Risk Factors For Suicidal Behavior Research Articles

Evaluation of a multimodal school-based depression and suicide prevention program among Dutch adolescents: design of a cluster-randomized controlled trial

BackgroundSince 2010, suicide has been the most important cause of mortality in youth aged 15 to 29 years in the Netherlands. Depression is an important risk factor for suicidal behaviors (i.e., suicide ideation, deliberate self-harm, planning, and suicide attempts) in adolescents. Adolescents who develop depressive symptoms, are also at risk for adult depression. This developmental continuity is especially noticeable in adolescents compared to other age groups; therefore, it is necessary to develop preventive strategies for teens. This study will test a multimodal school-based approach to suicide and depression prevention, which integrates universal and targeted approaches and includes various stakeholders (schools, adolescents, parents, and mental health professionals) simultaneously.MethodsWe will perform a cluster randomized controlled trial (RCT) with an intervention and control condition to test the effectiveness of a school-based multimodal stepped-prevention program for depression and suicidal behaviors in adolescents. Adolescents in their second year of secondary education will participate in the study. The participants in the intervention condition will receive the entire multimodal stepped-preventive program comprising early screening and detection of suicidal behaviors and depressive symptoms, a safety net consisting of gatekeepers at school, followed by universal and indicated prevention. The participants in the control condition will undergo only the screening and the safety net of gatekeepers at schools. They will complete assessments at baseline, post-intervention, and 6, 12, and 24-month follow-up. Primary outcome will be suicidal behaviors measured at 12-months follow-up. Additionally, the present study will identify mechanisms that mediate and moderate the program effects and test the effect of the program on various secondary outcomes.DiscussionIf the school-based multimodal stepped-prevention program proves to be effective, it could be implemented in schools on a large scale.Trial registrationThe study is registered in the Dutch Trial Register (NTR6622).

Suicidal thoughts and suicide attempts in adolescence among migrants

Migration is an experience with a creative and dynamic potential, but it can also serve to further isolate people. Migrant adolescents and ethnic minorities with a migrant background are particularly vulnerable to suicidal ideation and suicidal behaviour. International studies show a significant prevalence of suicide attempts among migrants and their children. Intergenerational conflicts and the family environment, for example poor communication and lack of parental support, are risk factors for suicidal behaviour in migrant adolescents. The valorisation of the culture of origin could contribute to the feeling of 'cultural continuity' which is a protective factor of the suicidal risk.

Workplace victimization risk and protective factors for suicidal behavior among active duty military personnel

BackgroundWorkplace victimization is a potential risk factor for suicidal behaviors (SB) among military personnel that has been largely overlooked. This paper examines both the impact of workplace victimization on reported SB and several potential protective factors associated with such suicidal behaviors in a large sample of active duty soldiers. MethodsA case-control study was conducted with 71 soldiers who reported SB in the past 12 months, each matched on sociodemographic characteristics to two others without reported suicidal behaviors. A multiple regression model was estimated to assess the effects of risk and protective factors while controlling for other variables. ResultsSB was associated with several aspects of victimization, mental health and substance abuse conditions, pain, impulsivity, stressors, negative life events, work-family conflict, active coping behaviors and positive military-related factors. Controlling for other variables, those with SB were more likely to have sought mental health or substance abuse services, to be depressed, anxious, impulsive, and less resilient than non-SB personnel. LimitationsStudy limitations included the use of retrospective self-report data, absence of some known SB predictors, and a population restricted to active duty Army personnel. ConclusionsSB among active duty personnel is associated with victimization since joining the military and is protected by resiliency. These findings suggest that in addition to the usual mental health factors, these additional predictors should be accounted for in SB intervention and prevention planning for active duty personnel.

Pathways to Attempted Suicide as Reflected in the Narratives of People with Lived Experience

Narratives, i.e., stories told by suicidal people, describing personal experiences and meanings given to these experiences, play an important role in understanding suicidal behaviour. The aim of the current study was to analyse suicidal processes that have resulted in attempted suicide and to improve the understanding of protective and risk factors of suicidal behaviour. Special emphasis was paid to religious/spiritual aspects. The material was collected in Estonia by conducting narrative interviews with adults (18 years or older) who had attempted suicide during their lifetimes (N = 8). Thematic analysis was used for analysing the data. The main themes identified from the narratives were: childhood and family relationships, romantic relationships, alcohol/drug abuse, losses, sleep, previous suicide attempts, and religious/spiritual beliefs. The findings of the study show that there are many pathways to attempted suicide and that the process leading to attempted suicide is complex. Protective and risk factors are both multi-faceted.

