A study of self-injurious and suicidal behavior in a veteran population.

This patient safety improvement study was conducted (1) to establish a database of intentional patient self-injuries and suicidal behavior among veterans in a large urban VA health care system, and (2) to investigate whether there were demographic and/or clinical characteristics of veterans who self-injure that might predict seriousness of suicidal intent and aid in future efforts at prevention. A total of 175 clinician-administered, post self-injury interviews were completed between 2006 and 2008 in a VA health care system in the Northeast. Findings suggest that self-injuries with high suicidal intent were characterized by male gender, older age, planning of self-injury, no wish to be saved, and a negative feeling about having survived. Additional results indicated that staff ratings of patient intent to die were significantly lower than patient self-rated intent to die, a finding that gives rise to questions of whether staff may tend to underestimate patient suicidal intent. Also, although more than 80% of the veterans in this sample considered their self-injurious actions impulsive, planning of self-injury was significantly associated with higher intent to die. Veterans who completed suicide during the study time period were significantly more likely than those who had nonfatal self-injuries to have experienced combat. The implications of these findings are discussed, including whether combat exposure may lead to an acquired capacity for lethal behaviors such as suicide (Joiner, 2005). (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Rigid thinking in suicidal individuals.

The folklore hypothesis that suicidal individuals think in a rigid manner was evaluated by the California F Scale and the Rokeach Map Test. They were administered to a suicidal attempt group, a group of psychosomatic patients, and to hospitalized normal Ss. It was found that the suicidal group earned significantly higher California F Scale scores (p     

Youth-Nominated Support Team for suicidal adolescents (Version 1): A randomized controlled trial.

In this study, the authors investigated the efficacy of the Youth-Nominated Support Team-Version 1 (YST-1), a psychoeducational social network intervention, with 289 suicidal, psychiatrically hospitalized adolescents (197 girls, 92 boys). Adolescents were randomly assigned to treatment-as-usual plus YST-1 or treatment-as-usual only. Assessments were completed pre- and postintervention (6 months). There were no main effects for YST-1 on suicide ideation or attempts, internalizing symptoms, or related functional impairment. Relative to other girls, however, those who received YST-1 reported greater decreases in self-reported suicidal ideation (actually treated analytic strategy) and significantly greater decreases in mood-related functional impairment reported by their parents (intent to treat and actually treated analytic strategies). This is the first randomized controlled clinical trial to investigate the efficacy of a social network intervention with suicidal youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lifetime suicidal ideation and suicide attempts in Asian Americans.

Few studies have examined the role of culturally relevant factors in suicidal behavior among Asian Americans. Using the National Latino and Asian American Study (NLAAS) (Alegria et al., 2004; Heeringa et al., 2004), the current study examined the role of culturally related variables (family conflict, perceived discrimination, and ethnic identity) on suicidal ideation and suicide attempts in a nationally representative sample of 2,095 Asian Americans. Important covariates were sociodemographic characteristics (gender, age, marital status, years of education, household poverty, and nativity status), depressive and anxiety disorders, and number of chronic conditions. Gender related correlates were also explored. The lifetime prevalence of suicidal ideation and attempts was 8.8% and 2.5%, respectively. Female gender, family conflict, perceived discrimination, and the presence of lifetime depressive or anxiety disorders were positively correlated with suicidal ideation and attempts. A high level of identification with one’s ethnic group was associated with lower rates of suicide attempts. Among Asian men, but not women, the presence of chronic medical conditions was associated with suicidal ideation. Findings highlight the contributions to suicide risk of cultural factors and gender differences in Asian Americans. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

New data on the nature of suicidal crises in college students: Shifting the paradigm.

This article presents new data on the nature of suicidal crises in college students. Data were collected from over 26,000 undergraduate and graduate students at 70 colleges and universities. An anonymous Web-based survey was designed to provide insight into the full spectrum of suicidal thought, intent, and action among college students. The authors discuss implications of these data and outline a new, problem-focused paradigm for conceptualizing the problem of college student suicidality and for guiding institutional policies and interventions at multiple points along the continuum of suicidal thoughts and behaviors. The proposed paradigm encompasses and expands on the current model of treating individuals in crisis in order to act preventively to reduce both prevalence and incidence of all forms of suicidality among college students. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of dread in suicidal behavior.

