Childhood Abuse, the Interpersonal-Psychological Theory of Suicide, and the Mediating Role of Depression

Child maltreatment and youth suicide risk: A developmental conceptual model and implications for suicide prevention

Experiences of child abuse and neglect are risk factors for youth suicidal thoughts and behaviors. Accordingly, suicide risk may emerge as a developmental process that is heavily influenced by the rearing environment. We argue that a developmental, theoretical framework is needed to guide future research on child maltreatment and youth (i.e., adolescent and emerging adult) suicide, and to subsequently inform suicide prevention efforts. We propose a developmental model that integrates principles of developmental psychopathology and current theories of suicide to explain the association between child maltreatment and youth suicide risk. This model bears significant implications for future research on child maltreatment and youth suicide risk, and for suicide prevention efforts that target youth with child maltreatment experiences.

Respiratory sinus arrhythmia, negative social interactions, and fluctuations in unmet interpersonal needs: A daily diary study

INTRODUCTION

This study examined daily fluctuations in the unmet interpersonal needs of thwarted belongingness and perceived burdensomeness in response to daily negative social interactions, as well as the moderating role of respiratory sinus arrhythmia (RSA) across adolescents at lower and higher risk for suicidal ideation.

METHODS

Fifty five adolescents with major depressive disorder (MDD, i.e., higher-risk group) and without MDD (i.e., lower-risk group) completed measures of resting RSA, and daily measures of negative social interactions, perceived burdensomeness, and loneliness, as a proxy for thwarted belongingness, for 10 consecutive days. Within-person analyses examined the association between daily negative social interactions and unmet interpersonal needs, and the moderating roles of RSA and higher-risk group status. Between-person analyses also examined the association between RSA and unmet interpersonal needs across groups.

RESULTS

At the within-person level, participants reported more unmet interpersonal needs on days when they reported more negative social interactions. At the between-person level, higher RSA was associated with decreased loneliness in both groups, and decreased burdensomeness among the higher-risk group.

CONCLUSIONS

Negative social interactions are associated with daily unmet interpersonal needs. Higher RSA may serve as a protective factor mitigating risk for unmet interpersonal needs, particularly burdensomeness, among adolescents at higher risk for suicidal ideation.

The collective impact of childhood abuse, psychache, and interpersonal needs on suicidal ideation among individuals with bipolar disorder: A discriminant analysis

BACKGROUND

Suicide is one of the ten leading causes of death in the United States. Childhood abuse, psychache (intense emotional pain), and interpersonal needs are widely known to be associated with suicidal thoughts and behaviors. However, only a limited number of studies investigate whether these variables, when analyzed collectively, are able to distinguish between a group of individuals who report suicidal ideation and those who deny such thoughts.

PARTICIPANTS AND SETTING

Data were collected from individuals (N =177) with a diagnosis of bipolar disorder participating in an intensive outpatient program that provides mental health care to indigent, mostly minority patients in Southeast United States.

METHODS

The dependent variable was item number 9 on the Beck Depression Inventory that asks about any suicidal thoughts in the past two weeks. We utilized discriminant analysis to test whether childhood abuse, interpersonal needs, and psychache were collectively able to accurately identify group membership of the study participants.

RESULTS

The discriminant model included six independent variables: three different types of childhood abuse (emotional, physical, and sexual), interpersonal needs (perceived burdensomeness and thwarted belongingness), and psychache. Results revealed that the model was able to correctly classify group membership in 75% of the individuals in the study.

CONCLUSION

In context of bipolar disorder, history of childhood abuse (particularly sexual and emotional abuse), intense psychache, and greater perceived thwarted belongingness and burdensomeness put an individual at a higher risk of suicidal ideation. Gaining insight into the interactions among these variables may lead to formulating early interventions to prevent suicide in patients reporting this constellation of symptoms.

