Past Suicidal Ideation Research Articles

Psychiatric comorbidity and suicide risk in patients with psoriasis

IntroductionPsoriasis has a significant impact on the mental and emotional functioning.ObjectiveIt has been reported that the risk of psychiatric comorbidity increases with the severity of the disorder, and the most frequent associations appear to be those with depression and anxiety.AimsTo analyze the association between psoriasis, mental disorders and suicidal ideation in a sample of patients affected by psoriasis. To investigate the differences between psoriasis patients and patients with other dermatologic diseases.MethodsParticipants were 242 consecutive patients (142 women and 100 men), 112 patients with psoriasis (46.3%), 77 with melanoma (31.8%) and 53 with allergy (21.0%). All patients were administered a structured sociodemographic interview and the following measures: the Hamilton Rating Scale for Depression (HAM-D) and the Hamilton Rating Scale for Anxiety (HAM-A). We also assessed current and previous suicidal ideation and previous suicide attempts.ResultsPatients with psoriasis (compared to other groups of patients) more frequently had a comorbid mood disorder (16.1% vs 3.9% and 0.0%, respectively for patients with melanoma and patients with allergy; χ22 = 14.98; P < 0.001), past suicidal ideation (33.9% vs 15.6% and 18.9%, respectively for patients with melanoma and patients with allergy; χ22 = 2.05; P < 0.01) and attempts (6.3% vs 0.0% and 0.0%, for the other groups of patients; χ22 = 8.37; P < 0.05). Patients with psoriasis reported higher HAM-D scores than melanoma patients.ConclusionsThe clinical evaluation of patients with psoriasis should include the assessment of psychiatric comorbidities and the routinely assessment of suicide risk.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The relationship between social support and suicide risk in a national sample of ethnically diverse sexual minority women

ABSTRACTThis study examined the relationship between three types of social support and suicidal ideation and lifetime attempts among a national sample of ethnically diverse sexual minority women (SMW). Participants (N = 150) completed measures of social support and suicidal ideation/attempts. After controlling for socioeconomic status, social support explained 12.3% of the variance in past suicidal ideation and 10.7% in lifetime suicide attempts. Social support from family and significant other were both inversely associated with suicidal ideation, and social support from family inversely with lifetime attempts. Interventions that strengthen family relationships could be a buffer of suicidality in this population.

Coping Styles and Suicide in Racially and Ethnically Diverse Lesbian, Bisexual, and Queer Women.

The purpose of the current study was to examine whether coping strategies are associated with past suicidal ideation and history of suicide attempts among sexual minority women (SMW). Participants were 150 racially and ethnically diverse lesbian, bisexual, queer, or "other" nonheterosexual-identified cisgender women who were recruited as part of a national online survey on the experiences of SMW. Simultaneous multiple regressions suggested that coping styles significantly explained 20.3% of the variance in past suicidal ideation and 30.4% of the variance in lifetime history of suicide attempts. Within these regressions, self-blame coping positively predicted past suicidal ideation, and religious coping and venting coping were associated with a higher lifetime history of suicide attempts. Based on these findings, directions for future research and interventions to reduce suicide risk among SMW are discussed.

Suicidal Ideation in University Students: Prevalence and Association With School and Gender

AbstractSuicidal ideation is often an indicator of mental health problems and a major risk factor for suicide. This study aims to present the prevalence of suicidal ideation and compare students of a Portuguese university by school and gender. A total of 366 individuals from four schools completed the Suicidal Ideation Questionnaire (cut-off point ≥ 41 is significant) and specific questions about lifetime and past week suicidal ideation. Frequency analysis and chi-square tests were performed. The lifetime, past year and past week prevalence of suicidal ideation was 12.6%, 10.7% and 10.7%, respectively. A higher percentage of suicidal ideators were attending the School of Human and Social Sciences, and were of the female gender. However, these variables are not significantly associated with suicidal ideation. The results obtained emphasize the need for more research and the importance of taking special precautions to help students to deal with their personal and professional contingency challenges.

