An examination of environmental and genetic contributions to the determinants of suicidal behavior among male twins

Associations between fearlessness about death and suicidal ideation in individuals with psychosis

BACKGROUND

Despite high rates of suicide among people with psychosis, relatively little is known about the mechanisms underlying the transition from suicidal ideation to behavior in this population. The Interpersonal Psychological Theory of Suicide (IPTS) proposes that fearlessness about death (FAD) may play a role in this relationship. The present study tested whether constructs of the IPTS [thwarted belongingness (TB), perceived burdensomeness (PB), and FAD] were associated with the severity of suicidal ideation in a sample of adults with histories of psychosis.

METHOD

261 adults with histories of psychosis completed measures of IPTS constructs, current severity of suicidal ideation, and history of suicidal attempts. We examined differences between those with past suicide attempts and those without and conducted regression analyses to evaluate the associations among TB, PB, FAD and severity of current suicidal ideation.

RESULTS

Contrary to expectations, a history of suicidal behavior was not uniquely associated with FAD. Regression analyses revealed TB × PB and FAD × PB interactions emerged as significant correlates of the severity of suicidal ideation, with the relationship between PB and suicidal ideation more pronounced at higher levels of FAD and TB. Interestingly, positive symptoms of psychosis were positively associated with PB.

IMPLICATIONS

This study provides support for broadening the investigation of FAD as a contributor to suicidal ideation in individuals with psychotic symptoms. Future research investigating the role of other contributors that may influence capability for suicide (e.g., impulsivity) may add additional understanding of suicide in this population.

Ethological Problems with the Interpersonal Theory of Suicide

Joiner and colleagues' Interpersonal Theory of Suicide (IPTS), a prominent "desire-capability" model of suicide-based on the common-sense idea that people take their own lives because they want to, and can-is critiqued from a biological perspective. Tinbergen's ethological "four questions" guide the analysis: evolution, survival value, ontogeny, and proximate causation, each addressing a different aspect of biological understanding. Problems for IPTS emerge with all four. As a parsimonious solution, the desire-capability hypothesis is reconceived as an ultimate, instead of proximate, mode of explanation. By this light, desire and capability for suicide combined in our species' ancestral past, thus making suicide a recurrent survival threat, and driving the evolution of special-purpose defensive adaptations. This stance tallies with the pain-brain theory of the evolution of suicide, and with Joiner and colleagues' own investigation into organismic anti-suicide defenses, which appears to conflict conceptually with IPTS. These defenses' evolved algorithm may make suicide an intrinsically aleatory phenomenon, opaque to usefully accurate prediction. Positive implications for prevention and research are proposed.

Interpersonal theory of suicide and stressful life events in a clinical sample of adolescents in Spain

AIMS

The interpersonal theory of suicide (ITPS) provides a theoretical model for suicidal behaviour. It includes two interpersonal variables, thwarted belongingness (TB) and perceived burdensomeness (PB). This study tested the relationship between ITPS interpersonal variables and suicide risk (presence/absence of suicidal ideation and suicide attempts throughout life) in a clinical sample of Spanish adolescents. We also assessed the potential mediation effect of these variables in the well-established relationship between stressful life events (SLE) and suicide risk.

METHODS

We recruited 147 adolescents aged 11-17 from the Child and Adolescent Mental Health Outpatient Services of the Jiménez Díaz Foundation (Madrid, Spain). Different questionnaires were administered to assess suicidal behaviour and SLE (SITBI, The Stressful Life Events Scale) and to calculate proxy measures for ITPS interpersonal factors (SDQ, STAXI-NA, CDI).

RESULTS

TB and PB significantly correlated with suicide risk. PB played a mediating role in the relationship between SLE and suicide risk: adolescents reporting SLE were more likely to enact suicide behaviours when they experienced higher PB. Patients scoring higher PB were more likely to receive more intense treatment but tended to abandon intervention promptly.

CONCLUSIONS

ITPS seems useful for predicting suicide risk in an adolescent clinical sample. The results suggest an important role for PB in the SLE-suicide risk relationship and may impact the treatment process. Our exploratory findings should be addressed in future studies.

Development and Validation of the Fearlessness About Suicide Scale

Recent work has identified fearlessness about suicide, rather than fearlessness about death, as more theoretically relevant in the assessment of capability for suicide and thus a more appropriate construct of measurement. The aim of the current project was to develop and validate a scale specifically assessing fearlessness about suicide. Across two studies, support for a 7-item, single-factor structure of the Fearlessness About Suicide Scale (FSS) emerged. The FSS factor structure demonstrated a good fit in the first study and was replicated in the second study. Measurement invariance was examined across those identifying as men and women and found to be comparable. The FSS also demonstrated test-rest reliability and good convergent and divergent validity in community and undergraduate samples. Overall, findings indicate that the FSS has a replicable factor structure that generalizes across those identifying as men and women and may better assess components of capability for suicide than existing scales.

Adolescent suicide attempts in the United States: When suicide ideation and suicide capability interact

INTRODUCTION

Guided by the interpersonal theory of suicide, this study examined whether the relationship between level of suicide ideation and attempted suicide varies as a function of suicide capability.

METHODS

Cross-sectional data were obtained from the 2017 and 2019 Youth Risk Behavior Survey in which 28,442 respondents were sampled. Confirmatory factor analysis was conducted to create a latent suicide capability variable. Structural equation modeling was used to test the moderating effects of suicide capability on the relationship between level of suicide ideation and attempted suicide, adjusting for sociodemographic characteristics, sadness/hopelessness, and the sampling design.

RESULTS

Compared to adolescent with no reported ideation, those reporting single and dual ideation experienced increased odds of attempted suicide. The relationship between level of suicide ideation and attempted suicide significantly varied as a function of capability. While adolescents with dual suicide ideation experienced higher rates of attempted suicide at increasing levels of capability, faster rates of change of attempted suicide at increasing levels of capability were observed among those with single and no reported ideation.

CONCLUSION

Capability may heighten the risk of suicide attempts among youth, suggesting that treatment efforts could be directed at reducing exposure to painful and provocative experiences associated with suicide behaviors.

Impact of Interpersonal Relationships and Acquired Capability for Suicide on Suicide Attempts: A Cross-Sectional Study

OBJECTIVE

This study examined the path model predicting suicide attempts (SA) by interpersonal need for suicide desire, acquired capability for suicide, the emotion dysregulation, and depression symptoms in people admitted to hospitals for medical treatment.

METHODS

A total of 344 participants (200 depressed patients with attempted suicide, 144 depressed patients with suicidal ideation) were enrolled for this study. Depression, anxiety, emotion regulation, interpersonal needs, and acquired capability for suicide were evaluated. A model with pathways from emotion regulation difficulties and interpersonal needs to SA was proposed. Participants were divided into two groups according to the presence of SA or suicidal ideation.

RESULTS

Acquired capability for suicide mediated the path from depression to SA. In the path model, difficulties in emotion regulation and interpersonal needs predicted depression significantly. Although depression itself was not significantly related to acquired capability for suicide, depression was significantly related to acquired capability for suicide in suicide attempter group.