Applying the interpersonal-psychological theory of suicide to inform the association between bullying victimization and suicidal ideation in college students

Objective: Victims of bullying are at increased risk for suicidal ideation. The purpose of the current study is to examine the impact of bullying victimization in childhood on college student's current report of suicidal ideation through two mechanisms derived from the interpersonal-psychological theory of suicide. Participants: Our sample consists of 304 undergraduate college students from a large, southeastern university. Methods: We employed a cross-sectional design with self-report surveys to examine the indirect effects of childhood bullying victimization frequency on suicidal ideation through thwarted belongingness and perceived burdensomeness. Results: The association between bullying victimization and suicidal ideation was explained by perceived burdensomeness, but not thwarted belongingness. Conclusions: Bullying victimization in childhood may have distal effects on suicidal ideation through influencing perceptions of worthlessness and self-hatred. Interventions in college settings that address the impact of bullying victimization on perceived burdensomeness may reduce potential for suicidal ideation among college students.

Exploring psychological and psychosocial correlates of non-suicidal self-injury and suicide in college students using network analysis

BACKGROUND

Non-suicidal self-injury (NSSI) and suicide are a serious health concern in young people. Remarkable progress has been made in understanding the correlates and risk factors for suicidality. However, it remains unclear the complex interplay between different factors and which factors are most saliently associated with NSSI and suicide risk and should be targeted for interventions.

METHODS

This study utilized network analysis to examine the interrelationship between NSSI, suicide and a variety of psychological (e.g., depression, psychotic-like experiences) and psychosocial (e.g., childhood maltreatment, family dysfunction, being bullied and social support) correlates in a sample of Chinese first year college students (n = 2328).

RESULTS

The severity of depressive symptoms was the only factor connected to both NSSI and suicide. Other psychiatric factors like psychotic experiences could only act in an indirect way via the bridging effect of depression. Emotional abuse, compared with other forms of childhood adversities, was found to be the most influential maltreatment form associated with suicidal ideation and attempts. Finally, social support showed the potential to lower the risk of self-injury and suicide in young people.

LIMITATIONS

Only a subset of risk and resilience factors of NSSI and suicide were included. Causal inference was impossible due to the cross-sectional design.

CONCLUSIONS

Our findings highlighted the importance of identifying risk groups with mental illnesses or negative childhood events, and providing additional support during the key time of transitioning into higher education.

Association between Exposure to Domestic Violence during Childhood and Depressive Symptoms in Middle and Older Age: A Longitudinal Analysis in China

Exposure to domestic violence (EDV) is a constant threat to social stability and global solidarity and may be associated with an increased risk of depression in later life. This study assessed the association between EDV during childhood and depressive symptoms in middle and older age. A total of 10,521 respondents obtained from the China Health and Retirement Longitudinal Study were enrolled in our analysis. Depressive symptoms were measured using the 10-item form of the Center for Epidemiological Studies Depression (CES-D) scale, and EDV included parental conflict and corporal punishment. A random-effects linear regression was used to assess associations. The results showed positive relationships between "not very often" (β = 0.862; 95% CI:0.512 to 1.211; p < 0.001), "sometimes" (β = 1.692; 95% CI:1.227 to 2.158; p < 0.001) and "often" (β = 2.143; 95% CI:1.299 to 2.987; p < 0.001) in parental conflict and the CES-D scores, compared with that of those reported "never" in parental conflict. Similarly, positive relationships between "sometimes" (β = 0.389; 95% CI:0.091 to 0.687; p = 0.011) and "often" (β = 1.892; 95% CI:1.372 to 2.413; p < 0.001) in corporal punishment and the CES-D scores were observed. EDV is associated with an increased risk of depression in later life. Future research could develop interventions that target EDV and explore the mechanisms in China to further decrease lifetime depression risk and improve the population's mental health.

