ARCHIVES OF SUICIDE RESEARCH

Sexual Fluidity and Suicidal Thoughts and Behaviors in Early and Middle Adulthood: Evidence From the National Longitudinal Study of Adolescent to Adult Health
Gunn JF, Brown Z and Ambron J
The present study seeks to explore the relationship between sexual fluidity and suicidal thoughts (STs) and behaviors (STBs) among adults in early and middle adulthood.
It's Risky Out Where We Are: Exploring Intersectional Factors of Intentional Overdose Among People Who Use Drugs in Regional Queensland, Australia
Piatkowski T, de Andrade D, Kill E, Hawgood J and Kõlves K
Globally, drug-related deaths impact both urban and non-urban areas. In Australia, regional areas face a concerning rise in drug-induced fatalities and suicides, exacerbated by structural factors like limited services and stigma. We sought to explore the experiences of people who use drugs (PWUDs) in regional Queensland to understand the structural vulnerabilities influencing drug-induced deaths.
Machine Learning Prediction of Self-Injurious Outcomes in Adolescents by Sexual and Gender Identity
Kako N, Pinder JB, Powers JP and Fox K
Sexual and gender minority adolescents face elevated rates of self-injurious thoughts and behaviors (SITBs) relative to peers, yet fewer studies have examined risk in these youth, and reasons for higher risk remain unclear. Modeling SITBs using traditional statistical models has proven challenging. More complex machine learning approaches may offer better performance and insights. We explored and compared multiple machine learning models of suicide ideation, suicide attempts, and non-suicidal self-injury-both past-year frequency and dichotomous lifetime occurrence-among adolescents of diverse gender identities and sexual orientations.
Suicide Patterns in Northern Pakistan: A 10-Year Analysis of Police Records from Three Districts of Gilgit-Baltistan
Yousafzai AW, Aziz M, Yousuf S, Bano S and Khan MM
Police records are an important resource in absence of a national suicide database in the context of Pakistan. We studied suicides reported across three districts of Gilgit-Baltistan (GB); causes, patterns of suicidal behaviors, and classification processes.
Designing Social Media Messages to Promote Action by Suicide Gatekeepers
Cox MM and Leshner G
Suicide prevention professionals and programs have focused on reaching not only individuals with suicide ideation, but also family, friends, and other acquaintances, referred to as suicide gatekeepers. Social media provide platforms that allow health communicators to reach a large population. This research focuses on examining and testing the most effective message framing (how the message provides a reward or consequence for the receiver) and message construct (precise focus and wording of a message) for social media posts intended to positively influence suicide gatekeeper intervention behavior on behalf of a friend or peer.
Sexuality-Based Stigma, Other Painful and Provocative Events, and Suicide Attempt Among Cisgender Sexually Minoritized Men in the United States
Wiginton JM, Baral SD, Sanchez TH, Wilcox HC and Murray SM
Guided by Minority Stress and Interpersonal and Ideation-to-Action Theories of Suicide, we sought to identify latent classes of painful and provocative events (PPEs), determine associations with class membership, and assess class-specific suicide attempt prevalence among cisgender sexually minoritized men (SMM) with suicidal ideation in the United States.
Examining Suicide Crisis Syndrome as an Indirect Indicator of Suicide Risk in the Military Suicide Research Consortium's Common Data Elements
Rogers ML, Richards JA, Peterkin D and Galynker I
The Suicide Crisis Syndrome (SCS) has accumulated support as an indicator of suicide risk in patient settings; however, it has not been evaluated in military/veteran populations. The present study tested the factorial structure, measurement invariance, latent mean differences, and incremental validity of a SCS proxy variable developed from the Military Suicide Research Consortium's (MSRC) Common Data Elements (CDE).
Longitudinal Differences in Mental Health Outcomes Among Latent Classes of Expanded Suicidality Dimensions
Nam S, Kim J, Jeong J, Park H and Song J
This study utilized latent class analysis to identify latent groups of individuals, reflecting the expanded dimensions of suicidality, which encompass not only one's own suicidality but also that of significant others. Drawing on data from Wave 3 and Wave 5 of the National Longitudinal Study of Adolescent to Adult Health, the analysis included 3215 individuals. The LCA revealed three distinct latent classes: the Exposed, the Suicidal, and the Non-Suicidal and Unexposed. Subsequent analysis using the Kruskal-Wallis test found significant longitudinal differences in mental health outcomes, including depression and suicidality, among these three latent classes over a 15-year period. Specifically, the Suicidal Class scored significantly higher than the Exposed Class and the Non-Suicidal and Unexposed Class for both depression and suicidality. Additionally, the Exposed Class scored significantly higher than the Non-Suicidal and Unexposed Class. These findings have implications for mental health researchers and practitioners, including the implementation of preventive and postventive interventions in the early stages, as well as the engagement of individual, family, and community partnerships in these interventions.
