Repetitive negative thinking and suicidal ideation in internalizing psychopathologies: A replication study

Suicidal ideation (SI), a risk factor for suicide, is prevalent in internalizing psychopathologies, including depression and anxiety. Rumination and worry are well-studied repetitive negative thinking (RNT) constructs implicated in internalizing psychopathologies. These constructs have shared and distinct characteristics. However, the relationship between rumination and worry and their associations with SI are not fully understood in clinical samples. The present study used correlational and regression analysis to evaluate these relationships as a secondary data analysis in treatment-seeking participants with internalizing psychopathologies in two independent samples (Study 1:n = 143; Study 2:n = 133). Results showed about half of the participants endorsed SI (Study 1:n = 79; Study 2:n = 71). Correlations revealed a significant, positive relationship between rumination and worry. Regression results with SI as the dependent variable showed rumination significantly positively corresponded with SI in both studies. Post-hoc partial correlations controlling for symptom severity (depression, anxiety), worry, and age showed the rumination-SI relationship was maintained in both studies. Findings for worry and SI were inconsistent between studies. Findings indicate rumination, but not worry, could be a stable, unique contributor to SI in internalizing psychopathologies. It may be useful to incorporate RNT into suicide risk assessment for individuals with internalizing conditions.

Intentions to use mental health and suicide prevention resources among individuals with symptoms of the suicide crisis syndrome and/or suicidal ideation

INTRODUCTION

The suicide crisis syndrome (SCS) has demonstrated efficacy in predicting suicide attempts, showing potential utility in detecting at-risk individuals who may not be willing to disclose suicidal ideation (SI). The present international study examined differences in intentions to utilize mental health and suicide prevention resources among community-based adults with varying suicide risk (i.e., presence/absence of SCS and/or SI).

METHODS

A sample of 16,934 community-based adults from 13 countries completed measures about the SCS and SI. Mental health and suicide prevention resources were provided to all participants, who indicated their intentions to use these resources.

RESULTS

Individuals with SCS (55.7%) were just as likely as those with SI alone (54.0%), and more likely than those with no suicide-related symptoms (45.7%), to report willingness to utilize mental health resources. Those with SI (both with and without SCS) were more likely to seek suicide prevention resources (52.6% and 50.5%, respectively) than those without SI (41.7% and 41.8%); however, when examining endorsements for personal use, those with SCS (21.6%) were more likely to use resources than individuals not at risk (15.1%).

CONCLUSIONS

These findings provide insight into individuals' willingness to use resources across configurations of explicitly disclosed (SI) and indirect (SCS) suicide risk.

Active suicidal ideation associated with dysfunction in default mode network using resting-state EEG and functional MRI - Findings from the T-RAD Study

Suicide in youth and young adults is a serious public health problem. However, the biological mechanisms of suicidal ideation (SI) remain poorly understood. The primary goal of these analyses was to identify the connectome profile of suicidal ideation using resting state electroencephalography (EEG). We evaluated the neurocircuitry of SI in a sample of youths and young adults (aged 10-26 years, n = 111) with current or past diagnoses of either a depressive disorder or bipolar disorder who were enrolled in the Texas Resilience Against Depression Study (T-RAD). Neurocircuitry was analyzed using orthogonalized power envelope connectivity computed from resting state EEG. Suicidal ideation was assessed with the 3-item Suicidal Thoughts factor of the Concise Health Risk Tracking self-report scale. The statistical pipeline involved dimension reduction using principal component analysis, and the association of neuroimaging data with SI using regularized canonical correlation analysis. From the original 111 participants and the correlation matrix of 4950 EEG connectivity pairs in each band (alpha, beta, theta), dimension reduction generated 1305 EEG connectivity pairs in the theta band, 2337 EEG pairs in the alpha band, and 914 EEG connectivity pairs in the beta band. Overall, SI was consistently involved with dysfunction of the default mode network (DMN). This report provides preliminary evidence of DMN dysfunction associated with active suicidal ideation in adolescents. Using EEG using power envelopes to compute connectivity moves us closer to using neurocircuit dysfunction in the clinical setting to identify suicidal ideation.

Modeling the associations between emotion regulation, suicide crisis syndrome and suicidal behavior: Results in community and clinical samples

BACKGROUND

Emotion Regulation (ER) and Suicide Crisis Syndrome (SCS) are psychological processes involved in suicide. Within ER, both the use of rumination and dysfunctional emotion beliefs are associated with suicide. SCS, a pre-suicidal mental state involving cognitive and affective dysregulation, is related to short-term suicide risk.

AIMS

Here, we first examined associations between ER (beliefs about the uncontrollability of emotions and rumination), SCS and suicide behavior, and second, we test a multistep model in which ER factors are linked to suicide behavior through SCS.

MATERIALS & METHODS

We conducted two cross-sectional studies to address this issue by self-reports. Study 1 used a community sample (N = 421). Study 2 used a clinical sample (N = 70).

RESULTS

Results from both studies showed that beliefs about the uncontrollability of emotions and rumination were associated with higher levels of SCS symptoms and suicide behavior, and that SCS was associated with suicide behavior. In addition, path analyses showed that uncontrollability beliefs were linked to rumination, which in turn was associated with SCS, and this variable mediated the association between ER factors and suicide ideation (in both community and clinical samples) and suicide attempts (in the community sample).

DISCUSSION

As we expected, in both samples, uncontrollability of emotions and rumination were positively related with SCS and suicide behavior.

CONCLUSION

We emphasize the importance of addressing uncontrollability beliefs and rumination in suicide prevention.

Associations of rumination with suicidal ideation and suicide attempts amongst individuals with major depressive disorder: A 12-month longitudinal study in China

BACKGROUND

This study aimed to explore the longitudinal associations of rumination with suicidal ideation and suicide attempts in individuals with major depressive disorder (MDD).

METHODS

Participants were derived from the Depression Cohort in China study (DCC). Those who completed at least one follow-up visit during the 12 months were included in the analysis. Dimensions of rumination including brooding and reflection were each measured using five items of the Ruminative Responses Scale. Suicidal ideation was assessed using the Beck Scale for Suicide Ideation. Suicide attempts were also assessed and all were analyzed with generalized estimating equations.

RESULTS

Our final sample included 532 participants aged 18 to 59 years (mean [SD], 26.91 [6.94] years) consisting of 148 (27.8%) males and 384 (72.2%) females. After adjusting for temporal trend and potential confounders, individuals with higher levels of reflection were more likely to report suicidal ideation (AOR =1.11, 95% CI:1.01-1.22). However, no statistically significant association was found between brooding and suicidal ideation (AOR =1.06, 95% CI:0.96-1.17). Conversely, individuals with higher levels of brooding were more likely to report suicide attempts (AOR =1.13, 95% CI:1.02-1.24), while no statistically significant association was observed between reflection and suicide attempts (AOR =0.91, 95% CI:0.82-1.01).

CONCLUSION

Rumination reflects a disturbance in cognitive emotional processing and manifests in different dimensions. Our findings suggest that high levels of reflection and brooding may be associated with a higher likelihood of having suicidal ideation and suicide attempts, respectively. However, it should be interpreted with caution, given that effect sizes are small.

Longitudinal Impact of Perfectionism on Suicidal Ideation among Chinese College Students with Perceived Academic Failure: The Roles of Rumination and Depression

OBJECTIVE

Suicide has become a nonnegligible cause of death among emerging adults, and academic performance is one of the most significant factors in Chinese college students' suicidal ideation. Based on this, we examined the risk and protective sides of perfectionism on suicidal ideation among college students with perceived academic failure experiences.

METHOD

In the current study, a total of 674 Chinese college students (63.6% females, Mage = 19.96, SD = 1.31) with perceived academic failure in the past six months participated in a survey and completed self-report measures assessing perfectionism, rumination, depression, and suicidal ideation twice with a six-month interval.

RESULTS

Negative perfectionism was a risk factor for suicidal ideation, while positive perfectionism had an opposite effect. In addition, intrusive rumination, deliberate rumination, and depression serially mediated the association between positive/negative perfectionism and suicidal ideation.

CONCLUSION

The results indicated perfectionism has both positive and negative sides to suicidal ideation. Clinicians might be aware of the risk and protective components of perfectionism when intervening with suicidal ideation among college students with perceived academic failure experiences.

