Intimate Partner Relationships on Suicidal Thoughts and Behaviors

Within the ideation-to-action framework, existing theories of suicidal thoughts and behaviors (STBs) primarily focus on the linear progression of suicide risk. This, however, neglects growing evidence that many suicidal individuals do not experience their suicide attempt as a planned action, and in some instances deny even having experienced any suicidal thoughts. Furthermore, recent research has found that risk factors differ substantially between persons and that this is reflected in the variety of suicidal pathways. Considering the strong variability of STBs, new innovative theoretical concepts and assessment methods are needed to advance our understanding of multiple suicidal pathways. In this review, we apply a dual-system framework to suicidality, the Dual-System Model of Suicidality (DSMS), which accounts for two different systems of information processing and behavior. The first of these described is the reflective system, whereby STBs are viewed from a self-regulation perspective and thusly considered as maladaptive coping behavior to perceived discrepancies regarding important goals. Applying a feedback-based view such as this to STBs provides a deeper understanding into underlying psychological processes involved in the development of STBs. The second system described by the DSMS is the impulsive system. Here, STBs are seen as a maladaptive self-organizing pattern that gets activated in high-risk situations of acute stress, negative affect, and when resources of the reflective system are depleted. In this context, the DSMS is informed by a strength model of self-regulation, which assumes that self-regulation resources are limited, an aspect with important theoretical and clinical implications for the development of STBs. In order to demonstrate the theoretical and practical utility of the DSMS, this review draws mainly on studies using ecological momentary assessment (EMA), a technology that allows to investigate moment-to-moment changes in STBs, and is therefore well suited for capturing the complex interplay of self-regulatory and impulsive processes proposed by the DSMS. The application of a dual-system framework to suicide research represents an innovative and integrative approach for expanding our knowledge about fundamental processes and how their dynamics lead to STBs. The usefulness of the DSMS, implications for future suicide research with EMA, and clinical implications are discussed.

Recent theories have implicated inflammatory biology in the development of psychopathology and maladaptive behaviors in adolescence, including suicidal thoughts and behaviors (STB). Examining specific biological markers related to inflammation is thus warranted to better understand risk for STB in adolescents, for whom suicide is a leading cause of death. Participants were 211 adolescent females (ages 9-14 years; Mage = 11.8 years, SD = 1.8 years) at increased risk for STB. This study examined the prospective association between basal levels of inflammatory gene expression (average of 15 proinflammatory mRNA transcripts) and subsequent risk for suicidal ideation and suicidal behavior over a 12-month follow-up period. Controlling for past levels of STB, greater proinflammatory gene expression was associated with prospective risk for STB in these youth. Similar effects were observed for CD14 mRNA level, a marker of monocyte abundance within the blood sample. Sensitivity analyses controlling for other relevant covariates, including history of trauma, depressive symptoms, and STB prior to data collection, yielded similar patterns of results. Upregulated inflammatory signaling in the immune system is prospectively associated with STB among at-risk adolescent females, even after controlling for history of trauma, depressive symptoms, and STB prior to data collection. Additional research is needed to identify the sources of inflammatory up-regulation in adolescents (e.g., stress psychobiology, physiological development, microbial exposures) and strategies for mitigating such effects to reduce STB.

Suicidal thoughts and behaviors (STBs) are among the most common reasons for admission to psychiatric inpatient units and a large percentage of these patients also engage in substance misuse. Yet, no known studies have examined whether patients with STBs admitted to inpatient psychiatry units are motivated to change their substance misuse and, if so, whether they benefit from MET-CBT for substance misuse while on the inpatient unit. This study assesses the relationship between STB and motivation to improve substance misuse among 321 (61.1% male, Mage = 35.3 years, 59.8% non-Hispanic/Latin White) patients admitted to an inpatient psychiatric unit with a substance use disorder (SUD) or substance misuse who attended at least one group MET-CBT session, 50.2% of whom were admitted to an inpatient unit for STBs. Patients admitted for STBs reported greater motivation to reduce substance misuse than patients admitted without documented STB, and they did not differ from patients without documented STBs on the number of MET-CBT sessions attended, or ratings of session helpfulness (which were high). Patients admitted for STBs reported significantly increased motivation to change substance misuse after attending MET-CBT for SUD. These findings indicate that psychiatric inpatients with STBs report motivation to change substance misuse as well as willingness to attend MET-CBT for their SUD.

