Risk For Future Suicide Attempts Research Articles

Lower levels of social support are associated with risk for future suicide attempts in a clinical sample of transgender and gender diverse adults.

Transgender and gender diverse (TGD) adults are disproportionately affected by suicide. Social support and connection to the broader TGD community may help lower TGD adults' odds of having a suicide attempt (SA). The current study examined whether baseline levels of social support and community connectedness were associated with TGD adult's prospective odds of having a SA over 12months of follow-up. Longitudinal data for the current study came from a patient cohort of TGD adults enrolled in the LEGACY Project. Descriptive statistics and an attrition analysis were used to examine characteristics of the cohort and missingness over time. Logistic generalized estimating equation models were used to examine factors associated with patients' odds of having a past 6-month SA at 6- or 12-month follow-up. During the 12-month follow-up period, a total of 26 patients (3.1%; N = 830) reported having a SA. The 6-month incidence of SAs was approximately 2% at both 6- and 12-months of follow-up (6 months: N = 830; 12 months: N = 495). Baseline factors associated with increased odds of a future SA included gender identity (transfeminine vs. transmasculine: adjusted odds ratio [aOR] = 3.73, 95% confidence interval [CI] = 1.26-11.08; nonbinary vs. transmasculine: aOR = 3.09, 95% CI = 1.03-9.21), having a prior SA (aOR = 6.44, 95% CI = 2.63-15.79), and having moderate vs. high perceived social support (aOR = 4.25, 95% CI = 1.65-10.90). Lower levels of social support are associated with risk for future suicide attempts among TGD adults. Findings may inform screening practices for future suicide risk and the development of interventions to improve mental health outcomes for TGD adults.

Cross-sectional and longitudinal relationships between complete blood count measures and adolescent suicidal behavior

ObjectiveReplicable biological predictors are needed to distinguish adolescents at risk for suicide attempts (SA) compared to those at risk for suicidal ideation (SI). Early evidence in adults identifies that complete blood count (CBC) measures may be directly related to suicidal behavior (SB). MethodsIn this retrospective chart review, we assessed if CBC measures differed between adolescents psychiatrically hospitalized for SA versus SI, initially in an exploratory test cohort (n = 110, age = 11–18, 67 % female, 72.7 % White) and then in an independent confirmatory replication cohort (n = 97). In longitudinal analyses, we identified if CBC measures predicted future SB over 90 days. CBC measures were also compared to a healthy adolescent cohort (n = 597) and a medically-hospitalized nonsuicidal adolescent cohort (“MH” cohort; n = 51). ResultsSuicide attempters had lower eosinophil percentages, eosinophil counts, and platelet counts as compared to suicide ideators, though in the replication cohort, only eosinophil percentages were lower in suicide attempters. In longitudinal analysis, both lower eosinophil blood counts and percentages were associated with future suicidal behavior. In cross-sectional comparative analyses, the MH cohort had similar or lower eosinophil percentages/counts to adolescents psychiatrically hospitalized with SA. ConclusionsThough lower eosinophil percentages and counts were present in adolescents with recent SA (compared to SI), such effects may be related to physical sequalae of SA. Nevertheless, both lower eosinophil counts and percentages appear to be valuable predictors of prospective suicidal behavior over 90 days amongst psychiatrically hospitalized adolescents. These findings may guide research seeking to effectively identify adolescents at elevated risk of future suicide attempts.

Suicide-related construct accessibility and attention disengagement bias in suicide ideation.

Previous attempts to determine whether attention bias toward suicide-related stimuli is associated with risk for future suicide attempts have yielded mixed findings that have been difficult to replicate. Recent evidence suggests that methods used to assess attention bias toward suicide-specific stimuli have low reliability. The present study used a modified attention disengagement and construct accessibility task to examine suicide-specific disengagement biases, along with cognitive accessibility of suicide-related stimuli, among young adults with different histories of suicide ideation. Young adults (N = 125; 79% women), screened for moderate-to-high levels of anxiety or depressive symptoms completed an attention disengagement and lexical decision (cognitive accessibility) task, along with self-report measures of suicide ideation and clinical covariates. Findings using generalized linear mixed-effects modeling revealed that young adults with recent suicide ideation displayed a suicide-specific facilitated disengagement bias, compared to peers with lifetime ideation. In contrast, there was no evidence of a construct accessibility bias for suicide-specific stimuli, irrespective of suicide ideation history. These findings point to a suicide-specific disengagement bias that may depend on the recency of suicidal thoughts and suggests automatic processing of suicide-specific information. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Childhood Sexual Abuse and Military Sexual Trauma Interact to Increase Suicide Risk: Results from a Nationally Representative Veteran Sample.