Symptoms of a feather flock together? An exploratory secondary dynamic time warp analysis of 11 single case time series of suicidal ideation and related symptoms

Suicidal ideation fluctuates over time, as does its related risk factors. Little is known about the difference or similarities of the temporal patterns. The current exploratory secondary analysis examines which risk symptoms have similar time dynamics using a mathematical algorithm called dynamic time warping (DTW). Ecological momentary assessment data was used of 11 depressed psychiatric outpatients with suicidal ideation who answered three daytime surveys at semi-random sampling points for a period of three to six months. Patients with 45 assessments or more were included. Results revealed significant inter-individual variability in symptom dynamics and clustering, with certain symptoms often clustering due to similar temporal patterns, notably feeling sad, hopelessness, feeling stuck, and worrying. The directed network analyses shed light on the temporal order, highlighting entrapment and worrying as symptoms strongly related to suicide ideation. Still, all patients also showed unique directed networks. While for some patients changes in entrapment directly preceded change in suicide ideation, the reverse temporal ordering was also found. Relatedly, within some patients, perceived burdensomeness played a pivotal role, whereas in others it was unconnected to other symptoms. The study underscores the individualized nature of symptom dynamics and challenges linear models of progression, advocating for personalized treatment strategies.

Ecological momentary assessments of cognitive dysfunction and passive suicidal ideation among college students

Cognitive dysfunction (CD), inclusive of specific cognitive content (e.g., hopelessness, unbearability) or impaired cognitive processes (e.g., attentional fixation on suicide, rumination), is a key risk factor for suicidal ideation (SI). This study aimed to evaluate multiple forms of CD using ecological momentary assessment (EMA) to determine the unique contributions of CD to concurrent and prospective SI. Fifty-five college students with a history of SI or non-suicidal self-injury completed EMA surveys measuring momentary CD and passive SI ("Wish to Die" [WTD], "Wish to Stay Alive" [WTL]) four times a day for 14 days (2149 total observations). Passive SI and CD variables showed notable within-person variability. Multiple CD variables were significant predictors of concurrent ideation when examined simultaneously in multilevel models with random intercepts and fixed slopes, and associations were stronger when participants were around others. Controlling for concurrent passive SI, between-person rumination was a significant predictor of prospective WTD, and both within-person unbearability and between-person hopelessness were each predictive of prospective WTL. These findings provide evidence for the roles of specific types of CD in conferring risk for passive SI and highlight potentially malleable factors that can be changed through targeted interventions.

Suicide-specific rumination as a predictor of suicide planning and intent

BACKGROUND

Suicide-specific rumination (SSR), that is repetitive negative thinking about suicide, has been proposed as a risk factor for suicidal behavior. Yet, few studies have investigated associations between SSR and suicide intent and planning in a longitudinal study design. The purpose of the present study was to investigate the association between SSR, suicide intent, suicide planning and suicide attempts in a sample of adult outpatients undergoing psychotherapy.

METHOD

Data from N = 637 patients (58.4% female, 41.6% male; Mage = 35.81, SDage = 13.50, range: 18-79 years) who started therapy at an outpatient clinic were collected. A subsample of n = 335 patients (n = 335; 56,4% female, 43,6% male; Mage = 35.4, SDage = 13.1, range: 18-73 years) also took part in a post-treatment assessment after twelve therapy sessions.

RESULTS

SSR differentiated lifetime suicide attempters from suicide ideators. Furthermore, SSR was associated with lifetime suicide attempt status above age, sex, suicide ideation, depression, anxiety, and stress. Finally, SSR served as a prospective predictor of both suicide planning and suicide intent.

CONCLUSION

The results emphasize the key role of SSR in understanding the suicidal process.

Examining the relationship between subtypes of rumination and non-suicidal self-injury: A meta-analytic review

INTRODUCTION

Non-suicidal self-injury (NSSI) is a highly prevalent maladaptive behavior, often used to cope with intense negative affect. Rumination is an emotion regulation strategy that leads to fixation on and exacerbation of (typically) negative affective states. However, studies examining the relationship between rumination and NSSI have yielded mixed results, showing high degrees of heterogeneity.

METHODS

The present study conducted meta-analyses (k = 50) of the association between overall rumination and NSSI, and independent meta-analyses for each of four subtypes of rumination (general, depressive, brooding, reflection rumination). Potential moderators that may influence the magnitude of these relationships were also examined.

RESULTS

A small-to-moderate positive association between rumination and NSSI was found independent of rumination subtype. Moderating effects included NSSI outcome measure and study design for overall rumination and general rumination, respectively. Race was found to moderate the relationships between both brooding and depressive rumination and NSSI, though in inverse directions. An analysis of effect heterogeneity across studies suggested that undetected moderators may be present.

CONCLUSION

Results of this study support the relationships between rumination subtypes and NSSI and identify factors that may impact these relationships. Continued research is needed to understand this association, particularly in more varied subtypes of rumination and cognitive-affective moderators.

Multiple paths to rumination within a network analytical framework

Theories of rumination have proposed different psychological factors to place one at risk for repetitive negative thinking. A comprehensive empirical test that captures the most relevant contributors to rumination is lacking. Building on influential self-regulatory and metacognitive frameworks, we modeled how key constructs in this context relate to ruminative thinking. 498 participants completed online questionnaires including indicators of rumination, metacognition, promotion goal orientation, effortful control, and depression. We estimated regularized partial correlation networks to investigate unique associations between the different constructs and followed these analyses up with directed acyclic graphs to identify potential pathways towards rumination. Results demonstrated that: (1) both self-regulatory and metacognitive factors were directly linked to rumination, amongst these were (2) positive beliefs, negative beliefs about uncontrollability and harm, cognitive self-consciousness, depression, effortful control, perfectionism, and (lack of) cognitive confidence, and (3) we identified multiple directed pathways, suggesting three direct contributors to rumination while controlling for the influence of all other variables: diminished effortful control, positive beliefs, and cognitive self-consciousness. This study is the first to comprehensively assess metacognitive and self-regulatory frameworks of rumination in a data-driven manner. Our findings suggest that there are multiple pathways towards rumination, which should be incorporated in clinical case conceptualization of rumination and related disorders.

Stigma, Support, and Ideation About Suicide in Indonesian Twitter: A Topic Modelling Study

Stigma surrounding suicide is a massive problem in Indonesia. Thus, it is important to study how conversations about suicide take place. We take a machine learning approach and study tweets with suicide keywords to understand how people converse about suicide or express suicide ideation. Tweets with suicide-related keywords were extracted from May to June 2023. 20,057 tweets were subject to topic modelling with an 11-topic solution. While most topics contain negative messages, no purely stigmatizing topics emerge, despite prior research suggesting overwhelming stigma. Various kinds of existential, emotional, and social tweets about suicide take place among Indonesian users, indicating that Indonesian Twitter users utilize the platform to express their thoughts and emotions. Notably, religious-spiritual keywords are highly prevalent, suggesting that in a highly religious society, there is a need for policy makers and awareness campaigns to frame their positive messaging within the society's religious context.

Reliability and validity of the Suicide Cognitions Scale-Revised (SCS-R) in emerging adulthood in Turkey

Suicidal thoughts and behaviors (STBs) are a significant public health problem. This study aims to examine the validity and reliability of the Turkish version of the Suicide Cognitions Scale-Revised (SCS-R). Participants (N = 442, age range: 18-29 years) completed the SCS-R, the Beck Depression Inventory, the Inventory of Statements About Self-injury, the Suicide Probability Scale, and the Suicide Rumination Scale. Principal component analysis showed that the SCS-R consisted of a single factor and that the SCS-R could differentiate between participants at high risk and low risk of suicide. High-to-moderate positive associations were found between the measures of depression, suicide probability, suicide rumination, and non-suicidal self-injury and suicide cognition. The Turkish version of the SCS-R has good psychometric properties. This scale can be used to screen for cognitive patterns that are most prone to suicide and to manage such cognitive characteristics, which are important steps for preventive interventions.

Preadolescent Suicidal Thoughts and Behaviors: An Intensive Longitudinal Study of Risk Factors

OBJECTIVE

Dramatic increases in rates of suicidal thoughts and behaviors (STBs) among youth highlight the need to pinpoint early risk factors. This study used intensive longitudinal sampling to assess what the concurrent associations were between risk factors and STB status, how proximal changes in risk factors were related to STB status, and how risk factors prospectively predicted changes in STB status in a preadolescent sample enriched for early childhood psychopathology.

