Suicidal Thoughts And Behaviors Research Articles

Strategic Treatment and Assessment for Youth (STAY): A Theoretically-Driven, Culturally-Tailored MBC Approach.

Racial and ethnic minoritized (REM) youth are at greater risk for depression and suicide than their White peers. Despite this, REM youth are much more likely than their White peers to prematurely dropout of treatment. Culturally tailored and scalable engagement models to improve mental health treatment retention among REM youth with depressive symptoms and suicidal thoughts and behaviors (STB) are urgently needed. Strategic Treatment Assessment for Youth (STAY) is a theoretically-driven, culturally tailored measurement-based care (MBC) approach to treatment engagement for REM youth with depressive symptoms and suicide risk. Specifically, STAY uses MBC feedback processes to reduce perceptual barriers to treatment, thus improving treatment retention and ultimately, client outcomes among REM youth. In addition to standard MBC components, STAY includes a greater emphasis on providing a client-centered rationale for MBC which includes assessing and discussing treatment expectations, the use of individualized progress measures and alliance measures, and cultural competence training. The goal of this manuscript is to describe the STAY model based on initial theoretical development and preliminary clinician-informed refinements. Further, a case example of STAY is presented with a particular focus on the use of feedback processes. Finally, the current and future directions to empirically examine STAY as a treatment retention strategy with REM populations are provided.

Automated Real-Time Tool for Promoting Crisis Resource Use for Suicide Risk (ResourceBot): Development and Usability Study.

Real-time monitoring captures information about suicidal thoughts and behaviors (STBs) as they occur and offers great promise to learn about STBs. However, this approach also introduces questions about how to monitor and respond to real-time information about STBs. Given the increasing use of real-time monitoring, there is a need for novel, effective, and scalable tools for responding to suicide risk in real time. The goal of this study was to develop and test an automated tool (ResourceBot) that promotes the use of crisis services (eg, 988) in real time through a rule-based (ie, if-then) brief barrier reduction intervention. ResourceBot was tested in a 2-week real-time monitoring study of 74 adults with recent suicidal thoughts. ResourceBot was deployed 221 times to 36 participants. There was high engagement with ResourceBot (ie, 87% of the time ResourceBot was deployed, a participant opened the tool and submitted a response to it), but zero participants reported using crisis services after engaging with ResourceBot. The most reported reasons for not using crisis services were beliefs that the resources would not help, wanting to handle things on one's own, and the resources requiring too much time or effort. At the end of the study, participants rated ResourceBot with good usability (mean of 75.6 out of 100) and satisfaction (mean of 20.8 out of 32). This study highlights both the possibilities and challenges of developing effective real-time interventions for suicide risk and areas for refinement in future work.

Longitudinal panel networks of risk and protective factors for early adolescent suicidality in the ABCD sample.

Rates of youth suicidal thoughts and behaviors (STBs) are rising, and younger age at onset increases vulnerability to negative outcomes. However, few studies have investigated STBs in early adolescence (ages 10-13), and accurate prediction of youth STBs remains poor. Network analyses that can examine pairwise associations between many theoretically relevant variables may identify complex pathways of risk for early adolescent STBs. The present study applied longitudinal network analysis to examine interrelations between STBs and several previously identified risk and protective factors. Data came from 9,854 youth in the Adolescent Brain Cognitive Development Study cohort (Mage = 9.90 ± .62 years, 63% white, 53% female at baseline). Youth and their caregivers completed an annual measurement battery between ages 9-10 through 11-12 years. Panel Graphical Vector Autoregressive models evaluated associations between STBs and several mental health symptoms, socioenvironmental factors, life stressors, and substance use. In the contemporaneous and between-subjects networks, direct associations were observed between STBs and internalizing symptoms, substance use, family conflict, lower parental monitoring, and lower school protective factors. Potential indirect pathways of risk for STBs were also observed. Age-specific interventions may benefit from prioritizing internalizing symptoms and early substance use, as well as promoting positive school and family support.