Childhood sexual abuse (CSA) and military sexual trauma (MST) are prevalent among veterans. Such exposures are associated with adverse mental-health sequelae, including elevated risk for suicidal thoughts and behaviors. Nonetheless, prior studies have largely focused upon discrete experiences of CSA or MST in circumscribed samples. In the current study, we analyzed data from a large, nationally representative sample of 4,069 US military veterans to examine main and interactive effects of CSA and MST in relation to suicidal thoughts and behaviors. After accounting for sociodemographics, psychiatric comorbidity, and trauma-related characteristics, we detected a significant interaction between MST and CSA as it related to report of past-year suicidal ideation, lifetime suicide attempt, and risk for future suicide attempt. These findings underscore the impact of sexual trauma throughout the lifespan, highlighting the continued importance of screening for trauma exposure and connecting veterans to appropriate, evidence-based treatment to decrease their risk for suicidal thoughts and behaviors.

Suicide plan prevalence, recurrence, and longitudinal association with nonfatal suicide attempt.

Each year, millions of people develop suicide plans. These plans are assumed to indicate imminent suicide risk, yet this has rarely been tested. The present study seeks to address two questions: (1) how prevalent are specific thoughts of suicide plans among individuals with a history of suicidal thoughts and behaviors and (2) do suicide plans confer risk of future suicide attempts in the short term? Secondary data analysis was performed on a longitudinal dataset (N=1021). Prevalence and frequencies of suicide planning features (i.e., method, time, place) at baseline and 3, 14, and 28 days post-baseline were calculated. Logistic regressions were conducted to assess whether suicide plans confer risk of suicide attempts across a 28-day follow-up period. Suicide planning more commonly involved thoughts of method than place and/or time. High variability in suicide planning was evident and thoughts of suicide plans frequently recurred. Contrary to assumptions, suicide plans displayed weak associations with nonfatal suicide attempt across the 28-day follow-up period. Suicide plans appear heterogeneous in nature. They do not appear to play a strong role in predicting nonfatal suicide attempts. Re-evaluation of the central role that suicide plans occupy within clinical risk assessments may be warranted.

Development and validation of the suicidal behaviours questionnaire - autism spectrum conditions in a community sample of autistic, possibly autistic and non-autistic adults

BackgroundAutistic people and those with high autistic traits are at high risk of experiencing suicidality. Yet, there are no suicidality assessment tools developed or validated for these groups.MethodsA widely used and validated suicidality assessment tool developed for the general population (SBQ-R), was adapted using feedback from autistic adults, to create the Suicidal Behaviours Questionnaire—Autism Spectrum Conditions (SBQ-ASC). The adapted tool was refined through nine interviews, and an online survey with 251 autistic adults, to establish clarity and relevance of the items. Subsequently, 308 autistic, 113 possibly autistic, and 268 non-autistic adults completed the adapted tool online, alongside self-report measures of autistic traits (AQ), camouflaging autistic traits (CAT-Q), depression (PHQ-9), anxiety (ASA-A), thwarted belongingness and perceived burdensomeness (INQ-15), lifetime non-suicidal self-injury, and the original version of the suicidality assessment tool (SBQ-R). Analyses explored the appropriateness and measurement properties of the adapted tool between the groups.ResultsThere was evidence in support of content validity, structural validity, internal consistency, convergent and divergent validity, test–retest validity, sensitivity and specificity (for distinguishing those with or without lifetime experience of suicide attempt), and hypothesis testing of the adapted tool (SBQ-ASC) in each group. The structure of the SBQ-ASC was equivalent between autistic and possibly autistic adults, regardless of gender, or use of visual aids to help quantify abstract rating scales.LimitationsThe samples involved in the development and validation of the adapted tool were largely female, and largely diagnosed as autistic in adulthood, which limits the generalisability of results to the wider autistic population. The SBQ-ASC has been developed for use in research and is not recommended to assess risk of future suicide attempts and/or self-harm. The SBQ-ASC has been designed with and for autistic and possibly autistic adults, and is not appropriate to compare to non-autistic adults given measurement differences between these groups.ConclusionsThe SBQ-ASC is a brief self-report suicidality assessment tool, developed and validated with and for autistic adults, without co-occurring intellectual disability. The SBQ-ASC is appropriate for use in research to identify suicidal thoughts and behaviours in autistic and possibly autistic people, and model associations with risk and protective factors.