METHOD

A total of 192 participants were included from the Parent-Child Interaction Therapy-Emotional Development (PCIT-ED) Study, a longitudinal study of children with and without preschool depression. Participants 7 to 12 years of age completed a diagnostic interview, followed by 12 months of intensive longitudinal sampling, assessing experiences of suicidal ideation and 11 psychosocial variables with known links to STBs in adolescents and adults. Preadolescents with STB history (high-risk) received surveys weekly, and those without STB history (lower-risk) received surveys monthly.

RESULTS

Female sex, elevated depressive symptoms, greater use of expressive suppression and rumination, emotional clarity, and perceived burdensomeness were uniquely concurrently associated with the likelihood of STB endorsement. Within the high-risk group, (1) increases in depression, expressive suppression, rumination, and perceived burdensomeness, and decreases in positive affect from weekt to weekt+1 were associated with a higher likelihood of a positive STB status at weekt+1; and (2) higher expressive suppression, perceived burdensomeness, and caregiver criticism and conflict at weekt compared to participants' mean levels prospectively predicted increases in the likelihood of a positive STB report from weekt to weekt+1.

CONCLUSION

Psychosocial factors influencing STBs in adolescents and adults also affect preadolescents in day-to-day life. Expressive suppression and perceived burdensomeness consistently emerged as novel risk indicators and potential targets for treatment. In addition, increases in depression, rumination, and caregiver criticism and conflict, as well as decreases in positive affect, might prompt heightened STB screening and assessments for preadolescents with a history of STBs.

Comparing Ruminative and Distracting Responses and Emotion Regulation Difficulties in Early Community Adolescents With and Without Self-Harm

Objectives

This study aimed to compare the demographic characteristics, responses to negative emotions, and difficulties in emotion regulation between self-harming adolescents and control individuals aged 12-14 years from the community.

Methods

Data were collected from adolescents in Chungcheong Province, South Korea, between September 2021 and November 2022. Demographic characteristics and responses to the Depressed Mood Questionnaire and Difficulties in Emotion Regulation Scale-16 (DERS-16) were compared between the self-harm and control groups.

Results

The self-harm group exhibited a higher prevalence of child abuse (odds ratio [OR]=4.787, 95% confidence interval [CI]=1.591-14.409, p=0.005) and school bullying victimization (OR=4.495, 95% CI=2.353-8.588, p<0.001) than those in the control group. The selfharm group displayed higher levels of rumination (t=7.88, p<0.001) and reduced distraction responses (reverse score t=2.25, p=0.025) than those of the control group. Additionally, the self-harm group scored higher on all subscales and the total DERS-16 score (t=7.61, p<0.001).

Conclusion

Interventions for self-harming adolescents should address child abuse and bullying victimization. Prevention programs for self-harming adolescents should focus on reducing rumination responses, increasing distractive responses, and addressing difficulties in emotion regulation using dialectical behavior therapy-skill training.

Repetitive negative thinking as a unique transdiagnostic risk factor for suicidal ideation

Repetitive negative thinking (RNT) is a transdiagnostic symptom observed across mood and anxiety disorders and is characterized by frequent, distressing thoughts that are perceived as uncontrollable. Specific forms of RNT have been linked to increased suicide risk. However, most work examining links between RNT and suicide has been conducted within specific disorders and subtypes of RNT (e.g., rumination in individuals with depression). The present study aimed to investigate associations between transdiagnostic RNT and suicidal ideation. We hypothesized RNT would be associated with suicide risk beyond disorder-specific clinical symptoms. Fifty-four participants with mood, anxiety, and/or traumatic stress disorders completed an interview assessing suicidal risk (Columbia-Suicide Severity Rating Scale (C-SSRS)) and self-report questionnaires assessing transdiagnostic RNT, depression, and anxiety. Based on C-SSRS, we divided participants into high or low suicide risk groups. We analyzed the relationship between suicidal risk group and RNT and found that RNT was uniquely associated with suicidal risk group, controlling for depression and anxiety severity. Our results suggest including assessments of RNT may have clinical utility for understanding the degree of suicide risk in individuals and point to the potential utility of including clinical interventions to target this symptom for those at high risk of suicide.

Internalizing and Externalizing Symptoms Moderate the Relationship Between Emotion Dysregulation and Suicide Ideation in Adolescents

The relationship between emotion dysregulation and suicide ideation may depend on the level of internalizing and externalizing symptoms. It was expected that both internalizing and externalizing symptoms would moderate the relationship between emotion dysregulation and suicide ideation, such that greater symptoms would strengthen the relationship between emotion dysregulation and suicide ideation. Adolescent participants (n = 559, Mage = 15.40, 85.0% white, 57.2% female) completed self-report measures that assessed emotion dysregulation, internalizing and externalizing symptoms, and recent suicide ideation. Both internalizing and externalizing symptoms moderated the relationship between emotion dysregulation and suicide ideation; this relationship strengthened as internalizing and externalizing symptoms increased. The results of this study indicate that internalizing and externalizing symptoms may both affect the connection between emotion dysregulation and suicide ideation. Future research should focus on targeting both internalizing and externalizing symptoms in treatment to help reduce emotion dysregulation and suicide ideation in adolescents.

Perseveration on suicidal thoughts and images in daily life: An examination of the cognitive model of suicide through a dynamic systems lens

According to the cognitive model of suicide, interactions between hopelessness and attentional biases toward suicidal information create a narrowed attentional focus on suicide as a viable solution, particularly in the presence of life stress, leading to increased suicide risk. This study used a dynamic systems approach to examine the short-term temporal patterns between stress, hopelessness, suicide-specific rumination, and suicidal intent. Adults (N = 237; M = 27.12 years; 62% cisgender women; 87% White/European American) with elevated suicidal ideation completed ecological momentary assessments six times a day for 14 days. A multilevel model approach informed by dynamic systems theory was used to simultaneously assess stable and dynamic temporal processes underlying perceived stress, hopelessness, suicide-specific rumination, and suicidal intent. Each variable demonstrated temporal stability. In support of the cognitive model of suicide, we observed (1) a reciprocal relationship between stress and hopelessness such that stress and hopelessness amplified each other (early-stage processes), and (2) reinforcing loops such that hopelessness, suicide-specific rumination, and suicidal intent amplified each other (later-stage processes). A dynamic systems modeling approach underscored the negative impact of a perpetuating cycle of suicide-specific rumination, deepening hopelessness, and escalating suicidal intent on increasing suicide risk, which may be targets for intervention.

Daily Levels and Dynamic Metrics of Affective-Cognitive Constructs Associate With Suicidal Thoughts and Behaviours in Adults After Psychiatric Hospitalization

The period after psychiatric hospitalization is an extraordinarily high-risk period for suicidal thoughts and behaviours (STBs). Affective-cognitive constructs (ACCs) are salient risk factors for STBs, and intensive longitudinal metrics of these constructs may improve personalized risk detection and intervention. However, limited research has examined how within-person daily levels and between-person dynamic metrics of ACCs relate to STBs after hospital discharge. Adult psychiatric inpatients (N = 95) completed a 65-day ecological momentary assessment protocol after discharge as part of a 6-month follow-up period. Using dynamic structural equation models, we examined both within-person daily levels and between-person dynamic metrics (intensity, variability and inertia) of positive and negative affect, rumination, distress intolerance and emotion dysregulation as risk factors for STBs. Within-person lower daily levels of positive affect and higher daily levels of negative affect, rumination, distress intolerance and emotion dysregulation were risk factors for next-day suicidal ideation (SI). Same-day within-person higher rumination and negative affect were also risk factors for same-day SI. At the between-person level, higher overall positive affect was protective against active SI and suicidal behaviour over the 6-month follow-up, while greater variability of rumination and distress intolerance increased risk for active SI, suicidal behaviour and suicide attempt. The present study provides the most comprehensive examination to date of intensive longitudinal metrics of ACCs as risk factors for STBs. Results support the continued use of intensive longitudinal methods to improve STB risk detection. Interventions focusing on rumination and distress intolerance may specifically help to prevent suicidal crises during critical transitions in care.