The Association Between Family Physical Abuse and Suicide Attempts Among Gender Minority Adolescents: A Comparison Study

Purpose: This study examines the prevalence of reported family physical abuse and the concurrent association between abuse and suicide attempts by adolescent gender identity. Methods: This study used the Profiles of Student Life: Attitudes and Behaviors dataset (N = 121,150 adolescents aged 11-19 [mean = 14.74, standard deviation = 1.78]) collected from 61 participating school districts and programs across the United States by Search Institute from 2012 to 2015. Multigroup logistic regression was used to examine the association between family abuse and suicide attempts by gender identity. Correlates included race/ethnicity, age, parent education, rurality, binge drinking, and tobacco use. Results: Results indicated that cisgender adolescents (i.e., participants who did not select a transgender identity) reported significantly less family abuse compared to gender minority adolescents. Family physical abuse was associated with higher odds of suicide attempts among all adolescents. The association was stronger for female adolescents compared to male adolescents but not significantly different across gender minority adolescents, including those who identify as transgender female to male, transgender male to female, and transgender without identifying or being unsure of their gender identity. The association between family physical abuse and suicide attempts was stronger among heterosexual female adolescents compared to sexual minority female, heterosexual male, sexual minority male, heterosexual gender minority, or sexual and gender minority adolescents. Conclusions: Findings highlight the importance of identifying and treating family abuse to prevent suicide attempts, particularly among gender and sexual minority adolescents.

The effects of peer bullying and poverty on suicidality in Chinese left behind adolescents: The mediating role of psychotic-like experiences

AIM

This study investigated the influence of childhood adversity, such as peer bullying and socioeconomic status, on the suicidal behaviour of left-behind Chinese adolescents to determine whether psychotic-like experiences (PLEs) mediated the associations between these childhood adversities and suicidality; suicidal ideation (serious thoughts about taking one's own life), suicide plans, and suicide attempts.

METHODS

A representative group of rural adolescents (n = 3346) was recruited from 16 rural high schools in China. Suicidality was assessed using the suicide module from the Mini International Neuropsychiatric Interview Kid. Participants also completed questionnaires on bullying, socioeconomic status, left-behind characteristics, and PLEs. Structural equation modelling was then employed to explore the relationships between these variables.

RESULTS

Peer bullying, poverty, and left-behind status were all found to significantly increase adolescent suicide risk, the relationships between which were mediated by PLEs. Peer bullying was found to play the most significant role in the PLEs and suicidality, with the risk of suicide increasing with the length of time a child had been left behind.

CONCLUSION

Adverse life events can lead to a high risk of PLEs, which in turn can increase the risk of suicide. These results could assist in identifying individuals at risk of suicidality and the design of appropriate interventions. The results also highlighted the role PLEs play in suicidality and highlighted the need for further research in this area.

How do physical and emotional abuse affect depression and problematic behaviors in adolescents? The roles of emotional regulation and anger

BACKGROUND

Rates of physical and emotional abuse are high among Chinese adolescents and elicit distinct psychopathologies. However, it remains unclear whether physical and emotional abuse relate to depression and behavior problems similarly or differently. In addition, few studies have examined if they share underlying mechanisms in adolescents.

OBJECTIVE

This study used longitudinal data to examine the mechanisms underlying the effect of physical and emotional abuse on depression and problematic behaviors through emotional regulation and anger in Chinese adolescents.

PARTICIPANTS AND SETTINGS

Participants were 1689 adolescents (with age ranging from 12 to 17 years) from junior and senior high schools in Zhejiang Province, China.

METHODS

Participants completed a childhood trauma questionnaire and an emotion regulation strategies questionnaire at time 1 (T1), and they completed an anger scale, a depression scale, and a problematic behaviors questionnaire one year later (T2). Structural equation modeling was used to examine the research hypotheses.

RESULTS

Physical abuse had direct positive effects on problematic behaviors but not on depression. However, emotional abuse had direct effects on depression and problematic behaviors, and indirect effects on both psychopathologies through expressive suppression and anger.