A Comparison of Dimensional and Categorical Approaches to Characterizing the Association Between Posttraumatic Stress Disorder and Future Suicide Attempts.

The present study compared the utility of categorical (i.e., diagnostic status) and dimensional (i.e., symptom severity) approaches to measuring posttraumatic stress disorder (PTSD) in predicting future suicide attempts among participants in a nationwide, longitudinal study of U.S. military veterans who were deployed in support of operations in Iraq or Afghanistan after the September 11, 2001, terrorist attacks (9/11) and were enrolled in Veterans Health Administration services (N = 1,649). Following an initial assessment of PTSD symptoms, we assessed for suicide attempts at two subsequent time points (M = 28.74 months, SD = 8.72 and M = 55.11 months, SD = 6.89 following the initial assessment). Between the initial and final assessments, 125 participants (7.58%) made at least one suicide attempt. All categorical and dimensional indicators of PTSD predicted suicide attempts at both time points except the categorical indicator for reexperiencing symptoms. Categorical indicators predicting suicide attempts demonstrated excellent sensitivity but poor specificity and overall accuracy. The point along the continuum at which PTSD symptom severity was most accurate regarding the prediction of future suicide attempts was well above the threshold previously established as indicating a probable diagnosis. Although this score was less sensitive than diagnostic indicators, it demonstrated greater specificity and overall accuracy in predicting future suicide attempts. The present results indicate that veterans whose PTSD symptoms satisfy the diagnostic criteria have a higher risk of future suicide attempts, but this risk appears to be even higher for veterans with symptom levels above the diagnostic threshold.

The Incubator Treatment Development Model: The SAFETY Treatment for Suicidal/Self-Harming Youth

Youths who make suicide attempts or engage in repetitive self-harm are at risk for future suicide attempts and death by suicide or self-harm. This treatment development report focuses on the Safe Alternatives for Teens and Youth (SAFETY) treatment. SAFETY is a 12-week outpatient child and family-centered cognitive-behavioral treatment, informed by dialectical-behavior therapy, and designed to promote safety following a suicide attempt or repeated episodes of self-harm. Previous reports have described results of small open and randomized treatment development trials. Here, we describe our “incubator” treatment development model. Combining scientific rigor with attention to the community context in which treatment is delivered, the incubator model emphasizes laboratory-based treatment development trials and quantitative and qualitative data generated through partnerships with community treatment sites and youth and parent consumers of care. Aims of this approach are to: (1) integrate information from our partners throughout the treatment development process; (2) create a more feasible and easily transportable “youth” and “family” centered treatment; and (3) accelerate the pace with which laboratory-based treatment advances can be incorporated into improvements in community care. We describe our incubator treatment development model and how data generated through our treatment development process and interactions between the laboratory and community teams contributed to the development of the SAFETY treatment.

Suicidal thoughts, suicidal attempts, and nonsuicidal self-injury among undergraduate health professionals

Background and Aim: Nonsuicidal selfinjury (NSSI) was observed in both males and females, with higher rate among females. NSSI could increase the risk of future suicide attempts. Adolescence is considered as stressful period because of identity crisis, physical growth, coupled with set of decision regarding future profession and personality traits. The study is aimed to find suicidal thoughts, suicidal attempts, extent of the NSSI and its impact on the undergraduate health professionals. Materials and Methods: A cross-sectional study was carried out among medical, dental, and physiotherapy undergraduate college students of Jamnagar, Gujarat. A total of 1850 students were approached, out of them 1050 medical, 500 dental and 300 were physiotherapy students. Participants were requested to fill the pro forma containing following parts: (1) Demographic details, (2) Inventory of Statements about Self-injury, (3) Impact of Non-Suicidal Self-Injury Scale. Results: A total of 1408 students completed the pro forma. Overall 13.99% prevalence rate of NSSI was reported. Female participants had higher prevalence of self-harming behavior than male participants (χ2 = 24.226, P < 0.001). NSSI was related to suicidal thoughts and suicidal attempts with (χ2 = 263.050, P < 0.001) and (χ2 = 197.777, P < 0.001), respectively. A negative correlation was observed with age of onset of NSSI behaviors with and numbers of NSSI behavior (r = −0.317, P < 0.001). Conclusions: Participants engaged in different NSSI behaviors for affect regulation, interpersonal boundaries, sensation seeking, self-punishment, revenge, and self-care. High prevalence of NSSI among young health professionals needs independent clinical attention. There is a need of crisis interventions for the management of self-harming behaviors and to prevent future fetal suicidal attempts.