Suicidal Thoughts and Behaviors Among Autistic Transgender or Gender-Nonconforming US College Students

Suicide risk is a global public health crisis, with suicide ranking as a consistent leading cause of death among adults in the US. Autistic individuals and transgender or gender-nonconforming (TGNC) individuals represent populations with notably elevated rates of suicidal thoughts and behaviors (STBs). To characterize suicidal thoughts and behaviors among TGNC and autistic individuals, using a large, nationally representative sample. This study is a secondary analysis of cross-sectional data from students at colleges and universities throughout the US who participated in the American College Health Association National College Health Assessment from 2019 to 2023. Autistic and TGNC identities were self-reported by participants. The frequency of intersectionality of autism and TGNC identities and whether those who had intersectional marginalized identities had increased likelihood of STBs were examined. STBs were self-reported by participants. A series of moderated regression analyses were performed to examine how the interaction between autism and possessing a marginalized gender identity (ie, TGNC status) was associated with STBs. The sample included 41 507 college students with a mean (SD) age of 23.35 (6.83) years. A total of 2410 participants (5.81%) identified as being TGNC. Overall, 326 TGNC participants (13.53%) also identified as autistic, whereas 625 of those who identified as cisgender (1.58%) also identified as autistic. Gender identity and autism were associated with greater odds of STBs. For suicidal ideation, gender identity had an odds ratio (OR) of 3.34 (95% CI, 2.99-3.73), and autism had an OR of 2.06 (95% CI, 1.76-2.42). For suicide attempts, gender identity had an OR of 2.74 (95% CI, 2.13-3.52), and autism had an OR of 2.39 (95% CI, 1.62-3.52). A significant interaction existed for attempts (OR, 0.51; 95% CI, 0.27-0.97); nonautistic cisgender individuals had the lowest attempt rate. This cross-sectional study addresses the dearth of information on how intersectionality in gender and autism status impacts the risk of STBs, and the results confirm the elevated risk of STBs among TGNC and autistic populations. Interventions are needed to support college students with these identities.

Men's Suicidal thoughts and behaviors and conformity to masculine norms: A person-centered, latent profile approach

BackgroundMen are up to four times more likely to die by suicide than women. At the same time, men are less likely to disclose suicidal ideation and transition more rapidly from ideation to attempt. Recently, socialized gender norms and particularly conformity to masculine norms (CMN) have been discussed as driving factors for men's increased risk for suicidal thoughts and behaviors (STBs). This study aims to examine the individual interplay between CMN dimensions and their association with depression symptoms, help-seeking, and STBs. MethodsUsing data from an anonymous online survey of 488 cisgender men, latent profile analysis was performed to identify CMN subgroups. Multigroup comparisons and hierarchical regression analyses were used to estimate differences in sociodemographic characteristics, depression symptoms, psychotherapy use, and STBs. ResultsThree latent CMN subgroups were identified: Egalitarians (58.6 %; characterized by overall low CMN), Players (16.0 %; characterized by patriarchal beliefs, endorsement of sexual promiscuity, and heterosexual self-presentation), and Stoics (25.4 %; characterized by restrictive emotionality, self-reliance, and engagement in risky behavior). Stoics showed a 2.32 times higher risk for a lifetime suicide attempt, younger age, stronger somatization of depression symptoms, and stronger unbearability beliefs. ConclusionThe interplay between the CMN dimensions restrictive emotionality, self-reliance, and willingness to engage in risky behavior, paired with suicidal beliefs about the unbearability of emotional pain, may create a suicidogenic psychosocial system. Acknowledging this high-risk subgroup of men conforming to restrictive masculine norms may aid the development of tailored intervention programs, ultimately mitigating the risk for a suicide attempt.