Yoga classes as an early intervention for college students reporting high levels of stress and anxiety: A pilot study

Background:Today's college students are experiencing unprecedented rates of stress, anxiety, and mental health issues. As a result, college counseling centers are often overwhelmed by the demand for mental health services. Methods: The current study evaluated the potential for Hatha yoga classes to be used as an alternative to conventional psychotherapy for college students reporting high levels of stress and anxiety. Results: After 6 weeks of twice-weekly, hour-long yoga classes, significant reductions in stress, anxiety, pathological worry, and rumination were reported by 7 undergraduate college students. Conclusions: Results of this pilot study suggest that Hatha yoga classes may serve as a widely accessible, cost-effective early intervention that can be offered as a first-line recommendation to students who are struggling with heightened levels of stress and anxiety.

The Suicide Dot Probe Task: Psychometric properties and validity in relation to suicide-related outcomes

BACKGROUND

Attentional biases to suicide-related stimuli have been linked to suicide-related outcomes. However, behavioral tasks that have been previously modified to capture suicide-specific attentional biases have demonstrated inconsistent reliability and validity. Adaptation of the Dot Probe Task, a computerized assessment that has been adapted to study a wide variety of biases, may be a promising candidate for assessing suicide-specific biases.

METHODS

In 280 recently discharged inpatients (51% male; Mage  = 40.22 years), we evaluated the psychometric properties of a modified Suicide Dot Probe Task. Participants completed this task and assessments of suicidal thoughts and behaviors at baseline and 6-month follow-up.

RESULTS

The Suicide Dot Probe Task demonstrated poor-to-moderate internal consistency and poor test-retest reliability, and participant response times were slower to suicide-specific and dysphoric stimuli than positive stimuli. However, there were no differences based on the presence or characteristics of recent or lifetime suicidal ideation or attempts. Participants' suicide-specific biases were not predictive of suicidal ideation or attempts at follow-up.

CONCLUSIONS

The Suicide Dot Probe Task exhibited questionable reliability, and differences in attentional biases were not associated with suicidal ideation or attempts. This study contributes to a body of research demonstrating the questionable utility of several behavioral tasks to study suicide-specific attentional biases.

The effect of cyberbullying victimization and traditional bullying victimization on suicidal ideation among Chinese female college students: The role of rumination and insomnia

BACKGROUND

The issue of college student suicide has emerged as a significant global public health concern. To date, there has been a lack of extensive research on the effects of distinct forms of bullying victimization (traditional bullying victimization and cyberbullying victimization) on suicidal ideation, as well as the differences between them. The present study aimed to investigate the relationship between two forms of bullying victimization and suicidal ideation among female college students, while also considering the potential mediating effects of rumination and insomnia.

METHODS

A total of 2106 female college students from Southern China participated in this study. The participants had a mean age of 19.83 years (SD = 1.04 years). Participants completed the MINI-C questionnaire, School Bullying Behavior Questionnaire, Cyberbullying Inventory (CBI), Ruminative Responses Scale (RRS), and Insomnia Severity Index (ISI). The mediation models were conducted using Model 4 and Model 6 of the Process macro program in SPSS.

RESULTS

The results showed that (1) the mediating effect of rumination in the relationship between different forms of bullying victimization and suicidal ideation was significant; (2) The mediating effect of insomnia in the relationship between traditional bullying victimization and suicidal ideation was not significant; the mediating effect between cyberbullying victimization and suicidal ideation was significant. (3) The chain mediating effect of rumination and insomnia in the relationship between different forms of bullying victimization and suicidal ideation were both significant.

CONCLUSION

This study endeavor represents the first attempt to investigate the relationship between two forms of bullying victimization and suicidal ideation.

The relationship between sleep and suicidality in schizophrenia spectrum and other psychotic disorders: A systematic review

Individuals with Schizophrenia Spectrum Disorders (SSDs) have significantly higher rates of suicidal thoughts, attempts, and death by suicide in comparison to the general population. Sleep disturbances (reduced duration, timing and quality of sleep) are risk factors for suicidality in the general population, with research indicating the relationship is both immediate and accumulative. Sleep disturbances are also considered to be implicated in the onset and exacerbation of psychotic symptoms in SSDs. Reducing the risk of suicidality in SSDs remains an important public health priority, thus exploration of contributing risk factors is warranted. Sleep monitoring may also offer an adjunct risk monitoring method to suicidality assessments in SSDs, and a potential treatment target for psychotic symptoms. This review aimed to explore proximal and longitudinal relationships between self-reported and objectively measured sleep and suicidality in SSDs and other psychotic disorders. A comprehensive search of four databases was conducted. Eleven studies met the inclusion criteria (10 cross sectional and 1 longitudinal). Narrative synthesis indicated that self-reported sleep disturbances and sleep disorders (e.g. insomnia) were associated with increased risk of suicidal ideation and attempt. However, one study employing polysomnography did not find sleep to be associated with suicidality. Methodological limitations of the evidence base include: i) little experimental or longitudinal evidence, (ii) self-report and/or single item assessment of sleep disturbance, (iii) limited use of validated measures of suicidality, (iv) considerable research in long-term schizophrenia but sparse evidence in early psychosis. Future research should explore (i) cross-sectional and longitudinal relationships between specific aspects of suicidality and objective sleep parameters, (ii) use qualitative or mixed-methods designs to disentangle the nuances and bidirectionality in the sleep-suicide relationship, (iii) explore the psychological processes underpinning or mediating the sleep-suicide relationship in SSDs.

Non-suicidal self-injury and suicidal ideation among adolescents: the chain-mediating role of rumination and decentering

Objective

To explore the relationship between non-suicidal self-injury and suicidal ideation in adolescents and examine the roles of rumination and decentering in that relationship.

Method

By means of a questionnaire, 175 adolescent patients in a psychiatric hospital in Fujian Province were given the Functional Assessment of Self-Mutilation: Chinese Version, Positive and Negative Suicide Ideation, Ruminative Response Scale: Chinese Version, and Experiences Questionnaire: Decentering Scale.

Results

(1) Adolescent non-suicidal self-injury was significantly positively related to suicidal ideation and rumination and significantly negatively related to decentering. Suicidal ideation was significantly positively related to rumination and significantly negatively related to decentering. Rumination was significantly negatively related to decentering. (2) Rumination and decentering played a complete chain-mediating role between non-suicidal self-injury and suicidal ideation. Non-suicidal self-injury was found to indirectly affect suicidal ideation along three pathways: the independent mediating role of rumination (the mediating effect accounted for 40.166%), independent mediating role of decentering (the mediating effect accounted for 41.274%), and chain-mediating role of rumination and decentering (the mediating effect accounted for 14.958%).

Conclusion

Adolescent non-suicidal self-injury can indirectly affect suicidal ideation through rumination and decentering. In the future, mindfulness and other methods should be used to improve individuals' levels of decentering and cultivate emotional regulation abilities, so as to reduce the incidence of non-suicidal self-injury and suicide in adolescents.

Understanding the Broader Impact of Stuttering: Suicidal Ideation

PURPOSE

Suicide and suicidal ideation are topics that have a long but limited history in stuttering research. Clinicians and clinical researchers have discussed personal and therapeutic experiences with clients who have attempted suicide, died by suicide, or struggled with suicidal thoughts. This study sought to (a) explore the occurrence of suicidal ideation in a sample of adults who stutter; (b) evaluate the relationship between adverse impact related to stuttering and suicidal ideation; and (c) document respondents' thoughts related to suicide, stuttering, and their intersection.

METHOD

One hundred forty adults who stutter completed the Suicide Behavior Questionnaire-Revised (SBQ-R). Of these, 70 participants completed the Perseverative Thinking Questionnaire (PTQ), and 67 completed the Overall Assessment of the Speaker's Experience of Stuttering (OASES). Participants who indicated at least some tendency for suicidal thoughts on the SBQ-R (n = 95) were then asked a set of follow-up questions to explore their experiences of suicidal ideation related to stuttering.

RESULTS

Quantitative data indicated that the majority of adults who reported experiencing suicidal ideation associated these experiences with stuttering (61.2%, n = 59). Individuals with higher Total Scores on the PTQ and OASES were predicted to experience significantly higher rates of suicidal ideation and, in particular, a higher likelihood of having more frequent suicidal ideation in the past year. Qualitative analyses revealed that suicidal ideation intersects meaningfully with the experience of stuttering.