Attention-deficit/hyperactivity disorder symptoms and suicide ideation and attempts: Findings from the Adult Psychiatric Morbidity Survey 2007

BackgroundAdults with attention-deficit/hyperactivity disorder (ADHD) may have an increased risk of engaging in suicidal behavior. This study examined this association in the general adult population where there has been little research. MethodsData came from the Adult Psychiatric Morbidity Survey 2007. This was a representative sample of the English adult household population aged ≥16 years (N=7403). The Adult ADHD Self-Report Scale (ASRS) was used to obtain information on ADHD symptoms. The Clinical Interview Schedule Revised (CIS-R) was used to assess six forms of common mental disorder (CMD). Information was also obtained on the lifetime and past 12-month occurrence of suicide ideation and attempts. Logistic regression analysis was used to examine these associations. ResultsAfter adjusting for comorbid disorders, adults with more ADHD symptoms had significantly higher odds for suicidal behavior. When a single cut-off point was used to classify ADHD (ASRS score ≥14), odds ratios ranged from 1.62 (lifetime suicide attempt) to 2.43 (past 12-month suicide ideation). When ADHD symptoms were categorized by strata (I: a score of 0–9; II: 10–13; III: 14–17; IV: 18–24), compared to adults in stratum I, those in stratum IV had odds ratios ranging from 2.16 (lifetime suicide ideation) to 3.68 (past 12-month suicide attempt). LimitationsADHD and suicide data came from self-reports which may have been affected by socially desirable responding. ConclusionsADHD symptoms were linked to suicidal behavior after controlling for comorbid conditions. Health care professionals should be alerted to the increased suicide risk among adults with ADHD symptoms.

Control-related frontal-striatal function is associated with past suicidal ideation and behavior in patients with recent-onset psychotic major mood disorders

ObjectiveSuicide is highly-prevalent in major mood disorders, yet it remains unclear how suicidal ideation and suicidal behavior relate to brain functions, especially those that support control processes. We evaluated how prefrontal cortex (PFC) activity during goal-representation (an important component of cognitive control) relates to past suicidal ideation and behavior in patients with psychotic major mood disorders. Method30 patients with recent-onset of either DSM-IV-TR-defined bipolar disorder type I (n=21) or major depressive disorder (n=9) with psychotic features, but neither in a major mood episode nor acutely psychotic at study, were evaluated for past suicidal ideation and behavior (Columbia Suicide Severity Rating Scale) and functional MRI during cognitive control task performance. Group-level regression models of brain activation accounted for current depression, psychosis and trait impulsivity. ResultsIntensity of past suicidal ideation was associated with higher control-related activation in right-hemisphere regions including the ventrolateral PFC (VLPFC) and orbitofrontal cortex, rostral insula, and dorsal striatum. Among those with past suicidal ideation (n=16), past suicidal behavior (n=8) was associated with higher control-related activation in right-hemisphere regions including VLPFC, rostrolateral PFC, and frontal operculum/rostral insula; and relatively lower activity in midline parietal regions, including cuneus and precuneus. LimitationsThe sample size of subjects with past suicidal behavior was modest, and all subjects were taking psychotropic medication. ConclusionsThis study provides unique evidence that in early-course psychotic major mood disorders, suicidal ideation and behavior histories directly relate to PFC-based circuit function in support of cognitive control.

Mortality Among OEF/OIF/OND Veterans Diagnosed with Traumatic Brain Injury (TBI) and/or Post Traumatic Stress Disorder (PTSD) Using VA Health Care System

To examine mental health indicators, in aggregate and stratified by sex, among a population-based sample of U.S. military veterans.Data are from veteran who completed the Veterans Health Module (VHM) of the 2011 and 2012 Behavioral Risk Factor Surveillance System (n = 10,406). VHM items included lifetime diagnoses of mental illnesses, service in a combat zone, sources of mental health care, and past 12-month suicidal ideation and attempt. We used weighted, multiple logistic regression models, adjusted for sociodemographics, to examine differences in suicidal ideation and attempt among men and women.Overall, 5.0% of the sample reported recent suicidal ideation and 1.0% reported attempting suicide. Among men, unemployment was positively associated with suicidal ideation, and combat exposure was negatively associated with suicidal ideation. Being separated, divorced, or widowed was positively associated with suicidal ideation among women. After adjusting for sociodemographic and VHM variables, veterans who sought mental health treatment from both Veterans Affairs (VA) and non-VA facilities had more than fourfold increased odds of suicidal ideation than veteran who sought mental health treatment from only VA facilities (adjusted odds ratio = 4.02; 95% confidence interval 1.23–13.13).Correlates of suicidal ideation differ between male and female veterans. Veterans who use both non-VA and VA facilities for mental health services may have greater risk of self-directed violence.