Psychological and genetic risk factors associated with suicidal behavior in Korean patients with mood disorders

IntroductionTo prevent suicide, a nationwide important issue in Korea, understanding its etiology is essential. This study aimed to delineate the risk factors for suicidal behavior in mood disorder patients in Korea. Methods216 patients with mood disorders were recruited. We measured suicidal ideation (SI) and suicide attempt (SA) history and the association of six gene polymorphisms with SB: COMT (rs4680), HTR1A (rs6295), TPH1 (rs1800532), BDNF (rs6265), SLC1A3 (rs2269272), and SLC1A2 (rs4755404). ResultsPatients in the high-SI and SA groups reported more severe depressive, hopelessness, and anxiety symptoms and lower resilience and used less social support-seeking coping than those in the non-significant SI and non-SA groups. Multivariate logistic analysis revealed that depressive disorder, depressive symptoms, poor social support, and less social support-seeking coping were significant independent predictors of suicidal ideation. After adjustment for covariates, age, alcohol consumption, and the rs4680 AA genotype in the COMT gene were associated with suicide attempt. LimitationsThe modest sample size and a relatively few candidate genes are limitations of the study. In addition, there is no normal control group and the retrospective evaluation of SA limits the interpretation of the causal relationship with factors affecting SA. ConclusionsSuicidal behavior in Korean patients with mood disorders may be associated with younger age, alcohol consumption, depressive symptoms, poor social support, less social support-seeking coping, and the COMT rs4680 Met/Met genotype.

T140. Resting State Amplitude of Low-Frequency Fluctuation is Associated With Suicidal Ideation

Suicide is a major cause of mortality. Suicidal ideation is a risk factor for suicidal behavior. Patients may have difficulty discussing suicidal thoughts, so a biomarker that assesses ideation would have clinical utility. Previous resting state functional MRI (fMRI) studies of suicidal ideation have used connectivity analyses with specific seeds and targets. Here, we conducted an exploratory whole brain analysis. Neurocognitive function was also considered because it has been associated with both suicidal ideation and resting state activity.

T217. FACTORS RELATED TO SUICIDAL BEHAVIOR IN KOREAN PATIENTS WITH BIPOLAR DISORDER: THE EFFECT OF MIXED FEATURES ON SUICIDALITY

BackgroundThe aim of the present study was to investigate various risk factors of suicidal behaviors, including mixed feature specifier, in Korean patients with bipolar disorder.MethodsWe retrospectively reviewed medical charts from 2005 to 2014. A total of 334 patients diagnosed with bipolar disorder using DSM-IV TR were enrolled. The subjects were categorized into two groups according to history of suicidal behaviors and compared regarding demographic and clinical characteristics including mixed feature specifier. We re-evaluated the index episode using the DSM-5 criteria and classified into index episode with and without mixed feature. Logistic regression was performed to evaluate significant risk factors associated with suicidal behavior.ResultsSuicidal behavior had independent relationship with mixed feature at index episode using DSM-5 criteria and number of previous depressive episodes in Korean bipolar patients. The mixed feature specifier was the strongest risk factor in the present study.DiscussionSuicidal behavior had independent relationship with mixed feature at index episode using DSM-5 criteria and number of previous depressive episodes in Korean bipolar patients. The mixed feature specifier was the strongest risk factor in the present study.

S137. DO HALLUCINATIONS PREDICT THE TRANSITION FROM SUICIDAL THOUGHTS TO ATTEMPTS? RESULTS FROM AN AUSTRALIAN LONGITUDINAL COHORT STUDY

