Understanding Of Suicidal Behavior Research Articles

Exploring risk factors and their differences on suicidal ideation and suicide attempts among depressed adolescents based on decision tree model

BackgroundSuicide has been recognized as a major global public health issue. Depressed adolescents are more prone to experiencing it. We explore risk factors and their differences on suicidal ideation and suicide attempts to further enhance our understanding of suicidal behavior. Methods2343 depressed adolescents aged 12–18 from 9 provinces/cities in China participated in this cross-sectional study. We utilized decision tree model, incorporating 32 factors encompassing participants' suicidal behavior. The feature importance of each factor was measured using Gini coefficients. ResultsThe decision tree model demonstrated a good fit with high accuracy (SI = 0.86, SA = 0.85 and F-Score (SI = 0.85, SA = 0.83). The predictive importance of each factor varied between groups with suicidal ideation and with suicide attempts. The most significant risk factor in both groups was depression (SI = 16.7 %, SA = 19.8 %). However, factors such as academic stress (SI = 7.2 %, SA = 1.6 %), hopelessness (SI = 9.1 %, SA = 5.0 %), and age (SI = 7.1 %, SA = 3.2 %) were more closely associated with suicidal ideation than suicide attempts. Factors related to the schooling status (SI = 3.5 %, SA = 10.1 %), total years of education (SI = 2.6 %, SA = 8.6 %), and loneliness (SI = 2.3 %, SA = 7.4 %) were relatively more important in the suicide attempt stage compared to suicidal ideation. LimitationsThe cross-sectional design limited the ability to capture changes in suicidal behavior among depressed adolescents over time. Possible bias may exist in the measurement of suicidal ideation. ConclusionThe relative importance of each risk factor for suicidal ideation and attempted suicide varies. These findings provide further empirical evidence for understanding suicide behavior. Targeted treatment measures should be taken for different stages of suicide in clinical interventions.

Interpersonal Psychological Theory of Suicide in Understanding Suicidal Behavior among Adolescents in Nepal

Suicidal behavior, a global public health issue, is one of the prevalent problems among adolescents in Nepal with highest rate of suicidal ideation and higher rates of suicidal attempt among the countries of South East Asia Region (SEAR). The Interpersonal psychological theory of suicide (IPTS) is a widely used and well-known theory that provides an interpersonal psychological framework which can contribute in understanding suicidal behavior. Although its application is found in international level, the lack of knowledge remains among Nepalese adolescents. Hence, this review is aimed to assess the applicability of IPTS in understanding suicidal behavior of adolescents in Nepal. A literature search was conducted using electronic databases (PubMed, Hinari, Nepjol, Research gate, and Google scholar). A scoping review of the articles published in peer-reviewed journals and grey literatures was done. We used the Preferred Reporting Items for Systematic Review and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR) in reporting the review and six-step process recommended by Arksey and O’Malley (2005) was adopted. Boolean operators (AND, OR, NOT) were used in search strategy which helped in combining key terms. The studies which assessed the relation between the constructs of IPTS i.e., thwarted belongingness, perceived burdensomeness and suicidal behavior among adolescents in Nepal were included, i.e., 14 studies which met the inclusion criteria.The findings revealed various risk factors which support the use of IPTS as those relate with the constructs of thwarted belongingness and perceived burdensomeness to explain suicidal behaviors among adolescents. Therefore, the findings indicated the use of the framework provided by IPTS in understanding suicidal behavior among Nepalese adolescents as well as highlighted the importance of interpersonal risk factors to prevent suicidal behavior.

Associations of impulsivity, hyperactivity, and inattention with nonsuicidal self-injury and suicidal behavior: longitudinal cohort study following children at risk for neurodevelopmental disorders into mid-adolescence

