Suicide Attempt Status Research Articles

Suicide-specific rumination as a predictor of suicide planning and intent

BackgroundSuicide-specific rumination (SSR), that is repetitive negative thinking about suicide, has been proposed as a risk factor for suicidal behavior. Yet, few studies have investigated associations between SSR and suicide intent and planning in a longitudinal study design. The purpose of the present study was to investigate the association between SSR, suicide intent, suicide planning and suicide attempts in a sample of adult outpatients undergoing psychotherapy. MethodData from N = 637 patients (58.4% female, 41.6% male; Mage = 35.81, SDage = 13.50, range: 18–79 years) who started therapy at an outpatient clinic were collected. A subsample of n = 335 patients (n = 335; 56,4% female, 43,6% male; Mage = 35.4, SDage = 13.1, range: 18–73 years) also took part in a post-treatment assessment after twelve therapy sessions. ResultsSSR differentiated lifetime suicide attempters from suicide ideators. Furthermore, SSR was associated with lifetime suicide attempt status above age, sex, suicide ideation, depression, anxiety, and stress. Finally, SSR served as a prospective predictor of both suicide planning and suicide intent. ConclusionThe results emphasize the key role of SSR in understanding the suicidal process.

The trauma-suicide connection among racial and ethnically diverse lesbian, gay, and bisexual adults: Examining the roles of intersectional discrimination and complex posttraumatic stress disorder

Aim We sought: (a) to explore the roles of complex posttraumatic stress disorder (CPTSD), racism, and heterosexist discrimination in linking exposure to traumatic events and lifetime suicide attempt among sexually diverse racial and ethnic minority adults; and (b) to explore differences by race/ethnicity. Methods We used structural equation modeling methods (moderated mediation analysis) to analyze a sample of sexually diverse racial and ethnic minority adults from the National Epidemiological Study of Alcohol and Related Conditions (NESARC-III) dataset (n = 632). Descriptive results are included for underpowered subgroups. Results We found significant differences by racial/ethnic identity, with CPTSD mediating associations between trauma exposure and suicide attempt status among Hispanic respondents, but not Black respondents. Furthermore, racism and heterosexist discrimination amplified the effects of trauma exposure on CPTSD symptoms among Hispanic respondents. Conclusion CPTSD may be an important mechanism in the trauma-suicide connection among some sexually diverse racial and ethnic minority people. These findings have important implications for suicide prevention work among sexually diverse populations, including the need for interventions that integrate traumatic stress treatment and employ an intersectional approach, addressing the influence of racism and heterosexism, particularly for Latinx and Hispanic groups.

Symptoms characteristics of personality disorders associated with suicidal ideation and behaviors in a clinical sample of adolescents with a depressive disorder.

Pathological personality traits have repeatedly been identified as important risk factors for suicidal ideation and behaviors. Moreover, impulsive-aggressive traits, have shown a consistent association with suicidal behaviors across the lifespan. Adolescence represents a critical period for the emergence of different personality traits, mood disorders, and suicidal behaviors, but the relationship between these variables remain poorly understood. These variables were examined in a cross-sectional case-control design involving three groups: 30 adolescents with a depressive disorder and past suicide attempt (Mean Age = 16.2, Females = 26), 38 adolescents with a depressive disorder but without past suicide attempt (Mean age = 16.0, Females = 29), and 34 healthy adolescent controls (Mean age = 15.2, Females = 22). Suicidal ideations were indexed using Suicidal Behavior Questionnaire (SBQ-R), psychiatric disorder assessed using a semi-structured questionnaire (K-SADS-PL), depressive symptoms with the Beck Depressive Inventory (BDI), symptoms characteristics of personality disorders with the Scheduled Clinical Interview for the DSM-IV (SCID-II) screening questionnaire, and impulsivity with the Barratt Impulsivesness Scale (BIS). Findings showed that impulsivity (F = 11.0, p < 0.0001) and antisocial symptoms characteristics of personality disorders (p < 0.001, d = 0.70) displayed the most robust association with adolescent suicide attempts. Borderline symptoms characteristics of personality disorders did not discriminate attempters from non-attempters but presented high correlations with suicidal ideation and depression severity. In an item-wise analysis, suicide attempt status was uniquely correlated with symptoms characteristics of an antisocial personality disorder. Suicide attempt status also correlated with non-suicidal self-injury and a chronic feeling of emptiness. The caveats of this cross-sectional study include the stability of symptoms characteristics of personality disorders in adolescence and the limited sample size. In sum, suicidal behaviors were characteristically correlated with increased impulsivity and antisocial symptoms characteristics of personality disorders, but other symptoms characteristics of personality disorders were relevant to adolescent depression and suicidal ideation. Understanding the emergence of symptoms characteristics of personality disorders and suicidal behaviors in a developmental context can ultimately inform not only the neurobiological origin of suicidal behaviors, but also provide new avenues for early detection and intervention.