CONCLUSIONS

Data from this study highlight the importance of considering broader life consequences of stuttering that some adults may experience, including suicidal ideation. By being cognizant that clients may develop such thoughts, speech-language pathologists can play a valuable role in identifying and providing necessary support for at-risk individuals.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23699688.

Testing the longitudinal relationship between muscle dysmorphia symptoms and suicidality: A network analysis investigation

Research on suicidality in muscle dysmorphia is limited despite the high rates of suicidal thoughts and behaviors in related disorders. This study employed network analysis to examine the longitudinal relationships between muscle dysmorphia symptoms, as well as the relations between MD symptoms and suicide risk factors. Fifty individuals (Mage = 30.6 years, 63 % male) meeting criteria for muscle dysmorphia received four daily surveys for three weeks. Multi-level vector autoregression analysis was used to estimate associations between muscle dysmorphia- and suicide-related thoughts, emotions, and behaviors. The most central nodes in the muscle dysmorphia networks related to assessing muscle size, dieting, using muscle-building supplements, experiencing body dissatisfaction, seeking reassurance, and avoiding others due to concerns about appearance. In the comorbidity networks, the most central suicide-related factors were feelings of burdensomeness, feeling disgusted, and dwelling on the past. Our findings indicated that various intrusive thoughts (body dissatisfaction, dieting), compulsions (seeking reassurance, body checking, supplement use), and beliefs (burden to others, disgust with oneself) predicted future engagement in muscle dysmorphia and suicide-related symptomology. Targeting intrusive thoughts and compulsions, as well as feelings of disgust and burdensomeness, may reduce the severity of these conditions.

Future-oriented repetitive thought, depressive symptoms, and suicide ideation severity: Role of future-event fluency and depressive predictive certainty

BACKGROUND

Knowing how future-oriented repetitive thought - i.e., repeated consideration of whether positive or negative outcomes will happen in one's future - leads to hopelessness-related cognitions may elucidate the role of anticipating the future in depressive symptoms and suicide ideation. This study examined future-event fluency and depressive predictive certainty - i.e., the tendency to make pessimistic future-event predictions with certainty - as mechanisms explaining the relation between future-oriented repetitive thought, depressive symptoms, and suicide ideation.

METHODS

Young adults (N = 354), oversampled for suicide ideation or attempt history, completed baseline measures of pessimistic future-oriented repetitive thought (i.e., the degree to which people consider whether negative outcomes will happen or positive outcomes will not happen in their futures), future-event fluency, depressive predictive certainty, depressive symptoms, and suicide ideation severity and were followed up 6 months later (N = 324).

RESULTS

Pessimistic future-oriented repetitive thought predicted depressive predictive certainty at 6-months, partially mediated by lower positive but not increased negative future-event fluency. There was an indirect relationship between pessimistic future-oriented repetitive thought and 6-month suicide ideation severity via 6-month depressive predictive certainty through 6-month depressive symptoms, and also via 6-month depressive symptoms (but not depressive predictive certainty) alone.

LIMITATIONS

Lack of an experimental design limits inferences about causality, and a predominantly female sample may limit generalizability by sex.

CONCLUSION

Clinical interventions should address pessimistic future-oriented repetitive thought - and its impact on how easily people can think about positive future outcomes - as one potential way to reduce depressive symptoms and, indirectly, suicide ideation.

Prospective Relation between Ruminative Subtypes and Suicide Ideation: Moderating Role of Problem Solving

Background

Although reflection has been characterized as a more adaptive subtype of rumination than brooding, evidence suggests that reflection is associated with suicide ideation. The present longitudinal study investigated the mediating role of hopelessness and depressive symptoms and the moderating role of problem solving in explaining why reflection may lead to suicide ideation.

Methods

Two hundred ninety-four undergraduates participated in the study and were followed up every 6 months over 18 months. Participants completed measures of brooding and reflection, hopelessness, depressive symptoms, problem solving, and suicide ideation.

Results

Results revealed that after adjusting for baseline suicide ideation, the serial mediation path from brooding (but not reflection) to suicide ideation via hopelessness and depressive symptoms was significant. Baseline reflection predicted suicide ideation 18 months later through depressive symptoms at 12 months for people average in passive problem solving, and for those low or average in active problem solving. Brooding predicted suicide ideation through depressive symptoms, regardless of problem-solving.

Conclusions

Reflection may result in suicide ideation via depressive symptoms among people with poor problem-solving skills. Clinical and theoretical implications are discussed.

Relationships between internalized stigma and depression and suicide risk among queer youth in the United States: a systematic review and meta-analysis

Background

Queer youth experience high rates of depression and suicidality. These disparities stem from stigma-based stressors, including internalized stigma (i.e., negative social views that minoritized individuals internalize about their own identity). Given the importance of this factor in understanding mental health disparities among queer youth, we completed a systematic review and meta-analysis examining the relationships between internalized stigma and outcomes of depression and suicide risk (i.e., suicidal ideation, non-suicidal self-injury, and suicidal behavior).

Methods

We followed the PRISMA standards. Six bibliographic databases were searched for studies in the United States from September 2008 to March 2022. Dual independent screening of search results was performed based on a priori inclusion criteria.

Results

A total of 22 studies were included for data extraction and review. Most studies examined general internalized homophobia, with few examining internalized biphobia or transphobia. Many studies examined depression as an outcome, few studies examined suicidal ideation or behavior, and no studies examined non-suicidal self-injury. Meta-analyses model results show the association between general internalized queer stigma and depressive symptoms ranged r = 0.19, 95% CI [0.14, 0.25] to r = 0.24, 95% CI [0.19, 0.29], the latter reflecting more uniform measures of depression. The association between internalized transphobia and depressive outcomes was small and positive (r = 0.21, 95% CI [-0.24, 0.67]). General internalized queer stigma and suicidal ideation had a very weak positive association (r = 0.07, 95% CI [-0.27, 0.41]) and an even smaller, weaker positive association with suicide attempt (r = 0.02, 95% CI [0.01, 0.03]).

Conclusion

Implications for clinical practice, policy, and future research are discussed.

Prevalence and correlates of suicidal behaviours in a representative epidemiological youth sample in Hong Kong: the significance of suicide-related rumination, family functioning, and ongoing population-level stressors

BACKGROUND

Young people are most vulnerable to suicidal behaviours but least likely to seek help. A more elaborate study of the intrinsic and extrinsic correlates of suicidal ideation and behaviours particularly amid ongoing population-level stressors and the identification of less stigmatising markers in representative youth populations is essential.

METHODS

Participants (n = 2540, aged 15-25) were consecutively recruited from an ongoing large-scale household-based epidemiological youth mental health study in Hong Kong between September 2019 and 2021. Lifetime and 12-month prevalence of suicidal ideation, plan, and attempt were assessed, alongside suicide-related rumination, hopelessness and neuroticism, personal and population-level stressors, family functioning, cognitive ability, lifetime non-suicidal self-harm, 12-month major depressive disorder (MDD), and alcohol use.

RESULTS

The 12-month prevalence of suicidal ideation, ideation-only (no plan or attempt), plan, and attempt was 20.0, 15.4, 4.6, and 1.3%, respectively. Importantly, multivariable logistic regression findings revealed that suicide-related rumination was the only factor associated with all four suicidal outcomes (all p < 0.01). Among those with suicidal ideation (two-stage approach), intrinsic factors, including suicide-related rumination, poorer cognitive ability, and 12-month MDE, were specifically associated with suicide plan, while extrinsic factors, including coronavirus disease 2019 (COVID-19) stressors, poorer family functioning, and personal life stressors, as well as non-suicidal self-harm, were specifically associated with suicide attempt.

CONCLUSIONS

Suicide-related rumination, population-level COVID-19 stressors, and poorer family functioning may be important less-stigmatising markers for youth suicidal risks. The respective roles played by not only intrinsic but also extrinsic factors in suicide plan and attempt using a two-stage approach should be considered in future preventative intervention work.