CONCLUSION

Interventions with two factors affecting SA will clarify the suicide risk and contribute to finding risk factors.

The Specific Roles of Loss of Interest and Loss of Pleasure in Recent Suicidal Ideation

BACKGROUND

Evidence suggests that recent changes in anhedonia may be more predictive of suicidal ideation than either state or trait anhedonia alone. However, the individual role that anhedonia symptoms play in suicidality is not yet well established.

METHODS

This study investigated whether state, trait, and recent changes in anhedonia predicted recent suicidal ideation, using cross-sectional data from two independent samples, one non-clinical (n = 2,138) and one clinical (n = 859), using binary logistic regression analyses.

RESULTS

In Study 1, loss of interest in people and loss of pleasure were associated with recent suicidal ideation independent of other depression symptoms, state and trait anhedonia. In Study 2, loss of interest in people, loss of interest in sex, and work inhibition were associated with recent suicidal ideation. In both studies, recent changes in anhedonia was uniquely associated with recent suicidal ideation.

CONCLUSIONS

These results indicate that recent changes in anhedonia and particularly the social aspect of the Loss of Interest in People item could be a significant risk factor in suicidal ideation.

No pain, no gain? Associations of athletic participation with capability for suicide among college students

INTRODUCTION

Suicide is a leading cause of death among college students. In order to advance understanding of suicide risk factors in this population, the present study provides a theoretically grounded test of associations between experiences in sports and both facets of capability for suicide (i.e., fearlessness about death and pain tolerance). Secondarily, the present study aimed to explore possible distinctions between subjective and objective pain tolerance.

METHODS

Undergraduate students (N = 153) completed the study at a single timepoint. A pressure algometer was used to measure objective pain tolerance, and self-report questionnaires assessed subjective pain tolerance, fearlessness about death (FAD), sports participation, sports-related injuries, level of contact in sport, and weight manipulation practices for sport.

RESULTS

Athletes had greater capability for suicide (i.e., higher objective and subjective pain tolerance and greater FAD) relative to non-athletes. Sports-related injuries were positively associated with both FAD and subjective pain tolerance, and level of contact in sport was positively associated with FAD. Objective and subjective pain tolerance were moderately correlated.

CONCLUSIONS

Sports-related injuries and level of physical contact in athletics are associated with the facets of capability for suicide among college student athletes. Discrepancies in results between subjective and objective pain tolerance suggest important distinctions between these constructs.

On prediction, refutation, and explanatory reach: A consideration of the Interpersonal Theory of Suicidal Behavior

Theory proposition, empirical evaluation, and resulting support or refutation are core pieces of the scientific process. These steps of theory-testing, however, can be complicated by relative rigidity and dogmatism, in combination with the logistical challenges inherent in conducting comprehensive, real-world tests of theories explicating complex scientific phenomena, especially rare ones. It may be argued that suicide is one such phenomenon, and one for which the field of psychology has struggled to develop satisfactory understanding. One leading theory of suicide, the Interpersonal Theory of Suicide, has garnered attention and, to a considerable degree, has weathered substantial scrutiny. Still, it is arguable that the theory has yet to be tested in full-that is, in accordance with all propositions originally put forth. In this effort, we sought to evaluate the current state of knowledge regarding the Interpersonal Theory of Suicide, as well as to suggest potential directions via which future work may proceed. We draw from the fields of philosophy, psychology, physics, and engineering in the hopes of engendering curiosity and critical thought about the assumptions researchers (ourselves included) bring to their work. We direct particular attention to the role of refutation in theory-testing; the supposed dichotomy of explanatory vs. algorithmic approaches; and the categorization of research programs as progressive vs. degenerative. In doing so, we hope not only to promote these ideas in the study of suicidal behavior but also to empiricists of all creeds and foci. We also include implications for suicide prevention efforts.

Application of the Interpersonal Psychological Theory of Suicide in a non-clinical community-based adolescent population

BACKGROUND

The Interpersonal Psychological Theory of Suicide (IPTS) provides a theoretical model of suicide behavior that explains the emergence of suicidal ideation and suicide attempt. Limited research has tested the IPTS with adolescents. The aim of the current study is to test the full IPTS model in a non-clinical community-based sample of adolescents.

METHODS

Data for the current study are drawn from the pre-intervention survey of the school-based Sources of Strength Australia Project, which included 1,382 adolescents aged 12-17 years. Participants completed measures of perceived burdensomeness, thwarted belongingness, capability for suicide (fearlessness about death), and suicidal ideation and behavior. The IPTS models were tested using hierarchical linear and logistic regression analyses.

RESULTS

Perceived burdensomeness and thwarted belongingness, and their interaction, were significantly (p< 0.001) associated with higher levels of suicidal ideation in the past month. The three-way interaction of perceived burdensomeness, thwarted belongingness and capability for suicide was not significantly associated with having had at least one suicide attempt in the past 12 months (p= 0.052).

LIMITATIONS

The data are cross-sectional and due to the low prevalence of suicide attempts in the sample, the study may be underpowered to fully test effects for suicidal behavior.

CONCLUSIONS

The results of the current study support the predictions of the IPTS in relation to suicidal ideation in adolescents. Given the clear associations between perceived burdensomeness and thwarted belongingness with suicide risk in adolescents there may be value in targeting these factors in the assessment and prevention of suicide in this population.

Interoception, Pain Tolerance, and Self-Injurious Behaviors: A Multidimensional Assessment

Impairments in interoception have been linked to self-injurious behaviors, and capability for suicide may account for this relationship. However, past studies have relied primarily on self-report and unidimensional measures. The present study aimed to replicate and extend previous findings by examining the relationship between interoceptive dysfunction, pain tolerance, and self-injurious behaviors using a multidimensional and multi-method approach. A sample of 245 undergraduate students (M_age = 19.27 years, SD = 2.81; 73.7% female, 72.% White/European American), who reported lifetime suicidal ideation on a screening survey completed a battery of self-report measures, four counterbalanced pain tolerance tasks, and a clinical interview assessing their self-injurious behaviors. A tendency to stay attuned to bodily sensations was significantly related to decreased pain tolerance. Only trust in one's body was significantly related to decreased presence of lifetime suicide attempts. No other facets of interoception or pain tolerance were significantly associated with self-injurious behaviors. Overall, these findings contrast with previous findings that capability for suicide may account for relations between interoceptive dysfunction and self-injurious behaviors. Nonetheless, the results of this study provide important information on the factor structure of interoceptive dysfunction and pain tolerance, and highlight the importance of careful selection of measures and operationalization of key constructs, particularly interoceptive dysfunction and pain tolerance.

