Risk Factors For Suicidal Thoughts Research Articles

Adverse childhood experiences, gender, and suicidality among Florida high school students: Examining intervening mechanisms

BackgroundAdverse childhood experiences (ACEs) represent a key risk factor for suicidal thoughts and behaviors among adolescents. However, the intervening mechanisms linking ACEs and suicidality, and whether such processes vary by gender, remain underexplored. ObjectiveThe present study examines whether the relationships between ACEs and the likelihood of experiencing suicidal thoughts and attempting suicide are indirect through depressive symptoms and low self-control. This study also investigates whether these direct and indirect paths might be moderated by gender. Participants and settingThe analyses make use of data on a statewide representative sample of students enrolled in public high schools in Florida (N = 23,078) from the 2022 Florida Youth Substance Abuse Survey (FYSAS). MethodsGeneralized structural equation modeling (GSEM) was used to estimate the direct and indirect effects of ACEs on the likelihood of suicidal thoughts and attempting suicide. The indirect effects were assessed using bootstrapping, and between-gender differences in the coefficients were tested. ResultsACEs has direct associations with depressive symptoms, low self-control, and both suicidality outcomes. The effects of ACEs on suicidal thoughts are indirect through both depressive symptoms and low self-control, and the effects of ACEs on suicide attempts are indirect through depressive symptoms. Limited gender differences in these pathways emerge. ConclusionsFor male and female youth, ACEs are associated with heightened depression symptoms and reduced self-control, and both of these factors partially explain the previously established relationship between ACEs and suicidality.

The relationship between event-related potential components and suicide risk in major depressive disorder

BackgroundSuicide is a serious global issue, with major depressive disorder (MDD) being a significant risk factor for suicidal thoughts and behaviors. There is an urgent need to determine whether event-related potential components (ERPs) could be used as an indicator to assess suicidal risk. MethodsFrom 2020 to 2023, 258 participants in total were recruited into the study. All participants were divided into four groups: MDD patients at high (n = 66), moderate (n = 66), and low risk (n = 56) of suicide, and healthy controls (HCs)(n = 70). Each participant provided socio-demographic information and underwent evaluations using clinical psychological scales such as 7-item Generalized Anxiety Disorder (GAD-7), Health Questionnaire-9 items (PHQ-9), and Nurses' Global Assessment of Suicide Risk (NGASR). The auditory brainstem response test and ERP examination were performed for all subjects. ResultsOur study found that the amplitude of P2–P3 and N2–P3 was significantly reduced in MDD patients at moderate and high risk of suicide, and these were negatively correlated with NGASR total score (all P < 0.05). Point B latency was positively correlated with NGASR total score (P < 0.05). Patients with MDD patients at low risk for suicide had a lower A-B amplitude compared to HCs (P < 0.05). No differences were found in MMN or P50 components between the four groups (all P > 0.05). ConclusionsMDD patients at higher risk of suicide exhibited severe impairment of cognitive function. ERP indices, such as the amplitude of P2–P3 and N2–P3, could be associated with the risk of suicide in MDD patients.

Cumulative adversity and emotion dysregulation effects on suicidal ideation and attempts in a community sample

Adversity, trauma, and emotion dysregulation are commonly cited risk factors for suicidal thoughts and behaviors. Thus, the role of these factors in conferring risk for suicidal ideation (SI) and suicide attempts (SA) amongst community adults was assessed. A cross-sectional cohort-based study with community adults (n=757; female=55.0%) assessed emotion dysregulation, cumulative adversity including highly stressful and traumatic events, as well as other known risk factors for suicidality (e.g., self-reported depression and anxiety history) to predict a lifetime history of SI or SA, SI but no SA, or SI and SA. Higher cumulative stress and trauma scores conferred risk for SI, specifically on the subscales major life events, recent life events, and chronic stressors. Higher emotion dysregulation was associated with an increased risk for a SA relative to no SI or SA, particularly nonacceptance of emotional responses. Lifetime trauma was the only predictor of SA relative to SI. Nonacceptance of emotions significantly mediated the association between life traumas and suicidality. Cumulative adversity and emotion dysregulation confer risk for suicidal ideation and attempts, and higher lifetime trauma predicted attempts over ideation. These findings suggest that targeting emotion dysregulation, and specifically nonacceptance of difficult emotions, may be a useful strategy in reducing suicidal behaviors in individuals with trauma history and concurrent suicidal ideation.