Negative association between non-suicidal self-injury in adolescents and default mode network activation during the distraction blocks of a rumination task

INTRODUCTION

Rumination, or repetitive and habitual negative thinking, is associated with psychopathology and related behaviors in adolescents, including non-suicidal self-injury (NSSI). Despite the link between self-reported rumination and NSSI, there is limited understanding of how rumination is represented at the neurobiological level among youth with NSSI.

METHOD

We collected neuroimaging and rumination data from 39 adolescents with current or past NSSI and remitted major depression. Participants completed a rumination induction fMRI task, consisting of both rumination and distraction blocks. We examined brain activation associated with total lifetime NSSI in the context of the rumination versus distraction contrast.

RESULTS

Lifetime NSSI was associated with a greater discrepancy in activation during rumination relative to distraction conditions in clusters including the precuneus, posterior cingulate, superior, and middle frontal gyrus, and cerebellum.

CONCLUSION

Difficulties associated with rumination in adolescents with NSSI may be related to requiring greater cognitive effort to distract from ruminative content in addition to increased attention in the context of ruminative content. Increasing knowledge of neurobiological circuits and nodes associated with rumination and their relationship with NSSI may enable us to better tailor interventions that can facilitate lasting well-being and neurobiological change.

Structural and functional brain correlates of suicidal ideation and behaviors in depression: A scoping review of MRI studies

Identifying and integrating the neural correlates of suicidal ideation and behaviors is crucial to expand the knowledge and develop targeted strategies to prevent suicide. This review aimed to describe the neural correlates of suicidal ideation, behavior and the transition between them, using different magnetic resonance imaging (MRI) modalities, providing an up-to-date overview of the literature. To be included, the observational, experimental, or quasi-experimental studies must include adult patients currently diagnosed with major depressive disorder and investigate the neural correlates of suicidal ideation, behavior and/or the transition using MRI. The searches were conducted on PubMed, ISI Web of Knowledge and Scopus. Fifty articles were included in this review: 22 on suicidal ideation, 26 on suicide behaviors and two on the transition between them. The qualitative analysis of the included studies suggested alterations in the frontal, limbic and temporal lobes in suicidal ideation associated with deficits in emotional processing and regulation, and in the frontal, limbic, parietal lobes, and basal ganglia in suicide behaviors associated with impairments in decision-making. Gaps in the literature and methodological concerns were identified and might be addressed in future studies.

Correlates of Suicide Among Middle and High School Students in Ghana

PURPOSE

We know little about the epidemiology of suicide among middle school students in Ghana, including the years preceding high school. This study explores the onset, characteristics, and recent patterns of suicide among Ghanaian middle and high school students.

METHODS

This study used the World Health Organization Global School-based Student Health Survey (GSHS, 2012), which has self-reported measures on suicide ideation, plan, and attempt of middle and high school students in Ghana. Correlation and logistic regression analyses were performed using Statistical Package for the Social Sciences (SPSS version 25).

RESULTS

The study found prevalence of suicidal behaviors among the population as follows: ideation (19%), plan (22%), and attempt (25%). Suicide ideation significantly increased the risk for suicide plan (odds ratio [OR] = 9.14; 95% confidence interval [CI] = 7.57-11.02) and attempt (OR = 11.89; 95% CI = 9.82-14.38), whereas suicide plan significantly increased the odds of suicide attempt (OR = 12.64; 95% CI = 10.50-15.19). There was a higher prevalence of suicide ideation, plan, and attempts among middle school students than high school students although only suicide attempt differences were significant (28.4% > 22.3%; χ² = 17.1, p < .001).

DISCUSSION

The onset of suicide among Ghanaian students occurs at younger ages than previously thought, and there were increasing trends in suicide behaviors as age increases. This finding highlights a potential suicide crisis among preteens, which warrants attention. Additional studies are needed to observe these increasing trends, identify risk, protective, and precipitating factors to help prevent suicide among these children.

Interpersonal and intrapersonal predictors of suicidal thoughts and actions in first-year college students

OBJECTIVE

The aim was to determine the unique predictors of suicide risk in first-year college students.

PARTICIPANTS

First-year students (N = 665) at a Midwestern university participated.

METHODS

An online survey assessed Joiner's interpersonal factors (i.e., thwarted belongingness, perceived burdensomeness, and acquired capability) as well as intrapersonal factors (i.e., perfectionism, self-compassion, emotional intelligence/reactivity, and growth mindset) often associated with suicidal thoughts and actions.

RESULTS

Linear regression indicated that the factor set significantly predicted thoughts, F (12, 632) = 114.90, p < .000, R² = .680, and actions, F (12, 632) = 58.42, p < .000, R² = .526. Perceived burdensomeness, acquired capability, and underrepresented sexual orientation were positive predictors of both thoughts and actions, whereas growth mindset was a negative predictor of thoughts and stressful life events was a positive predictor of actions.

CONCLUSION

The results offer direction for evidence-informed interventions aimed at reducing suicide risk in first-year college students.

Metacognitions about suicidal thoughts

BACKGROUND

Rumination about suicide has recently been identified as a risk factor for suicidal behavior. According to the metacognitive model of emotional disorders, the activation and maintenance of rumination is dependent on specific metacognitive beliefs. On this background, the current study is concerned with the development of a questionnaire to assess suicide-specific positive and negative metacognitive beliefs.

METHODS

Factor structure, reliability and validity of the Scales for Suicide-related Metacognitions (SSM) were investigated in two samples comprised of participants suffering from lifetime suicide ideation. Participants of sample 1 (N = 214; 81.8% female; M_age = 24.9, SD_age = 4.0) took part in a single assessment using an online survey. Participants of sample 2 (N = 56; 71.4% female; M_age = 33.2, SD_age = 12.2) took part in two online assessments within a two week time-period. To establish convergent validity questionnaire-based assessments of suicidal ideation, general and suicide specific rumination and depression were used. Furthermore, it was analyzed whether suicide-related metacognitions predict suicide-specific rumination cross-sectionally and prospectively.

RESULTS

Factor analyses revealed a two-factor structure of the SSM. Results indicated good psychometric properties, and provided evidence for construct validity and stability of the subscales. Positive metacognitions predicted concurrent and prospective suicide-specific rumination beyond the effect of suicide ideation and depression and rumination predicted concurrent and prospective negative metacognitions.

CONCLUSION

Taken together the results provide initial evidence that the SSM is a valid and reliable measure of suicide-related metacognitions. Furthermore, findings are in line with a metacognitive conceptualization of suicidal crises and provide first indications of factors that might be relevant for the activation and maintenance of suicide-specific rumination.

Moderating roles of grit and locus of control on rumination and suicidality

Cognitive factors constitute an important risk factor to the development of suicidal thoughts and behaviors (STBs). Engaging in depressive and anger rumination are uniquely associated with elevated vulnerabilities to STBs. Variations in attentional focus and control may further modify the impacts of rumination. For one, grit resembles the inflexible thinking patterns inherent in rumination, potentially contributing to one's capability of persisting in carrying out suicidal behaviors despite fears of pain or death. In the context of rumination, locus of control may alter the perspectives to which individuals attribute negative experiences. The current study examines the moderating roles of grit and locus of control on the impact of depressive and anger rumination on suicidality. Participants (N = 322) completed a battery of self-report questionnaires measuring depressive rumination, anger rumination, grit, locus of control, and suicidal history (a history of suicidal ideation, history of suicidal attempts, or neither). Using hierarchical multinomial logistic regression in R, results revealed that, as opposed to working together, the proposed variables are more independently informative in distinguishing those with a history of suicidal ideation, suicidal attempts, or neither. Findings provide unique contribution to the suicide literature pertaining to how individuals may perceive of their own internal locus of control and grit following suicidal thoughts and beliefs. Clinical implications and future directions are provided as recommendations in line with current findings.

Minority stress, repetitive negative thinking, and internalizing symptoms in sexual minorites: Does cognitive content matter?

BACKGROUND

The Psychological Mediation Framework theorizes that repetitive negative thinking (RNT) mediates the relationship between minority stress and mental health, and this theory has been consistently supported by previous research. Yet, it is unclear whether the process or content of RNT is more important in the development of internalizing symptoms in sexual minorities. Consequently, the goal of the current study was to use structural equation modeling to determine whether there are significant indirect effects of repetitive negative thought content in the relationship between minority stress and internalizing psychopathology.