BackgroundThe knowledge of how the separate Attention-Deficit/Hyperactivity Disorder (ADHD) subdimensions (impulsivity, hyperactivity, and inattention) are associated with nonsuicidal self-injury (NSSI) and suicidal behavior (SB) is limited. The objective of this study was to investigate the associations of childhood ADHD subdimensions with NSSI and SB in children at risk of neurodevelopmental disorders (NDDs; including ADHD).MethodsThe sample (N = 391) included twin pairs where at least one twin screened positive for at least one NDD or common comorbidity at age 9 or 12. Data on ADHD subdimensions was collected through a telephone interview with a caregiver/legal guardian at age 9 or 12, and data on NSSI and SB was collected through an in-person clinical assessment at age 15. The associations between the ADHD subdimensions and NSSI or SB were tested in three different models: (1) univariable, (2) together with the other ADHD subdimensions, and (3) in a confounder-adjusted model including other NDD symptoms in addition to ADHD subdimensions, for NSSI and SB separately.ResultsA total of 32 (8.2%) adolescents reported life-time engagement of NSSI, and 18 (4.6%) SB. Childhood impulsivity was associated with SB and childhood inattention with NSSI, in all models. Hyperactivity was not meaningfully associated with any of the outcomes.ConclusionImpulsivity and inattention, but not hyperactivity, may be of particular importance in understanding SB and NSSI. Brief screening for impulsivity and inattention in childhood could facilitate detection of children vulnerable to NSSI and SB and indicate valuable information for preventive and intervention strategies.

Disability and suicidal behaviors among women of reproductive age.

Limited research exists on suicidal behaviors among women with disabilities. This study examined disability, suicidal behaviors, and associated health determinants among non-pregnant women of reproductive age. Data from the 2015-2019 National Survey on Drug Use and Health (n = 76,750) were used to estimate associations between disability and suicidal behaviors and evaluate the effects of health determinants on suicidal behaviors among non-pregnant women of reproductive age with disabilities. Approximately 22% of non-pregnant women of reproductive age with disabilities reported suicidal behaviors compared to only 4.3% of women without disabilities. Women with disabilities had greater adjusted odds of past-year suicidal behaviors (AOR 1.73; 95% CI 1.60-1.87) than those without disabilities. Psychological distress (OR 3.66; 95% CI 2.98-4.49), major depressive episode (OR 3.22; 95% CI 2.82-3.67), unmet perceived mental health need (OR 2.29; 95% CI 1.98-2.65), age 18-25years (OR 1.65; 95% CI 1.43-1.92), and illicit drug use (OR 1.40; 95% CI 1.20-1.64) were significantly associated with higher odds of suicidal behaviors, and specifically suicidal ideation, among women with disabilities. Non-pregnant women of reproductive age with disabilities are at increased risk for exhibiting suicidal behaviors. Better understanding of suicidal behaviors among women with disabilities can assist public health officials and medical professionals in developing meaningful prevention, detection, and intervention programs.

Attitudes towards suicidal behavior among nursing students

The existence of an association between negative attitudes from health professionals, such as prejudice, stigma and discrimination, can lead to difficulties in dealing with a person who has attempted suicide and, consequently, to a decrease in the quality of the care provided. In this context, this article aimed to verify attitudes related to suicidal behavior among nursing students at a private educational institution in the Federal District, Brazil. It was a quantitative, descriptive study that used two questionnaires: a sociodemographic and academic one, and another with questions addressing attitudes towards suicide, called Questionnaire on Attitudes Towards Suicidal Behavior. A total of 253 nursing students participated; in general, the data revealed that they did not have any negative attitude towards suicidal people. The main attitudes that brought some difficulty to students were related to: asking about suicidal behavior and inducing someone to go ahead with it; feeling helpless when faced with a person who thinks about killing themself; lack of professional preparation to deal with patients who have gone through this psychological suffering of attempting self-extermination; and the presence of a conservative and religious attitude towards suicide. Understanding the attitudes of students in the health field, especially nursing students, still in the training period, can bring about a change in the understanding of suicidal behavior, a prejudice-free nursing care, strengthen broad discussions around the topic, openly and without taboos, as well as provide a comprehensive and humanized care.

Catalytic Reaction Model of Suicide.

Suicide is a devastating outcome of unresolved issues that affect mental health, general wellbeing and socioeconomic stress. The biology of suicidal behavior is still poorly understood, although progress has been made. Suicidal behavior runs in families and genetic studies have provided initial glimpses into potential genes that contribute to suicide risk. Here, we attempt to unify the biology and behavioral dimensions into a model that can guide research in this area. The proposed model envisions suicidal behavior as a catalytic reaction that may result in suicide depending on the conditions, analogously to enzyme catalysis of chemical reactions. A wide array of substrates or reactants, such as hopelessness, depression, debilitating illnesses and diminished motivation can mobilize suicidal thoughts and behaviors (STBs), which can then catalyze the final step/act of suicide. Here, we focus on three biological substrates in particular: threat assessment, motivation to engage in life and impulsivity. Genetic risk factors can affect each of these processes and tilt the balance toward suicidal behavior when existential crises (real or perceived) emerge such as loss of a loved one, sudden changes in social status or serious health issues. Although suicide is a uniquely human behavior, many of the fundamental biological processes are evolutionarily conserved. Insights from animal models may help to shape our understanding of suicidal behavior in man. By examining counterparts of the major biological processes in other organisms, new ideas about the role of genetic risk factors may emerge along with possible therapeutic interventions or preventive measures.