B - 47 Attentional Risk Factors for Suicidal Thoughts and Behaviors: a Synthesis of the Literature and Meta-Analysis.

Theory suggests that attentional processes, such as attentional bias and attentional control, may contribute to suicidal thoughts and behaviors (STBs). Specifically, among individuals with suicidal ideation, attentional biases towards suicide-related information may increase distress. This combined with the inability to disengage and shift attention away from suicidal thoughts (i.e., deficits in attentional control) might contribute to increased risk for suicidal behavior. Despite this, there has been limited research examining associations between attentional biases and STBs or attentional control and STBs. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms used to identify articles included: ("attention* bias" or "attentional control") AND (suicid*). The search returned 77 articles, 49 when duplicates were removed. Following full text reviews, a total of 16 articles were retained for meta-analysis. A significant relationship was observed between attentional bias and STBs (r = 0.10, 95% CI: 0.05, 0.15), but not attentional control and STBs (r = -0.07, 95% CI: -0.24, 0.10). The funnel plot for attentional bias and STBs suggested low risk of publication bias. The limited number of studies identified, and therefore low power, precluded moderator analyses from being conducted. Additional experimental and longitudinal research with diverse assessments of attentional risk factors (e.g., dot probe, eye tracking) is needed. Despite these limitations, the present study provides preliminary evidence for the association between attentional bias and STBs.

Attentional Risk Factors for Suicidal Thoughts and Behaviors: A Synthesis of the Literature and Meta-Analysis

Attentional Risk Factors for Suicidal Thoughts and Behaviors: A Synthesis of the Literature and Meta-Analysis

Complex Posttraumatic Stress Disorder Links Trauma Exposure and Suicidal Behaviors Among Sexual Minority Populations: A New Target in Suicide Prevention?

ABSTRACT Exposure to potentially traumatic events and posttraumatic stress are known risk factors for suicidal thoughts and behaviors (STB). Research suggests that sexual minorities are disproportionately exposed to traumatic events and experience greater STB than their heterosexual peers, although few studies have explored connections between these parallel disparities. Further, existing literature may implicate complex posttraumatic stress disorder (CPTSD) as a potential mechanism in the trauma-suicide connection among sexual minorities. This study uses a sample from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; n = 1351) to test structural equation models for associations between trauma exposure, heterosexist discrimination, and CPTSD with suicide attempt status. We found CPTSD mediated associations between exposure to traumatic events and presence of a lifetime suicide attempt among sexual minority male and female samples. Discrimination demonstrated a synergistic effect on the association between trauma exposure and CPTSD, but, among males, CPTSD did not fully explain associations between discrimination and suicide attempts. Our findings suggest that CPTSD should be considered an important mechanism in the trauma-suicide connection for sexual minorities and may be a potentially important target for suicide prevention and that interventions should address the influence of discrimination on traumatic stress in this high-risk population.

A Call to Prioritize Integrated Suicide Interventions in Adolescent Substance Use Treatment

ABSTRACT Substance use is identified as a risk factor for suicidal thoughts and behaviors among adolescents. Scholars have developed and investigated the feasibility, acceptability, and effectiveness of combined suicide and substance use interventions for adolescents psychiatrically hospitalized following a suicidal crisis who also have co-occurring substance use problems. However, little research has been done to develop and investigate the effectiveness of combined suicide and substance use interventions within outpatient substance use settings for adolescents. Because social workers are well-positioned to deliver integrated interventions, greater focus is needed on teaching and implementing integrated substance use and suicide interventions at an individual and institutional level.