Risk Factors for Suicide in Pakistan: A Mixed Methods Study of Psychological Autopsies and Perspectives of Health Professionals
Ali SA, Saleem T and Arafat SMY
Suicide is a significant but understudied public health concern in developing nations like Pakistan, where risks factors have not been investigated by mixed methods studies. Hence, we aimed to explore the risk factors for suicide based on a mixed methodology.
Firearm Availability Reduces the Stability of Suicidal Ideation: Results from an Ecological Momentary Assessment Study
Bryan CJ, Tabares JV, Butner JE, Daruwala SE, Bozzay ML and Gorka SM
Firearm availability is correlated with increased risk of suicide but its link with suicidal ideation remains unclear. Previous studies are limited by retrospective reports and prospective designs with lengthy gaps between assessments that are ill-suited for measuring fluctuations in suicidal ideation. This study used ecological momentary assessment (EMA) to repeatedly assess suicidal ideation in a sample of 138 U.S. adults (81 handgun owners, 57 non-owners). Participants received six EMA prompts per day for 28 consecutive days. Results revealed no group differences in the frequency, maximum amplitude, or variability of suicidal ideation across male and female handgun owners and non-owners. Stability of suicidal ideation significantly differed across groups, however ((1,132) = 4.5,  = 0.036); male handgun owners had the strongest stability and male non-owners had the weakest stability. Stability of suicidal ideation was significantly lower when participants reported a firearm was nearby as compared to when no firearm was nearby ((4,17732) = 5.6,  < 0.001). Results suggest firearm availability increases reactivity to the environment, slows recovery from acutely elevated risk states, and may increase vulnerability to sudden shifts to higher risk states characterized by increased probability of suicidal behavior. Although these effects were observed in both handgun owners and non-owners, they disproportionately impact handgun owners because they report being near firearms more often.
Barriers to Youth Disclosing Self-Injurious Thoughts and Behaviors: A Focus on the Therapeutic Context
Mirichlis S, Burke TA, Bettis AH, Dayer K and Fox KR
Disclosure of self-injurious thoughts and behaviors (SITBs) can serve as a catalyst to receiving mental health and lifesaving care; yet, many young people do not disclose these experiences to their therapists. In this study we aimed to identify barriers to adolescents disclosing their SITBs to their therapists and to compare these barriers across non-disclosure of suicidal ideation, suicidal behavior, and non-suicidal self-injury.
Black and White Demographic Patterns of Gun Ownership and Suicide, 2021
Hemenway D, Azrael D, Barber C, Fischer S and Miller M
We use 2021 data to compare the demographic patterns of adult White and Black gun ownership with their respective race-specific rates of firearm, non-firearm and total suicide, and the percentage of suicides using firearms.
Outcomes of Universal Suicide Risk Screening in Medical Inpatients
MacKrell K and Nestadt PS
Universal screening for suicide risk has not been shown to reduce suicide rates or reliably predict suicide, but there have been few studies assessing other potential benefits of this practice. We aimed to investigate the feasibility of implementing a universal inpatient suicide risk screening protocol and determine if a positive suicide screen was predictive of the need for psychiatric admission, and if it reduced the length of stay prior to psychiatric admission.
Bullying Victimization and Self-Harm Among Adolescents from Diverse Inner-City Schools: Variation by Bullying Sub-Types and the Role of Sex
Wilson-Lemoine E, Hirsch C, Knowles G, Smith S, Blakey R, Davis S, Chamberlain K, Stanyon D, Ofori A, Turner A, Putzgruber E, Crudgington H, , Dutta R, Pinfold V, Reininghaus U, Harding S, Gayer-Anderson C and Morgan C
Bullying has consistently been highlighted as a risk factor for youth self-harm. Less is known about associations by bullying sub-type (i.e., physical, verbal, relational, cyberbullying), among boys and girls in diverse urban populations. This study aimed to explore: (1) prevalence of bullying and lifetime self-harm; (2) cross-sectional associations between bullying and self-harm. Both aims investigated bullying sub-types and the role of sex.