Transitions in Suicide Risk from Early Adolescence to Early Adulthood

Objective Understanding patterns of suicide risk over the course of development can aid our ability to prevent suicide. Our community-based study examined changes in suicide risk status and predictors of changes in risk status in a sample of 521 adolescents over six assessments between the start of middle school and young adulthood (ages 12–22). Methods Suicidal thoughts and behaviors (STB) were measured with the Diagnostic Interview Schedule for Children and the Moods and Feelings Questionnaire. Latent transition analysis (LTA) was utilized to evaluate transitions in suicide risk status over the course of development. Nine risk factors’ initial values and change over time were modeled as predictors in the LTA. Results Latent class analysis identified a four-class model of developmental suicide risk patterns: Class 1: Infrequent STB (73–87% of participants), Class 2: Diminishing STB (1–17% of participants), Class 3: Escalating STB (6–16% of participants), and Class 4: Consistently High STB (1–5% of participants). LTA demonstrated that infrequent STB members and escalating STB members were likely to maintain their risk class across time points. Conclusions Classification of STB trajectories demonstrated self-worth and family involvement were salient variables affecting transitions in risk over time and suggest prevention targets early in adolescence that could have impact on suicide risk in adulthood.

A systematic review on passive sensing for the prediction of suicidal thoughts and behaviors

Passive sensing data from smartphones and wearables may help improve the prediction of suicidal thoughts and behaviors (STB). In this systematic review, we explored the feasibility and predictive validity of passive sensing for STB. On June 24, 2024, we systematically searched Medline, Embase, Web of Science, PubMed, and PsycINFO. Studies were eligible if they investigated the association between STB and passive sensing, or the feasibility of passive sensing in this context. From 2107 unique records, we identified eleven prediction studies, ten feasibility studies, and seven protocols. Studies indicated generally lower model performance for passive compared to active data, with three out of four studies finding no incremental value. PROBAST ratings revealed major shortcomings in methodology and reporting. Studies suggested that passive sensing is feasible in high-risk populations. In conclusion, there is limited evidence on the predictive value of passive sensing for STB. We highlight important quality characteristics for future research.

Suicide risk with ASD traits or ADHD traits in non-clinical young adults

The impact of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) traits on suicidal thoughts and behaviors (STBs) remains inadequately explored. Hence, the present study aims to delve deeper into these intricate issues, contributing to a better understanding of these complex challenges among Chinese youth. The data of 90,882 participants was collected from 63 Chinese universities and colleges in Jilin, China. We aim to explore the risks of STBs on ASD, ADHD, and co-occurrence of ASD + ADHD by using the Autism Spectrum Quotient-10 items (AQ-10) and Adult ADHD Self Report Scale (ASRS). Propensity score matching (PSM) was implemented to balance demographical variables across the four groups. Binary logistic regression was then conducted to further analyze and compare suicide risk across the four groups, also accounting for sex differences. Suicide risks were significantly higher in the ADHD (OR = 1.24, p < 0.001) and ASD + ADHD(OR = 1.49, p < 0.001) traits group. However, there was no significant difference in suicide risk between the ASD traits group (OR = 1.00, p = 1.00) and the control group. The risk of suicide was significantly higher for females than for males across all four groups (p < 0.001). These results indicate the importance of screening for ASD + ADHD traits in young adults, especially females due to its higher risk of STBs. Further studies are warranted to delve deeper into this issue, emphasizing the necessity of formal diagnostic tests and directing focused attention toward addressing these complexities.

Measurement Invariance of the Four-Item Entrapment Scale Short-Form (E-SF): A Transnational Examination Across Race/Ethnicity, Sexual Orientation, and Suicide Attempt History Among Minoritized Adults.