Ethical Issues to Consider in Designing Suicide Prevention Studies: An Expert Consensus Study

Aim Research is imperative to advance our understanding of suicidal behavior and its prevention. Suicide prevention research involves various ethical issues, many of which are not straightforward to address. Hence, suicide prevention researchers sometimes face particular issues when designing their research studies. This expert consensus study aimed to identify the most important ethical issues to consider when designing suicide prevention studies. Methods People with lived experience of suicide (N = 32) and suicide prevention researchers (N = 34) rated 80 statements on a 5-point Likert scale from “essential” to “should not be included.” Results There was significant agreement between and within the two groups of participants with regard to the most highly rated statements. The most highly rated statements for both groups included the importance of the ethical principles of merit, integrity, justice, and beneficence. Additionally, lived experience participants placed emphasis on the support and care for researchers, and suicide prevention researchers placed emphasis on the risk management protocols and support services for participants. Conclusion There was strong agreement between people with lived experience of suicide and suicide prevention researchers regarding what to consider when designing ethically sound suicide prevention research, including the importance of ethical principles and support for both participants and researchers. HIGHLIGHTS There was strong agreement between people with lived experience of suicide and researchers. Researchers emphasized adherence to national guidelines. People with lived experience of suicide valued care for study participants and researchers.

Advancing Suicide Research

Advancing Suicide Research

Ethical concerns in suicide research: thematic analysis of the views of human research ethics committees in Australia

BackgroundSuicide research aims to contribute to a better understanding of suicidal behaviour and its prevention. However, there are many ethical challenges in this research field, for example, regarding consent and potential risks to participants. While studies to-date have focused on the perspective of the researchers, this study aimed to investigate the views and experiences of members of Human Research Ethics Committees (HRECs) in dealing with suicide-related study applications.MethodsThis qualitative study entailed a thematic analysis using an inductive approach. We conducted semi-structured interviews with a purposive sample (N = 15) of HREC Chairs or their delegates from Australian research-intensive universities. The interview guide included questions regarding the ethical concerns and challenges in suicide-related research raised by HREC members, how they dealt with those challenges and what advice they could give to researchers.ResultsThe analysis identified four main themes: (1) HREC members’ experiences of reviewing suicide-related study applications, (2) HREC members’ perceptions of suicide, suicide research, and study participants, (3) Complexity in HREC members’ decision-making processes, and (4) HREC members’ relationships with researchers.ConclusionsReliance on ethical guidelines and dialogue with researchers are crucial in the assessment of suicide-related study applications. Both researchers and HREC members may benefit from guidance and resources on how to conduct ethically sound suicide-related studies. Developing working relationships will be likely to help HRECs to facilitate high quality, ethical suicide-related research and researchers to conduct such research.

Study of risk factors for suicide attempts in patients with bipolar disorder

IntroductionBipolar disorder (BD) has the highest suicide attempt rate among psychiatric disorders. Many factors are associated with the risk of suicide attempt in BD, but the relation between them has still not been explicitly stated.ObjectivesThis study aimed to examine the clinical variables characterizing patients with BD with prior suicide attempt (PSA).MethodsThis was a descriptive and analytical study, conducted over 3 months, involving 31 euthymic patients with BD, followed up in the outpatient psychiatry department of Hedi Chaker University Hospital in Sfax (Tunisia). General, clinical and therapeutic data were collected using a pre-established questionnaire. Quality of life (QOL) was assessed with the «36 item Short-Form Health Survey» (SF-36). Impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11).ResultsThe mean age was 47.25 years and the sex ratio was 1.6. Family history of suicide attempts was found in 25% of cases. Mean score of SF36 was 34 and high degree of impulsivity was noted in 62.5% of cases. The frequency of BD patients with PSA was 12.3% (N=8), with two of these (25%) having more than one PSA. Comorbid alcohol abuse (p=0.000), somatic illness (p=0.013), high degree of impulsivity (p=0.032), and impaired quality of live (p=0.003) were significantly more frequent in BD patients with PSA.ConclusionsWe found several clinical variables associated with PSA in BD patients. Even though these retrospective findings did not address causality, they could be clinically relevant to better understanding suicidal behavior in BD and adopting proper strategies to prevent suicide in higher risk patients.