Depression, Anxiety, and Stress Mediate the Relationship Between Poor Sleep Quality and Suicidal Ideation Among Young Chinese Men
Zhang H, Zhang L, Zhang H and Guo H
Poor sleep quality exacerbates suicidal ideation. Depression, anxiety, and stress may play important roles in this relationship. However, the underlying mechanisms remain unknown.
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Perinatal Factors and Their Association with Early-Adulthood Suicidal Behavior in a Brazilian Birth Cohort
Eccles H, Kingsbury M, Murray J, Geoffroy MC, Menezes AMB, Blair DL, Calegaro G, Wehrmeister FC, Gonçalves H and Colman I
The objectives of this study were to investigate the relationship between perinatal risk factors and suicidal ideation and attempts in young adults in Pelotas, Brazil.
A Qualitative Assessment of Reasons for Living and Dying in the Context of Feeling Trapped Among Adults in the United Kingdom
Matheson L, Rasmussen S, Moxie J and Cramer RJ
Contemporary approaches to suicide assessment and treatment incorporate reasons for living (RFL) and reasons for dying (RFD). This study qualitatively explored individuals' self-described RFL and RFD in the context of suicidal thinking and behaviors.
Financial Stress Amongst People Who Self-Harm in Sri Lanka
Nyakutsikwa B, Taylor PJ, Hawton K, Poole R, Weerasinghe M, Dissanayake K, Rajapakshe S, Hashini P, Eddleston M, Konradsen F, Huxley P, Robinson C and Pearson M
Socioeconomic status deprivation is known to be associated with self-harm in Western countries but there is less information about this association in Low and Middle Income Countries (LMIC). One way of investigating this is to assess the prevalence of indicators of financial stress in people who self-harm. We have assessed the prevalence and correlates of day-to-day financial hardships amongst individual presenting with non-fatal self-harm to hospitals in Sri Lanka.
Typologies of Psychiatric Diagnoses Among Inpatients with Recent Suicide Attempts
Lord KA, Tolin DF and Diefenbach GJ
Psychiatric multimorbidity is a well-documented risk factor for suicide. However, diagnostic heterogeneity and patterns of comorbidity likely exists within the population of those who attempt suicide. Person-centered statistical approaches, such as latent class analysis (LCA), extract distinguishable groups differentiated by prevalence and comorbidity of psychiatric disorders.
Transitions in Suicide Risk from Early Adolescence to Early Adulthood
Adrian M, James KM, Gallop R, Chu PV, Vander Stoep A and McCauley E
Understanding patterns of suicide risk over the course of development can aid our ability to prevent suicide. Our community-based study examined changes in suicide risk status and predictors of changes in risk status in a sample of 521 adolescents over six assessments between the start of middle school and young adulthood (ages 12-22).
Assessing a Suicide Prevention Helpline's Impact on Caller Crisis Level and Suicidality
Pauwels K, De Jaegere E, Vanderreydt P, Aerts S, Vande Gaer E and Portzky G
Worldwide helplines are considered an important part of suicide prevention strategies. Nevertheless, evidence regarding the impact of suicide prevention helplines on the suicidality of its users remains limited and is frequently confronted with methodological issues. This study aimed to assess the impact of crisis calls on callers' levels of crisis and suicidality both immediately after the call and at follow-up compared to before the call. After the call, the satisfaction of the callers with the intervention was also assessed.
The Transtheoretical Model of Change and Recovery from a Suicidal Episode
Sokol Y, Wahl Y, Glatt S, Levin C, Tran P and Goodman M
The Transtheoretical Model of Change (TTM) is an established model outlining five stages of change within a psychotherapeutic context: pre-contemplation, contemplation, preparation, action, and maintenance. Research shows that these models benefit patients and clinicians by enhancing their understanding of complex processes and identifying optimal therapeutic support for individuals at specific times. This study aimed to apply the TTM to personal recovery following a suicidal episode.