Conflict-related anterior cingulate functional connectivity is associated with past suicidal ideation and behavior in recent-onset schizophrenia

Suicide is highly prevalent in schizophrenia (SZ), yet it remains unclear how suicide risk factors such as past suicidal ideation or behavior relate to brain function. Circuits modulated by the prefrontal cortex (PFC) are altered in SZ, including in dorsal anterior cingulate cortex (dACC) during conflict-monitoring (an important component of cognitive control), and dACC changes are observed in post-mortem studies of heterogeneous suicide victims. We tested whether conflict-related dACC functional connectivity is associated with past suicidal ideation and behavior in SZ. 32 patients with recent-onset of DSM-IV-TR-defined SZ were evaluated with the Columbia Suicide Severity Rating Scale and functional MRI during cognitive control (AX-CPT) task performance. Group-level regression models relating past history of suicidal ideation or behavior to dACC-seeded functional connectivity during conflict-monitoring controlled for severity of depression, psychosis and impulsivity. Past suicidal ideation was associated with relatively higher functional connectivity of the dACC with the precuneus during conflict-monitoring. Intensity of worst-point past suicidal ideation was associated with relatively higher dACC functional connectivity in medial parietal lobe and striato-thalamic nuclei. In contrast, among those with past suicidal ideation (n = 17), past suicidal behavior was associated with lower conflict-related dACC connectivity with multiple lateral and medial PFC regions, parietal and temporal cortical regions. This study provides unique evidence that recent-onset schizophrenia patients with past suicidal ideation or behavior show altered dACC-based circuit function during conflict-monitoring. Suicidal ideation and suicidal behavior have divergent patterns of associated dACC functional connectivity, suggesting a differing pattern of conflict-related brain dysfunction with these two distinct features of suicide phenomenology.

Morningness-eveningness, current depression, and past suicidality.

Previous research has reported that people who feel at their peak in the evening are more prone to depression and affective disorders. In a sample of 194 undergraduate students (54 men, 140 women; M age=21.6 yr., SD=1.4), using a simple correlational design, describing oneself as an evening person and scores on Horne and Őstberg's Morningness-Eveningess Scale were correlated with higher scores on measures of depression, hopelessness, defeat, and entrapment, but not with a report of past suicidal ideation or attempts, thereby supporting previous research findings.

Associations of racial/ethnic identities and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning individuals

BackgroundOur aim was to examine the associations of racial/ethnic identity and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning (LGBQ) and heterosexual college students. An additional aim was to determine the prevalence of passive suicidal ideation (i.e., death ideation) and active suicidal ideation among culturally diverse LGBQ individuals. MethodsData from the National Research Consortium probability-based sample of college students from 70 postsecondary institutions (n=24,626) were used to examine active and passive suicidal ideation in the past 12-months and lifetime active suicidal ideation among students by sexual orientation, racial/ethnic identity, and religious affiliation. ResultsAcross most racial/ethnic groups and religious affiliations, LGBQ students were more likely to report active suicidal ideation than non-LGBQ individuals. Among LGBQ students, Latino individuals had lower odds of reporting both past 12-month passive and active suicidal ideation than their non-Hispanic white LGBQ counterparts. Compared to Christian LGBQ students, Agnostic/Atheist LGBQ individuals had greater odds of reporting past 12-month passive suicidal ideation, and Jewish LGBQ students were less likely to endorse past 12-month passive and active suicidal ideation. LimitationsCross-sectional design and self-reported data. ConclusionsResults corroborate previous research showing elevated prevalence of suicidal ideation among LGBQ individuals in comparison to their heterosexual counterparts. These findings are among the first to document prevalence differences within the LGBQ population based on intersectional identities (race/ethnicity and religious affiliation). Providers should recognize that LGBQ individuals might need support in negotiating the complex relationship between multiple identities, especially due to their elevated prevalence of suicidal ideation.