Feelings of entrapment-posited to arise when attempts to escape from defeating or humiliating circumstances are blocked-may confer increased risk for psychopathology and suicidal thoughts and behaviors (STB), particularly among minoritized individuals who often have more frequent exposure to such experiences. Including entrapment in empirical models may aid research efforts in further exploring its role in minority mental health. The Entrapment Scale Short-Form (E-SF), a brief version of the 16-item Entrapment Scale, is one tool that may be utilized toward this end; however, to do so meaningfully, its psychometric properties and measurement invariance must be evaluated in diverse samples. This study aimed to examine the factor structure, measurement invariance, and convergent validity of the E-SF across race/ethnicity and sexual orientation in a combined transnational sample of minoritized adults (total N = 1,194). Results supported a one-factor model of the E-SF that was invariant across samples, race/ethnicity, sexual orientation, and history of suicide attempt. Furthermore, significant positive correlations observed between theoretically relevant constructs of anxiety, depression, and posttraumatic stress disorder symptoms supported its convergent validity. Implications include disproportionate levels of entrapment experienced by minoritized individuals-particularly by sexual minorities-which likely reflect the discrimination frequently endured by these individuals.

Relations between worry, thought control, suicidal ideation and attempt history

ABSTRACT Background Thought processes such as worries are often described as difficult to control and predict suicidal thoughts and behaviors (STBs). Due to their uncontrollable nature, worries may lead to STBs as people attempt to escape their own internal thought processes. Objective Examine the indirect role of perceived uncontrollability of one’s thoughts in the relationship between worry and STBs. Design and Method We used stepwise mediation models to examine the proposed relationship in a sample of 145 undergraduates with lifetime suicidal ideation. STBs were categorized into (1) severity of lifetime suicidal ideation, (2) likelihood and (3) severity of recent suicidal ideation, and (4) lifetime suicide attempt. The likelihood and severity of recent ideation were separated due to the skewed nature of suicidal thoughts, with many people reporting zero ideation. Results Worry was related to the severity of lifetime ideation, the likelihood of reporting recent ideation, and the severity of recent ideation through lower levels of perceived ability to control one’s thoughts. Worry was not related to a lifetime suicide attempt. Conclusion The perception that one’s thoughts are uncontrollable may be a core feature of worry for the development and worsening of suicidal thinking. Interventions targeting internal perceptions of uncontrollability may be beneficial for suicidal ideation management.

Prevalence of current suicidal thoughts and lifetime suicide attempts in individuals with cancer and other chronic diseases in Germany: Evidence for differential associations from a representative community cohort

BackgroundResearch indicates an elevated risk for suicidal thoughts and behaviors (STBs) among individuals with cancer, but community-based studies on the prevalence of STBs in comparison to the general population and other chronic diseases are lacking. MethodsData was drawn from the representative population-based, prospective Gutenberg Health Study (GHS). Participants (N = 12,382; age: M = 59.5, SD = 10.8; 48.9 % women) completed highly standardized medical assessments and validated questionnaires such as the PHQ-9. In addition to prevalence estimates (stratified by STBs and gender), logistic regression models were calculated (controlling for confounders). ResultsThe sample included 1910 individuals with cancer, 8.2 % of whom reported current suicidal thoughts and 2.0 % reported lifetime suicide attempts. There was neither a significant association between a cancer diagnosis and suicidal thoughts (p = .077) nor suicide attempts (p = .17) in models adjusting for age, gender, and income. Other chronic diseases were linked to suicidal thoughts and attempts only in men. LimitationsAlthough the investigation of the two kinds of STB are a strength of the study, the items' different time frames complicate comparisons. In addition, the cross-sectional design limits the ability to understand observed relationships and to identify periods of risk. ConclusionThis study expands the evidence base regarding the vulnerability to STBs in individuals with cancer, including long-term survivors. It highlights their heterogeneity, differential risk factors underlying suicidal thoughts and attempts, and the relevance of other (contextual) factors shaping an individual's susceptibility to suicidal crises.