Alterations in gray matter volumes and intrinsic activity in the prefrontal cortex are associated with suicide attempts in patients with bipolar disorder

Bipolar disorder (BD) is associated with increased suicidal behavior. Understanding the neural features of suicide attempts (SA) in patients with BD is critical to preventing suicidal behavior. The prefrontal cortex (PFC) is a key region related to SA. In this study, forty BD patients with a history of SA (BD+SA), 70 BD patients without a history of SA (BD-SA), and 110 individuals in a healthy control (HC) group underwent structural magnetic resonance imaging (MRI) and resting-state functional MRI. We used voxel-based morphometry (VBM) and amplitude of low frequency fluctuations (ALFF) techniques to examine the gray matter volumes (GMVs) and ALFF values in the PFC. Compared with the HC group, both the BD+SA and BD-SA groups had lower GMVs and higher ALFF values in the medial PFC (MPFC), ventral PFC (VPFC), and dorsolateral PFC (DLPFC). The ALFF values in the MPFC, VPFC, and DLPFC in the BD+SA group were significantly higher than those in the BD-SA group. These findings suggest that BD patients with SA have intrinsic activity abnormalities in PFC regions. This provides potentially identifiable neuroimaging markers in BD patients with SA that could be used to increase our understanding of suicidal behavior.

Interpersonal theory of suicide: prospective examination.

The interpersonal theory of suicide (IPTS) is one of the most intensively researched contemporary theories on the development of suicidal ideation and behaviour. However, there is a lack of carefully conducted prospective studies. To evaluate the main predictions of the IPTS regarding the importance of perceived burdensomeness, thwarted belongingness and capability for suicide in predicting future suicide attempts in a prospective design. Psychiatric in-patients (n = 308; 53.6% (n = 165) female; mean age 36.82 years, s.d. = 14.30, range 18-81) admitted for severe suicidal ideation (n = 145, 47.1%) or a suicide attempt completed self-report measures of thwarted belongingness, perceived burdensomeness, capability for suicide, hopelessness, depression and suicidal ideation as well as interviews on suicide intent and suicide attempts and were followed up for 12 months. Logistic regression and receiver operating characteristics (ROC) analysis were conducted. The interaction of perceived burdensomeness, thwarted belongingness and capability for suicide was not predictive of future suicide attempts, but perceived burdensomeness showed a significant main effect (z = 3.49, P < 0.01; OR = 2.34, 95% CI 1.59-3.58) and moderate performance in screening for future suicide attempts (area under the curve AUC = 0.729, P < 0.01). 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 perceived burdensomeness in understanding suicidal ideation and behaviour.

Decomposing implicit associations about life and death improves our understanding of suicidal behavior.

The Death/Suicide Implicit Association Test (IAT) is effective at detecting and prospectively predicting suicidal thoughts and behaviors. However, traditional IAT scoring procedures used in all prior studies (i.e., D‐scores) provide an aggregate score that is inherently relative, obfuscating the separate associations (i.e., “Me = Death/Suicide,” “Me = Life”) that might be most relevant for understanding suicide‐related implicit cognition. Here, we decompose the D‐scores and validate a new analytic technique called the Decomposed D‐scores (“DD‐scores”) that creates separate scores for each category (“Me,” “Not Me”) in the IAT. Across large online volunteer samples (N > 12,000), results consistently showed that a weakened association between “Me = Life” is more strongly predictive of having a history of suicidal attempts than is a stronger association between “Me = Death/Suicide.” These findings replicated across three different versions of the IAT and were observed when calculated using both reaction times and error rates. However, among those who previously attempted suicide, a strengthened association between “Me = Death” is more strongly predictive of the recency of a suicide attempt. These results suggest that decomposing traditional IAT D‐scores can offer new insights into the mental associations that may underlie clinical phenomena and may help to improve the prediction, and ultimately the prevention, of these clinical outcomes.