The roles of borderline personality disorder symptoms and dispositional capability for suicide in suicidal ideation and suicide attempts: Examination of the COMT Val158Met polymorphism

There is a need to identify the subset of individuals with borderline personality disorder (BPD) symptoms at greatest risk for transitioning from suicidal ideation to a suicide attempt. Contemporary models of suicide risk propose that the capability for suicide is necessary for moving from suicidal ideation to a suicide attempt. Few studies have examined dispositional capability factors for suicide, especially among individuals with BPD symptoms. One candidate may be the catechol-o-methyltransferase (COMT) Val158Met polymorphism given its influence on pain sensitivity and fear. This study examined the interactive relation of BPD symptoms and the COMT Val158Met polymorphism to suicidal ideation and suicide attempts. Fifty-nine treatment-seeking patients were recruited. Participants were administered a series of clinical interviews to evaluate BPD symptoms and suicidal thoughts and behaviors. Saliva samples were collected for genotyping. The relation between BPD symptoms and suicidal ideation was not influenced by the Val158Met polymorphism. However, among Val/Val carriers, the probability of a lifetime suicide attempt increased as BPD symptom severity increased. Findings provide preliminary support for the Val/Val variant as a dispositional factor that may increase risk for suicide attempts in BPD; however, results must be interpreted with caution until replication of findings occurs in larger samples.

The Frequency and Subjective Impact of Painful and Provocative Events on the Acquired Capability for Suicide

BACKGROUND

Leading theoretical explanations for suicide state that for suicide death to occur, a person must have sufficient capability to enact an attempt. Exposure to painful and provocative events is hypothesized to play an important role in acquiring the capability for suicide over a lifetime. Unfortunately, assessment tools for painful and provocative events have focused solely on the frequency of events, neglecting the potential contributions of perceived impact. Further, past measurements have used predetermined items for painful and provocative events thereby neglecting other relevant events. The current study uses visual analog scales (VAS) to assess both the frequency and impact of painful and provocative events and how these contribute to the capability for suicide.

METHOD

Data were collected from 787 adults via Amazon's online platform.

RESULTS

Findings indicated that the frequency VAS and impact VAS both had a moderate correlation with the original Painful and Provocative Events Scale. Greater scores on the frequency VAS were associated with increased capability, whereas lower scores on the subjective impact VAS were associated with increased capability scores. Both VAS independently predicted capability above and beyond the PPES.

LIMITATIONS

Temporal or causal associations are unable to be drawn due to cross-sectional data. In addition, the sample was largely homogenous (White = 72%, female = 63.5%), limiting generalizability.

CONCLUSIONS

These initial findings demonstrate individuals who perceive painful and provocative events as being less impactful may have increased capability, and that VAS may be appropriate to approximate the impact and frequency of painful and provocative events.

Child abuse and suicidality in the context of the Interpersonal Psychological Theory of Suicide: A network analysis

OBJECTIVES

While there is evidence for an association of child abuse with suicidality in the course of life, the underlying mechanisms remain unclear. The Interpersonal Psychological Theory of Suicide (IPTS) provides a theoretical framework to investigate this relationship. The present study examines how different subtypes of child abuse are related to suicidal ideation and to attempts in the context of the IPTS.

METHODS

146 psychiatric inpatients (M = 37.9 years, 62% female) with an acute suicidal crisis (n = 71) or a recent suicide attempt (n = 74) were examined at baseline (T0) and six (T1) months later. We measured emotional, physical, and sexual abuse, the constructs of the IPTS (thwarted belongingness, perceived burdensomeness, and capability for suicide) and suicidal ideation as well as suicide attempts. Using the statistics program R, a network analysis of all named constructs was conducted. Centrality measures were computed.

RESULTS

Emotional abuse was the most central kind of abuse in the network and had a direct relationship with suicide attempts and an indirect relationship with suicidal ideation via perceived burdensomeness. Physical and sexual abuse showed no significant relations with the different constructs of the IPTS.

CONCLUSION

The major limitation of this study was the modest sample size which reduced the number of variables able to be included in the network. Regarding child abuse, the results underline that emotional abuse plays a central role in this network and may be important for suicide risk assessment. Future research should address this topic in a larger sample.

PRACTITIONER POINTS

Emotional abuse was the most central kind of abuse in this network analysis. Sexual abuse was the only kind of abuse with a direct relation to suicidal ideation. Capability for suicide had just a marginal position in the network analysis. Early interventions addressing the effects of child abuse are recommended. Replications in larger samples and with more relevant variables are needed.

Depressed adolescents' exposure to suicide attempts and suicide loss

This study explored depressed adolescent inpatients' (N = 158) experiences of exposure to friends' and family members' suicidal behaviors. Most of the participants (n = 102, 64.6%) reported exposure to suicide-related behavior. Teens exposed to suicide were more likely than non-exposed peers to report experiencing physical abuse, sexual abuse, and suicide attempts. No differences were observed between those exposed to only suicide attempts and those exposed to both suicide attempts and deaths in clinical characteristics or suicidal behaviors. Exposure to any form of suicide-related behavior may be associated with multiple forms of adversity in childhood.

An Examination of the Interpersonal Theory of Suicide's Tenets among Women with Bulimic-Spectrum Pathology

Objective: Suicide attempts and self-injurious behaviors (SIBs) are known to be elevated among people with bulimia nervosa (BN). The aim of the current study was to examine the Interpersonal-Psychological Theory of Suicide (IPTS) as a framework for understanding, assessing, and mitigating suicidal behavior among women with BN. The IPTS suggests that for individuals to enact lethal suicide attempts, they must have both the desire to die (consisting of thwarted belongingness and perceived burdensomeness) as well as the capability to die (often acquired through repeated exposure to provocative or painful experiences).Method: Two-hundred and four women with eating disorders, the majority of whom met criteria for a current DSM-IV diagnosis of BN, completed measures from which proxies for IPTS variables were formed. Bivariate correlations and multiple regressions tested main effects and interactions of study variables. Tests of the difference between dependent correlations probed differential associations between study variables and suicidal ideation versus suicidal behavior.Results and Conclusions: Results yielded considerable but not unalloyed support for the theory, with desire to die variables (particularly perceived burdensomeness) more strongly associating with suicidal ideation than behavior, and the opposite holding true regarding capability. These findings suggest that the IPTS may provide a useful framework for understanding, assessing, and mitigating suicide risk among individuals with BN.

Suicidal thoughts and behaviors in preadolescents: Findings and replication in two population-based samples

INTRODUCTION

Given increasing concern in suicide in preadolescent children, this study aimed to characterize and identify potential indicators of risk for suicidal ideation (SI) and suicide attempts (SAs) in this population.

METHODS

Data were drawn from two population-based samples of preadolescents: the 2007 and 2010 Minnesota Student Survey and analyses were restricted to 11- and 12-year-olds. Sociodemographic characteristics, childhood maltreatment, parental relations, peer relations, and school climate were examined in relation to past-year SI and SA. To examine correlates of SI, unconfounded by risk for SA, individuals with a history of SA were excluded from SI analyses. Correlates of SA were examined among individuals with past-year SI. Logistic regression analyses were conducted with past-year SI and SA as criterion variables.