Review on the Integration of Just-in-time Adaptive Intervention and Internet-based Cognitive Behavioral Therapy in Reducing Suicidal Thoughts and Behavior

Suicide remains a major public health challenge in the world. The current suicide prevention approaches face challenges in timing mismatch, access barriers, and lack of personalization, complicating the environment for successfully reducing suicidal thoughts and behaviors (STBs). Mobile health has been an emerging but effective approach to supporting and treating mental illnesses. The strengths of Just-in-Time Adaptive Interventions (JITAI) and Internet-based Cognitive Behavioral Therapy(iCBT) are potential approaches to resolving the current challenges of suicide prevention. This paper examines the definitions of JITAIs and iCBT and explores their use in mitigating suicidal thoughts and behaviors. It is proposed that the integration of JITAIs and iCBT could address the current obstacles in preventing suicidal thoughts and behaviors due to their advantages in availability, accessibility, and personalization. However, this integration also has its limitations, necessitating further research. The paper underscores the necessity of future empirical studies on the combined use of JITAIs and iCBT to reduce suicidal thoughts and behaviors.

Perceived and Internalized Stigma Towards Suicide and Their Roles in Suicidal Thoughts and Behaviors Among Chinese College Students.

Although perceived and internalized suicide stigma are considered risk factors for suicidal thoughts and behaviors (STBs), their specific roles in STBs are not well understood. This study examined the relationships among perceived and internalized suicide stigma, hopelessness, unbearable pain, suicidal desire, and suicide attempts in college students. A total of 1,387 Chinese college students (mean age: 22.22 years) completed the relevant scales. Structural equation modeling was used to determine the relationships of interest. The results showed that perceived stigma primarily had indirect impacts on suicidal desire through internalized stigma, which subsequently affected unbearable pain and hopelessness. The findings of this study suggest that the internalization of suicide stigma is an important predictor of STBs. These findings advocate for stigma interventions aimed at reducing internalized stigma as a potentially effective strategy for suicide prevention, as it may alleviate unbearable pain and hopelessness, which are significant contributors to suicidal desire and attempts.

Feasibility and Acceptability of Ecological Momentary Assessment to Assess Suicide Risk among Young People with Mood Disorder in China

Suicidal thoughts and behaviors (STBs) are increasing among young people (aged 12–24 years) in China. Although Ecological Momentary Assessment (EMA) has been increasingly used to study STBs worldwide, no study has been conducted on young people with mood disorders (MD) in China. This mixed-method study aimed to evaluate the feasibility and acceptability of suicide risk monitoring in 75 young people with MD. Participants completed five to eight daily EMA surveys and wore smart bands for the EMA study. Semi-structured interviews were used to collect feedback. High adherence to EMA surveys (73.0 %) and smart bands (87.4 %) indicated feasibility. Participants reported an overall positive experience with the EMA study (helpful, friendly, and acceptable). Additionally, the reasons they were willing to comply with the EMA study were: (1) seeing the possibility of returning to “normal,” and (2) experiencing the process of returning. However, a small proportion of participants had negative experiences (e.g., annoyance and missing prompts). The results of this mixed-methods study provide preliminary support for the feasibility and acceptability of using EMA (combined smartphones and wearable sensor devices) to assess suicidality among young people with MD in the Chinese cultural and social context.

Temporal Patterns of Suicidality Among Adolescents Receiving Behavioral and Mental Health Services in the Community: A Survival Analysis.

Adolescent suicide is a major public health concern, particularly among adolescents who have endured Adverse Childhood Experiences (ACEs). Adolescents who have been exposed to multiple ACEs are as much as three times more likely to present with suicidality compared to the general adolescent population. Adolescents who have been exposed to multiple ACEs are also more likely to receive behavioral and mental health services in the community. It is therefore important to understand patterns of suicidality among this sub-population of adolescents in order to provide the best clinical care. The present study examined the temporal patterns of suicidality among adolescents who have been exposed to multiple ACEs and are receiving behavioral and mental health services in the community. Using Electronic Health Record (EHR) data from a community-based behavioral and mental health care organization, an exploratory survival analysis was conducted on time to suicidal thoughts and behaviors (STBs) after suicidality risk screen at intake. Average time from suicidality risk screen at intake to STB was 185 days (6.2 months). Youth who screened negative for suicidality risk at intake had a longer survival time than youth who screened positive for suicidality risk, and the survival distributions between the two groups was significant. Predictors of STBs were also examined, with gender being a significant predictor of an STB occurring during the follow-up period. These findings may be used to guide suicidality screening and clinical practice at community-based behavioral and mental health care organizations serving adolescents who have been exposed to multiple ACEs.