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.

Association between Smartphone Addiction and Suicide.

Objective: This study aimed to explore the associations between smartphone overdependence (smartphone addiction) and suicidal ideation and attempts among Korean adolescents to acknowledge the risk of smartphone overuse. Methods: Data were obtained from the results of the 2020 Korea Youth Risk Behavior Web-based Survey. Smartphone addiction was categorized into three groups: adolescents who scored less than 23 were categorized as the general user group and formed the reference, those with scores of 23–30 were categorized as the potential-risk user group, and those with scores higher than 31 were categorized under the high-risk user group. Suicidal ideation and suicide attempt were identified as dependent variables in the present study. Multiple logistic regression was used to analyze the relationship between SA and suicidal ideation and suicide attempt status among Korean adolescents. Results: This study included 41,173 general users of smartphones, 12,142 potential-risk users, and 1633 high-risk users from among 54,948 adolescents who were middle- and high-school students. Adolescents with potentially risky smartphone use showed a higher likelihood of suicidal ideation (OR: 1.50, CI: 1.42–1.60). Similarly, adolescents with high-risk smartphone use showed a significant risk of suicidal ideation (OR: 2.49, CI: 2.21–2.81) and suicide attempt (OR: 1.87, CI: 1.48–2.37) compared to the adolescents who were general users. Conclusion: Our study results encourage parents and social workers to acknowledge that adolescents’ smartphone addiction leads to a higher risk to their mental health, wherein they may engage in suicidal ideation and even resort to a suicide attempt.

Psychological well-being in US veterans with non-fatal suicide attempts: A multi-cohort population-based study

BackgroundMost people who survive suicide attempts neither re-attempt suicide nor die by suicide. Research on suicide attempt survivors has primarily focused on negative endpoints (e.g., increased suicide risk) rather than positive outcomes. One important outcome is psychological well-being (PWB), defined as positive functioning across emotional, intrapersonal, and interpersonal domains. We compared PWB among US military veterans with (i.e., attempt survivors) and without (i.e., non-attempters) a history of suicide attempt(s) using data from three nationally representative cohorts. MethodsEach US veteran cohort (Cohort1: N = 3148; Cohort2: N = 1474; Cohort3: N = 4042) completed measures of suicidality (e.g., attempt history), character strengths (e.g., curiosity, optimism), psychological symptoms (e.g., depression), and indicators of PWB (e.g., happiness). t-Tests were conducted to examine group differences in PWB; hierarchical regressions were conducted to examine suicide attempt status as a predictor of PWB controlling for symptoms and demographics. Multivariable regressions were conducted to identify predictors of PWB among attempt survivors. ResultsIn each cohort, reported PWB was markedly lower among suicide attempt survivors than non-attempters (ds = 0.9–1.2), even after adjusting for mental health symptoms. Individual differences in PWB were observed, with a subset of suicide attempt survivors reporting higher PWB levels than non-attempters (1.4–7.4 %). Curiosity and optimism were positively associated with PWB among suicide attempt survivors (rs = 0.60–0.78). LimitationsData were cross-sectional, limiting inferences about causation and directionality of associations. ConclusionsFindings highlight diminished PWB as an important and understudied concern among veteran attempt survivors. Collectively, our findings underscore the importance of considering PWB in the research, assessment, and treatment of suicidality.

Assessing the clinical utility of MMPI-2-RF interpersonal theory of suicide proxy indices in psychiatric hospitalization setting.