Diagnosed Posttraumatic Stress Disorder and Other Trauma-Associated Stress Disorders and Risk for Suicide Mortality.

Strong evidence exists for posttraumatic stress disorder (PTSD) as a risk factor for suicidal thoughts and behaviors across diverse populations. However, few empirical studies have examined PTSD and other trauma-associated stress disorders as risk factors for suicide mortality among health system populations. This study aimed to assess trauma-associated stress diagnoses as risk factors for suicide mortality in a U.S. health system population. This case-control, matched-design study examined individuals who died by suicide between 2000 and 2015 and had received care from nine U.S. health systems affiliated with the Mental Health Research Network (N=3,330). Individuals who died by suicide were matched with individuals from the general health system population (N=333,000): 120 individuals with PTSD who died by suicide were matched with 1,592 control group members, 84 with acute reaction to stress were matched with 2,218 control individuals, and 331 with other stress reactions were matched with 8,174 control individuals. After analyses were adjusted for age and sex, individuals with any trauma-associated stress condition were more likely to have died by suicide. Risk was highest among individuals with PTSD (adjusted OR [AOR]=10.10, 95% CI=8.31-12.27), followed by those with other stress reactions (AOR=5.38, 95% CI=4.78-6.06) and those with acute reaction to stress (AOR=4.49, 95% CI=3.58-5.62). Patterns of risk remained the same when the analyses were adjusted for any comorbid psychiatric condition. All trauma-associated stress disorders are risk factors for suicide mortality, highlighting the importance of health system suicide prevention protocols that consider the full spectrum of traumatic stress diagnoses.

A Suicide-Specific Diagnosis – The Case Against

A Suicide-Specific Diagnosis – The Case Against

Drug abuse and suicidal thoughts among employees: an emerging economy perspective

PurposeAnchored with turbulence emanating from the COVID-19 pandemic, the work environment has become more stressful with debilitating effects on the well-being of employees. Employees rely on varying means of coping including drug abuse. However, the association between drug abuse and suicidal thoughts among employees in Ghana is unknown. Therefore, this study sought to examine the relationship between drug abuse and suicidal thoughts among employees in Ghana.Design/methodology/approachIn a cross-sectional survey, this study purposively sampled 470 employees from three sectors of the Ghanaian economy (telecommunication, banking and manufacturing). The data was analysed using the multivariate analysis (MANOVA), Pearson’s r test and hierarchical regression.FindingsAnalysis of data revealed a positive relationship between drug abuse and suicidal thoughts, indicating that drug abuse is a risk factor for suicidal thoughts. Besides, it was also revealed that banking sector employees have a higher risk of having suicidal thoughts than employees in the telecommunication and manufacturing sectors.Practical implicationsManagers of organisations need to redesign work to embrace the challenging circumstances brought about as a result of COVID-19 and post-COVID implications. The work environment needs to be more supportive to shield employees from the physical and emotional demands of work during and after this period of the COVID-19 pandemic. Today than ever, investment in the implementation of employee-assisted programmes (EAPs) and employee well-being programmes (EWPs) to equip employees with the needed skills to cope with stressful conditions has been more than justified.Originality/valueFrom a broader perspective, this study identifies drug abuse as a key risk factor for suicidal thoughts among employees, thereby highlighting the fact that smoking cessation programs and drug management therapies are an integral part of well-being programmes aimed at establishing equilibrium and gradually creating a wide gap between employees and suicidal thoughts.