METHODS

Measures of RNT, internalizing symptoms, and proximal minority stress were completed online by 205 cisgender sexual minority adults. Structural equation modeling was used to examine indirect effects of proximal stress on internalizing symptoms through content-independent RNT, depressive rumination, and sexual orientation-related rumination.

RESULTS

Significant direct effects of proximal minority stress on internalizing symptoms were observed. Indirect effects of proximal stress on internalizing symptoms were observed for content-independent RNT and depressive rumination, but not sexual orientation-related rumination.

CONCLUSIONS

The current study provides evidence that the process and affective valence of RNT contributes more to internalizing symptoms in sexual minorities when compared with sexual orientation-related content. Theoretical and clinical implications are discussed.

Factor Structure and Validation of the Revised Suicide Crisis Inventory in a Korean Population

OBJECTIVE

Because of the exceptionally high suicide rates in South Korea, new assessment methods are needed to improve suicide prevention. The current study aims to validate the revised Suicide Crisis Inventory-2 (SCI-2), a self-report measure that assesses a cognitiveaffective pre-suicidal state in a Korean sample.

METHODS

With data from 1,061 community adults in South Korea, confirmatory factor analyses were first conducted to test the proposed one-factor and five-factor structures of the SCI-2. Also, an exploratory factor analysis (EFA) was performed to examine possible alternative factor structure of the inventory.

RESULTS

The one-factor model of the SCI-2 resulted in good model fit and similarly, the five-factor model also exhibited strong fit. Comparing the two models, the five-factor was evaluated as the superior model fit. An alternative 4-factor model derived from EFA exhibited a comparable model fit. The Korean version of the SCI-2 had high internal consistency and strong concurrent validity in relation to symptoms of suicidal ideation, depression, and anxiety.

CONCLUSION

The SCI-2 is an appropriate and a valid tool for measuring one's proximity to imminent suicide risk. However, the exact factor structure of the SCI-2 may be culture-sensitive and warrants further study.

Nonsuicidal self-injury and rumination: A meta-analysis

Trait rumination is the tendency to overthink and focus on negative emotions and events and is related to a number of psychological disorders and maladaptive behaviors including nonsuicidal self-injury (NSSI). The purpose of this study was to conduct a meta-analysis of the relationship between trait rumination and NSSI behaviors. Results from 60 samples showed small effect sizes between trait rumination and NSSI engagement, NSSI frequency, and the number of methods used to self-injure in cross-sectional samples. Results from 13 samples showed small effect sizes between trait rumination and NSSI engagement and NSSI frequency in longitudinal samples. Moderator analyses indicated that this relationship is similar whether the type of rumination is depressive or not and is generally consistent across different ages, genders, and ethnicities. These results help clarify the role of trait rumination as a risk factor for NSSI.

Childhood maltreatment influences suicidal behavior: Rumination mediates and regulatory emotional self-efficacy moderates

To investigate the mediating role of rumination in the association between childhood maltreatment and suicidal behavior, and the moderating role of regulatory emotional self-efficacy, university students (N = 1,458) from 5 universities in China completed questionnaires in classrooms. Path analyses showed emotional maltreatment had the greatest positive association with suicidal behavior and rumination compared with other types of childhood maltreatment. Rumination partly mediated the relationship between childhood maltreatment and suicidal behavior. High regulatory emotional self-efficacy moderated the relation between ruminating childhood maltreatment and suicidal behavior.

An Integrated Conceptual Model to Understand Suicidality among Queer Youth to Inform Suicide Prevention

In this article, we apply and combine elements from four theoretical frameworks (i.e., Minority Stress Theory, Person-in-Environment and Risk and Resilience Framework, Interpersonal-Psychological Theory of Suicide, and Intersectionality) to explain the problem of queer youth suicide through our integrated conceptual model, Queer Prevention of Youth Suicidality Model (Queer-PRYSM). The need for this conceptual model is based on the current state of the literature, including mixed empirical findings on factors related to queer youth suicidality, no scholarly consensus on specific contributing factors regarding high rates of suicidality among queer youth (including queer youth subgroups), and the absence of a unifying theory to explain the queer youth suicide risk. To address these limitations in theory, evidence, and scholarship explaining suicidality among queer youth we present our integrated model with growing, current, relevant research with queer youth. Queer-PRYSM includes minority stressors specific to queer youth, mental health problems, interpersonal-psychological factors, socioecological factors (i.e., family, school, peers, and community), and intersectionality concepts. Queer-PRYSM is essential to understanding the relationship of distal and proximal risk and protective factors in queer youth suicide and developing evidence-informed suicide preventive interventions that can be incorporated into practice, policy, and system structures.

Moderating role of coping in the association between minority stress and suicidal ideation and suicide attempts among sexual and gender minority young adults

OBJECTIVE

This study examined associations of minority stressors (i.e., victimization, internalized homonegativity, and stigma consciousness), and coping styles (i.e., active, avoidant, and passive) with suicidal ideation and suicide attempts (suicidality) among sexual and gender minority (SGM) young adults, and whether coping style moderated these associations.

METHODS

Logistic regression analyses examined these associations among 1432 SGM young adults (ages 18-29).

RESULTS

Minority stressors and passive coping were associated with a higher likelihood of suicidality. Avoidant coping was associated with a lower likelihood of lifetime suicidal ideation and attempts among sexual minority participants, and active coping with a lower likelihood of past-year suicidal ideation among sexual minority participants. Moderation analyses among sexual minority participants showed that when avoidant coping was high, associations between low victimization (compared with no victimization) and lifetime suicide attempts, and stigma consciousness and lifetime suicide attempts became non-significant, and the association between internalized homonegativity and lifetime suicide attempts became significant. Among gender minority participants, when passive coping was high the association between low victimization and lifetime suicidal ideation became significant.

CONCLUSION

This study underlines the importance of minority stress and coping for suicidality among SGM young adults and the need for more research regarding the role of coping.

Sexual compulsivity, erectile dysfunction, and suicidality among male survivors of military sexual violence

Although military sexual trauma (MST) is associated with an increased risk of suicide, suicide attempts, and suicidal ideation among service members and veterans, there is limited knowledge regarding the mechanisms of MST and suicidality among men. The current study examined whether MST was associated with sexual compulsivity and/or erectile dysfunction and if these, in turn, explained elevated suicidal thoughts and the likelihood of engaging in future suicidal behavior after accounting for mental health, military, and demographic characteristics. Service members and veterans who reported their gender as male (N = 508) were recruited via social media and completed online self-report measures assessing MST, erectile dysfunction, sexual compulsivity, suicidal ideation frequency, and the likelihood of engaging in future suicidal behavior. Path analysis was used to examine the study hypotheses. In total, 67 participants (13.2%) reported a history of MST; of these individuals, 27 (40.3%) reported suicidal ideation in the past 12 months, and 29 (43.9%) reported an increased likelihood of engaging in future suicidal behavior. MST was associated with increased sexual compulsivity, which, in turn, predicted more frequent suicidal ideation as well as a higher self-reported likelihood of engaging in future suicidal behavior. MST was associated with higher levels of erectile dysfunction, but erectile dysfunction was not associated with suicidal ideation in the adjusted model. Although the data were cross-sectional, precluding determinations of causality, the results support assessing and intervening with regard to sexual compulsivity to mitigate the risk for suicide-related outcomes among men who experience MST.

Toward an integrative model of transdiagnostic risk factors and suicide: A network comparison of psychiatric outpatients

Predictive models using traditional statistical methods have largely failed to describe suicide etiology. Network theory, which conceptualizes factors as mutually interacting, reinforcing elements of a complex outcome, can model relationships between transdiagnostic and neurocognitive vulnerability factors. The present study used a network approach to produce an atheoretical model of psychological factors and their interrelationships within a population of ideators and non-ideators. We developed two network models (i.e., suicidal ideators and psychiatric controls) describing the relationships between a diverse set of risk factors and symptom measures for a population of psychiatric outpatients. We compared networks using three measures of network structure (i.e., network structure invariance, global strength invariance, edge invariance) and described the differences. Network structures for ideators (N = 229) and non-ideators (N = 454) were stable and accurate. In non-ideators, cognitive-affective depression symptoms (Expected Influence [EI]: 2.06), trauma avoidance (EI: 1.08), and negative affect (EI: 0.81) were most influential to the psychological network. In ideators, cognitive-affective depression symptoms (EI: 1.77), intolerance of uncertainty-negative self-referent implications (EI: 1.29), and negative affect (EI: 1.19) were most influential. Invariance testing did not indicate significant differences in overall network structure between ideators and non-ideators (p = .111), but did indicate significant differences in node strength (p = .013). Significant differences in node EI were detected for intolerance of uncertainty-negative self-referent implications, anxiety sensitivity physical concerns, thwarted belongingness, worry, and negative affect. These findings indicated differences in network structures for suicidal psychiatric outpatients and provide crucial directions for future research on therapeutic targets for suicidal thoughts and behaviors.