119 Primary Predictors of Suicide Outcomes One Year After Screening Positive for Suicide Risk in the Emergency Department

Although suicide is difficult to predict in the general population, emergency department (ED) patients presenting with suicide risk factors such as substance abuse or depression are a readily identifiable population at elevated risk for suicidal behavior. However, little is known about which factors have the strongest association with future suicide outcomes. This study aimed to determine the predictors associated with suicide outcomes documented during the 12 months following an ED visit where the patient screened positive for active suicidal ideation or behavior. Data were collected during the first two phases of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE), a quasi-experimental suicide intervention study involving eight EDs across the U.S. Sites enrolled adults with active suicidal ideation or an attempt in the last week. Data collection included baseline interview; 6- and 12-month chart reviews; and 6-, 12-, 24-, 36-, and 52-week telephone follow-up assessments. The suicide composite outcome included reporting a preparatory act (eg, buying pills), interrupted or aborted attempt, a suicide attempt, or a suicide in the 12 months following the initial ED visit. Variables with a univariable association with suicide outcomes at P<.10 were included in the multivariable logistic regression model. In the final model, P<.05 was considered statistically significant. Among the 874 subjects (phase 1=497; phase 2=377), the median age was 37 years (interquartile range 27-47) with 56% female, 74% white, and 87% non-Hispanic. At baseline, 577 (66%) had suicidal ideation only and 297 (34%) a suicide attempt in the last month. Twelve-month outcomes were available for 782 (90%), who completed at least one of the 5 telephone follow-up assessments or had documentation of a suicide attempt or suicide completion during the 6- or 12-month chart review. In the one year after the initial ED visit, 430 (55%) reported a preparatory act, interrupted or aborted attempt, a suicide attempt, or had committed suicide. Subjects were more likely to have suicidal behavior within one year after the initial ED visit if they reported at the initial ED visit that they had a high school education or less (OR 1.63; 95% CI, 1.18-2.26; P=.003), had a primary care provider (OR 1.43; 95% CI, 1.01-2.00; P=.04), were unemployed (OR 1.64; 95% CI, 1.16-2.32; P=.006), had active suicidal ideation with a plan and intent to act (OR 10.2; 95% CI, 1.13-91.56; P=.04), had a severe health issue (eg, stroke, HIV) (OR 1.49; 95% CI, 1.06-2.10; P=.02), had a history of mental health problem(s) (OR 1.99; 95% CI, 1.14-3.47; P=.02), or a had a history of suicide attempt(s) (OR 1.60; 95% CI, 1.11-2.30; P=.01). The strongest predictors of reporting suicidal behavior within one year after the initial ED visit were related to patient characteristics (demographics and medical history) and past suicidal ideation and behavior. This suggests that in addition to psychiatric history, individual characteristics such as education level and employment as well as severe medical conditions should be considered when assessing suicide risk in an adult ED population. Understanding the factors that predict future suicide behaviors for this population will help guide the design and implementation of improved suicide-related interventions in the ED.

Prevalence of suicidal ideation and other suicide warning signs in veterans attending an urgent care psychiatric clinic