399 The development of a digital game to prevent suicide in youth who misuse substances

OBJECTIVES/GOALS: Suicide is the second leading cause of death in teens. Substance misuse, including opioids, is a risk factor for suicidal thoughts and behaviors among teens. School-based approaches are promising, yet they lack evidence on their effectiveness. To fill this gap, we created supportED, a digital game to prevent suicide in youth who misuse substances. METHODS/STUDY POPULATION: We conducted focus groups and interviews to inform the development of the digital game and discuss approaches to enhance user experiences, acceptability, and feasibility of the intervention. A semi-structured focus group/interview guide was developed, pilot tested, and used in focus groups/interviews. The guides aligned with constructs from a safety planning intervention, a well-recognized, evidence-based suicide prevention intervention, to identify potential warning signs of emotional distress, coping strategies, and resources for seeking help to prevent suicidal thoughts and behaviors. Focus groups/interviews were led by a facilitator, who is also a certified school counselor and licensed professional counselor, and a co-facilitator who took field notes and provided debrief summaries. RESULTS/ANTICIPATED RESULTS: A total of 35 participants, including 10 high-school-aged teens [aged 16-19], 10 college-aged youth [aged 18-22], 10 school-based providers, and five interviews with adults who had experience with opioids in their youth informed the development stage. Of the focus group participants, 25.7% identify as female (n=23), 71.4% identify as male (n=6), and 2.9% do not identify as male or female (n=1); 60% identify as White (n=18), 20% identify as multi-racial (n=6), 10% identify as Black (n=3), 3.3% identify as Asian (n=1), and 6.7% identify as race unknown (n=2); and, 37.1% (n=13) identify as Hispanic/Latinx. Salient themes that emerged focused on opioids, substance misuse, mental health, bullying, grief, family, identity, and stigma to create six distinct narratives in the digital game. DISCUSSION/SIGNIFICANCE: Findings informed the development of a digital game to prevent suicide among adolescents who misuse substances. The digital game is currently being evaluated in a pilot RCT to assess the preliminary efficacy of the intervention, user experience, usability, and feasibility of delivering the intervention and protocols among 60 youth.

Emotion dysregulation as a mechanism linking posttraumatic stress disorder to subsequent suicidal thoughts and behaviors following inpatient psychiatric discharge

Posttraumatic stress disorder (PTSD) is a well-known risk factor for suicidal thoughts and behaviors (STBs). However, there is a scarcity of longitudinal studies exploring underlying pathways. This study sought to examine the mechanistic role of emotion dysregulation in the relations between PTSD and STBs following discharge from psychiatric inpatient treatment, a particularly high-risk period for suicide. Participants were 362 trauma-exposed psychiatric inpatients (45% female, 77% white, Mage = 40.37). PTSD was assessed via a clinical interview (Columbia Suicide Severity Rating Scale) during hospitalization, emotion dysregulation was assessed via self-report 3-weeks post-discharge, and STBs were assessed via a clinical interview 6-months post-discharge. St'1ructural equation modeling showed that emotion dysregulation significantly mediated the relation between PTSD and suicidal thoughts (β = 0.10, SE = 0.04, p = .01, 95%CI [0.04, 0.39]) but not suicide attempts (β = 0.04, SE = 0.04, p = .29, 95%CI [-0.03, 0.12]) post-discharge. Findings highlight a potential clinical utility of targeting emotion dysregulation among individuals with PTSD to prevent suicidal thoughts following discharge from psychiatric inpatient treatment.

Early childhood sleep problems predict increased risk for the later development of suicidal thoughts.

Suicidal thoughts and behaviors in youth are an escalating and immediate public health concern. To better understand youth suicidal thoughts and behaviors, it is important to identify risk factors in early childhood that predict the later emergence of youth suicidal thoughts and behaviors. Research with adults and adolescents has identified sleep disturbances as a risk factor for suicidal thoughts and behaviors, but this has yet to be examined in early childhood. Using a prospective, 17-year longitudinal design, the current study explored the association between early childhood sleep disturbances and concurrent and later suicidal thoughts and behaviors (in separate models) across childhood and adolescence. Results indicate that sleep problems in early childhood are associated with increased probability for suicidal thoughts after age 8, even when controlling for prior and concurrent depression severity. Our findings suggest that early childhood sleep difficulties warrant increased clinical attention and management, as they may contribute to the maintenance and exacerbation of suicidal thoughts over time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Graded response item response theory in scaling suicidal thoughts and behaviors among trauma-exposed women with substance use disorders.