CONCLUSIONS

Physical and emotional abuse had distinct effects and influencing mechanisms on adolescents' externalizing and internalizing problems. Compared with physical abuse, emotional abuse elicited more harms and subsequent psychopathologies.

Childhood Trauma Associations With the Interpersonal Psychological Theory of Suicide and Social Cognitive Biases in Psychotic Disorders

Childhood trauma (CT) is associated with suicidal ideation and behaviors (SI/SB) in people with psychosis. The interpersonal psychological theory of suicide (IPTS) suggests that there are four factors that increase suicide risk: thwarted belongingness, perceived burdensomeness, acquired capacity for suicide, and hopelessness. The IPTS constructs and social cognitive biases are associated with SI/SB in psychotic disorders. However, the role of CT in IPTS constructs and social cognitive biases has not been examined in psychosis. In an outpatient community sample of persons with psychotic disorders (N = 96) assessed with the Childhood Trauma Questionnaire, the aims of this study were to a) evaluate rates of CT in this sample, b) determine the relationship between CT types and lifetime SI/SB, and c) explore the relationship between CT types, IPTS constructs, and social cognitive biases. All participants reported experiencing CT. Emotional abuse was associated with greater SI severity and higher rates of lifetime suicide attempts, as well as with greater perceived burdensomeness and more severe negative social cognitive biases. Other CT types were minimally associated with SI/SB or IPST constructs; hopelessness was not associated. Overall, negative interpersonal beliefs and social cognitive biases may explain how CT increases suicide risk in psychosis.

Independent and Cumulative Effects of Recent Maltreatment on Suicidal Ideation and Thoughts of Self-harm in a National Sample of Youth

PURPOSE

This study examines the impact of several forms of past-year maltreatment on thoughts of self-harm and suicidal ideation and considers how these effects may vary by gender.

METHODS

Analyses are based on telephone interviews with a nationally representative sample of 6,364 youth aged 10-17 years, from three waves (2008, 2011, and 2014) of the National Survey of Children's Exposure to Violence. Suicidal and self-harm ideation were measured with items from the Trauma Symptoms Checklist for Children. Emotional maltreatment, physical maltreatment, neglect, and witnessing family violence were measured using items from the Juvenile Victimization Questionnaire.

RESULTS

Over 8% of the sample reported suicidal and/or self-harm ideation in the past month, with females more likely to report these outcomes than males. Youth who experienced recent emotional maltreatment, neglect, or witnessing family violence were more likely to report suicidal or self-harm ideation, independent of the other maltreatment types, presence of an internalizing disorder, and demographics. A dose-response relationship between the number of types of maltreatments and these outcomes was also evident. Finally, females were more negatively affected by emotional abuse and by experiencing two forms of past-year maltreatment than their male counterparts.

CONCLUSIONS

Emotional abuse was the type of maltreatment most strongly related to thoughts of self-harm and/or suicidal ideation and was particularly detrimental to females in this sample. Given the especially damaging effects of exposure to multiple forms of maltreatment, our research highlights the importance of including comprehensive maltreatment assessment in youth suicide and self-harm prevention efforts.

The Influence of Family-Related Factors on Suicide in Major Depression Patients

OBJECTIVE

To explore the influence of family-related factors on suicide-related behaviors of patients with major depression disorder, and to provide scientific evidence for effective preventive measures.

METHODS

A total of 852 outpatients at Renmin Hospital of Wuhan University were enrolled in this cross-sectional study from April 2019 to January 2021. The general demographic information and family-related information of the patients were collected via a general information questionnaire, the Family Assessment Device, the Egna Minnen av Barndoms Uppfostran, and the Childhood Trauma Questionnaire.

RESULTS

Participants without suicide-related behaviors accounted for 10.45% of the total sample, those with suicidal ideation accounted for 47.54%, those with suicidal plans accounted for 24.77% and with suicidal attempts for 17.25%. Patients with major depression disorder who have lower education level, who were separated from their parents, who have severely impaired family function, who experienced childhood abuse, and whose parents adopted apathetic and severe child-rearing styles had a higher risk of suicide-related behaviors. In the multivariate regression model, degree of major depression disorder, education and child-rearing style were independent risk factors for suicide-related behaviors.