BackgroundSuicide prevention in the clinical setting is focused on evaluating risk in the coming hours to days, yet little is known about which factors increase acute risk. PurposeTo determine the prevalence of factors that may serve as warnings of heightened acute risk. MethodsVeterans attending an urgent care psychiatric clinic (n=473) completed a survey on suicidal ideation and other acute risk warning signs. ResultsMore than half the sample (52%) reported suicidal ideation during the prior week. Of these, more than one-third (37%) had active ideation which included participants with a current suicide plan (27%) and those who had made preparations to carry out their plan (12%). Other warning signs were also highly prevalent, with the most common being: sleep disturbances (89%), intense anxiety (76%), intense agitation (75%), hopelessness (70%), and desperation (70%). Almost all participants (97%) endorsed at least one warning sign. Participants with depressive syndrome and/or who screened positive for post-traumatic stress disorder endorsed the largest number of warning signs. Those with both depressive syndrome and post-traumatic stress disorder were more likely to endorse intense affective states than those with either disorder alone. All p-values for group comparisons are <.008. ConclusionOur major findings are the strikingly high prevalence of past suicidal ideation, suicide attempts, current suicidal ideation and intense affective states in veterans attending an urgent care psychiatric clinic; and the strong associations between co-occurring post-traumatic stress disorder and depressive syndrome with intense affective states.

Suicidality among veterans: implications of sexual minority status.

Using the California Quality of Life surveys, we examined suicidal ideation and attempts in 129 lesbian, gay, and bisexual (LGB) veterans and in 315 heterosexual veterans in 2008-2009 and 2012-2013. Although there were no significant differences in the past 12-month suicidal ideation and lifetime attempts, LGB veterans had higher odds of lifetime suicidal ideation than heterosexual veterans (adjusted odds ratio = 3.00; 95% confidence interval = 1.38, 6.53). Suicide assessment and prevention efforts in LGB veterans could benefit from a life-course perspective regarding suicide risk.

Frontal cortex control dysfunction related to long-term suicide risk in recent-onset schizophrenia

ObjectiveSuicide is highly-prevalent and the most serious outcome in schizophrenia, yet the disturbances in neural system functions that confer suicide risk remain obscure. Circuits operated by the prefrontal cortex (PFC) are altered in psychotic disorders, and various PFC changes are observed in post-mortem studies of completed suicide. We tested whether PFC activity during goal-representation (an important component of cognitive control) relates to long-term suicide risk in recent-onset schizophrenia. Method35 patients with recent-onset of DSM-IV-TR-defined schizophrenia (SZ) were evaluated for long-term suicide risk (using the Columbia Suicide Severity Rating Scale) and functional MRI during cognitive control task performance. Group-level regression models associating control-related brain activation with suicide risk controlled for depression, psychosis and impulsivity. ResultsWithin this group, past suicidal ideation was associated with lower activation with goal-representation demands in multiple PFC sectors. Among those with past suicidal ideation (n=18), reported suicidal behavior was associated with lower control-related activation in premotor cortex ipsilateral to the active primary motor cortex. ConclusionsThis study provides unique evidence that suicide risk directly relates to PFC-based circuit dysfunction during goal-representation, in a major mental illness with significant suicide rates. Among those with suicidal ideation, the overt expression in suicidal behavior may stem from impairments in premotor cortex support of action-planning as an expression of control. Further work should address how PFC-based control function changes with risk over time, whether this brain–behavior relationship is specific to schizophrenia, and address its potential utility as a biomarker for interventions to mitigate suicide risk.

Parental expressed emotion and suicidal ideation in adolescents with bipolar disorder

Family environmental variables are risk factors for recurrent courses of mood disorder in adolescents. The present study examined the association between parental expressed emotion (EE)—critical, hostile and/or emotionally overinvolved attitudes toward a concurrently ill offspring—and suicidal ideation in adolescents with bipolar disorder. The sample consisted of 95 adolescents with a bipolar I or II diagnosis who had experienced a mood episode in the prior 3 months. Participants (mean age=15.54 years, S.D.=1.4) were interviewed and completed questionnaires regarding current and past suicidal ideation prior to their participation in a treatment trial. Parents completed five-minute speech samples from which levels of EE were assessed. High EE attitudes in parents were associated with current suicidal ideation in adolescents. This relationship was independent of the effects of age, gender, current depressive or manic symptoms, comorbid diagnoses, bipolar I/II subtypes, family adaptability, and family cohesion. These results underscore the importance of addressing the emotional reactivity of caregivers in treating adolescents with bipolar disorder who have suicidal ideation.

College student stressors, depression, and suicidal ideation.