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF Ben-Porath & Tellegen, 2008/2011) has been applied to suicide risk assessment through derived proxy indices of perceived burdensomeness, thwarted belongingness, and the acquired capability for suicide (Anestis et al., 2018, Joiner, 2005). However, limited research has examined the clinical utility of these proxy indices outside the outpatient setting.This study examined the performance of these proxy indices in identifying past-month suicide ideation intensity and attempts upon admission to a psychiatric inpatient program and changes in suicidal ideation intensity at discharge. We expected these indices and their interaction would be associated with suicide ideation intensity and attempts at baseline and with a lack of significant improvement in suicide ideation intensity at discharge, including when controlling for MMPI-2-RF Suicide/Death Ideation (SUI) scale scores. Participants were 1007 patients in a private inpatient psychiatric hospital in the southwestern United States, 968 of whom completed study measures at admission and discharge. Participants were administered the C-SSRS and MMPI-2-RF upon admission, while the C-SSRS was administered again prior to discharge. A series of moderation analyses were conducted to examine the main and interaction effects of the MMPI-2-RF derived proxy indices on suicidal ideation intensity and suicide attempts at admission. Logistic regression analyses were conducted to examine whether MMPI-2-RF proxy index scores at admission were associated with changes in suicidal ideation intensity at discharge. Neither the proxy indices nor their interaction was associated with all study outcomes. The acquired capability for suicide proxy index and its interaction with other indices were not associated with suicide attempt status at admission. However, high thwarted belongingness proxy index scores were associated with greater suicidal ideation intensity at admission; high perceived burdensomeness proxy index scores were indicative of a lack of significant change in suicide ideation intensity at discharge. These results indicate a need to further examine these proxy indices in high acuity samples.

Service-Connected Disabilities and Suicide Attempts in Veterans: The Moderating Role of Mental Health Care Utilization

United States veteran suicide rates have increased over the past two decades. Designations of service-connected disabilities (designations tied to injury during military service) are also increasing, especially those associated with mental health disorders. However, recent research around disability and suicide in veterans is mixed, and no research has been completed on the association between disability and mental health service utilization. The current study hoped to fill these gaps in the literature with a secondary data analysis of a sample of 36,048 Veterans Healthcare Administration (VHA) veterans. Mental health disorders and demographics were controlled for in a logistic regression model predicting suicide attempt status by the intersection of service-connected disability and mental health care utilization. Mental health service visits moderated the positive relationship between service-connected disability designations and suicide attempts; those who utilized services were less likely to attempt suicide, especially those at higher service-connected disability designations with mental health disorders. The results suggest individuals who have disability designations that also seek help are less likely to make a suicide attempt. The study was limited by scope of the sample (only VHA veterans with service connected disabilities). Results have implications for preventative interventions in the VHA/Veterans Benefits Administration.

Mortality following non-fatal suicide attempts by Veterans in Veterans Health Administration care.

Little is known regarding long-term mortality outcomes after non-fatal suicide attempts among Veterans Health Administration (VHA) patients, which may inform services delivery and program evaluation. For 4,601,081 Veterans with 2005 VHA encounters, we assessed unadjusted and age-adjusted all-cause and cause-specific mortality through 2017, overall and for Veterans with (N=8243) versus without (N=4,592,838) 2005 VHA suicide attempt documentation. Standardized mortality ratios compared mortality rates by suicide attempt status. Multivariable proportional hazards regression models assessed age- and gender-adjusted mortality risk. Among Veteran VHA users with non-fatal suicide attempt diagnoses, 1.6% died of suicide, 4.6% of non-suicide external causes, and 30.7% of any cause. In age- and gender-adjusted analyses, Veterans who attempted suicide had increased suicide (hazard ratio [HR]=4.52, 95% confidence interval [CI]=3.82-5.36), non-suicide external cause (HR=3.75, 95% CI=3.38-4.17), and all-cause (separate due to non-proportional hazards: 2006, HR=2.05, 95% CI=1.81-2.31; 2007-2017, HR=1.72, 95% CI=1.65-1.80) mortality through 2017. Over 12years, Veteran VHA patients with non-fatal suicide attempt diagnoses had increased risk of suicide, non-suicide external cause, and all-cause mortality. Over 98% of Veteran VHA users who had a diagnosed non-fatal attempt did not die by suicide, highlighting additional program evaluation outcomes and opportunities to support physical and mental health.

Repetitive Negative Thinking About Suicide: Associations With Lifetime Suicide Attempts.

