy, and Belgium. Highest rates of suicidal ideation were found among widowed, but also married couples, aged between 65 and 70, and older adults living in rural area. Results also reinforced that elderly's suicidal ideation was universally associated with poor health, limited access to activities, a lack of social contact, and worse subjective well-being. The path from depression to suicidal ideation was significant with a larger magnitude. Conclusions Passive suicidal ideation is a critical mental health index. In order to diminish the likelihood of suicide thoughts and acts in older adults, national policy should integrate psychological services in elderly care to help older adults better cope with depressive symptoms and long-term health problems. Local government should foster local support groups for elderly and promote suicide prevention-intervention program for those elderly seeking help.

Commentary on translational impact: Distinguishing between passive and active suicidal ideation to address the mental health needs of female juveniles.

Commentary on translational impact: Distinguishing between passive and active suicidal ideation to address the mental health needs of female juveniles.

A-255 Severe Psychological Dysfunction in a Neurologically Complex Patient during a Pre-Surgical Evaluation for Normal Pressure Hydrocephalus Shunt Implantation

Abstract Objective Psychological syndromes like depression and anxiety are common in neurological conditions and lead to poorer quality of life and disability. However, these syndromes are often under-recognized in neurologic patients and are thus under-diagnosed due to overlapping symptomatology. Here, we report on a patient with a complex neurological history as well as clinically significant affective symptoms. Participants The patient is a 69-year-old Caucasian female recently diagnosed with normal pressure hydrocephalus. Relevant medical history was significant for focal epilepsy with complex seizures, obstructive sleep apnea, and cerebrovascular accident. She underwent neuropsychological evaluation as part of a pre-surgical workup for shunt implantation. Results The patient’s neurocognitive profile was marked by significant impairments in most cognitive domains and she was not independent in activities of daily living. On self-report measures of current emotional functioning, she reported clinically severe levels of depression, anxiety, apathy, executive dysfunction, and disinhibition. During the clinical interview, she reported experiencing passive suicidal ideation as well as a significant history of traumatic experiences. Conclusion The psychological symptoms the patient was experiencing undoubtedly impacted her neurocognitive status and functioning abilities, though she was receiving no treatment for these symptoms. Addressing symptoms resulting from psychological syndromes in patients with neurological conditions is an important role for neuropsychologists, as accurate diagnosis of psychological syndromes can inform treatment recommendations and improve patient outcomes. This case illustrates the importance of documenting a thorough clinical history, including past psychiatric history, as well as a detailed examination of self-reported current psychological functioning as part of a comprehensive neuropsychological case formulation.

Evaluation of Suicide Risk in Chronic Schizophrenic Hospitalized Patients

Schizophrenic patients have a high risk for suicide. Research indicates that suicide is the cause of death in 5–13% of schizophrenic patients. Many factors are known to be involved in the suicidal process, some of which are different from those in the general population. The aim of the study was to evaluate the suicidal intent in schizophrenic hospitalized patients. In this descriptive cross sectional study, the numbers of patients who participated and continued all the psychometrics were 94 patients, 58 males and 36 females. Psychiatric sheet of General Secretariat of Mental Health, Structured interview using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V) and Arabic version of Beck Scale for Suicide Ideation (BSS) were done for all patients. According to BBS, 44.7% of the studied patients had no suicide ideation, 34.0% had passive suicide ideation, 11.7% had active suicide ideation and 9.6% had both passive and active suicidal ideation at the time of study. It was concluded that suicidal risk is high among schizophrenic patients. Marital status, onset and duration of schizophrenia, history of undergoing ECT, depressed mood and sense of hopelessness were found to have a strong association with suicide ideation.

Impact of a Brief, Bystander Bullying Prevention Program on Depressive Symptoms and Passive Suicidal Ideation: A Program Evaluation Model for School Personnel.

The purpose of this article is to present a study that can serve as a model of program evaluation for school personnel that can be used to improve services and demonstrate program efficacy to key stakeholders. The study presented in this article evaluated the impact of a brief, bystander bullying program ("stealing the show," "turning it over," "accompanying others," and "coaching compassion," [STAC]) on depressive symptoms and passive suicidal ideation among middle school students in a rural, low-income community (N = 130). This topic was selected as there is limited research examining the efficacy of bystander programs on improving mental health outcomes for students trained to intervene. Results of the study indicated students trained in the STAC program reported reductions in depressive symptoms and passive suicidal ideation at a 6-week follow-up compared with an increase in symptoms reported by students in the control group. We discuss these findings and the use of program evaluation by school personnel to support prevention programming.

Mental Health Problems and Risk of Suicidal Ideation and Attempts in Adolescents.

Obtaining recent estimates of the prevalence of suicide-related outcomes across adolescence and its associated mental health problems (MHPs) is important for clinical practice. We estimated the prevalence of suicide-related outcomes at ages 13, 15, 17, and 20 years (2011-2018) in a contemporary population-based cohort and documented associations with MHPs throughout adolescence. Data came from 1618 participants in the Québec Longitudinal Study of Child Development. Internalizing (depression and anxiety) and externalizing (oppositional/defiance, conduct issues, and attention deficit and/or hyperactivity) MHPs were assessed with validated questionnaires. Outcomes were self-reported past-year passive and serious suicidal ideation and suicide attempt. Lifetime prevalence of passive suicidal ideation (13-17 years old), serious suicidal ideation, and suicide attempt (13-20 years old) were 22.2%, 9.8%, and 6.7%, respectively. Prevalence was twice as high for females as for males. Overall, rates of passive (15-17 years old; 11.8%-18.4%) and serious ideation (13-20 years old; 3.3%-9.5%) increased over time but were stable for attempt (13-20 years old; 3.5%-3.8%). In univariable analyses, all MHPs were associated with suicide-related outcomes at all ages (risk rate ratio range: 2.57-3.10 [passive ideation] and 2.10-4.36 [suicide attempt]), and associations were similar for male and female participants (sex interaction P > .05). Magnitude of associations were generally stronger for more severe suicide-related outcomes (passive ideation < serious ideation < attempt). In multivariable analyses, internalizing problems were associated with suicidal ideation, whereas both depressive and conduct symptoms were associated with attempt. Suicidal ideation and attempt were common, especially for females and youth presenting with depressive and conduct problem symptoms. Clinicians should systematically assess suicidal risk in teenagers, especially in those presenting with MHPs.

How Clinicians Incorporate Suicide Risk Factors Into Suicide Risk Assessment.

Background: The literature has focused on explicit communications of suicidal ideation, although such communications are infrequent and less overt symptoms are comparable indicators of suicide risk. Aims: Our aim was to understand how clinicians consider inexplicit suicide risk factors in assessments of risk. Method: A national sample of 75 psychiatric crisis clinicians were provided with three vignettes, which varied in nine variables related to suicide risk. Clinicians rated imminent suicide risk and identified an appropriate level of care for each hypothetical patient. Results: Prior suicide attempt, intent to die, presence of a suicide plan, desire to die, hopelessness, burdensomeness, and passive suicidal ideation (defined as a combination of hopelessness, burdensomeness, desire to die, and anhedonia) significantly impacted risk perception while depression and anhedonia did not. Level of care was significantly associated with passive suicidal ideation, suicide plan, desire to die, and hopelessness. Limitations: Limitations of the study include its small sample size, experienced clinicians, and reliance on hypothetical patients. The study design did not allow for all variables to be compared against one another. Conclusion: Clinicians considered less overt risk factors for suicide when assessing risk. Future research should examine whether this knowledge is applied in real-life scenarios and if less experienced clinicians equally consider these risk factors.