Brain grey matter abnormalities in first episode non-affective psychosis patients with suicidal behaviours: The role of neurocognitive functioning

BackgroundSuicide is one of the leading causes of premature death in first-episode psychosis (FEP) patients. The understanding of suicidal behaviour (SB) is limited, and new and integrative approaches focusing on the likely relationship of the biological and cognitive features of SB in the early phases of psychosis are warranted. We aimed to study the relationship of brain grey matter anomalies and cognitive functioning with SB or suicidal risk in a large sample of non-affective FEP patients. MethodsWe used a voxel-based morphometry analysis in 145 FEP patients to investigate the pattern of structural brain abnormalities related to SB. In addition, bivariate and multivariate analyses were performed to explore the relationship between cognitive functioning and SB. ResultsA reduction in grey matter volume in the frontal area, temporal gyrus, precuneus, uncus, amygdala, left cuneus and subcallosal gyrus as well as a marked regional volume reduction in the right hemisphere was linked with the presence of SB. Additionally, worse global cognitive functioning and living in urban areas were identified as suicide risk factors. ConclusionsThis study provides some insights about the brain abnormalities associated with SB in FEP patients. Specifically, the areas reported are involved in important functions related to SB, such as impulsivity, problem solving or responses to pain. Thus, the results confirm the relevant role of cognitive functioning on SB.

El intento suicida en zonas rurales como un desafío a los modelos explicativos vigentes: discusión de una serie de casos

Introducción: Existen diversos modelos explicativos de suicidio que enfatizan factores de riesgo como la predisposición genética o la presencia de enfermedades de salud mental en la explicación etiológica de la intención suicida. El modelo de Grito de desesperanza/huida sería hasta el momento una versión que recoge de mejor manera las variables de la ruralidad. Se expone además un tercer modelo explicativo que se acerque al fenómeno de la intención suicida desde una visión integradora y comprensiva mediante el re-enmarque.&#x0D; Objetivo: Aplicar a una misma serie de casos de intención suicida de zonas rurales en Ecuador los aspectos relevantes de los distintos modelos de explicación del suicidio y discriminar las diferencias que cada modelo presenta a fin de desarrollar herramientas de salud mental que puedan ser aplicadas.&#x0D; Metodología: La investigación tuvo un primer componente cuantitativo descriptivo en el cual se aplicó un cuestionario a las historias clínicas que tuvieron diagnósticos médicos relacionados con intención suicida. Posteriormente se administró una entrevista semiestructurada a los participantes que accedieron a hacerlo. Finalmente se aplicó los diferentes modelos expuestos a la serie de casos.&#x0D; Resultados: El cuestionario se aplicó a un total de 35 historias clínicas de 35 personas (n=35). El 63% (n = 22) fueron del sexo femenino, con respecto a la composición etaria cerca del 60% (n = 21) eran menores de 18 años. Una tercera parte (n = 11) de los participantes correspondieron en el estado civil “No solteros”. Todas las personas que fueron atendidas tuvieron fácil acceso al uso de agroquímicos; en el 91% de los casos en estudio el detonante fue una discusión familiar con sus padres o sus cónyuges.&#x0D; Conclusiones: Se necesitan modelos de comprensión de la conducta o intención suicida que contengan las variables propias de las zonas rurales. Los modelos actuales permiten comprender la problemática de manera parcial y aún con los sesgos de la enfermedad mental como el factor más relevante. Lo cual no siempre será acertado en zonas rurales.

Genome-Wide DNA Methylation Patterns in Suicide Victims: Identification of New Candidate Genes.

Suicide is a major global public health problem with significant impact on society. According to the World Health Organization, every year about 800.000 people commit suicide, while at the global level suicide accounts for 50% of all violent deaths among men and for 71% among women. Suicide is a complex phenomenon which cannot be attributed to a single causal factor, but to a combination of simultaneous effects of multiple factors which are expressed in the form of psychological, biological and sociological indicators. Analysis of epigenetic mechanisms (methylation of the DNA, modifications of histone proteins and (networks of) miRNA), which link the interaction between genes and the environment, could importantly contribute to better understanding of suicidal behaviour. Recent studies on suicidal behaviour and DNA methylation show differences in DNA methylation pattern, with numerous sites among suicide victims. Using next generation sequencing, genome-wide studies helped identify novel candidate genes while studies of already known candidate genes (such as glucocorticoid receptor and BDNF) gave us better insight into the interplay of genetics and epigenetics. Epigenetic studies importantly contribute to elucidation of new biomarkers for suicidal behaviour. However, present studies are very different in design and often performed on very small samples, and these limitations could be overcome with more careful study preparation.