Comparative clinical utility of screening for Suicide Crisis Syndrome versus suicidal ideation in relation to suicidal ideation and attempts at one-month follow-up

INTRODUCTION

Suicidal ideation (SI) has numerous limitations in predicting suicidal behavior. The Suicide Crisis Syndrome (SCS) is proposed as an alternative method of detecting risk. This study compares the relative utility of SI and SCS in statistically predicting SI and behaviors at one-month follow-up.

METHODS

382 psychiatric patients (98 inpatients, 284 outpatients) completed baseline measures and provided information about suicide-related outcomes one month later. Participants were grouped based on responses to measures assessing SCS and SI.

RESULTS

Rates of follow-up suicidal behavior were significantly higher among those reporting both SCS and SI (22.2%) than those reporting SI alone (6.0%) or neither SCS nor SI (0.9%). SCS alone (8.3%) had descriptively, but not statistically, higher rates of suicidal behavior than those with neither SCS nor SI, and did not differ from SI alone and the combination of SCS and SI. Those reporting SI-with and without SCS-had higher levels of follow-up suicidal thoughts than those without SI.

CONCLUSION

The SCS was equivalent to SI, and incrementally informative alongside SI, in detecting individuals at risk of future suicidal behavior, whereas SI was more strongly related to future SI than SCS. The combination of SCS and SI may be clinically useful in detecting individuals who are at risk for suicide.

Youth voices and experiences regarding a school-based cognitive behavioral therapy skills intervention: lessons for future engagement and adaptation

Background

The Cognitive Behavioral Therapy Skills Intervention (or CBTSI) aims to build mental health literacy and knowledge, allowing youth to build resilience and improve mental health broadly. In Ontario, Canada, youth voice is scant and European studies have largely reported on youth factors supporting stigma reduction, help-seeking intentions and overall satisfaction with a given intervention. Process evaluations and implementation that underpin what youth require to embrace mental health literacy interventions, particularly those that embed key learning principles in the everyday curriculum, have not been broached. The goal of this study is to understand both barriers and facilitators to engagement with the CBTSI (an intervention novel in itself because of the combined mental health plus cognitive behavior therapy (CBT) skills principles embedded in literacy) and the resources and structures that students report requiring, to fully engage with such an intervention.

Methods

Student focus groups were conducted utilizing qualitative interviews that were analyzed thematically. Analysis was informed using principles of pragmatism and analyzed inductively using thematic analysis (Braun and Clarke, Qual Res Psychol 3:77–101, 2006), first looking at the whole and then coding for themes, within an interpretivist framework. Youth were in middle school (grade 7 and 8) in Toronto, Canada who had received the CBTSI. Face to face interview guides with iterative questioning were conducted in February of 2020, and these interviews were audio-recorded and professionally transcribed. Teachers randomly chose a subset of youth whose parents consented to the research to ensure ethno-racial similarity to classroom demographics.

Results

There were eight groups with sixty students who participated. Students were 12 to 14 years of age. Major themes were identified: maximizing the opportunities for involvement and self-determination created an atmosphere where confidence and self-compassion could flourish, signalling to the students that they understood and were able to deploy the strategies they were taught; students expressed that the intervention needs to be adapted to enhance personal dignity, respecting both individual wishes and goals in light of the variability in student reported mental health. A model explains the structures and adaptations required to maximize learning based on youth feedback.

Interpretation

Mental health literacy incorporating CBT is a promising population-based health promotion intervention. Future adaptations and implementation decisions regarding the CBTSI need to address the wishes and experiences of these youth. Youth voice in this study explored factors that prevent and promote the uptake of the key lessons within the context of existing variability in student mental health that is often found within the context of a regular classroom. The results should be used to adapt the CBTSI as it is disseminated more broadly.

Aberrant resting-state functional connectivity of major depressive disorder with higher risk of suicide

Aim

Suicide prevention for depressive patients is an important clinical issue in psychiatry. However, not all depressive patients plan or attempt suicide. In this study, we investigated the differences of functional brain networks between a high-risk group and a low-risk group for suicide by comparing resting-state functional connectivity (rsFC).

Methods

The subjects were 29 patients with major depressive disorder, nine of whom had attempted suicide. The suicidal ideation of all subjects was assessed with the Columbia-Suicide Severity Rating Scale, then the subjects were divided into two groups based on the most severe suicidal ideation (MSI) in their lifetime. We compared rsFC between the two groups.

Results

Of the 29 subjects, 16 were in the severe MSI group. We found that the severe MSI group members had significantly smaller rsFC in two networks: one comprised the right dorsolateral prefrontal cortex and the default-mode network, and the other comprised the left rostrolateral prefrontal cortex and the striatum, amygdala, and hippocampus. These regions are reported to be associated with rumination, retrieval suppression, and delay discounting (DD).

Conclusion

Our results suggest that functional networks related to rumination, retrieval suppression, and DD might be impaired in depressive patients with severe suicidal ideation. It might be beneficial for psychiatrists to assess these characteristics in terms of suicide prevention for depressive patients.

Neuroticism, rumination, depression and suicidal ideation: A moderated serial mediation model across four countries

Background/objective

Research has highlighted the role of neuroticism, rumination, and depression in predicting suicidal thoughts, but studies on how these variables interplay are scarce. The aims of the present study were to test a model in which emotional stability (i.e., low neuroticism) would act as an antecedent and moderator of rumination and depressed mood in the prediction of suicidal ideation (i.e., moderated serial-mediation), and to explore their replicability across four countries and sex, among college students as an at-risk-group for suicide.

Method

Participants were 3482 undergraduates from U.S, Spain, Argentina, and the Netherlands. Path analysis and multi-group analysis were conducted.

Results

Emotional stability was indirectly linked to suicidal ideation via rumination and depressed mood. Moreover, emotional stability moderated the associations between rumination and depressed mood, and between depressed mood and suicidal ideation. Findings were consistent in males and females, and across countries studied.

Discussion

Regardless of sex and country, people with low emotional stability reported higher levels of rumination, which in turn was associated with more depressed mood, and these were associated with higher reports of suicidal thoughts. This cascade of psychological risk factors for suicidal ideation seems to be more harmful in people who endorse low levels of emotional stability.

Emotion-related impulsivity and rumination: Unique and conjoint effects on suicidal ideation, suicide attempts, and nonsuicidal self-injury across two samples

INTRODUCTION

Rumination and emotion-related impulsivity predict suicidal ideation, suicide attempts, and nonsuicidal self-injury (NSSI). Because rumination and emotion-related impulsivity, though, are highly correlated, we consider their unique vs. conjoint influence on suicidal ideation and self-harm.

METHOD

Across two samples of adults (N's = 171 and 191), we examined how rumination and emotion-related impulsivity relate to suicidal ideation, suicide attempts, and NSSI. We assess the more general process of repetitive negative thinking and the more specific process of suicide-related rumination. Participants completed the Three-Factor Impulsivity Index and the self-report Columbia-Suicide Severity Rating Scale. Those in sample 1 completed the Perseverative Thinking Questionnaire and the Deliberate Self-Harm Inventory, and those in Sample 2 completed the Suicide Rumination Scale.

RESULTS

Emotion-related impulsivity and both forms of rumination showed robust bivariate correlations with suicidal ideation, suicide attempts, and NSSI. Neither rumination or impulsivity related to suicide attempts controlling for ideation or to NSSI. In multivariable analyses, emotion-related impulsivity but not general rumination was tied to suicidal ideation. In contrast, suicide-related rumination was more directly tied to suicidal ideation than was impulsivity.

CONCLUSIONS

Findings provide support for a more nuanced approach to the forms of impulsivity and rumination related to suicidal ideation.