BackgroundAlthough suicidal ideation is a well-documented risk factor for suicidal behaviour, the majority of those with suicidal thoughts do not go on to make an attempt. Therefore, it is important to improve prediction of which individuals are more likely to act on their suicidal thoughts, as highlighted in Klonsky and May’s (2015) ideation-to-action framework. Auditory hallucinations (AH) and psychological distress (PD) are strongly associated with both suicidal thoughts and behaviour, but their role in the ideation-to-attempt transition has not been investigated in a longitudinal dataset.MethodsParticipants were from an Australian longitudinal cohort of 1793 adolescents (12–17 years). Suicidal thoughts and behaviours were measured using the Self-Harm Behaviour Questionnaire. The Diagnostic Interview Schedule for Children was used to assess AH. PD was categorised using the General Health Questionnaire (GHQ) clinical cut-off. Those reporting suicidal ideation were stratified into four groups: (i) Those who did not have PD or AH (reference group), (ii) AH only, (iii) PD only, and (iv) PD and AH. Using logistic regression, we examined associations between baseline suicidal ideation, and incident suicide attempts during the 12-month follow-up, stratified by the four comparison groups. All analyses were adjusted for age and sex.ResultsAH were strongly and independently associated with baseline suicidal ideation (OR=3.84; 95%CI=2.46–6.02) and suicide attempts in the following 12 months (OR=3.21; 95%CI=1.18–8.76). Among adolescents with baseline suicidal ideation (n=235; 13.1%), 14 or 6.0% attempted suicide at follow-up. Those with AH only were not at significantly increased risk of transition from suicidal thoughts to attempts (OR=2.97; 95%CI=0.26–34.59). Similarly, adolescents with PD only did not have a significant increase in transition from ideation to attempts (OR=4.48; 95%CI=0.91–22.14). Adolescents who had both PD and AH had an eight-fold increased risk (OR=8.42; 95%CI=1.46–48.67) of acting on their suicidal thoughts.DiscussionAdolescents with both PD and AH had the greatest likelihood of acting on their suicidal thoughts. AH alone did not significantly predict the transition from suicidal thoughts to attempts despite high odds ratios, possibly due to the low prevalence of suicide attempts among ideators and consequently limited statistical power. Future studies examining for negative and distressing content of hallucinations may assist in explaining their role in the ideation-to-attempt transition. Screening adolescents who are distressed and have hallucinations may assist with predicting those at greatest risk of future suicide attempts.

Substance use and self-harm: a cross-sectional study of the prevalence, correlates and patterns of medical service utilisation among patients admitted to a South African hospital

BackgroundSubstance use is a potentially modifiable risk factor for suicidal behaviour. Little is known about the epidemiology of substance use among self-harm patients in South Africa. This study set out to collect epidemiological data about the prevalence, correlates, and patterns of medical service utilisation among self-harm patients who used substances at the time of self-injury.MethodsData from 238 consecutive self-harm patients treated at an urban hospital in South Africa were analysed using bivariate and multivariate statistics.ResultsApproximately 20% of patients reported substance use at the time of self-harm. When compared to other self-harm patients, higher rates of patients who had used substances: had depressed levels of consciousness on admission; utilised more medical resources and required longer hospital admissions; cited relationship difficulties and financial concerns as reasons for their self-harm; reported a previous episode of self-harm; and intended to die as a result of their injuries. Although the observed differences were not statistically significant (p > 0.05), the proportional differences were congruent with international literature.ConclusionAcute use of substances among self-harm patients warrants more focused research and clinical attention particularly in the context of reducing utilisation of scarce medical resources.

Psychopathic personality traits as a form of dispositional capability for suicide

The capability to enact lethal self-harm has recently been highlighted as a critical risk factor for suicidal behavior. Klonsky and May's (2015) three step theory of suicide (3ST) expanded upon the construct of the capability for suicide by dividing it into categories: dispositional, acquired, and practical. The current study examined constructs of Patrick and colleagues’ (2009) triarchic model of psychopathy as indicators of dispositional capability in gun owners, a sample at heightened risk for death by suicide (Anestis and Houtsma, 2017). We anticipated that specific psychopathic traits would exhibit robust associations with other components of the capability for suicide. In a sample of 300 gun-owning adults, Boldness was uniquely related to all indicators of practical capability in both male and female gun owners, and a Boldness*Meanness interaction predicted the highest levels of some capability components. These results are consistent with theoretical conceptualizations of the triarchic model. Our findings indicate that, among US gun owners, dispositional factors may impact comfort with and aptitude with guns, which may enhance our understanding of which gun owners are at the greatest risk of gun suicide should they develop suicidal thoughts.