Despite very high rates of suicidal thoughts and behaviors (STB) in autistic adults, the key psychosocial drivers of this phenomenon remain unknown. To investigate, we examined how lifetime stressor exposure and severity, which have been found to predict STB in non-autistic populations, related to STB in a multinational dataset of 226 autistic adults from the United Kingdom and Australia (67% female; Mage = 41.8, SD = 13.6, range = 19–73 years old). Results revealed that autistic men and women differ with respect to the count, severity, and type of stressors they experienced over the life course. Whereas autistic men were exposed to more numerous legal/crime-related stressors, autistic women experienced more stressors related to social relationships and chronic humiliation and typically experienced stressors as more severe. In addition, whereas chronic interpersonal loss was related to STB for men, acute stressors involving physical danger and lower exposure to chronic entrapment were related to STB in autistic women. These findings indicate that certain lifetime stressors may be differentially experienced, and relevant to STB, in autistic men versus women. They also suggest that screening for lifetime stressor exposure may help identify autistic individuals at greatest risk of suicide.Lay abstractWhen we encounter life events that we experience as stressful (“stressors”), it sets off a biological stress response that can impact mental health and contribute to suicidal thoughts and behaviors (STB). Although we know about specific stressors that are associated with STB in the general population, little is known about the kinds of stressors that increase the risk of STB in autistic people and whether these associations differ by gender. To examine this issue, we cataloged the life stressors that autistic men and women experienced over the entire life course and investigated how these stressors were related to STB. Data were derived from a multinational sample of 226 autistic adults from the United Kingdom and Australia who completed the Stress and Adversity Inventory for Adults. We found that autistic men and women differed in terms of both the lifetime stressors they experienced as well as their perceived severity. Whereas men experienced more legal/crime-related stressors, women experienced more stressors related to relationships with other people and more long-lasting stressors associated with humiliation. Autistic women often perceived life stressors as more severe than men, which is important given that it is the perceived severity of stressors that most strongly affects our health. We also found that different stressors may predict STB in autistic men versus women. Whereas loss of loved ones was most strongly associated with STB for men, for women, physically dangerous stressors were most relevant. In addition, women with fewer lifetime stressors involving entrapment had higher lifetime STB. These results suggest that lifetime stressor exposure may be important to assess to understand suicide risk in autistic people. Additional research is needed to confirm these associations and to examine possible mechanisms linking stress and STB.

Momentary stress and social context among adolescents at risk for suicide: An experience sampling study.

There has been growing interest in preventive intervention "crossover" effects on suicidal thoughts and behaviors (STBs), in which targeting early risk factors may mitigate distal risk for STBs without STBs having been the targeted outcomes of the primary study. The present study extends an 11-study integrative data analysis of the Coping Power (CP) intervention (N = 3182) to assess indirect effects of different forms of CP on teacher- and parent-reported STBs as transmitted through different subdimensions of internalizing and externalizing problems. Compared to school-as-usual, all forms of CP (Standard/Group CP, Individual CP, CP with Mindfulness, Internet-Enhanced CP) led to reductions in parent- and/or teacher-reported youth STBs. Subgroup analyses suggested that boys benefitted from Individual CP and CP with Mindfulness mediated by reductions in aggressive behavior, whereas boys in Standard CP saw reductions in STBs mediated by reductions in conduct problems. Girls saw reductions in STBs in CP with Mindfulness mediated by reductions in anxiety. Some inferences made for individual and paths and mediation effects differed when using standard parametric approaches for inference versus bias-corrected percentile bootstrapping. These differences highlight cautions regarding statistical inference for prevention researchers who study highly skewed zero-inflated latent variables such as STBs. Findings are discussed in light of (a) earlier etiological research on biological sex-specificity in the pathways to early risk for suicide and (b) how variation in program components of CP and its adaptations may reduce STB risk across different populations, age groups, and modes of program delivery.

Understanding suicidal thoughts and behaviors in Black youth within the child welfare system: An exploration of protective factors.