Repetitive negative thinking has been identified as an important predictor of suicide ideation and suicidal behavior. Yet, only few studies have investigated the effect of suicide-specific rumination, i.e., repetitive thinking about death and/or suicide on suicide attempt history. On this background, the present study investigated, whether suicide-specific rumination differentiates between suicide attempters and suicide ideators, is predictive of suicide attempt history and mediates the association between suicide ideation and suicide attempts. A total of 257 participants with a history of suicide ideation (55.6% female; Age M = 30.56, Age SD = 11.23, range: 18-73 years) completed online measures on suicidality, general and suicide-specific rumination. Suicide-specific rumination differentiated suicide attempters from suicide ideators, predicted suicide attempt status (above age, gender, suicide ideation, general rumination) and fully mediated the association between suicide ideation and lifetime suicide attempts. Overall, though limited by the use of a non-clinical sample and a cross-sectional study design, the present results suggest that suicide-specific rumination might be a factor of central relevance in understanding transitions to suicidal behavior.

Context-Specific Interpersonal Problem-Solving and Suicidal Thoughts and Behaviors.

Background: Interpersonal problem-solving difficulties constitute a suicide risk factor that may be particularly relevant among college students. Most studies have examined general interpersonal problem-solving; however, context-specific abilities may have greater clinical implications. Aim: This study examined whether individuals with and without a history of suicidal thoughts and behaviors differed in context-specific interpersonal problem-solving. Method: Undergraduate students (n = 112) completed a brief interview and interpersonal problem-solving tasks with positive (e.g., initiating romantic relationship) and negative (i.e., physical revenge) resolutions. Results: Individuals with a history of suicide ideation generated more effective solutions and more alternatives in the negative-resolution scenario; no significant differences were identified for the positive-resolution scenarios. No group differences were found based on suicide attempt status. Limitations: Our results do not account for the mechanisms that influence problem-solving abilities in negative-resolution scenarios. Conclusion: Clinical efforts may benefit from targeting the translation of interpersonal problem-solving abilities to situations with positive resolutions.

Age effects on clinical and neurocognitive risk factors for suicide attempt in depression — Findings from the AFSP lifespan study

BackgroundStudies of risk factors for suicidal behavior are typically restricted to narrow age ranges, making it difficult to determine if they have the same relevance or potency across the full adult lifespan. MethodsThis study examined selected clinical and neurocognitive risk factors for suicidal behavior – borderline personality traits, aggression, depressive rumination, memory performance, and language fluency– in a multi-site sample (N = 309, ages 16–80) of depressed patients with a recent (last 5 years) suicide attempt or no history of attempt, and demographically similar non-psychiatric controls. We examined cross-sectional age and attempter/non-attempter differences on these risk factors, and whether certain risk factors were more prominent discriminators of past suicide attempt earlier or later in the lifespan. Correlations with age were computed, and logistic regression was used to classify attempter status based on each risk factor and its interaction with age. ResultsNearly all risk factors were negatively correlated with age. Borderline traits, aggression, memory, and category fluency each predicted attempter status (p < 0.05), but these effects were not different across ages. In contrast, the association between rumination and suicide attempt status differed across the lifespan, becoming a stronger discriminator of past suicidal behavior at older ages. LimitationsThe cross-sectional design limits our developmental findings. ConclusionsDespite age-related changes in symptom severity or neurocognitive performance, key risk factors for suicidal behavior previously identified in studies with more restricted age-ranges are salient throughout the adult lifespan. In contrast, depressive rumination may be particularly salient in later life.

Examination of measurement invariance of the Acquired Capability for Suicide Scale.

Capability for suicide is frequently assessed using the Acquired Capability for Suicide Scale (ACSS) or the Acquired Capability for Suicide Scale-Fearlessness About Death (ACSS-FAD); however, the measurement invariance of these self-report measures across relevant demographic groups has not been tested. The current study aimed to examine the measurement invariance of the ACSS and ACSS-FAD across (a) gender; (b) suicide attempt status; and (c) military deployment history in a sample of 2,551 participants (M = 28.92, SD = 10.73; 56.7% male, 68.5% White) who participated in one of several studies funded by the Military Suicide Research Consortium. Results indicated that the ACSS exhibited poor model fit; thus, further investigation of measurement invariance was not conducted. Furthermore, although partial measurement invariance of the ACSS-FAD was met for gender, scalar invariance was not supported across military deployment history, and no form of measurement invariance was met across suicide attempt status. Overall, given the lack of strong model fit and measurement invariance in the ACSS and ACSS-FAD across several demographic groups, new or modified self-report measures for capability for suicide may be warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Do suicidal desire and facets of capability for suicide predict future suicidal behavior? A longitudinal test of the desire-capability hypothesis.