Suicidal Risk and Affective Temperaments, Evaluated with the TEMPS-A Scale: A Systematic Review

Among risk factors for suicidal behavior, there is growing interest in associations with stable affective temperament types, particularly based on assessment with the TEMPS-A self-rating scale. As research on this topic has not been reviewed systematically, we synthesized relevant, reported research findings. Systematic searching identified peer-reviewed reports pertaining to associations of suicidal behavior or ideation with affective temperament types evaluated with TEMPS-A. We summarized available findings and applied quantitative meta-analytic methods to compare scale scores in suicidal versus nonsuicidal subjects. In 21 of 23 TEMPS-A studies meeting inclusion criteria, anxious, cyclothymic, depressive, or irritable temperament scores were significantly higher with previous or recent suicide attempts or ideation in both psychiatric and general population samples compared to nonsuicidal controls, whereas hyperthymic temperament scores were lower in 9 of 11 reports. These findings were synthesized by random-effects meta-analyses of standardized mean differences in TEMPS-A temperament scores in suicidal versus nonsuicidal subjects. Associations ranked: depressive ≥ irritable > cyclothymic > anxious > hyperthymic (negative). Affective temperaments, especially depressive and irritable, were strongly associated with suicidal risk, whereas hyperthymic temperament appeared to be protective.

Suicidal Behavior Among Hospitalized Adults With Inflammatory Bowel Disease: A United States Nationwide Analysis.

Suicidal behavior in inflammatory bowel disease (IBD) has been minimally explored. We aimed to determine United States (US) nationally representative prevalence estimates of suicidal ideation (SI) and suicide/self-inflicted injury (S/SII) among hospitalized adults with IBD and to examine trends in suicidal behavior over time. A retrospective cross-sectional study using National (Nationwide) Inpatient Sample data (2006-2011) identified adults with Crohn's disease (CD) or ulcerative colitis (UC), SI or S/SII, and multiple comorbid risk factors for suicidal behavior. We identified 331,777 (estimated 1.64 million) IBD-related hospitalizations (64% CD, 36% UC) and 39,787,239 (estimated 196.08 million) hospitalizations among the general US population. Among IBD-related hospitalizations, 2502 discharges were associated with SI (prevalence 0.76%) and 1104 with S/SII (prevalence 0.33%). Both were significantly greater in CD versus UC (P < 0.001). Relative to the general US population, IBD patients were significantly less likely to demonstrate suicidal behavior: (SI:0.33% versus 0.59%, P < 0.001) (S/SII:0.75% versus 1.04%, P < 0.001). Multivariable logistic regression revealed that IBD was associated with decreased odds of SI (adjusted odds ratio [aOR] 0.62, 95%CI 0.60-0.65) and S/SII (aOR 0.43, 95%CI 0.40-0.45) relative to the general population, and suicidal behavior was lower in IBD compared to disease-related controls with rheumatoid arthritis and systemic lupus erythematosus. Similar increasing trends in suicidal behavior were observed in IBD and non-IBD populations (2006-2011). In this large US database, SI or S/SII occurred in over 1% of the IBD population and was increased in CD versus UC.

Multiple tissue methylation analysis of HTR2A exon I in suicidal behavior.

The main aim of the current study was to investigate epigenetic alterations in serotonin 2A receptor (HTR2A) exon I CpG sites as possible risk factors for suicidal behavior. We also aimed to analyze the epigenetic alterations in two different tissues as epigenetic mechanisms are tissue specific. These epigenetic changes may lead to a better prediction of suicidal behavior. Direct CpG methylation analysis was carried out on genomic DNA from the saliva of 20 schizophrenia suicide attempters and 27 non-attempters, and from post-mortem brain tissues of nine suicide victims and 11 controls. We used bisulfite pyrosequencing to assess the contributions of six CpG sites including the rs6313 (C102T) site in the first exon of HTR2A in suicide attempters and suicide victims. DNA methylation analysis did not find a significant difference in CpG methylation between suicide attempters and non-attempters (P=0.759) or between suicide victims and controls (P=0.189). We found a strong positive correlation between CpG methylation levels in blood and saliva (r=0.547, P<0.001). DNA methylation analysis confirmed that the overall methylation level of HTR2A exon I was around 80% for DNA extracted from saliva and almost 30% in the frontal cortex DNA. The results of this investigation do not support the evidence that methylation analysis of the HTR2A may be useful for investigating the epigenetic factors involved in suicidal behavior.