The proposition that inhibition of the experience of dread ordinarily evoked by suicidal intention is a necessary condition for suicidal action was evaluated by comparison of genuine and faked suicide notes. 3 judges, unaware that some notes were simulated, independently rated 33 matched pairs of genuine and faked notes in terms of 5 variables. On the basis of a combined X2 analysis, confirmation was achieved for 4 of 5 hypotheses (p     

Differentiating suicidal motivations and manifestations in a forensic sample.

This research investigated the potential multidimensional associations among suicide criteria (i.e., previous attempt, suicide intent, suicidal desire, suicide preparation) and empirically relevant, psychological variables (i.e., depression, hopelessness, internal perturbation-based reasons, extrapunitive/manipulative motivations). Further, the relative statistical importance of the psychological variables was also evaluated. For a sample of 235 male prison inmate volunteers (mean age 31.9 yrs), 3 key findings emerged. First, internal perturbation-based reasons for attempting suicide statistically predicted each suicide criterion. Second, these reasons often outperformed hopelessness in statistically predicting suicide criteria. Third, associations among suicide criteria and psychological variables were multidimensional, not unidimensional. In particular, independent dimensions of Negative Cognitions and Action Orientation emerged and replicated previous findings. Implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A practical, evidence-based approach for means-restriction counseling with suicidal patients.

Assessing a patient's access to potentially lethal means for suicide and taking steps to restrict access to means are common expectations for reasonable outpatient management of suicidal patients. Although scientific evidence supports means restriction as a suicide prevention strategy, means restriction continues to be infrequently utilized by clinicians, in large part because of the general lack of available training and guidance. The present article reviews the conceptual basis and empirical evidence for means restriction, discusses common barriers to means-restriction counseling, and provides practical procedures and tools (e.g., the means receipt, the crisis support plan) for accomplishing means-restriction counseling in routine clinical practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychopathy and suicide: A multisample investigation.

Evidence suggests that behavioral aspects of psychopathy are associated with suicidal behavior, whereas the affective and interpersonal aspects are not. The authors tested the robustness of this bifurcated association across 1,711 persons and 12 samples of adult and juvenile criminal offenders, forensic psychiatric patients, and civil psychiatric patients. The authors observed a small but significant partial correlation (.13) between the behavioral/impulsive lifestyle features of psychopathy and suicidality, but no effect for affective/interpersonal features. Several method and sample features (mental disorder; psychopathy and suicidality measurement format) significantly strengthened or weakened this association. The authors conclude that it is not possible to speak of "the" association between psychopathy and suicide, but that this relationship appears to be partially dependent on methodological (i.e., self-report vs. clinician-administered psychopathy measures) and sample composition (i.e., age; mental illness) factors. Recommendations for practice are provided, including that clinicians should not consider psychopathy a buffer against suicidal behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age, suicide, science, and clinical psychology: A review of A. Leenaars (Ed.), Life span perspectives of suicide.

Reviews the book, Life span perspectives of suicide edited by A. Leenaars (see record 1991-97542-000). There is an ever-growing literature on suicide, much of which seems redundant. Accordingly, I look for novel data and true theoretical progress in the context of modern science. This volume promises a unique focus on developmental variations in suicidal behaviour, which should be quite timely. The editor and author of several chapters, Antoon Leenaars, is a highly respected activist in suicide prevention. Among the 20 chapters with 21 authors, the quality varies from enlightening to very disappointing. While this volume has some very strong chapters that meet scientific criteria while providing fresh insights and stimulus for research, some of the chapters unfortunately leave me with serious scientific concerns. I would like to see integration of new data with modern science, rather than conjecture through outdated hypothetical constructs. In particular, much of the chapter on suicide in middle adulthood by Balance and Leenaars reads like a list of Freud's concepts, as if there had been no progress in the psychology of middle adulthood during the last half century. Another concern is that clinical and scientific judgements sometimes become confused in this volume, as is often true of suicide research. Leenaars approaches suicide evaluatively, repeatedly stating that it is tragic and to be eradicated. However noble, when matters of fact are under discussion, this violates the longstanding scientific tradition of objectivity. Finally, none of the authors has made any reference whatsoever to biological theories of aging and senescence, when so much insight could be gained. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suicidal desire and the capability for suicide: Tests of the interpersonal-psychological theory of suicidal behavior among adults.