Identifying factors impacting missingness within smartphone-based research: Implications for intensive longitudinal studies of adolescent suicidal thoughts and behaviors.

Intensive longitudinal research-including experience sampling and smartphone sensor monitoring-has potential for identifying proximal risk factors for psychopathology, including suicidal thoughts and behaviors (STB). Yet, missing data can complicate analysis and interpretation. This study aimed to address whether clinical and study design factors are associated with missing data and whether missingness predicts changes in symptom severity or STB. Adolescents ages 13- to 18 years old (N = 179) reporting depressive, anxiety, and/or substance use disorders were enrolled; 65% reported current suicidal ideation and 29% indicated a past-year attempt. Passively acquired smartphone sensor data (e.g., global positioning system, accelerometer, and keyboard inputs), daily mood surveys, and weekly suicidal ideation surveys were collected during the 6-month study period using the effortless assessment research system smartphone app. First, acquisition of passive smartphone sensor data (with data on ∼80% of days across the whole sample) was strongly associated with survey data acquisition on the same day (∼44% of days). Second, STB and psychiatric symptoms were largely not associated with missing data. Rather, temporal features (e.g., length of time in study, weekends, and summer) explained more missingness of survey and passive smartphone sensor data. Last, within-participant changes in missing data over time neither followed nor predicted subsequent change in suicidal ideation and psychiatric symptoms. Findings indicate that considering technical and study design factors impacting missingness is critical and highlight several factors that should be addressed to maximize the validity of clinical interpretations in intensive longitudinal research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prediction of suicidal thoughts and behaviors based on the diurnal cortisol pattern and THC dosage in continued cannabis users, a 5 year population-based matched cohort study

It appears that the THC dosage is the link between dysregulation of the hypothalamic pituitary adrenal (HPA) axis and suicidal thoughts and behaviors (STB). We proposed a new model to understand the underlying pathophysiological mechanism of STB based on the interaction of cortisol and THC dosage.From September 1, 2019, to January 1, 2024, we conducted a population-based, matched-pair, nested case-control study resulting from a three-wave complete longitudinal, multicenter cohort study on a sample of congress 60 clients. A total of 368 male continued cannabis users (CCu) were allocated to four categories, including low, moderate and high THC dosages and relapse, using optimal matching. Several HPA axis measures were analyzed in the saliva using liquid chromatography with tandem mass spectrometry (LC-MS-MS), and carboxylic acids levels in the urine were assessed via gas chromatography/mass spectrometry (GC–MS). We used structural equation modeling (SEM) to examine the relationship between the variables of interest and the model fit test, and used the Akaike information criterion (AIC) to compare the model fit and select the best-fitting model. Population attributable fractions (PAFs) and cumulative risk score were also calculated for the best-fitting pattern.The analysis showed that the likelihood of STB in individuals with a cortisol awakening response (CAR) and a blunted diurnal cortisol slope (DCS) and higher area under the curve (AUC) who reported heavy cannabis use was more than three times higher than the control group (OR 3.2, 95 % CI 2.4–4.1).These findings indicate the importance of the specific cortisol secretion pattern in the increased clinical expression of STB and may be an important factor for guiding preventive efforts in this area.