Objective: The co-occurrence of substance use disorders (SUD) and trauma-exposure is a risk factor for suicidal thoughts and behaviors (STB). However, traditional methods of measurement for suicidal thoughts and behaviors are limited by an overreliance on dichotomous (i.e., yes or no) and averaged/summed scale score measurements. Further, among trauma-exposed individuals with SUD, it remains unclear which specific demographic factors, types of SUDs, and trauma sequelae (e.g., posttraumatic stress disorder [PTSD] symptom clusters) may be associated with elevated STB. The present study utilized item response theory to (a) generate empirically derived STB severity scores and, (b) examine which demographic factors, SUD diagnoses, and DSM-IV PTSD symptom clusters are associated with suicidality in a trauma-exposed sample with SUDs. Method: Female trauma-exposed participants with SUDs (N = 544) were recruited from community substance use treatment facilities in the National Drug Abuse Treatment Clinical Trials Network (CTN). Clinician-administered interviews assessed STB, SUDs, and PTSD symptoms. Results: Results indicated that the unidimensional item response theory (IRT) model used to estimate latent STB severity scores fit well, with strong local reliability at higher levels of latent STB severity. Regression predictors of elevated STB severity included younger age, opioid dependence, and higher PTSD reexperiencing symptoms. Conclusions: Clinicians are advised to screen for and target opioid use disorders and reexperiencing symptoms when addressing suicidal thoughts and behavior in trauma-exposed individuals with SUDs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Physical pain-suicidality association in all ages: a complete and updated meta-analysis

IntroductionThis work represents the continuation of the studies presented in two e-posters during the EPA 2021 conference (De Filippi et al., 2021; Rignanese et al., 2021), which addressed the physical pain-suicidality association (k=44 studies).ObjectivesThe aim of this meta-analysis is to provide an update of those studies, integrating data relating to adolescents, adults, and olders.MethodsWe started with the analysis of three papers, in particular a meta-analysis (Calati et al., 2015) and two systematic reviews (Hinze et al., 2019; Santos et al., 2019). After searching on Pubmed (until September 2020), data were extracted from articles comparing the rates of current and lifetime suicidal thoughts and behaviours (death wish, suicidal ideation, suicidal planning, suicide attempt and suicide death: DW, SI, SP, SA, and SD) in adolescents, adults, and olders with any type of physical pain and in individuals who did not report this condition. Data were analysed using Comprehensive Meta-Analysis Software (CMA) version 2.Results67 studies were included, of which 16 on adolescents, 29 on adults, 16 on olders, and 6 on mixed ages. Although quite high between-study heterogeneity was detected in most analyses, results suggested that individuals with physical pain are more likely to report any form of suicidal outcome if compared to those not affected by pain.ConclusionsCollected data are therefore in line with previous literature on this topic, which considered physical pain an extremely predictive risk factor for suicidal thoughts and behaviours. However, further research on this topic would be extremely useful.DisclosureNo significant relationships.

Persistent suicidal ideation in a large intensive outpatient adolescent population sample: A preliminary report on the role of sleep disturbance.

Sleep disturbance is a unique, yet understudied, risk factor for suicidal thoughts and behaviors (STBs). The present study sought to explore the relationship between suicidal ideation (SI) and self-reported sleep disturbance in a sample of adolescents in an intensive outpatient program targeting suicidality (N = 691). Analyses conducted include paired samples t tests, multiple linear regression, and analysis of variance to examine group differences in sleep disturbance over time. Sleep disturbance and SI were associated at each timepoint, and sleep disturbance at admission predicted SI at discharge. Those with the most severe SI at discharge indicated increased sleep disturbance relative to admission, whereas those reporting no SI at discharge nearly resolved all sleep difficulties. Future studies should utilize objective sleep measures, longitudinal assessments, and include a more diverse sample to better inform the relationship of sleep and SI. These findings suggest that directly managing sleep disturbance during treatment could decrease the risk of STBs.

Does Body Mass Index Confer Risk for Future Suicidal Thoughts and Behaviors? A Meta-analysis of Longitudinal Studies.