The interpersonal-psychological theory of suicidal behavior (T. E. Joiner, 2005) proposes that an individual will not die by suicide unless he or she has both the desire to die by suicide and the ability to do so. Three studies test the theory's hypotheses. In Study 1, the interaction of thwarted belongingness and perceived burdensomeness predicted current suicidal ideation. In Study 2, greater levels of acquired capability were found among individuals with greater numbers of past attempts. Results also indicated that painful and provocative experiences significantly predicted acquired capability scores. In Study 3, the interaction of acquired capability and perceived burdensomeness predicted clinician-rated risk for suicidal behavior. Implications for the etiology, assessment, and treatment of suicidal behavior are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Thorough informed consent: A developing clinical intervention with suicidal clients.

In this article, I provide commentary on the Rudd et al. (2009) article advocating thorough informed consent with suicidal clients. I examine the Rudd et al. recommendations in light of their previous empirical-research and clinical-practice articles on suicidality, and from the perspective of clinical practice with suicidal clients in university counseling center settings. I conclude that thorough informed consent is a clinical intervention that is still in preliminary stages of development, necessitating empirical research and clinical training before actual implementation as an ethical clinical intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family Intervention for Suicide Prevention: A specialized emergency department intervention for suicidal youths.

Suicide attempts and suicidal ideation are common problems among youths seen in clinical practice. Despite the high risk of repeated suicidal behavior in these patients, clinicians are faced with a lack of empirically supported treatments for these youths. This article describes the Family Intervention for Suicide Prevention (FISP), a second-generation adaptation of the Specialized Emergency Room Intervention, an evidence-based practice. Although designed for use in emergency settings, the FISP can be used by practitioners working in a wide range of settings where youths present with suicidal emergencies. Rooted in cognitive–behavioral and family systems theory, the FISP is designed to mobilize family support and problem solving, reframe the suicide attempt as a critical event that requires treatment, reinforce more adaptive coping, motivate patients and families to initiate and adhere to follow-up treatment, and promote linkage to follow-up care. This approach can be used with a wide range of patients and offers an evidence-informed tool for practicing clinicians. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Help-seeking tendencies in Asian Americans with suicidal ideation and attempts.

Among rising concerns surrounding heightened suicide in certain subgroups of Asian Americans, it is important to understand the help-seeking rates and pathways among Asian Americans experiencing suicidality. This study examined perceived need for care, help-seeking behavior, and chosen sources of care among Asian Americans compared with Latinos in the National Latino and Asian American Study who reported a history of lifetime suicidal ideation, suicide attempts, or mental disorders without history of suicide. Consistent with existing literature in Caucasians, suicide attempts in Asian Americans and Latinos were related to greater help seeking and perceived need beyond that of mental disorders only. However, Asian Americans with suicide attempts still reported lower perceived need and help-seeking behaviors compared with Latinos. In contrast to both the existing literature and Latinos in this study, Asian Americans with suicidal ideation were no more likely to perceive a need for help or seek help than Asian Americans with a mental disorder without history of suicide and were less likely to seek and perceive a need for help than Latinos with suicidal ideation. These findings point to the idea that Asian Americans who have serious suicidal ideation or attempts may underestimate the importance of their condition and do not receive the level of attention and support needed. Findings also show that Asian Americans with suicidal ideation and attempts prefer seeking help from nonprofessional rather than professional sources of help, other than medical professionals. Clinical implications for outreach, assessment, and management of suicide are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Risk for suicidal ideation in the U.S. Air Force: An ecological perspective.

Objective: Suicidal members of the U.S. military often fail to disclose their suicidal urges and behaviors. Military suicide prevention efforts may therefore be enhanced if they also target less stigmatized psychosocial factors that may decrease risk of suicidality. In keeping with Bronfenbrenner's (1977, 1994) model, this study simultaneously examined 4 ecological levels (i.e., individual, family, workplace, and community) of factors variously associated with increased or decreased risk for suicidal ideation. Method: Active-duty U.S. Air Force members (N = 52,780; 79.3% male; 79.2% non-Hispanic White; mean age = 31.78 years, SD = 7.38) completed the 2006 Community Assessment survey (a biennial, anonymous survey conducted at 82 U.S. Air Force bases worldwide), including the Centers for Disease Control and Prevention's (2008) 5-item measure of past-year suicidality along with scales assessing an array of potential predictors. Results: The 1-year rate of suicidal ideation, defined as (a) more than rarely thinking about suicide or (b) ever seriously considering suicide, was approximately 4%. In multivariate models, for men and women, individual- (depressive symptoms and alcohol problems), family- (relationship satisfaction and intimate partner victimization), workplace- (hours worked), and community-level (social support) variables were retained in the final model. However, some sex differences in retained predictors were noted (e.g., men: dissatisfaction with the U.S. Air Force way of life; women: workplace relationship satisfaction and financial stressors). Conclusions: Addressing depressive symptoms and alcohol use, facilitating healthy relationship functioning, and increasing job satisfaction and social support may aid military suicide prevention efforts. These findings illustrate the importance of attending to multiple levels of potential influence when designing integrated suicide prevention and intervention programs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Treating co-occurring Axis I disorders in recurrently suicidal women with borderline personality disorder: A 2-year randomized trial of dialectical behavior therapy versus community treatment by experts.