Knowledge of suicide history, current depressive symptoms, and future suicide risk within couples

Research on suicide prevention and intervention has overwhelmingly focused on the suicidal individual. However, suicidal individuals exist within interpersonal relationships. This study tests 1) how accurately members of romantic couples know each other's depression symptoms, suicide histories, and risk for future suicidal thoughts and behaviors and 2) whether couple-specific factors moderate those associations. Participants were 43 mixed-sex couples (N = 86 individuals) recruited for a larger study of National Guard or Reserves members and their partners. Participants reported on their own depression symptoms, suicide history and expectation of future suicide risk, as well as their perceptions of their partners' depression symptoms, suicide history and future suicide risk. Effects were tested for moderation by communication style and relationship satisfaction. Results suggest that many individuals knew about their partners' depression symptoms and past suicidal ideation (77%). In contrast, fewer were aware of their partners' future suicide ideation risk (44%) and the minority knew about past suicidal behavior (23%) or risk for future suicide attempt (14%). Associations were not moderated by positive or negative communication styles or relationship satisfaction. Taken together, these results suggest that while romantic partners share some parts of their suicide histories with each other, some aspects are kept private. Notably, regardless of communication style or relationship quality, results were consistent, suggesting that even couples in strong relationships may not be aware of each other's suicide history and risk. Implications for the development of couples-based suicide prevention interventions are discussed.

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.

Clinical prediction of suicide attempt in schizophrenia using a machine learning approach

ObjectiveSuicide is a major concern for those afflicted by schizophrenia. Identifying patients at the highest risk for future suicide attempts remains a complex problem for psychiatric intervention. Machine learning models allow for the integration of many risk factors in order to build an algorithm that predicts which patients are likely to attempt suicide. Currently, it is unclear how to integrate previously identified risk factors into a clinically relevant predictive tool to estimate the probability of a patient with schizophrenia for attempting suicide.MethodsWe conducted a cross-sectional assessment on a sample of 345 participants diagnosed with schizophrenia spectrum disorders. Suicide attempters and non-attempters were clearly identified using the Columbia Suicide Severity Rating Scale (C-SSRS) and the Beck Suicide Ideation Scale (BSS). We developed two classification algorithms using a regularized regression and random forest model with sociocultural and clinical variables as features to train the models.ResultsBoth classification models performed similarly in identifying suicide attempters and non-attempters. Our regularized logistic regression model demonstrated an accuracy of 66% and an area under the curve (AUC) of 0.71, while the random forest model demonstrated 65% accuracy and an AUC of 0.67.ConclusionMachine learning algorithms offer a relatively successful method for incorporating many clinical features to predict individuals at risk for future suicide attempts. Increased performance of these models using clinically relevant variables offers the potential to facilitate early treatment and intervention to prevent future suicide attempts.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Classification of suicide attempters in schizophrenia using sociocultural and clinical features: A machine learning approach.

Suicide is a major concern for those afflicted by schizophrenia. Identifying patients at the highest risk for future suicide attempts remains a complex problem for psychiatric interventions. Machine learning models allow for the integration of many risk factors in order to build an algorithm that predicts which patients are likely to attempt suicide. Currently it is unclear how to integrate previously identified risk factors into a clinically relevant predictive tool to estimate the probability of a patient with schizophrenia for attempting suicide. We conducted a cross-sectional assessment on a sample of 345 participants diagnosed with schizophrenia spectrum disorders. Suicide attempters and non-attempters were clearly identified using the Columbia Suicide Severity Rating Scale (C-SSRS) and the Beck Suicide Ideation Scale (BSS). We developed four classification algorithms using a regularized regression, random forest, elastic net and support vector machine models with sociocultural and clinical variables as features to train the models. All classification models performed similarly in identifying suicide attempters and non-attempters. Our regularized logistic regression model demonstrated an accuracy of 67% and an area under the curve (AUC) of 0.71, while the random forest model demonstrated 66% accuracy and an AUC of 0.67. Support vector classifier (SVC) model demonstrated an accuracy of 67% and an AUC of 0.70, and the elastic net model demonstrated and accuracy of 65% and an AUC of 0.71. Machine learning algorithms offer a relatively successful method for incorporating many clinical features to predict individuals at risk for future suicide attempts. Increased performance of these models using clinically relevant variables offers the potential to facilitate early treatment and intervention to prevent future suicide attempts.