Text mining analysis of teachers' reports on student suicide in South Korea.

A teacher as a suicide prevention gatekeeper has an important role in identifying suicide risks and warning signs in students. After a student's suicide, teachers in Korea have to write a student suicide case report based on their direct and indirect observations. In particular, the section 'characteristic of student suicide' of this report contains valuable information about the suicide; however, it is unstructured, and thus cannot be analyzed using conventional statistical methods. We aimed to identify the characteristics of observed Korean students, who have committed suicide, using text mining techniques as well as to improve our understanding of suicidal behaviors in the school contexts. Therefore, a series of text mining techniques: topic analysis, word correlation, and word frequency analysis, in three problem categories: health, school, and family problems, were used to analyze the characteristics of student suicides. Topic analysis showed that only 30% of the student suicide case reports identified problematic student characteristics related to suicide. Correlations between words showed that words in one problem category were often correlated with words in other problem categories. Frequency word analysis showed that the three problem categories varied across gender and school levels. These results provide interesting insights into the characteristics of suicides among Korean students and important implications for suicide intervention in the education field.

Association of childhood trauma and genetic variability of CRH-BP and FKBP5 genes with suicidal behavior in bipolar patients

BackgroundAround 8% of bipolar disorder (BD) patients die by suicide every year, accounting for the highest rate among the psychiatric population. Suicidal behavior (SB) is mediated by an intertwining system of extrinsic and intrinsic factors. Childhood trauma (CT) and gene variants of the stress-management hypothalamic-pituitary-adrenal (HPA) axis have been reported as risk factors for SB. The aim of this study was to elucidate the association of CT and HPA axis genetic variants with SB. Methods135 BD patients were recruited for clinical assessment of CT and SB by means of the Childhood Trauma Questionnaire (CTQ) and the Columbia Suicide Severity Rating Scale (C-SSRS), respectively. A total of 28 single nucleotide polymorphisms (SNPs) from 8 HPA axis genes (POMC, NR3C2, CRH-BP, NR3C1, FKBP5, CRHR2, CRHR1, and MC2R) were genotyped. ResultsThe analyses showed an association of total CTQ score (p = 0.003), emotional abuse (p = 0.001), sexual abuse (p = 0.005) and emotional neglect (p = 0.005) with SB. CRH-BP rs7728378-C carriers (p = 0.004; OR = 3.05), FKBP5 rs3777747-AA (p = 0.039; OR = 0.34) and FKBP5 rs2766533-GG genotypes (p = 0.001; OR = 2.93) were associated with SB although only rs2766533 survived multiple test correction. No gene-environment interaction was found. LimitationsThe relatively small sample size limits the statistical power to detect smaller environmental and genetic effects. Cross-sectional data collection in psychometric assessments can yield biased data. ConclusionsThe present study characterizes novel SB risk factors and replicates previous findings in BD patients. CT and variability in CRH-BP and FKBP5 genes should be further studied for a better understanding of SB and ultimately help in suicide prevention.

Suicidal Imagery in Borderline Personality Disorder and Major Depressive Disorder

A better understanding of suicidal behavior is important to detect suicidality in at-risk populations such as patients with borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD). Suicidal tendencies are clinically assessed by verbal thoughts rather than by specifically asking about mental images. This study examines whether imagery and verbal thoughts about suicide occur and differ between patients with BPD with and without comorbid PTSD compared to patients with MDD (clinical controls). All patient groups experienced suicide-related images. Patients with BPD with comorbid PTSD reported significantly more vivid images than patients with MDD. Severity of suicidal ideation, number of previous suicide attempts, and childhood traumata were significantly associated with suicidal imagery across all patient groups. The authors demonstrate for the first time that suicide-related mental imagery occurs in BPD and is associated with suicidal ideation. This finding highlights the importance of assessing mental imagery related to suicide in clinical practice.

The necessity, validity, and clinical utility of a new diagnostic entity: Acute suicidal affective disturbance.

Here we argue for the necessity, validity, and clinical utility of a new diagnostic entity, acute suicidal affective disturbance (ASAD). We expand on the conceptual, clinical, and practical rationale for ASAD, propose its defining features, describe research results to date, and suggest avenues for future research. There is accruing evidence for the existence of a previously unclassified, rapid-onset mood disturbance that geometrically escalates and regularly results in life-threatening behavior. ASAD research may not only improve the field's understanding of suicidal behavior but also enhance clinical effectiveness and save lives.