CONCLUSION

Patients with major depression disorder who have been separated from their parents, have severely impaired family function, were abused in childhood or have been exposed to improper childrearing styles have a greater risk of suicide. Family-related factors play a predictive role in suicide in patients with major depression disorder. More attention should be paid to family-related factors to reduce the occurrence of suicidal ideation and attempt.

Suicidal Ideation in a Veterans Affairs Residential Posttraumatic Stress Disorder Treatment Setting: The Roles of Thwarted Belongingness and Perceived Burdensomeness

Suicide is a significant public health concern, and, specifically, the veteran population has exhibited a 22% higher risk of death by suicide than the general population (Department of Veterans Affairs, 2017). The interpersonal psychological theory of suicide (IPTS; Joiner, 2005) appears to be the most widely researched theory to examine factors associated with suicidal ideation. The IPTS applies to veteran suicidal ideation in that veterans may feel they are burdensome to others or that they do not belong following their transition from active duty. The current study sought to (a) identify the prevalence and correlates of the IPTS constructs perceived burdensomeness and thwarted belongingness; (b) examine the main and interactive effects of these constructs on suicidal ideation; and (c) examine their indirect effects in the associations between posttraumatic stress disorder (PTSD) symptomatology, depressive symptomatology, and substance use with suicidal ideation in a sample of veterans in PTSD residential treatment (N = 125). Regression results demonstrated that perceived burdensomeness was significantly associated with suicidal ideation, β = .50, p < .001; however, thwarted belongingness and the interaction of the two were not. In the models of indirect effects, perceived burdensomeness emerged as the only significant indirect effect in the association between PTSD symptomatology and suicidal ideation, β = .01 (SE = .00), 95% CI [.0050, .0149], as well as between depressive symptomatology and suicidal ideation, β = .02 (SE = .01), 95% CI [.0109, .0311]. Study limitations and future directions are also discussed.

Understanding Capability and Suicidal Ideation among First Responders

OBJECTIVE

The present study seeks to determine differences in lifetime suicidal ideation, dispositional capability, acquired capability, and practical capability among those who have and have not served as first responders, and among subgroups of first responders.

METHODS

Data were collected as part of a large online (n = 3,500) study seeking to understand firearm ownership in the United States. Participants were recruited via Qualtrics Panels and were demographically matched to the 2010 US census. Binary logistic regressions and an exploratory multinomial logistic regression examined differences between first responders and non-first responders and among subgroups of first responders.

RESULTS

First responders reported more lifetime suicidal ideation and higher acquired, practical, and dispositional capability than did non-first responders. Findings indicated that first responders with and without military affiliation did not differ in terms of suicidal ideation or capability for suicide. Lastly, law enforcement officers (LEOs) reported more lifetime suicidal ideation than emergency medical technicians (EMTs). LEOs, EMTs, and firefighters did not differ in terms of capability for suicide.

DISCUSSION

The findings highlight that suicidal ideation and capability for suicide differ between first responders and non-first responders and among subgroups of first responders. The mechanisms driving the increased rates of suicidal ideation and capability among first responders are unknown; however, it is likely due to a combination of personal and occupational factors. Although not without its limitations, the present study provides an understanding of suicide risk among first responders.

Differentiating U.S. military veterans who think about suicide from those who attempt suicide: A population-based study

OBJECTIVE

Several vulnerability factors for suicidal behavior in U.S. veterans have been identified. However, little is known about factors that differentiate veterans who contemplate suicide from those who attempt suicide. This study examined sociodemographic and clinical characteristics that distinguish veterans who think about suicide from those who attempt suicide.