Clinician Prediction of Future Suicide Attempts

Objective: Established risk assessment tools are often inaccurate at predicting future suicide risk. We therefore investigated whether clinicians are able to predict individuals’ suicide risk with greater accuracy. Method: We used the SAFE Database, which included consecutive adult (age ≥18 years) presentations ( N = 3818) over a 22-month period to the 2 tertiary care hospitals in Manitoba, Canada. Medical professionals assessed each individual and recorded his or her predicted risk for future suicide attempt (SA) on a 0-10 scale—the clinician prediction scale. The SAD PERSONS scale was completed as a comparison. SAs within 6 months, assessed using the Columbia Classification Algorithm for Suicide Assessment, were the primary outcome measure. Receiver operating characteristic curve and logistic regression analyses were conducted to determine the accuracy of both scales to predict SAs, and the scales were compared with z scores. Clinician prediction scale performance was stratified based on level of training. Results: Clinicians were able to predict future SAs with significantly greater accuracy (area under the curve [AUC] = 0.73; 95% CI, 0.68 to 0.77; P &lt; 0.001) compared with the SAD PERSONS scale ( z = 3.79, P &lt; 0.001). Both scales nonetheless showed positive predictive value of less than 7%. Analyses by level of training showed that junior psychiatric residents and non–psychiatric residents did not accurately predict SAs, whereas senior psychiatric residents and staff psychiatrists demonstrated greater accuracy (AUC = 0.76 and 0.78, respectively). Conclusions: Clinicians are able to predict future attempts with fewer false positives than a conventional risk assessment scale, and this skill appears related to training level. Predicting future suicidal behaviour remains very challenging.

Responses to Traumatic Brain Injury Screening Questions and Suicide Attempts among Those Seeking Veterans Health Administration Mental Health Services.

Psychometrically sound screening tools available to aid in the identification of lifetime history of traumatic brain injury (TBI) are limited. As such, the Traumatic Brain Injury-4 (TBI-4) was developed and implemented in a Veterans Health Administration (VHA) mental health clinic. To provide information regarding both the predictive validity and clinical utility of the TBI-4, the relationship between screening results and future suicide attempts was evaluated. The aim of this study was to determine whether a positive screen on the TBI-4 was associated with increased risk for suicide attempt within 1-year post screening. The TBI-4 was administered to 1,097 Veterans at the time of mental health intake. Follow-up data regarding suicide attempts for the year post-mental health intake were obtained from suicide behavior reports (SBRs) in Veteran electronic medical records (EMRs). Fisher's exact tests were used to determine the proportion of suicide attempts by TBI-4 status. In the year post TBI-4 screening, significantly more Veterans who screened positive had a documented suicide attempt as compared to those who screened negative (p = 0.003). Those with a positive TBI screen at mental health intake had a higher proportion of SBRs than those who screened negative for TBI. Findings provided further psychometric support for the TBI-4. Moreover, results suggest the inclusion of this screen could prove to be helpful in identifying those who may be at risk for future suicide attempt within 1-year post screening.

A New Psychosocial Treatment for Suicidality

Individuals hospitalized for self-harm, regardless of suicidal intent, are at high risk for future suicide attempts. Few medications have specific

Higher Childhood Peer Reports of Social Preference Mediates the Impact of the Good Behavior Game on Suicide Attempt.

The Good Behavior Game (GBG) is a universal classroom-based preventive intervention directed at reducing early aggressive, disruptive behavior and improving children's social adaptation into the classroom. The GBG is one of the few universal preventive interventions delivered in early elementary school that has been shown to reduce the risk for future suicide attempts. This paper addresses one potential mechanism by which the GBG lowers the risk of later suicide attempt. In this study, we tested whether the GBG, by facilitating social adaptation into the classroom early on, including the level of social preference by classmates, thereby lowers future risk of suicide attempts. The measure of social adaptation is based on first and second grade peer reports of social preference ("which children do you like best?"; "which children don't you like?"). As part of the hypothesized meditational model, we examined the longitudinal association between childhood peer social preference and the risk of future suicide attempt, which has not previously been examined. Data were from an epidemiologically based randomized prevention trial, which tested the GBG among two consecutive cohorts of first grade children in 19 public schools and 41 classrooms. Results indicated that peer social preference partially mediated the relationship between the GBG and the associated reduction of risk for later suicide attempts by adulthood, specifically among children characterized by their first grade teacher as highly aggressive, disruptive. These results suggest that positive childhood peer relations may partially explain the GBG-associated reduction of risk for suicide attempts and may be an important and malleable protective factor for future suicide attempt.