RESULTS

Results from the 2007 and 2010 data sets were highly consistent. The prevalence of past-year SI was 9.28% and 9.25% in 2007 and 2010, respectively. Of the total sample, 1.90% and 1.87% reported a past-year SA (17.00% and 16.78% of those with past-year SI). Overall, effect sizes were generally modest to medium. The strongest effects were observed for sexual and physical abuse, parental support, and perceived safety at school (ps < .001). In multivariate analyses of SI and SA, sexual and physical abuse had the largest effect sizes (ORSI  = 2.18 [95% CI = 1.90-2.51] to 2.96 [95% CI = 2.69-3.26]; ORSA  = 1.55 [95% CI = 1.29-1.86] to 2.26 [95% CI = 1.82-2.80]).

CONCLUSIONS

SI and SA occur at a concerning rate among preadolescent children. Screening for childhood sexual and physical abuse may be important for identifying those at risk for these clinical outcomes.

The role of the 5-HTTLPR polymorphism in acquired capability for suicide

OBJECTIVE

According to the Interpersonal Psychological Theory of Suicide, capability for suicide comprises two dimensions: fearlessness about death and elevated pain tolerance. The short (S) allelic variant of the serotonin transporter gene-linked polymorphic region (5-HTTLPR) has repeatedly been associated with more violent and lethal suicide methods and lethality of suicide attempts. The current study aimed to investigate whether 5-HTTLPR allelic variants are associated with fearlessness about death and pain tolerance/persistence and whether it moderates the relationship between childhood maltreatment and acquired capability for suicide.

METHOD

A cohort of 208 inpatients hospitalized due to a recent suicide attempt or severe suicidal ideation was genotyped for the 5-HTTLPR and assessed for childhood maltreatment. Subjective pain tolerance and fearlessness about death as well as objective pain persistence was assessed using a pressure algometer.

RESULTS

Fearlessness about death, pain tolerance, and pain persistence did not differ between 5-HTTLPR genotypes. However, there was a significant correlation between self-reported childhood maltreatment and fearlessness about death that emerged exclusively in homozygous S-allele carriers.

CONCLUSION

Results suggest that there are no "high-risk"-alleles that generally increase capability for suicide. However, in terms of future suicide-related behaviors exposure to childhood maltreatment events could exert a particularly negative influence on homozygous S-allele carriers by increasing their fearlessness about death.

ADAPTED TO FEAR: FEARLESSNESS ABOUT DEATH IS ASSOCIATED WITH HEART RATE VARIABILITY

Objective: Capability for suicide, which refers to an individual's ability to enact potentially lethal harm to oneself and overcome the fear of dying, is an empirically supported component of the Interpersonal-Psychological Theory of Suicide. Although an abundance of research has examined capability for suicide through the use of self-report data, little research has assessed specific psychophysiological mechanisms that may contribute to capability for suicide. We assessed relationships between capability for suicide (fearlessness about death and pain tolerance), high frequency heart rate variability (HF HRV), and subjectively reported fear during a death related event. Given that greater HRV is associated with calmness and lack of distress, we predicted that HRV during a fearful event would be positively associated with the capability for suicide.

Method: Data were collected from 101 undergraduates. Participants self-reported fearlessness about death and had their pain tolerance assessed with an algometer. HF HRV was assessed prior to, during, and following a film-viewing task designed to elicit fear of death.

Results: Correlations revealed that fearlessness about death was negatively associated with self-reported fear during the film viewing and positively associated with self-reported and objective pain tolerance. Linear regressions found that fearlessness about death, but not self-reported or objective pain tolerance, was positively associated with HF HRV during the film-viewing and recovery.

Discussion: During a fearful, death related event, greater HF HRV was associated with greater fearlessness about death, suggesting that HF HRV may represent one possible mechanism through which fearlessness about death is maintained.

The significance of the Interpersonal-Psychological Theory of Suicide in an oncological context-A scoping review

OBJECTIVES

Since individuals afflicted with cancer are at an elevated risk of dying by suicide, understanding suicide-related ideation and behaviours is critical in identifying vulnerable patients. The interpersonal theory of suicide (IPTS) provides a framework to research risk factors for suicide and has been validated in different samples. The aim of this scoping review is to study literature related to IPTS and cancer patients.

METHODS

This scoping review was registered with the OPEN Science Framework (osf.io/92465). The databases PsycINFO, Web of Science, PubMed and PubMed Central were searched. Eligible research needed to use a minimum of one psychometric element to measure at least one of the factors of the IPTS in individuals with cancer.

RESULTS

Ninety-six studies were identified and screened. Eligible research included individuals with cancer and the use of at least one measurement of at least one of the factors of the IPTS. Overall, four articles met the inclusion criteria and three studies found significant associations of components of the IPTS and suicidal ideation/behaviour.

CONCLUSION

While these initial findings support the notion that the IPTS is relevant for individuals with cancer as well, a direct validation of the IPTS in cancer patients is needed.

A test of the interpersonal theory of suicide in a large, representative, retrospective and prospective study: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

The interpersonal theory of suicide hypothesizes that perceived burdensomeness, thwarted belongingness, and hopelessness lead to active suicidal thoughts and individuals with active suicidal thoughts and elevated capability for suicide are most likely to attempt suicide. We retrospectively and prospectively tested this theory in a large sample of 7677 U.S. Army soldiers followed post-deployment for up to nine months. The interaction of perceived burdensomeness and hopelessness (OR = 2.59) was significantly associated with lifetime suicidal thoughts; however, the interactions of thwarted belongingness and perceived burdensomeness and of thwarted belongingness and hopelessness were not. Consistent with the theory, capability for suicide prospectively predicted suicide attempts during and following deployment (OR = 1.22); however, among soldiers reporting lifetime suicidal thoughts, capability did not predict attempts, only perceived burdensomeness did (OR = 1.36). Results supported some, but not all, theory hypotheses, suggesting that additional constructs may be needed to better identify the psychological factors that lead soldiers to attempt suicide.

Social Support Mediates the Association between Disclosure of Suicide Attempt and Depression, Perceived Burdensomeness, and Thwarted Belongingness

OBJECTIVE

Prior research has found disclosure of concealable stigmatized statuses, including suicide attempt survivorship, to be associated with positive mental health outcomes. This study sought to test the mediating effect of self-reported social support on the association between disclosure of suicide attempt and suicide risk factors in a sample of undergraduate college students.

METHOD

Data were analyzed from 149 undergraduate college students with a history of one or more suicide attempts. Three parallel mediation analyses tested the simultaneous mediating effect of family social support and peer social support on the association between suicide attempt disclosure and suicide risk factors.

RESULTS

Significant total indirect effects in all models indicated family social support and peer social support simultaneously mediated the association between disclosure of suicide attempt and depression, perceived burdensomeness, and thwarted belongingness. The indirect effect on thwarted belongingness via peer social support was stronger than the indirect effect via family social support.

CONCLUSIONS

Disclosure of suicide attempt was associated with higher social support, which was associated with lower suicide risk factors. In a therapeutic context, it is important to consider social support when discussing disclosure of suicide attempt.