METHOD

Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a population-based sample of 4069 veterans. Analyses estimated the lifetime prevalence of suicide ideation (SI) and suicide attempts (SA); and examined differences between veterans with a history of attempt(s), and SI without a history of attempt(s).

RESULTS

A total 25.9% of U.S. veterans reported lifetime SI and 3.9% reported a SA. Several factors distinguished veterans with a history of SA from those with SI only: the strongest were younger age (odds ratio [OR] = 0.97, 95% CI = 0.95-0.98), nonsuicidal self-injury (OR = 1.81, 95% CI = 1.11-3.03), adverse childhood experiences (OR = 1.14; 95% CI = 1.06-1.23), alcohol use disorder (OR = 1.99; 95% CI = 1.28-3.12), lower household income (OR = 0.62; 95% CI = 0.40-0.95), and physical disability (OR = 1.69; 95% CI = 1.07-2.70).

CONCLUSIONS

Although a quarter of U.S. veterans contemplate suicide in their lifetimes, the majority do not attempt suicide. Specific sociodemographic and clinical features may differentiate veterans who contemplate versus attempt suicide.

The Interaction Effects of Suicidal Ideation and Childhood Abuse on Brain Structure and Function in Major Depressive Disorder Patients

Suicidal ideation (SI) is a direct risk factor for suicide in patients with depression. Regarding the emergence of SI, previous studies have discovered many risk factors, including childhood abuse as the major public problem. Previous imaging studies have demonstrated that SI or childhood abuse has effects on brain structure and function, respectively, but the interaction effects between them have not been fully studied. To explore the interaction effect between SI and childhood abuse, 215 patients with major depressive disorder completed the Childhood Trauma Questionnaire to evaluate childhood abuse and Beck's Scale for Suicidal Ideation to evaluate SI. Then, they completed magnetic resonance imaging (MRI) within one week after completing questionnaires. Respectively, we preprocessed the structural and functional images and analyzed gray matter volumes (GMV) and mean fractional amplitude of low-frequency fluctuation (mfALFF) values. Results showed that the changes of GMV in the cuneus, precuneus, paracentric lobule, inferior frontal gyrus, and caudate nucleus and local activity in cuneal and middle temporal gyrus are in relation with SI and childhood abuse. And in left caudate, SI and childhood abuse interact with each other on the influence of GMV. That is, the influence of SI in GMV was related to childhood abuse, and the influence of childhood abuse in GMV was also related to SI. Therefore, the combination of SI and childhood abuse based on imaging should help us better understand the suicide ideation developing mechanism and propose more effective targeted prevention strategies for suicide prevention.

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.

Abuse and suicide risk among college students in the United States: Findings from the 2019 Healthy Minds Study

BACKGROUND

Suicide has increased among American youth, and remains a concern on college campuses where students have reported increasing levels of psychological distress, alcohol use, social isolation, and loneliness. Abuse is known to be a risk factor for suicide, but more research is needed to understand whether current specific types of abuse and their co-occurrence are related to current suicidal thoughts and behaviors among young adults in college.

METHODS

We analyzed data from the 2019 wave of the Healthy Minds Study, a cross-sectional, web-based survey administered to undergraduate and graduate students. Using multivariable logistic regression, we examined the associations between abuse and suicidal thoughts and behaviors, adjusting for sociodemographic and mental health covariates.

RESULTS

In the past 12 months, 12.56% of the sample reported suicidal ideation, 5.70% reported making a suicide plan, and 1.28% reported making a suicide attempt. Over a third of the sample reported at least one type of abuse over the past 12 months. Emotional, physical, and sexual abuse were all associated with greater odds of all suicide outcomes, adjusting for sociodemographic characteristics and mental health. Endorsing multiple types of abuses was associated with greater odds of suicide outcomes in a dose-response fashion.

LIMITATIONS

Data were cross-sectional and the response rate for this survey was 16%.

CONCLUSIONS

Universities can implement a multi-pronged approach that covers screening for types of abuse, initiating awareness campaigns around abuse and suicide, and training faculty and staff to make appropriate referrals. Student services must also be equipped to address students who perpetrate abuse.