This study was designed to explore whether stressors from college-related activities and stressors from general life experiences differed in their power to predict depression and suicidal ideation in college students. In a sample of 165 college undergraduates, depression was predicted by both sources of stress whereas past and current suicidal ideation were predicted only by general life stress.

Relationship Between Current Sleep Duration and Past Suicidal Ideation or Attempt Among Korean Adolescents

ObjectivesTo comprehensively examine the relationship between current sleep duration and past suicidal idea or attempt among Korean adolescents.MethodsData came from the 2009 Korea Youth Risk Behavior Web-based Survey with 75 066 participants (with the participation rate of 97.6%) in 800 middle and high schools. Binary logistic regression was conducted by gender and depressed mood to identify significant factors for suicidal ideation/attempt. The dependent variable was the log odds of suicidal ideation/attempt, while the independent/control variables were sleep duration and other demographic, socio-economic and health-related factors.ResultsA negative association between sleep duration and suicidal ideation or attempt was weaker for those with depressed mood than for those without such experience in Korea for Year 2009. The odds ratio of suicidal ideation/attempt regarding less than 4 hours of sleep compared to 6 to 7 hours of sleep, was smaller in a group with depressed mood than in a group without such experience, for example, 1.64 (95% confidence interval [CI], 1.29 to 2.08) vs. 2.06 (95% CI, 1.34 to 3.17) for men's suicidal ideation, 2.50 (95% CI, 1.69 to 3.69) vs. 3.89 (95% CI, 1.74 to 8.66) for men's suicidal attempt. A negative association between age (or self-rated health) and suicidal ideation/attempt was also weaker for those with depressed mood than for those without such experience in the nation for the year.ConclusionsThere was a negative association between sleep duration and suicidal ideation/attempt in Korea for Year 2009 and this association was weaker for those with depressed mood than for those without such experience. Based on the findings of this study, adolescents' better mental health and longer, more comfortable sleep might help to prevent their suicidal ideation and attempt in Korea.

An Evaluation of a Unique Gatekeeper Training for Suicide Prevention of College Students: Demonstrating Effective Partnering within Student Affairs

For college students, suicide is the second leading cause of death resulting in over 1,100 student deaths per year (Center for Disease Control, 2009). Researchers from the American College Health Association (2011), assessed over 105,000 students across the United States, and found that almost 10% of students seriously contemplated suicide and 1.5% had made a suicide attempt in the past year. In addition, Hirch and Barton (2011) surveyed 439 college students and found that 46% of students reported past suicidal ideation, 10% reported making a past suicide attempt, and 2% reported that they might attempt suicide in the future (Hirsch & Barton, 2011). Thus, the development of suicide prevention programs on college campuses is an important and urgent task. Researchers have indicated that there are numerous risk factors linked to college student suicidal behavior including previous suicide attempts, history of depression or other mental illness, alcohol or drug use, stress, low self-esteem, academic problems, relationship issues, and loneliness (Center for Disease Control, 2009). Some students enter college with pre-existing mental health conditions, while others may develop risk factors during their time in college. Garlow et al. (2008) found an association between suicidal ideation, a history of suicidal acts, and depressive symptoms in college students. Specifically, individuals with more severe symptoms of depression were more likely to experience suicidal ideation. An association was also found between suicidal ideation and other internal distress such as anxiety, irritability, and rage (Garlow et al., 2008). College is a major transitional period, which may increase the likelihood for depressive symptoms and exposure to drugs and alcohol which are two major risk factors for suicide (Westefeld et al., 2006). Gatekeeper Suicide Prevention The problem of college student suicide has drawn national attention and encourages college mental health professionals to focus on suicide prevention and intervention. One type of prevention effort for at-risk students is the gatekeeper training method. Gatekeepers have primary contact with people at risk for suicide and identify them by recognizing suicidal risk factors. In essence, gatekeepers open the gate to assistance for people at risk for suicide (Gould & Kramer, 2001). Gatekeeper training programs aim to enhance recognition and referral by training staff at colleges and universities to help identify students at risk and refer these students to appropriate supportive services or counseling. Research on gatekeeper training programs for college students is limited. Findings from a recent study on gatekeeper skills of community members after a brief suicide prevention training program, indicated that 10% of participants met criteria for acceptable gatekeeper skills prior to the training compared to 54% of participants after training (Cross, Matthieu, Lezine, & Knox, 2010). According to Aseltine and Demartino (2004), youth who are suicidal may turn to their peers first for help, therefore gatekeeper prevention programs that teach peers how to recognize warning signs of suicide, deal effectively with a student in distress, and make appropriate referrals are important. The benefit of peers helping peers has been supported by research on peer health education programs on college campuses. There is significant support in the literature for the positive effects of peer health educators on college students in regards to making healthy decisions about alcohol and drug use, sex, nutrition and exercise, and mental health issues (Sloane & Zimmer, 1993; White, Park, Israel, & Cordero, 2009). Peer health educators have credibility from students and are therefore more likely to facilitate attitude and behavior changes, as well as, be able to understand the experiences of their fellow classmates (Sloane & Zimmer, 1993). In a systematic review of gatekeeper training programs, Isaac et al. …