How Is the Presence of Company Related to Thwarted Belongingness in Real Time? Taking a Closer Look at the Conceptualization of the Construct of the Interpersonal Theory of Suicide

(1) Background: The role of thwarted belongingness (TB) in predicting suicidal ideation, as originally assumed by the Interpersonal Theory of Suicide, is repeatedly challenged by empirical findings. This could be due to an inadequate conceptualization of the construct of TB that is assumed to be influenced by intrapersonal and interpersonal factors. (2) Methods: We examined the associations of TB with intrapersonal variables related to depression, and with interpersonal variables related to an individual’s actual social environment. We analyzed data from an ecological momentary assessment study in psychiatric inpatients with depressive disorders. N = 73 participants rated momentary TB, depressive affect and status of company up to 10 times per day, over a period of six days, on smartphones. (3) Results: TB was lower when assessed while participants were in company compared to when they were alone, and the more desired the company was, the less TB was experienced. Individuals who had a partnership experienced less momentary TB. Furthermore, higher levels of momentary depressive affect, as well as more stable levels of depression, were related to higher levels of TB, and the relation between the presence of company and TB was weaker for more depressed persons. (4) Conclusions: Our findings can be seen as evidence that both intrapersonal and interpersonal factors relate to TB, and thus support the conceptualization of TB as proposed by the Interpersonal Theory of Suicide.

Euthanasia Distress and Fearlessness About Death in German Veterinarians

Background: The elevated risk of suicide in veterinarians is still not well understood, but euthanasia distress and increased fearlessness about death (FAD) have been discussed as specific risk factors. Aims: We investigated German veterinarians to test whether FAD is increased compared with the general population, whether FAD is associated with euthanasia distress, and whether there are differences between different fields in veterinary medicine. Methods: German veterinarians were assessed via self-report instruments and compared with a representative general population sample. There was no difference in FAD. Lower euthanasia distress was significantly associated with higher FAD. Limitations: Although we were able to recruit a large sample of veterinarians, the generalizability is limited by the voluntary nature of participation and the related risk of bias. Results: There was no difference in FAD. Lower euthanasia distress was significantly associated with higher FAD. Conclusion: Although lower euthanasia distress as an indicator of habituation to euthanasia is associated with higher FAD, one cannot assume that increased FAD in veterinarians is a specific risk factor for suicidality in veterinarians.

Fearlessness about death does not differ by suicide attempt method

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

Suicidal behaviors among American Indian/Alaska Native firefighters: Evidence for the role of painful and provocative events

Firefighters represent a group at elevated suicide risk. Identifying segments of the fire service at increased risk may facilitate the targeted provision of suicide prevention initiatives. Among the general population, American Indian/Alaska Native (AI/AN) individuals report higher rates of suicide attempts. This study sought to examine suicide attempt rates among AI/AN firefighters and to determine if greater exposure to painful and provocative events and/or fearlessness about death explains the relationship between AI/AN identity and suicidal behaviors. A total of 917 US firefighters completed a web-based mental health survey (6.2% AI/AN). Participants completed a modified version of the Self-Injurious Thoughts and Behaviors Interview-Short Form, the Painful and Provocative Events Scale, and the Acquired Capability for Suicide Scale-Fearlessness About Death scale. Bootstrap mediation analyses were conducted, controlling for years of service as a firefighter. Although AI/AN firefighters accounted for only 6.2% of the sample, they accounted for 34.4% of the career suicide attempts. AI/AN firefighters were 16.31 (95% CI = 7.96, 33.42) times more likely to report a career suicide attempt history than non-AI/AN firefighters, adjusting for years of service as a firefighter. Painful and provocative events, but not fearlessness about death, was a statistically significant mediator of the relationship between AI/AN identity and suicide attempts. Firefighters identifying as AI/AN represent a subgroup within the fire service at increased risk for suicide. Findings suggest that greater exposure to painful and provocative events among AI/AN firefighters may explain the elevated suicide risk among this population.

Proximal Correlates of Suicidal Ideation and Behaviors: A Test of the Interpersonal-Psychological Theory of Suicide

OBJECTIVE

The interpersonal-psychological theory of suicide hypothesizes proximal causes of suicidal ideation and behaviors; however, past studies have generally tested distal relations. The present study tested the proximal nature of the theory's hypotheses.

METHODS

A repeated-measures design collected daily survey data on the theory constructs over 90 days from 206 (150 women) college students with previous histories of suicidal ideation. Participants completed 7,342 (39.6%) of the 18,540 surveys sent.

RESULTS

Thwarted belongingness and perceived burdensomeness both positively associated with passive suicidal ideation at the daily level. A statistical trend revealed that perceived burdensomeness was associated with daily active suicidal ideation only at high levels of thwarted belongingness and hopelessness. Active suicidal ideation, but not capability for suicide, was positively associated with suicidal behavior at the daily level.

CONCLUSIONS

These results support the theory's predictions regarding passive and active suicidal ideation, with limited support regarding suicidal behaviors. The proximal associations of the IPTS constructs with daily suicidal ideation suggest areas for potential intervention with suicidal clients.

Comparison of Perceived Burdensomeness, Thwarted Belongingness, Capability for Suicide, and Suicidal Ideation among Heterosexual and Sexual Minority Individuals in Mississippi

This study sought to compare risk factors for suicidal ideation among heterosexual and sexual minority college students from a previously understudied conservative region of the United States. Suicidal ideation, thwarted belongingness (TB), perceived burdensomeness (PB), and capability for suicide were examined. It was found that PB was significantly higher among sexual minorities than heterosexual individuals, TB and capability were not significantly different, and suicidal ideation was not significantly different when controlling for depression but was significant when depression was not a covariate. Additionally, among sexual minorities and heterosexuals, TB and PB were correlated with ideation and that the strength of the relationship between PB and ideation was dependent on how much TB the individual is experiencing. Sexual minorities, when compared to heterosexual individuals, do not have higher TB or capability, but do have higher levels of PB and suicidal ideation.

Suicide Risk and Restricted Emotions in Women: The Diverging Effects of Masculine Gender Norms and Suicide Capability

This study investigated whether gender moderated the association between masculine socialization pressures of restrictive emotionality and suicide risk through suicide capability (i.e., fearlessness about death). A sample of inpatients admitted for recent suicidality (n = 194) completed validated measures of restrictive emotionality, fearlessness about death, and current suicide risk. A moderated mediation effect was found opposite the hypothesized direction: fearlessness about death mediated the relationship between endorsement of the masculine gender norm of restrictive emotionality and suicide risk in women, but not men. Gender did not moderate the association between restrictive emotionality and fearlessness about death. The diverging gender effects suggest that the masculine gender norm of restrictive emotionality is associated with suicide capability in men and women, while acquired fearlessness about death is more informative of risk for suicide in women than men.