Adolescent suicide and suicidal thoughts and behaviors (STB) are an escalating public health crisis, especially among Black adolescents. Parents play a central role in suicide prevention efforts and are primarily responsible for ensuring their child's safety after a suicidal crisis. However, their needs in caring for children with STB are often overlooked. Parental self-efficacy (PSE) is a parent's belief in their ability to effectively fulfill their parenting role and is a strong predictor of parenting competence and child well-being. PSE in adolescent suicide prevention (PSE-SP) will be explored in this study and is conceptualized as a parent's perceived ability to support their child in crisis, keep them safe, and prevent future suicidal behavior. There is limited research on how parent and adolescent characteristics influence PSE-SP. This paper describes the protocol for a mixed-methods study to understand the psychosocial factors associated with PSE-SP among parents of adolescents following an emergency department visit for suicidal behavior. Data will be collected through cross-sectional surveys, medical record data extraction, and qualitative interviews. Given the disproportionate increase in STB among Black adolescents and the paucity of research that seeks to understand the experience of Black parents in this context, this study will oversample parents who identify as Black/African American. Results will address a clinical research gap on how to best equip and support parents caring for children with STB, informing the development of culturally responsive parent-centered interventions for adolescent suicide prevention.

BackgroundThere are fewer studies on prospective predictors of first-time suicidal thoughts and behaviors (STB) among first-year university students and fewer studies prospectively identifying and screening for those at high risk of suicide among college students. This study assessed the impact of prospective baseline variables on the risk of new STB onset among first-year university students over two years and developed a multivariate risk prediction model.Methods4,560 first-year university students (38.4% males, mean age:18.34) from China participated and completed this prospective cohort study over a three-year period from 2018 to 2020. LASSO regression, and logistic regression models under resilient networks, were used for risk predictor variable screening and final prediction model building. Independent validation sets were used for external validation of the models. Independent validation sets were used for external validation of the models. Area Under the Curve (AUC), accuracy, F1 scores, and Hosmer-Lemeshow test metrics were used to evaluate the model performance.ResultsThe incidence rates of suicidal thoughts, suicidal behaviors, and STB within two years were 4.89%,1.03%, and 4.96%, respectively. Predictors in the final model included females, always solo activity, bigotry under pressure, socially oriented perfectionism, drinking to relieve stress, autonomy attitude, poorer parental marriage satisfaction, maternal emotional warmth, perceived others social support, and number of lifetime severe traumatic events. The predictive model had an AUC of 0.738 (95% CI: 0.697–0.780) for predictive accuracy in the training dataset as well as 0.710 (95% CI: 0.657–0.763) for predictive accuracy in the validation dataset, which represents a high degree of model discrimination.ConclusionBased on this predictive model of suicidal thoughts and behaviors, this study may help to assess and screen college students at risk for STB and develop suicide prevention strategies for at-risk populations.

Suicide stigma is a multifaceted social issue with far-reaching consequences for mental health. While previous research has linked it to suicidal thoughts and behaviors (STBs), the roles of perceived and internalized forms of suicide stigma in influencing STBs remain unclear. This study investigated the potential causal relationships between perceived and internalized suicide stigma, hopelessness, unbearable pain, and thwarted connectedness in relation to STBs among 546 Chinese college students (mean age = 20.92 years). Three-wave longitudinal data with a time gap of roughly 3 months were analyzed by using structural equation modeling. The results showed that the second-wave internalized stigma mediated the relationship between baseline perceived stigma and the third-wave unbearable pain, hopelessness, and thwarted connectedness, which are considered risk factors of STBs. Furthermore, the coexistence of unbearable pain and hopelessness, and the coexistence of unbearable pain and connectedness mediated the influences of perceived and internalized suicide stigma on STBs. These findings demonstrated that the temporal evolution of perceived and internalized suicide stigma contributes to risk factors predicting STBs.

Introduction: This meta-analysis examined the association between dimensional and categorical conceptualizations of attachment styles and suicidal thoughts and behaviors (STBs). Methods: Random-effects meta-analysis was conducted to examine the associations between categorical secure attachment, categorical insecure attachment, and insecure attachment dimensions and STBs. Methodological moderators were also explored. This protocol was registered in PROSPERO (CRD42020152604). Results: Systematic search for articles published by December 2020 returned 58 eligible studies and 159 cross-sectional effects. Secure attachment was inversely associated with suicidal thoughts and not associated with suicide attempts. All categorical insecure attachment styles were positively associated with suicidal thoughts. Only fearful and preoccupied attachment were associated with risk for suicide attempts. Dimensional attachment anxiety was more strongly associated with suicidal thoughts and attempts than dimensional attachment avoidance. Discussion: Overall, attachment styles characterized by high attachment anxiety were associated with greatest vulnerability to STBs. Longitudinal studies are needed to better understand the association between attachment insecurity and STBs.