Acceptability and Feasibility of an Ecological Momentary Intervention for Managing Emotional Distress Among Psychiatric Inpatients at Risk for Suicide
Kleiman EM, Bentley KH, Jaroszewski AC, Maimone JS, Fortgang RG, Zuromski KL, Kilbury EN, Stein MB, Beck S, Huffman JC and Nock MK
The weeks following an inpatient psychiatric hospitalization are known to be the highest-risk time for suicide. Interventions are needed that are well-matched to the dynamic nature of suicidal thoughts and easily implementable during this high-risk time. We sought to determine the feasibility and acceptability of a novel registered clinical trial that combined three brief in-person sessions to teach core cognitive-behavioral therapy (CBT) skills during hospitalization followed by smartphone-based ecological momentary intervention (EMI) to facilitate real-time practice of the emotion management skills during the 28 days after hospital discharge. Results from this pilot study ( = 26) supported some aspects of feasibility and acceptability. Regarding feasibility, 14.7% of all screened inpatients met study eligibility criteria. Half (50.3%) of those who were ineligible were ineligible because they were not part of the population for whom this treatment was designed (e.g., symptoms such as psychosis rendered them ineligible for the current study). Those who were otherwise eligible based on symptoms were primarily ineligible due to inpatient stays that were too short. Nearly half (48%) of study participants did not receive all three in-person sessions during their hospitalization. Among enrolled participants, rates of engagement with the smartphone-based assessment and EMI prompts were 51.47%. Regarding acceptability, quantitative and qualitative data supported the perceived acceptability of the intervention, and provided recommendations for future iterations. Well-powered effectiveness (and effectiveness-implementation) studies are needed to determine the effects of this promising and highly scalable intervention approach.
The Progression of Lethality Across Multiple Suicide Attempts: A Systematic Review
Wafy G, Ajayi L, Siddiqi S, Saravanamuttoo T, Shorr R, Solmi M, Colman I and Fiedorowicz JG
Suicide is a major global public health concern. While some progress has been made in understanding risk factors for suicidal behavior, other relevant questions have received less attention. One such question relates to the longitudinal course of suicidal behavior amongst individuals with multiple suicide attempts. This systematic review investigated whether there is an increase in the lethality across multiple suicide attempts.
Development and Validation of Electronic Health Record Measures of Safety Planning Practices as Part of Zero Suicide Implementation
Boggs JM, Yarborough BJH, Clarke G, Aguirre-Miyamoto EM, Barton LJ, Beck A, Bruschke C, Buttlaire S, Coleman KJ, Flores JP, Penfold R, Powers JD, Richards JA, Richardson L, Runkle A, Ryan JM, Simon GE, Sterling S, Stewart C, Stumbo S, Quintana LM, Yeh HH and Ahmedani BK
Safety planning for suicide prevention is an important quality metric for Zero Suicide implementation. We describe the development, validation, and application of electronic health record (EHR) programs to measure uptake of safety planning practices across six integrated healthcare systems as part of a Zero Suicide evaluation study.
Reliability of Suicide Risk Estimates: A Vignette Study
Kolochowski FD, Kreckeler N, Forkmann T and Teismann T
Suicide risk assessments are obligatory when patients express a death wish in clinical practice. Yet, suicide risk estimates based on unguided risk assessments have been shown to be of low reliability. Since generalizability of previous studies is limited, the current study aimed to assess inter-rater and intra-rater reliability of risk estimates conducted by psychotherapists and psychology students using written case vignettes.
Suicidal Ideation in Medicinal Cannabis Patients: A 12-Month Prospective Study
Lynskey MT, Thurgur H, Athanasiou-Fragkouli A, Schlag AK and Nutt DJ
To document the prevalence and correlates of suicidal ideation (SI) among individuals seeking cannabis-based medicinal products (CBMPs); to test whether SI declines or intensifies after three months of CBMP treatment and to document 12-month trajectories of depression in those reporting SI and other patients.
Trauma Exposure Moderates the Link Between Cognitive Flexibility and Suicide Risk in Pre-Adolescent Children
Chen SE, Chick CF and O'Hara R
Trauma exposure (TE) and cognitive flexibility (CF) are risk factors for self-injurious thoughts and behaviors (SITBs). However, it is unknown whether these risk factors contribute to mechanisms associated with distinct categories of SITBs. The current study examined the potential moderating role of TE in the relationships between CF and multiple SITBs, including active suicidal ideation (SI), passive SI, non-suicidal self-injury (NSSI), and history of suicide attempt (SA), among pre-adolescent children.
Examining Highly Novel Positive Future Thinking in Suicidal and Nonsuicidal Adolescents
Nam RJ and Cha CB
Although traditionally considered protective, certain forms of positive future thinking (PFT) may be associated with greater suicide risk. In this first a priori investigation of potential maladaptive forms of PFT, we tested whether novelty (i.e., dissimilarity to past experiences) and lack of attainment of the imagined positive future may explain counterintuitive associations between PFT and suicidal ideation (SI).