Biological bases of suicidal behaviours: A narrative review

Suicidal behaviour is a multifaceted phenomenon that concerns all human populations. It has been suggested that a complex interaction between the individual genetic profile and environmental factors throughout life underlies the pathophysiology of suicidal behaviour. Although epidemiological and genetic studies suggest the existence of a genetic component, exposure to biological and psychosocial adversities, especially during critical developmental periods, also contributes to altering the biological responses to threat and pleasure. This results in amplified maladaptive cognitive and behavioural traits and states associated with suicidal behaviours. Alterations in the cognitive inhibition and decision-making capacity have been implicated in suicidal behaviours. Structural and functional changes in key brain regions and networks, such as prefrontal cortex, insula and default mode network, may underlie this relationship. Furthermore, the shift from health to suicidal behaviour incorporates complex and dynamic changes in the immune and stress responses, monoaminergic system, gonadal system and neuroplasticity. In this review, we describe the major findings of epidemiological, genetic, neuroanatomical, neuropsychological, immunological and neuroendocrinological studies on suicide behaviours to provide a solid background for future research in this field. This broad overview of the biological bases of suicide should promote neuroscience research on suicidal behaviours. This might lead to improved biological models and to the identification of evidence-based biomarkers, treatment options and preventive strategies.

(In)stability of Capability for Suicide in Psychiatric Inpatients: Longitudinal Assessment Using Ecological Momentary Assessments

OBJECTIVE

The study examines the temporal stability of capability for suicide (i.e., its state-like component), because it has been recently discussed that capability for suicide may be subject to shift over time.

METHOD

Seventy-four psychiatric inpatients with an unipolar depressive disorder were included in the study (mean age 37.9 years, 71.6% female, 32.4% with a history of suicide attempt). After a baseline assessment with several self-report questionnaires, ecological momentary assessments were applied over six consecutive days using smartphones. Capability for suicide was rated with three items once a day. For daily capability for suicide, descriptive and variability statistics and associations with baseline clinical characteristics (depression, suicidal ideation, childhood maltreatment, and history of suicide attempt) were analyzed. The prospective association of daily level of active suicidal ideation and daily capability was investigated by multilevel analysis.

RESULTS

Indicators of within-person variability and temporal instability supported considerable fluctuation in daily capability for suicide. Yet the degree of temporal instability showed individual differences. Baseline and daily suicidal ideation were positively associated with daily fearlessness about death and perceived capability.

CONCLUSION

The results provide first evidence that capability for suicide includes a dynamic short-term component that is linked to clinical variables such as suicidal ideation.

Examining Patterns of Change in the Acquired Capability for Suicide Among Eating Disorder Patients

OBJECTIVE

Several models of suicidal behavior posit that, to transition from suicidal ideation to attempting suicide, individuals must have an acquired capability for suicide (ACS), comprised of fearlessness about death (FAD) and pain tolerance. ACS is hypothesized to increase monotonically through exposure to painful and provocative experiences. However, recent research suggests that ACS can decrease, bringing into question the hypothesis of monotonic increase. This study examined the nature of change in ACS over time within a sample of patients with eating disorder (ED). We predicted that there would be two classes of change in ACS: one high and increasing and one moderate and stable.

METHOD

One hundred female patients with ED reported on ACS at admission and weekly during treatment.

RESULTS

Growth mixture modeling to test models of FAD and pain tolerance identified that, for both factors, a one-class intercept-only model was the best-fitting model, suggesting that patients entered treatment with midlevel ACS and experienced no significant linear change over the course of treatment.

CONCLUSIONS

Acquired capability for suicide demonstrated stability in this study; results highlight the need for additional research examining ACS across different timescales and in varied populations.

The Capability for Suicide in Firefighters

OBJECTIVE

Suicide among firefighters is a critical mental health concern that remains under studied. The interpersonal-psychological theory of suicidal behavior (IPTS) states that, to engage in lethal suicidal behaviors, an individual must possess thwarted belongingness, perceived burdensomeness, and fearlessness about death (IPTS factors). Social cognitive theory may assist IPTS in explaining suicidal behavior.

METHOD

Participants for the study were 216 volunteers and career firefighters. The sample was almost exclusively male, non-Hispanic or Latino, and Caucasian with a mean age of 40.6. We examined the mediating effect of firefighter coping self-efficacy (FFCSE) and coping self-efficacy for trauma (CSE-T) in the relationship between critical incidents and the IPTS factors. Moderated mediation analyses were performed with separate conditional effects of each social support subscale on the indirect effect of each self-efficacy perception in the relationship between critical incidents and the IPTS factors.

RESULTS

Mediation analysis indicated that FFCSE did not mediate the relationships; however, CSE-T did mediate the relationships between critical incidents and the IPTS factors. These significant indirect effects of CSE-T were moderated by social support from significant other.

CONCLUSIONS

CSE-T within the context of significant other support is important to consider in understanding firefighter mental health.

An Investigation into the Acquired Capability for Suicide

OBJECTIVE

The acquired capability for suicide (ACS) is one of the most important breakthroughs in suicide research. ACS refers to an individual's increased fearlessness about death over time from experiencing painful and provocative events (PPE) and is based on opponent-process theory-a habituation model. Few studies have investigated how ACS develops and found that ACS remained relatively stagnant.

METHOD

This study sought to expand these findings by observing how ACS develops in two cross-sectional data sets involving high-risk nonclinical samples of physicians (n = 419) and veterinary students (n = 124). Participants completed online questionnaires assessing both general PPEs (e.g., witnessing abuse) and job-specific PPEs (e.g., exposure to euthanasia), as well as ACS.

RESULTS

Our results partially replicated prior findings indicating that more PPEs do not significantly affect ACS.

CONCLUSIONS

Limitations of this study include the use of cross-sectional data and self-report measures. These results, in combination with existing models of habituation, suggest ACS may not progress linearly.

Establishing the psychometric properties and construct validity of the Painful and Provocative Events Scale-Revised

BACKGROUND

Engagement in painful and provocative events is central to hypotheses for how capability for suicide develops. However, the existing measure of painful and provocative events is not psychometrically sound. We developed a measure with improved psychometric properties: the Painful and Provocative Events Scale (PPES)-Revised.

METHOD

In study 1, 447 adults (53.5% women, mean age = 35.4 years) answered 77 items describing painful and/or provocative experiences. Exploratory factor analysis (EFA) was performed. In study 2, 403 adults (55.1% women, mean age = 38.1 years) answered the retained items and confirmatory factor analysis (CFA) was performed. The scale's factorial invariance across gender was examined. Estimates of convergent and discriminant validity were obtained.

RESULTS

EFA yielded a two-factor structure, which was confirmed with CFA. The factor structure was invariant across men and women. Estimates of convergent and discriminant validity were promising.

LIMITATIONS

Limitations include non-weighted items, additional need for CFA among high-risk groups, lack of assessment of person-specific painful and provocative events, and need for prospective research to establish the scale's predictive validity.

CONCLUSIONS

By assessing painful and provocative events more uniformly and reliably than the existing measure, the PPES-Revised has the potential to advance the understanding of capability for suicide.

Do suicide attempters and suicide ideators differ in capability for suicide?