Suicidal and Help-Seeking Behaviors Among Youth in an Online Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Social Network

ABSTRACTLGBTQ youth have a great burden for suicidal ideation/behavior compared to their non-LGBTQ peers. While scholars have explored risk factors for suicidal behaviors, little is known about protective factors among LGBTQ youth, let alone within group differences in terms of help-seeking. Data were collected from 203 TrevorSpace (e.g., a social network for LGBTQ youth) users via online survey to examine suicidal and help-seeking behaviors among LGBTQ individuals. Among participants who reported suicidal ideation/behavior, a large proportion did not seek help (73.1% of gay men, 33.3% of bisexual men, 42.9% of bisexual women, 14.3% of lesbian women, 41.2% of queer individuals) when they considered or attempted suicide. Among those who sought support, reaching out to a friend was most common. However, family support was associated with fewer suicidal behaviors. Our findings underscore the need to examine the effectiveness of specific sources of help and the impact of exposure to social connectedness.

Prevalence of suicidal behaviour and associated factors in a large sample of Chinese adolescents.

Suicidal behaviour is prevalent among adolescents and is a significant predictor of future suicide attempts (SAs) and suicide death. Data on the prevalence and epidemiological characteristics of suicidal behaviour in Chinese adolescents are limited. This study was aimed to examine the prevalence, characteristics and risk factors of suicidal behaviour, including suicidal thought (ST), suicide plan (SP) and SA, in a large sample of Chinese adolescents. This report represents the first wave data of an ongoing longitudinal study, Shandong Adolescent Behavior and Health Cohort. Participants included 11 831 adolescent students from three counties of Shandong, China. The mean age of participants was 15.0 (s.d. = 1.5) and 51% were boys. In November-December 2015, participants completed a structured adolescent health questionnaire, including ST, SP and SA, characteristics of most recent SA, demographics, substance use, hopelessness, impulsivity and internalising and externalising behavioural problems. The lifetime and last-year prevalence rates were 17.6 and 10.7% for ST in males, 23.5 and 14.7% for ST in females, 8.9 and 2.9% for SP in males, 10.7 and 3.8% for SP in females, 3.4 and 1.3% for SA in males, and 4.6 and 1.8% for SA in females, respectively. The mean age of first SA was 12-13 years. Stabbing/cutting was the most common method to attempt suicide. Approximately 24% of male attempters and 16% of female attempters were medically treated. More than 70% of attempters had no preparatory action. Female gender, smoking, drinking, internalising and externalising problems, hopelessness, suicidal history of friends and acquaintances, poor family economic status and poor parental relationship were all significantly associated with increased risk of suicidal behaviour. Suicidal behaviour in Chinese adolescents is prevalent but less than that previously reported in Western peers. While females are more likely to attempt suicide, males are more likely to use lethal methods. Multiple child and family factors are associated with suicidal behaviour. These findings highlight the importance of early screening and intervention of suicidal behaviour in Chinese adolescents.

Are comorbid anxiety disorders a risk factor for suicide attempts in patients with mood disorders? A two-year prospective study

BackgroundComorbid anxiety disorders have been considered a risk factor for suicidal behavior in patients with mood disorders, although results are controversial. The aim of this two-year prospective study was to determine if lifetime and current comorbid anxiety disorders at baseline were risk factors for suicide attempts during the two-year follow-up. MethodsWe evaluated 667 patients with mood disorders (504 with major depression and 167 with bipolar disorder) divided in two groups: those with lifetime comorbid anxiety disorders (n=229) and those without (n=438). Assessments were performed at baseline and at 3, 12, and 24 months. Kaplan-Meier survival analysis and log-rank test were used to evaluate the relationship between anxiety disorders and suicide attempts. Cox proportional hazard regression was performed to investigate clinical and demographic variables that were associated with suicide attempts during follow-up. ResultsOf the initial sample of 667 patients, 480 had all three follow-up interviews. During the follow-up, 63 patients (13.1%) attempted suicide at least once. There was no significant difference in survival curves for patients with and without comorbid anxiety disorders (log-rank test=0.269; P=0.604). Female gender (HR=3.66, P=0.001), previous suicide attempts (HR=3.27, P=0.001) and higher scores in the Buss-Durkee Hostility Inventory (HR=1.05, P≤0.001) were associated with future suicide attempts. ConclusionsOur results suggest that comorbid anxiety disorders were not risk factors for suicide attempts. Further studies were needed to determine the role of anxiety disorders as risk factors for suicide attempts.

Alcohol Involvement in Suicide and Self-Harm.