Capability-based models propose that people die by suicide because they want to, and they can. Despite the intuitive appeal of this hypothesis, longitudinal evidence testing its predictive validity has been limited. This study tested the predictive validity of the desire-capability hypothesis. A total of 1,020 self-injuring and/or suicidal adults were recruited worldwide online from suicide, self-injury, and mental health web forums. After baseline assessment, participants completed follow-up assessments at 3, 14, and 28 days after baseline. Participant retention was high (>90%) across all follow-up assessments. Analyses examined the effect of the statistical interaction between suicidal desire and indices of capability for suicide on future nonfatal suicide attempts. Main analyses focused on the fearlessness about death facet of capability for suicide; exploratory analyses examined preparations for suicide. Logistic regression was used to predict suicide attempt status at follow-up; zero-inflated negative binomial models were implemented to predict the frequency of nonfatal suicide attempts at follow-up. Results were consistent across models, finding very little evidence of the desire-capability interaction as a significant predictor of suicide attempt status or frequency at follow-up. We close with a discussion of the limitations of this study as well as the implications of our findings for future suicide science. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Predicting suicidal behavior by implicit associations with death? Examination of the death IAT in two inpatient samples of differing suicide risk.

Assessment of implicit self-associations with death, measured by a death Implicit Association Test (IAT), has shown promise for the prediction of suicide risk. The present study examined whether the performance on the death IAT is associated with lifetime, recent, or future suicide attempt status as well as self-report measures of suicide risk factors (e.g., perceived burdensomeness, thwarted belongingness) in two inpatient samples with low versus high severity of suicidality. Furthermore, we investigated whether explicit suicidal ideation and implicit associations with death predict recent and future suicide attempt status. Seventy-one depressed inpatients with recent/lifetime suicidal ideation (first sample) as well as 226 inpatients with a recent suicide attempt or a severe suicidal crisis (second sample) were interviewed on lifetime suicidal ideation and behavior, completed self-report measures (i.e., suicidal ideation, thwarted belongingness, perceived burdensomeness), and conducted the death IAT. The second sample was also interviewed and completed self-report measures longitudinally, 6, 9, and 12 months later. The IAT was conducted twice in this sample, at the beginning of the assessment (T₀) as well as 12 months later (T₃). Implicit associations with death neither differ between lifetime suicide ideators, single attempters, and multiple attempters, nor between recent and future nonattempters and attempters. IAT scores were unrelated to other suicide risk factors. Neither the IAT scores nor the interaction of IAT scores and explicitly stated suicidal ideation was predictive of recent or future suicide attempts. The present study points to a limited utility of the death IAT for the prediction of suicide risk. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Using categorical data analyses in suicide research: Considering clinical utility and practicality.

Categorical data analysis is relevant to suicide risk and prevention research that focuses on discrete outcomes (e.g., suicide attempt status). Unfortunately, results from these analyses are often misinterpreted and not presented in a clinically tangible manner. We aimed to address these issues and highlight the relevance and utility of categorical methods in suicide research and clinical assessment. Additionally, we introduce relevant basic machine learning methods concepts and address the distinct utility of the current methods. We review relevant background concepts and pertinent issues with references to helpful resources. We also provide non-technical descriptions and tutorials of how to convey categorical statistical results (logistic regression, receiver operating characteristic [ROC] curves, area under the curve [AUC] statistics, clinical cutoff scores) for clinical context and more intuitive use. We provide comprehensive examples, using simulated data, and interpret results. We also note important considerations for conducting and interpreting these analyses. We provide a walk-through demonstrating how to convert logistic regression estimates into predicted probability values, which is accompanied by Appendices demonstrating how to produce publication-ready figures in R and Microsoft Excel. Improving the translation of statistical estimates to practical, clinically tangible information may narrow the divide between research and clinical practice.