Magnetic resonance imaging markers of suicide attempt and suicide risk in adolescents.

More than 36,000 people in the United States die from suicide annually, and suicide is the third leading cause of death in adolescence. Adolescence is a time of high risk for suicidal behavior, as well as a time that intervention and treatment may have the greatest impact because of structural brain changes and significant psychosocial development during this period. Functional and structural neuroimaging studies in adults who have attempted suicide suggest distinct gray matter volume abnormalities in cortical regions, as well as prefrontal cortical and dorsal anterior cingulate gyrus neural circuitry differences compared with affective and healthy adult controls. Recent functional neuroimaging studies in adolescents with a history of suicide attempt suggest differences in the attention and salience networks compared with adolescents with depression and no history of suicide attempt and healthy controls when viewing angry faces. In contrast, no abnormalities are seen in these areas in the absence of emotional stimuli. These networks may represent promising targets for future neuroimaging studies to identify markers of risk for future suicide attempt in adolescents.

A Population-Based Longitudinal Study of Recent Stressful Life Events as Risk Factors for Suicidal Behavior in Major Depressive Disorder

The purpose of this study is to investigate whether the type and number of stressful life events (SLEs) will be associated with suicidal behavior in a 3-year follow-up period in persons with major depressive disorder (MDD). Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative longitudinal survey of mental health in non-institutionalized adults in the United States. The survey consisted of two waves: Wave 1 (2001-–2002) and Wave 2 (2004–2005), n = 34,653. Twelve past-year SLEs were assessed at baseline. These SLEs were categorized into the following groups based on previous research: Loss or victimization; Relationship, friendship, or interpersonal stress; Financial stress; and Legal problems. Only respondents with MDD at Wave 1 were included (n = 6,004). Several SLEs were strongly associated with suicide attempts, among which, “serious problems with neighbor, friend, or relative” (adjusted odds ratio [AOR] = 2.21; 95% confidence interval [95% CI]: 1.41, 3.45) and “major financial crisis, bankruptcy, or unable to pay bills” (AOR = 2.31; 95% CI: 1.45, 3.66) were the most robust predictors of suicide attempts even after adjusting for sociodemographic variables and any anxiety, substance use, or personality disorder. People with MDD who had been exposed to certain SLEs are at elevated risk for future suicide attempts, even after accounting for the demographic factors and psychiatric comorbidity.

Nonsuicidal self-injury as a prospective predictor of suicide attempts in a clinical sample of military personnel

BackgroundNonsuicidal self-injury (NSSI) is a risk factor for suicide attempts, but it has received little attention in military populations, for whom suicide rates have doubled over the past decade. In the current study, the relationship of NSSI with future suicide attempts was prospectively examined in a sample of active duty Soldiers receiving outpatient psychiatric treatment for suicide ideation and/or a recent suicide attempt. MethodsData were collected as part of a two-year prospective study of 152 active duty Soldiers (87% male, 71% Caucasian, mean age=27.53) in outpatient mental health care who reported current suicide ideation and/or a suicide attempt during the month preceding intake. Suicide attempts and NSSI were assessed using the Suicide Attempt Self Injury Interview. ResultsForty percent of Soldiers with a history of nonsuicidal self-injury and 25% of Soldiers with a history of suicide attempt made a suicide attempt during the 2-year follow-up. Soldiers with a history of nonsuicidal self-injury were more than twice as likely to make a subsequent suicide attempt (hazard ratio [HR]=2.25, P=.045). Soldiers with a history of suicide attempt were no more likely to make a subsequent suicide attempt than Soldiers without a previous suicide attempt (HR=.88, P=.787). Thirty percent of Soldiers with a history of suicide attempt had also engaged in nonsuicidal self-injury. Forty-two percent of Soldiers with histories of both nonsuicidal self-injury and suicide attempt made a subsequent suicide attempt and were more likely to make a suicide attempt during follow-up than Soldiers with a history of suicide attempt only. Number of NSSI episodes, but not number of suicide attempts, was significantly associated with increased risk for future suicide attempt. Results were unchanged when adjusting for baseline symptom severity. LimitationsPredominantly male, active duty Army sample. ConclusionsAmong Soldiers in outpatient mental health care, a history of NSSI is a stronger predictor of future suicide attempts than a history of suicide attempts. Soldiers with a history of both NSSI and suicide attempt are at especially increased risk.