Alcohol misuse and alcohol consumption are significant risk factors for suicidal behavior. This study sought to identify factors associated with alcohol consumption in cases of suicide and nonfatal self-harm presentations. Suicide cases in Cork, Ireland, from September 2008 to June 2012 were identified through the Suicide Support and Information System. Emergency department presentations of self-harm in the years 2007-2013 were obtained from the National Self-Harm Registry Ireland. Alcohol consumption was detected in the toxicology of 44% out of 307 suicide cases. Only younger age was significantly associated with having consumed alcohol among suicides. Alcohol consumption was noted in the case notes in 21% out of 8,145 self-harm presentations. Logistic regression analyses indicated that variables associated with having consumed alcohol in a self-harm presentation included male gender, older age, overdose as a method, not being admitted to a psychiatric ward, and presenting out-of-hours. Data was limited to routinely collected variables by the two different monitoring systems. Alcohol consumption commonly precedes suicidal behavior, and several factors differentiated alcohol-related suicidal acts. Self-harm cases, in particular, differ in profile when alcohol is consumed and may require a tailored clinical approach to minimize risk of further nonfatal or fatal self-harm.

Early life stress predicts negative urgency through brooding, depending on 5-HTTLPR genotype: A pilot study with 6-month follow-up examining suicide ideation

The present study examined the interaction between early life stress and 5-HTT genotypes in predicting two risk factors for suicidal behavior – the brooding subtype of rumination and impulsivity, in the form of negative urgency – over time. Furthermore, we examined early life stress, brooding, and impulsivity as predictors of suicidal ideation over time. Participants with and without a history of early life stress were genotyped for the 5-HTTLPR polymorphism and completed assessments assessing brooding and negative urgency at baseline and 6-month follow up. Early life emotional abuse was associated with negative urgency at follow-up. We found an indirect effect of early life emotional abuse on negative urgency through brooding among individuals with 5-HTT low expressing genotypes but not among individuals with 5-HTT high expressing genotypes. Further, a logistic regression analysis revealed that negative urgency was associated with higher odds (O.R. = 16.2) of reporting suicide ideation (versus no ideation) at follow-up. Our findings suggest that brooding and negative urgency may result from the interaction between early life emotional abuse and 5-HTT low expressing genotypes. Further research is necessary to understand how early life stress interacts with 5-HTT genotypes to confer risk for suicidal behavior through psychological mechanisms.

Sex differences in social risk factors for suicidal behaviour

ObjectiveTo explore the sex differences in social risk factors for attempted suicide using a case-control design. MethodsIndividuals who attempted suicide (n = 146) were compared to psychiatric and community controls (n = 197). Information about social factors was collected upon recruitment. Logistic regression was used to assess associations between social factors and attempted suicide. ResultsDifferences were found between men and women in social risk factors associated with suicide attempts. Completion of post-secondary education (OR 0.30, 95% CI 0.14–0.64, p = 0.002) and religious practice (OR 0.43, 95% CI 0.19–0.92, p = 0.031) were significant protective factors in women. Unemployment (OR 4.31, 95% CI 1.44 – 13.72, p = 0.01) and stressful life events (OR 4.71, 95% CI 1.58 – 16.61, p = 0.009) were significantly associated with increased risk of suicide attempts in men. Subgroup analyses revealed that these factors were only significant in comparisons with non-psychiatric controls. ConclusionOur findings could aid clinicians in assessing suicide risk and identifying vulnerable individuals by tailoring the assessment of risk factors for men and women.

Suicide Crisis Syndrome Mediates the Relationship Between Long-term Risk Factors and Lifetime Suicidal Phenomena.

In recent years, there has been growing attention to the distinction between acute and long-term suicidal risk factors. We have previously characterized an acute, negative affect state, termed the suicide crisis syndrome (SCS), as a marker of near-term suicidal risk. Here, we test whether documented long-term risk factors (i.e., trait vulnerabilities), including perfectionism, impulsivity, chronic substance abuse, insecure attachment, poor social support, and childhood trauma, associate to suicidal phenomena through a pathway of the SCS. A sample of 207 psychiatric inpatients were administered a battery of eight scales, including the Suicide Trigger Scale (STS-3) as a measure of the SCS. While both STS-3 and all trait vulnerabilities were associated with lifetime suicidal ideation and attempts, only STS-3 was related to pre-admission suicide attempts. The STS-3 significantly mediated the effect of each trait vulnerability on lifetime suicidal phenomena (combining ideation and behavior), with the proportion of mediating effect ranging from .29 to .56. Reverse mediation analyses were only significant for insecure attachment, supporting a largely unidirectional mediation effect. The SCS appears to serve as an acute risk factor for suicidal behavior in psychiatric inpatients and may act as a mechanism by which long-term risk factors increase suicidal risk.