Suicide ideation is a prerequisite for suicide attempts. However, the majority of ideators will never act on their thoughts. It is therefore crucial to understand what differentiates those who consider suicide from those who attempt suicide. The aim of this study was to investigate the role of different aspects of capability for suicide (fearlessness about death, subjective pain tolerance, objective pain persistence) in differentiating suicide ideators from suicide attempters, single attempters from multiple attempters and recent attempters from distant attempters. A total of 308 psychiatric inpatients (53.6% female; age: M=36.92, SD=14.30) suffering from suicide ideation with or without lifetime suicide attempts were compared regarding fearlessness about death, subjective pain tolerance and objective pain persistence (assessed with a pressure algometer). No differences in fearlessness about death, subjective pain tolerance and objective pain persistence were found in suicide ideators vs. attempters, single vs. multiple attempters and recent vs. distant attempters. It might be presumed that fearlessness about death, subjective pain tolerance and objective pain persistence do not offer useful information for the differentiation between suicide ideators and attempters, however, there are several limitations to take into account. Further effort is needed to understand more clearly what differentiates suicide ideators from suicide attempters.

The psychological scars of suicide: Accounting for how risk for suicidal behavior is heightened by its past occurrence

Not only is suicidal behavior strongly predicted by its past occurrence, but the risk for recurrence appears to increase with each subsequent attempt. The current paper discusses a potential explanation for this phenomenon, that suicide attempts may leave a residual psychological scar that heightens risk for future attempts. This possibility is evaluated against two alternatives: (i) risk for first and subsequent suicide attempts is accounted for by a shared diathesis pre-existing the first lifetime attempt, and (ii) different rates of developmental decline in risk factors account for differences in prospective number of attempts. In this discussion, a formalized conceptual framework of psychological scarring is presented, along with considerations of particular relevance to its study. Finally, the clinical implications of determining the processes underlying the association between suicide attempts and heightened risk for recurrence are discussed.

Emotional Intelligence Moderates Anhedonia and Suicidal Ideation in Depressed Patients

The rising rate of suicidal ideation in adults is a growing concern in the world. In an effort to understand the prevalence of suicidal ideation, and what can be done to prevent it, this study was designed to examine the associations among anhedonia, emotional intelligence, and suicidal ideation. Emotional intelligence was evaluated as a moderator in the relationship between anhedonia and suicidal ideation among Iranian depressed adults. The participants were 217 depressed inpatients at five hospitals in Tehran, Iran, ranging age from 45 to 79 years. Structural equation modeling demonstrated that adult patients suffering from depression that exhibited higher levels of anhedonia and lower levels of emotional intelligence were predisposed to suicidal ideation. Multigroup analysis indicated emotional intelligence as a moderator in the relationship between anhedonia and suicidal ideation. The results emphasize the role of emotional intelligence in mitigating the devastating effects of anhedonia on suicidal ideation.

The role of childhood abuse for suicidality in the context of the interpersonal theory of suicide: An investigation in German psychiatric inpatients with depression

BACKGROUND

Several studies provide evidence for a relationship between childhood abuse and suicidality across the lifespan. To examine this association in the context of the Interpersonal Psychological Theory of Suicide (IPTS), we investigated whether its constructs thwarted belongingness, perceived burdensomeness and capability for suicide are potential mediators.

METHODS

Eighty-four German psychiatric inpatients with unipolar depression (M = 37.6 years, 69% female) and current or lifetime suicidal ideation were included. For the assessment we used the Childhood Trauma Screener (CTS), the Rasch-based Screening for Depression (DESC-I), the Interpersonal Needs Questionnaire (INQ), the German Capability for Suicide Questionnaire (GCSQ), the Beck Scale for Suicide Ideation (BSS) and the Suicide Behaviors Questionnaire-Revised (SBQ-R). Simple and multiple mediator analyses were applied.

RESULTS

Most patients (70%) had experienced childhood abuse. Emotional abuse showed an indirect association with suicidal ideation via thwarted belongingness and perceived burdensomeness, whereas physical and sexual abuse were indirectly related to suicide risk via capability for suicide.

LIMITATIONS

The small sample size and the cross-sectional design are limiting factors of the present study.

CONCLUSIONS

Childhood abuse is a common experience of inpatients with unipolar depression. This study showed its indirect effects on suicidal ideation and risk for suicide, mediated by the constructs of the IPTS. Further research should investigate this issue in other populations and clinicians should be aware of the devastating effects of childhood abuse.

Suicide Risk across Latent Class Subgroups: A Test of the Generalizability of the Interpersonal Psychological Theory of Suicide

It remains unclear whether the Interpersonal Psychological Theory of Suicide (IPTS; Joiner, ) is generalizable to the population or holds more explanatory power for certain subgroups compared to others. The aim of this study was to (1) identify subgroups of individuals who endorsed suicide ideation in the past month based on a range of mental health and demographic variables, (2) compare levels of the IPTS constructs within these subgroups, and (3) test the IPTS predictions for suicide ideation and suicide attempt for each group. Latent class, negative binomial, linear, and logistic regression analyses were conducted on population-based data obtained from 1,321 adults recruited from Facebook. Among participants reporting suicide ideation, four distinct patterns of risk factors emerged based on age and severity of mental health symptoms. Groups with highly elevated mental health symptoms reported the highest levels of thwarted belongingness and perceived burdensomeness. Tests of the IPTS interactions provided partial support for the theory, primarily in young adults with elevated mental health symptoms. Lack of support found for the IPTS predictions across the subgroups and full sample in this study raise some questions around the broad applicability of the theory.

Prospective prediction of first lifetime onset of suicidal ideation in a national study of substance users

Suicide rates have increased over the past several decades. Prior research has evaluated risk factors for suicidal behavior, but much of this work does not adequately differentiate between risk factors for suicidal ideation (SI) and suicide attempts, nor does it differentiate between first-onset SI and recurrent ideation. This study seeks to identify risk factors for first-onset SI among a high-risk group: individuals receiving treatment for substance use disorders. Data were drawn from the National Treatment Improvement Evaluation Study, a prospective study examining the impact of addiction treatment programs. Patients with no lifetime history of suicide attempts or ideation (n = 2560) were assessed at baseline and one year later for prospectively-occurring SI. Sociodemographic variables, mental health indices, interpersonal factors, and substance use severity indicators were evaluated as prospective predictors of first-onset SI in linear regression models. Current mental health problems (OR = 1.54, 95% CI = 1.19-2.01), current substance use problems (OR = 1.33, 95% CI = 1.04-1.70), and difficulty accessing treatment for substance use problems (OR = 1.90, 95% CI = 1.16-3.11) emerged as significant predictors of first-onset SI in a multivariate analysis, suggesting that individuals with current mental health or substance use related symptoms are among the most at risk for developing SI. Difficulty obtaining treatment remained significant, highlighting the importance of treatment accessibility. Future clinical work and research would benefit by addressing these issues, potentially by focusing on mental health treatment in substance abuse programs and evaluating barriers to treatment.