This study evaluated whether dialectical behavior therapy (DBT) was more efficacious than treatment by nonbehavioral psychotherapy experts in reducing co-occurring Axis I disorders among suicidal individuals with borderline personality disorder (BPD). Women with BPD and recent and repeated suicidal and/or self-injurious behavior (n = 101) were randomly assigned to 1 year of DBT or community treatment by experts (CTBE), plus 1 year of follow-up assessment. For substance dependence disorders (SDD), DBT patients were more likely to achieve full remission, spent more time in partial remission, spent less time meeting full criteria, and reported more drug- and alcohol-abstinent days than did CTBE patients. These findings suggest that improvements in co-occurring SDD among suicidal BPD patients are specific to DBT and cannot be attributed to general factors associated with nonbehavioral expert psychotherapy. Further, group differences in SDD remission were not explained by either psychotropic medication usage or changes in BPD criterion behaviors. DBT and CTBE did not significantly differ in the reduction of anxiety disorders, eating disorders, or major depressive disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Revealing the form and function of self-injurious thoughts and behaviors: A real-time ecological assessment study among adolescents and young adults.

Self-injurious behaviors are among the leading causes of death worldwide. However, the basic nature of self-injurious thoughts and behaviors (SITBs) is not well understood because prior studies have relied on long-term, retrospective, aggregate, self-report assessment methods. The authors used ecological momentary assessment methods to measure suicidal and nonsuicidal SITBs as they naturally occur in real time. Participants were 30 adolescents and young adults with a recent history of self-injury who completed signal- and event-contingent assessments on handheld computers over a 14-day period, resulting in the collection of data on 1,262 thought and behavior episodes. Participants reported an average of 5.0 thoughts of nonsuicidal self-injury (NSSI) per week, most often of moderate intensity and short duration (1–30 min), and 1.6 episodes of NSSI per week. Suicidal thoughts occurred less frequently (1.1 per week), were of longer duration, and led to self-injurious behavior (i.e., suicide attempts) less often. Details are reported about the contexts in which SITBs most often occur (e.g., what participants were doing, who they were with, and what they were feeling before and after each episode). This study provides a first glimpse of how SITBs are experienced in everyday life and has significant implications for scientific and clinical work on self-injurious behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk and protective factors for suicidal behavior in abused African American women.

This study examined risk and protective factors that differentiate low-income, abused African American women (N=200) who attempted suicide from those who had never made a suicide attempt. Results from multivariate analyses revealed that numerous and/or severe negative life events, a history of child maltreatment, high levels of psychological distress and depression, hopelessness about the future, and alcohol and drug problems were factors associated with attempter status. Protective factors associated with nonattempter status included hopefulness, self-efficacy, coping skills, social support, and effectiveness in obtaining material resources. Culturally competent intervention approaches for abused women should target increasing their protective factors and reducing their risk factors to decrease the likelihood that these women engage in suicidal behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negativity in problematic and nonproblematic families: A multigroup social relations model analysis with structured means.

The aim of the study was to determine whether there are differences in patterns of negativity between families with and without an adolescent with externalizing problem behavior. We used a structured means Social Relations Model in order to examine negativity in multiple levels of the family system. The sample consisted of 120 problematic and 153 nonproblematic families (two parents, two children), who rated the level of negativity in the relationship with each family member. Although a simple mean differences test would lead us to believe that differences in negativity between groups of families can be ascribed to the interaction between parent and adolescent, the results of the present study indicate that these differences are actually related to the characteristics of a problematic child. (PsycINFO Database Record (c) 2011 APA, all rights reserved)