Implicit measures of suicide vulnerability: Investigating suicide-related information-processing biases and a deficit in behavioral impulse control in a high-risk sample and healthy controls

ObjectiveRelevant implicit markers of suicidal thoughts and behaviors (STBs) have only been studied in isolation with mixed evidence. This is the first study that investigated a suicide attentional bias, a death-identity bias and a deficit in behavioral impulsivity in a high-risk sample and healthy controls. MethodWe administered the Death Implicit Association Test, the Modified Suicide Stroop Task, and a Go/No-Go Task to inpatient suicide ideators (n = 42), suicide attempters (n = 40), and community controls (n = 61). ResultsSuicide ideators and attempters showed a suicide attentional bias and a death-identity bias compared to healthy controls. Ideators and attempters did not differ in these implicit information-processing biases. Notably, only attempters were more behaviorally impulsive compared to controls; however, ideators and attempters did not significantly differ in behavioral impulsivity. Moreover, implicit scores were positively intercorrelated in the total sample. ConclusionIn line with the Cognitive Model of Suicide, ideators and attempters display suicide-related information processing biases, which can be considered as implicit cognitive markers of suicide vulnerability. Furthermore, attempters have elevated levels of behavioral impulsiveness. These results are highly relevant in the context of crisis intervention strategies and warrant further research.

Discrepancies in prevalence estimates of suicidal ideation and attempts in 18- to 22-year-old US college students: a comparison of three surveys.

Suicidal thoughts and behaviors (STB) have been increasing among US college students. Accurate measurement of STB is key to understanding trends and guiding suicide prevention efforts. We aimed to compare the prevalence estimates of STB among college students from two campus-based surveys (the National College Health Assessment [NCHA] and the Healthy Minds Study [HMS]) and one general population study (the National Survey on Drug Use and Health [NSDUH]). Estimates were generated from the three surveys for past year suicidal ideation (PYSI) and past year suicide attempts (PYSA) among 18- to 22-year-old full-time college students. Data were combined from each survey to develop bivariate and multivariate regression models for odds of PYSI and PYSA. Estimates for PYSI varied between the three surveys: 34.3% for NCHA, 15.0% for HMS, and 10.7% for NSDUH. Estimates for PYSA were 2.6% for NCHA, 1.6% for HMS, and 1.7% for NSDUH. After adjusting for demographic and educational characteristics, odds of PYSI remained significantly lower for HMS participants (aOR 0.31, 95% CI 0.29-0.33) and NSDUH participants (aOR 0.19, 95% CI 0.19-0.30) compared to NCHA participants. The odds of PYSA for HMS participants were lower than those for NCHA participants (aOR 0.63, 95% CI 0.54-0.73). Estimates of PYSI and PYSA vary between leading sources of data on college student mental health. The differences are likely related to question wording, survey implementation, as well as institutional and individual representation. Accounting for these differences when interpreting estimates of STB can help guide suicide prevention efforts.

Risk Factors Associated with Suicidal Ideation and Suicidal Behavior in Wildland Firefighters

Introduction Wildland firefighters are posited to have a higher suicide rate than general firefighters and the general population. However, the rates and risk factors of suicide among wildland firefighters is not fully understood. Methods For this preregistered study, 564 participants were recruited from Facebook to obtain a final sample of 246 participants with valid data who were current or former wildland firefighters in the United States. Participants completed online measures of suicidal ideation, history of suicidal behaviors, posttraumatic stress disorder (PTSD) symptoms, problematic alcohol use, and occupational exposure to suicide. Results In this sample, 22% of wildland firefighters reported a history of at least one suicide attempt, and 36.7% reported current suicidal ideation. PTSD symptoms, but not problematic alcohol use or exposure to suicide, were positively associated with suicidal ideation and a history of suicide attempts. Additionally, PTSD symptoms explained significantly more variance in suicidal ideation than depression symptoms alone. Conclusions Wildland firefighters demonstrate rates of suicide attempts that exceed those of non-wildland firefighters and of the general population at large. In addition, PTSD symptoms may contribute to suicidal thoughts and behaviors (STB) in this population. This is the largest study of STB in wildland firefighters to date.