The intensity of suicidal ideation at the worst point and its association with suicide attempts

This study seeks to determine if the severity of suicidal ideation at the worst point can differentiate individuals who think about suicide (ideators) from those who make a suicide attempt (attempters). Subsequently, the indirect effect of worst point ideation on differentiating ideators from attempters through various pathways such as an increased capability for suicide, painful and provocative experiences, non-suicidal self-injury (NSSI), and planning for suicide was examined. The sample included 229 adults with a lifetime history of suicidal ideation who were recruited through Amazon's Mechanical Turk program and asked to complete a battery of self-report questionnaires. Furthermore, the sample was oversampled on the basis of prior suicide attempts. Our results suggest that there is a strong relationship between worst point ideation and suicide attempts such that there is a greater likelihood of endorsing past suicide attempts when individuals reported high intensity at the worst point of their suicidal ideation. An elevated level of painful and provocative events partially accounted for the aforementioned relationship while a heightened capability for suicide. The results from the present study suggest utility in managing intensity of suicidal ideation and the importance of addressing painful and provocative behaviors to prevent potentially lethal suicide attempts in the future.

Military Deployments and Suicide: A Critical Examination

Deployment to a combat zone is a fundamental mission for most military forces, but prior research suggests that there is a complex and nuanced association between deployment and related risk factors for suicide. Deployment and combat experiences vary greatly among military personnel and can affect a variety of protective and risk factors for suicide. This article offers a critical examination of the association among modern U.S. military deployments, suicide attempts, and death while considering the context of a prominent theory of suicide. Although previous work has demonstrated that deployment is not associated with suicide overall in this population, there is growing evidence that risk may be elevated shortly after deployment, and for some subgroups. Specific aspects of combat exposure, including the experience of killing or witnessing death in combat, may be important contributing factors. An analysis of the literature illustrates that deployment-related risk factors for suicide are complex. The limitations of the literature are discussed, and future directions are suggested.

Theoretical and empirical foundations of a novel online social networking intervention for youth suicide prevention: A conceptual review

Suicide is a major public health problem and is the second leading cause of death in young people worldwide. Indicating a lack of adequate treatment approaches, recent data suggest a rising suicide rate. Current approaches to suicide prevention do not sufficiently account for the specific needs of young people or the ways in which they engage with the health system, nor are they adequately theory-driven. In this paper, we review an empirically-supported theoretical model of suicide together with the latest evidence in treating young people who are at risk. We discuss the potential efficacy of social-media-based online interventions, with a particular focus on how they may be uniquely placed to target interpersonal risk factors for suicide. We highlight the risks associated with such interventions, including the potential for contagion to occur. Based on prominent theoretical models and gaps in existing treatment approaches, we propose a newly-developed, theory-driven, online social-networking-based intervention for suicide prevention in young people.

Non-monotonic temporal variation in fearlessness about death: A latent class growth analysis

According to the Interpersonal-Psychological Theory of Suicide, fearlessness about death is proposed to increase monotonically (i.e., either increasing or remaining stable) and thus, not be amenable to intervention; however, this assumption has not been explicitly tested. We utilized latent class growth modeling to examine the trajectory of this construct over a brief interval (i.e., data collected every three days over a 15-day time period) among college students (N = 716), and found evidence that fearlessness does not monotonically increase. Specifically, our analyses revealed three classes, each with distinct trajectories over time: a High/Increasing class (i.e., high intercept, significantly increasing slope), Average/Stable class (i.e., average intercept, flat and non-significant slope), and Low/Decreasing class (i.e., low intercept, significantly decreasing slope). The emergence of a Low/Decreasing group is in contrast to the assertion that fearlessness cannot decrease over time. Exploratory results also indicated that lifetime exposure to certain events (e.g., abuse, injury) was associated with membership in the Low/Decreasing class, suggesting that some individuals may be responding differently to painful and/or fear-inducing stimuli than the IPTS predicts. Our findings contradict the current conceptualization of fearlessness about death, and suggest instead that this construct fluctuates upward and downward over a brief interval.

Interoceptive Deficits, Nonsuicidal Self-Injury, and Suicide Attempts Among Women with Eating Disorders

People with eating disorders (EDs) have an elevated risk for both nonsuicidal self-injury (NSSI) and suicide compared to the general population. This study tests two theoretically derived models examining interoceptive deficits as a risk factor for NSSI, and examining interoceptive deficits, NSSI, fearlessness about death, and pain tolerance as risk factors for suicide. Ninety-six adult, treatment-seeking women with EDs completed self-report questionnaires at a single time point. Interoceptive deficits were significantly associated with NSSI, and NSSI was in turn associated with both pain tolerance and fearlessness about death. Further, pain tolerance was in turn associated with past suicide attempts, although fearlessness about death was not associated with suicide attempts. Interoceptive deficits had a direct association with fearlessness about death but not pain tolerance. Results regarding the relation between interoceptive deficits and suicide attempts were mixed, yet overall suggest that interoceptive deficits are related to suicide attempts largely indirectly, through the effects of mediating variables such as NSSI, fearlessness about death, and pain tolerance. Results suggest that interoceptive deficits and pain tolerance merit further investigation as potential risk factors for fatal and nonfatal self-harm among individuals with EDs.

Preliminary Validation of a Korean Version of the Acquired Capability for Suicide Scale-Fearlessness About Death

The interpersonal-psychological theory of suicide proposes that the desire for suicide must be accompanied by the capability to do so in order for an individual to engage in suicidal behavior. The Acquired Capability for Suicide Scale-Fearlessness about Death (ACSS-FAD) measures fearlessness about death, a core component of the capability for suicide. This study aimed to validate a Korean version of the ACSS-FAD in a college student sample. We administered the ACSS-FAD and measures of suicide ideation, fear of suicide, death anxiety, pain anxiety, and depression in a sample of Korean college students (N = 301) and analyzed its reliability, factor structure, invariance across genders, convergent validity, and discriminant validity. The one-factor model achieved satisfactory model fit. Across genders, partial metric invariance and partial scalar invariance were established. The results also revealed that the ACSS-FAD has good internal consistency, convergent validity (positive correlations with fear of suicide, death anxiety, and pain anxiety), and discriminant validity (no relation with depression). The Korean version of the ACSS-FAD presents adequate psychometric properties and may be considered to be a promising instrument for measuring fearlessness about death in college students.

Psychopathic personality traits as a form of dispositional capability for suicide

The capability to enact lethal self-harm has recently been highlighted as a critical risk factor for suicidal behavior. Klonsky and May's (2015) three step theory of suicide (3ST) expanded upon the construct of the capability for suicide by dividing it into categories: dispositional, acquired, and practical. The current study examined constructs of Patrick and colleagues' (2009) triarchic model of psychopathy as indicators of dispositional capability in gun owners, a sample at heightened risk for death by suicide (Anestis and Houtsma, 2017). We anticipated that specific psychopathic traits would exhibit robust associations with other components of the capability for suicide. In a sample of 300 gun-owning adults, Boldness was uniquely related to all indicators of practical capability in both male and female gun owners, and a Boldness*Meanness interaction predicted the highest levels of some capability components. These results are consistent with theoretical conceptualizations of the triarchic model. Our findings indicate that, among US gun owners, dispositional factors may impact comfort with and aptitude with guns, which may enhance our understanding of which gun owners are at the greatest risk of gun suicide should they develop suicidal thoughts.