Testing the Four Main Predictions of the Interpersonal–Psychological Theory of Suicidal Behavior in an Inpatient Sample Admitted Due to Severe Suicidality

This study aimed to evaluate four main predictions of the Interpersonal Psychological Theory of Suicide (IPTS): the importance of perceived burdensomeness (PB), thwarted belongingness (TB), hopelessness (H), and capability for suicide (CS) for (passive/active) suicide ideation, suicide intent and suicide attempts. N = 308 psychiatric inpatients admitted due to severe suicidality (53.6% female: n = 165; age: M = 36.82, SD = 14.30, range: 18–81) completed self-report measures of TB, PB, H, CS and suicide ideation as well as interviews on suicide intent and suicide attempts. TB and PB were associated with (passive/active) suicidal ideation, whereas the three-way interaction PB, TB, and H was not associated with active suicide ideation. Fearlessness about death in conjunction with active suicidal ideation was not associated with suicide intent and the interaction of PB, TB, and CS was neither predictive of recent suicide attempt status nor lifetime number of suicide attempts. Given the cross-sectional nature of the data, conclusions on causality should be handled carefully. The results challenge the theoretical validity of the IPTS and its clinical utility—at least within the methodological limitations of the current study. Yet, findings underscore the importance of PB in understanding suicidality.

Latent infection, inflammatory markers and suicide attempt history in depressive disorders

BackgroundNumerous reports have described increased rates of exposure to Toxoplasma gondii levels in individuals with a history of suicide attempts in comparison with well controls, or psychiatrically ill individuals, with no suicide attempt history. Such findings suggest that the behavioral effects this parasite exerts on rodent hosts extends to humans though few studies have searched for underlying mechanisms. MethodsThe present study compared 96 patients with an active depressive disorder and a history of at least two suicide attempts to 126 depressed patients with no history of suicide attempts by IgG and IgM levels of Toxoplasma gondii and cytomegalovirus (CMV). The groups were also compared by IL_1b, TNF-alpha, CRP, IL_6, and IL_1ra titers. ResultsToxoplasma gondii IgM levels were higher, and seropositivity more likely, in the suicide attempt group. CMV IgG levels were also higher among suicide attempters. Several of these immunoglobulin measures were more robustly associated with the number of suicide attempts than with the dichotomy of suicide attempter and non-attempter. These two antibody levels were also additive in their association with suicide attempter status. IL_1a levels were lower in suicide attempters and correlated negatively with levels of antibodies to Toxoplasma gondii and CMV. LimitationsThese include a sample size insufficient to explore differences across mood disorder diagnoses or demographic groupings. ConclusionsThese results indicate that exposure to common infectious agents such as Toxoplasma gondii and CMV are associated with increased risk of suicide attempts but the mechanism of association does not appear to involve the activation of cytokines. Elucidation of the mechanisms which define the relationship between infections and suicide attempts may lead to new methods for the prediction and prevention of suicide attempts.

Fearlessness about death does not differ by suicide attempt method

Modern theories of suicide, such as the Interpersonal Theory of Suicide, have overcome past conceptual limitations within suicide research by examining factors that help differentiate suicide attempters from those who experience suicidal ideation, but never attempt suicide. One such factor that has been studied extensively is fearlessness about death. Given the varying levels of lethality for different methods used in suicide attempts, an important question is if different levels of fearlessness about death are needed for specific methods. The central aim of this study was to test whether various methods for suicide are associated with different levels of fearlessness about death in a large sample of suicide attempt survivors. Participants were 620 suicide attempt survivors from active military, veteran, and civilian populations. Suicide attempt status was confirmed by two independent raters coding qualitative accounts and participants indicating at least one past attempt with intent to die on other survey items. Results indicated that fearlessness about death does not differ by attempt method and that nearly all methods are statistically equivalent to one another. Despite several methods requiring significantly more time facing mortal fear and severe physical anguish (e.g., cutting, hanging/asphyxiation), as well as certain means being much more lethal (e.g., firearm), differences in ability to enact a suicide attempt with a particular method was not associated with fearlessness about death. This may further indicate the importance of clinicians focusing on practical capability aspects (e.g., means safety, access, comfort with method) with patients at an increased risk for suicide.

Psychache Predicts Suicide Attempter Status Change in Students Starting University.

Unlike many investigations that focus on suicide ideation rather than suicidal behavior, the present research evaluates the merit and relative efficacy of psychache (i.e., unbearable mental pain) for predicting self-reported suicide attempts among university students who are starting university. A sample of 516 elevated-risk undergraduates was assessed during the first three weeks of starting university and, again, 10weeks later. Psychache and depression, but not hopelessness, could predict change in suicide attempter status. When measures of psychache, depression, and hopelessness were considered simultaneously, only psychache provided significant, unique predictive power. Findings are interpreted as supporting Shneidman's model whereby psychache is seen as the cause of suicide.