Body mass index (BMI) outside of the "normal" range is commonly cited as a predictor of adverse health outcomes and has been identified as a potential risk factor for suicidal thoughts and behaviors (STBs). This meta-analysis provides a descriptive and quantitative summary of the literature evaluating the longitudinal relationship between BMI/weight status and STBs. The longitudinal literature examining the relationship between BMI/weight status and STBs is small and methodologically constrained. Within the existing literature, BMI and weight status are generally weak or nonsignificant risk factors for STBs. It is possible that body weight has a complex relationship with physical and mental health, including STBs, which may not be possible to accurately capture with a singular metric such as BMI. BMI and weight status do not appear to robustly predict STBs, at least within the methodological constraints of the existing literature.

Anhedonia and Suicide.

Suicide is a leading cause of death, and presently, there is no definitive clinical indicator of future suicide behaviors. Anhedonia, a transdiagnostic symptom reflecting diminished ability to experience pleasure, has recently emerged as a risk factor for suicidal thoughts and behaviors (STBs). This overview, therefore, has the following aims. First, prior research relating anhedonia to STBs will be reviewed, with a particular focus on clarifying whether anhedonia is more closely associated with suicidal thoughts versus behaviors. Second, the National Institute of Mental Health's Research Domain Criteria Positive Valence Systems provide a useful heuristic to probe anhedonia across different units of analysis, including clinical symptoms, behaviors, neural mechanisms, and molecular targets. Accordingly, anhedonia-related constructs linked to STBs will be detailed as well as promising next steps for future research. Third, although anhedonia is not directly addressed in leading suicide theories, this review will provide potential inroads to explore anhedonia within diathesis-stress and interpersonal suicide frameworks. Last, novel approaches to treat anhedonia as a means of reducing STBs will be examined.

Addressing co-occurring suicidal thoughts and behaviors and posttraumatic stress disorder in evidence-based psychotherapies for adults: A systematic review.

Posttraumatic stress disorder (PTSD) is a well-established risk factor for suicidal thoughts and behaviors. Historically, guidelines for treating PTSD have recommended against the use of trauma-focused therapies for patients who are at high risk for suicide, likely due to concerns about potential suicide-related iatrogenesis, specifically the "triggering" of suicidal behaviors. This systematic review examined evidence of the impact of treatments specifically designed to treat PTSD or suicide on both PTSD- and suicide-related outcomes. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and a total of 33 articles met the full inclusion criteria: 23 examining PTSD treatments, four examining suicide-focused treatments, and six examining combined treatments. PTSD and combined treatments reduced both PTSD- and suicide-related outcomes, with most studies focusing on cognitive processing therapy or prolonged exposure. Suicide-focused treatments (e.g., cognitive therapies for suicide prevention) also reduced suicide-related outcomes, but the findings were mixed for their impact on PTSD-related outcomes. Overall, PTSD treatments had the most support, primarily due to a larger number of studies examining their outcomes. This supports current clinical guidelines, which suggest utilizing PTSD treatments for individuals who have PTSD and are at risk for suicide. Suicide-focused and combined treatments also appeared to be promising formats, although additional research is needed. Future research should seek to compare the effectiveness of the approaches to the treatment of PTSD and suicidal thoughts and behaviors concurrently as well as to inform guidelines aimed at supporting decisions about the selection of an appropriate treatment approach.

Advances in Research on Adolescent Suicide and a High Priority Agenda for Future Research.

Suicide is the second leading cause of death for adolescents in the United States, yet remarkably little is known regarding risk factors for suicidal thoughts and behaviors (STBs), relatively few federal grants and scientific publications focus on STBs, and few evidence-based approaches to prevent or treat STBs are available. This "decade in review" article discusses five domains of recent empirical findings that span biological, environmental, and contextual systems and can guide future research in this high priority area: (1) the role of the central nervous system; (2) physiological risk factors, including the peripheral nervous system; (3) proximal acute stress responses; (4) novel behavioral and psychological risk factors; and (5) broader societal factors impacting diverse populations and several additional nascent areas worthy of further investigation.