Shame, pride, and suicidal ideation in a military clinical sample

BackgroundSuicide risk among U.S. military personnel has been increasing over the past decade. Fluid vulnerability theory (FVT; Rudd, 2006) posits that acute suicidal episodes increase in severity when trait-based (e.g., shame) and state-based (e.g., hopelessness) risk factors interact, especially among individuals who have been previously suicidal. In contrast, trait-based protective factors (e.g., pride) should buffer the deleterious effects of risk factors. Methods77 active duty military personnel (95% Air Force; 58.4% male, 39.0% female; 67.5% Caucasian, 19.5% African–American, 1.3% Native American, 1.3% Native Hawaiian/Pacific Islander, 1.3% Asian, and 5.2% other) engaged in outpatient mental health treatment completed self-report surveys of shame, hopelessness, pride, and suicidal ideation. Multiple generalized regression was utilized to test the associations and interactive effects of shame, hopelessness, and worst-point past suicidal ideation on severity of current suicidal ideation. ResultsShame significantly interacted with hopelessness (B=−0.013, SE=0.004, p<0.001) and worst-point suicidal ideation (B=0.027, SE=0.010, p=0.010), augmenting each variable's effect on severity of current suicidal ideation. A significant three-way interaction among shame, worst-point suicidal ideation, and pride was also observed (B=−0.010, SE=0.0043, p=0.021), indicating that pride buffered the interactive effects of shame with worst-point suicidal ideation. LimitationsSmall sample size, cross-sectional design, and primarily Air Force sample. ConclusionsAmong military outpatients with histories of severe suicidal episodes, pride buffers the effects of hopelessness on current suicidal ideation. Results are consistent with FVT.

Clinical Correlates of the Weight Bias Internalization Scale in a Sample of Obese Adolescents Seeking Bariatric Surgery

The aim of this study was to evaluate psychometric properties and clinical correlates of the Weight Bias Internalization Scale (WBIS) in a sample of obese adolescents seeking bariatric surgery. Sixty five adolescents enrolled in a bariatric surgery program at a large, urban medical center completed psychiatric evaluations, self-report questionnaires including the WBIS and other measures of psychopathology and physical assessments. The WBIS had high internal consistency (Cronbach's α = 0.92). As in previous research with adults, the one underlying factor structure was replicated and 10 of the original 11 items were retained. The scale had significant partial correlations with depression (r = 0.19), anxiety (r = 0.465), social, and behavioral problems (r = 0.364), quality of life (r = -0.480), and eating (r = 0.579), shape (r = 0.815), and weight concerns (r = 0.545), controlling for BMI. However, WBIS scores did not predict current or past psychiatric diagnosis or treatment or past suicidal ideation. Overall, the WBIS had excellent psychometric properties in a sample of obese treatment-seeking adolescents and correlated significantly with levels of psychopathology. These findings suggest that the WBIS could be a useful tool for healthcare providers to assess internalized weight bias among treatment-seeking obese youth. Assessment of internalized weight bias among this clinical population has the potential to identify adolescents who might benefit from information on coping with weight stigma, which in turn may augment weight loss efforts.