Background: Suicidal thoughts and behaviors (STBs) are thought to be the result, at least in part, of abnormalities in various neural systems. Event-related potentials (ERPs) are a useful method for studying neural activity and can be leveraged to study neural deficits related to STBs; however, it is unknown how effective ERPs are at differentiating various STB groups. The present meta-analysis examined how well ERPs can differentiate (a) those with and without suicidal ideation, (b) those with and without suicide attempts, (c) those with different levels of suicide risk, and (d) differences between those with suicide attempts versus those with suicidal ideation only. Method: Our meta-analysis included 208 effect sizes from 2,517 participants from 27 studies. We used a random-effects meta-analysis using a restricted maximum likelihood estimator with robust variance estimation. Results: Our qualitative review found that for each ERP and STB combination, the literature is highly mixed. Our meta-analyses found a small-to-moderate relationship between ERPs and suicidal ideation, suicide attempt, suicide risk, and differences in ERPs between those with suicide attempts versus those with suicidal ideation only. We also found evidence that the literature may be suffering from small-sample bias and poor statistical power. Conclusions: Our results suggest that ERPs may complement other approaches, such as fMRI, in the study of the neurobiology of individuals with STBs. However, the current literature is severely underpowered to detect the effect sizes estimated in this meta-analysis. We recommend large-scale collaboration and improvements in measurement practices to combat the issues in this literature.

Substance addictions and suicidal thoughts and behaviors: Evidence from a multi-wave epidemiological study

Black adolescents in the United States have experienced an increase in suicidal thoughts and behaviors (STBs). Since Black adolescents are overrepresented in the youth punishment system, more research is needed to investigate correlates of STBs for this population. The purpose of this paper is to explore and establish correlates of individual, family, and community risk and protective factors and their relationship to lifetime STBs in a national sample of Black youth with arrest histories. Guided by an intersectional eco-behavioral lens, we investigated individual, family and contextual risk and protective factors for STBs among a national sample of justice-involved Black youth aged 12–17 with a history of arrest (n = 513). We used logistic regression models to test risk and protective factors for STBs. Among the sample, 9.78% endorsed suicidal ideation, and 7.17% endorsed a previous suicide attempt. Further, gender (female) and depression severity were risk factors for STBs, while positive parenting and religiosity were protective factors for STBs. School engagement was associated with lower levels of suicidal ideation. The findings suggest suicide prevention and intervention efforts should identify developmentally salient risk and protective factors to reduce mental health burden associated with STBs and concurrent alleged law-breaking activity of Black youth.

BackgroundHealthcare workers are a key occupational group at risk for suicidal thoughts and behaviors (STB). We investigated the prevalence and correlates of STB among hospital workers during the first wave of the Spain COVID‐19 outbreak (March–July 2020).MethodsData come from the baseline assessment of a cohort of Spanish hospital workers (n = 5450), recruited from 10 hospitals just after the height of the coronavirus disease 2019 (COVID‐19) outbreak (May 5–July 23, 2020). Web‐based self‐report surveys assessed 30‐day STB, individual characteristics, and potentially modifiable contextual factors related to hospital workers' work and financial situation.ResultsThirty‐day STB prevalence was estimated at 8.4% (4.9% passive ideation only, 3.5% active ideation with or without a plan or attempt). A total of n = 6 professionals attempted suicide in the past 30 days. In adjusted models, 30‐day STB remained significantly associated with pre‐pandemic lifetime mood (odds ratio [OR] = 2.92) and anxiety disorder (OR = 1.90). Significant modifiable factors included a perceived lack of coordination, communication, personnel, or supervision at work (population‐attributable risk proportion [PARP] = 50.5%), and financial stress (PARP = 44.1%).Conclusions and RelevanceThirty‐day STB among hospital workers during the first wave of the Spain COVID‐19 outbreak was high. Hospital preparedness for virus outbreaks should be increased, and strong governmental policy response is needed to increase financial security among hospital workers.