Suicide attempts among people with eating disorders and adverse childhood experiences: Results from a nationally representative sample of adults

OBJECTIVE

People with eating disorders (EDs) have elevated rates of suicide attempts. A need exists to identify factors that help predict which people with EDs might be at greater risk for suicidal behavior. Adverse childhood experiences (ACEs) are associated with both EDs and with suicide attempts. Thus, the current study examined whether having histories of ACEs and EDs augments lifetime risk for suicide attempts.

METHOD

This study included 36,146 adult participants in the National Epidemiologic Survey on Alcohol and Related Conditions-III who completed structured diagnostic interviews and answered questions regarding ACEs and suicide attempts. Weighted means, frequencies, and cross-tabulations were computed for prevalence of ACEs and suicide attempts by ED diagnosis. Multiple logistic regression was used to compare risk of lifetime suicide attempts by ED diagnosis and ACE history.

RESULTS

Prevalence of ACEs among people with EDs was 54.1-67.8%. ACE history and ED diagnosis were associated with elevated odds of experiencing a lifetime suicide attempt (AORs = 4.64-6.45 and 3.20-4.06, respectively). There was no ACE history-by-ED interaction on risk of suicide attempt, regardless of forms of EDs.

DISCUSSION

ACEs are common among people with EDs and associated significantly with suicide attempts, but ACEs and EDs do not appear to interact to augment risk for suicide attempts. Considering ACE exposure in theoretical models of suicidal behavior in people with and without EDs and in suicide risk assessment and management with people with EDs may prove useful.

Association between sexual abuse victimization during the life course and suicidal behaviors in male and female college students in China: Timing, duration, types and patterns

BACKGROUND

A certain link between sexual abuse (SA) victimization and suicidal behaviors has been confirmed, but it remains unclear whether this association varies with regard to SA characteristics and gender.

METHODS

Participants were 4034 college students drawn from a cross-sectional study conducted in Hefei, China. Gender-stratified latent class analysis (LCA) and logistic regression models were used to examine the relationships between timing, duration, types and patterns of SA victimization and suicidal behaviors.

RESULTS

For the males, SA in the elementary school or earlier period was associated with suicidal ideation (OR: 3.29, 95%CI: 2.20-5.38), plans (OR: 3.44, 95% CI: 1.54-7.77) and preparations (OR:3.05, 95% CI: 1.19-7.74). All types of SA were significantly associated with the four types of suicidal behaviors. Dose-response relationship and cumulative effect were found between duration, types of SA victimization and suicidal behaviors. Three latent classes of SA victimization were identified for males and females, respectively. For males, the "moderate SA" class and "persistent SA" class were associated with the four types of suicidal behaviors. For the females, SA during the university period was associated with suicidal ideation (OR: 2.47, 95% CI: 1.24-4.93). Only suicidal ideation was associated with the "moderate SA" class.

LIMITATIONS

The cross-sectional survey design did not allow to conclude any causality.

CONCLUSIONS

The relationship between SA victimization and suicidal behaviors varies in terms of SA victimization characteristics and the relationships were stronger in males than in females.

Searching for a Sense of Place: The Process of How Adolescent Girls Overcome Suicidality

Adolescent suicide is a preventable health problem; however, warning signs are often missed. In this study we developed a grounded theory to explore the process of how adolescent girl suicide attempters escape suicide in a sample of 12 young female adults ages 18-25. Using grounded theory methods of constant comparison, memo-writing, axial, and theoretical coding, searching for a sense of place emerged as the core process encompassing social process stages of: (1) existing in a toxic environment; (2) seeing suicide as the only way out; (3) seeing new ways to escape. Implications for nursing practice, education, and research are discussed.

Low Parental Warmth and High Youth Impairment: A Recipe for Perceived Burdensomeness?

Theory and research document the role of perceived burdensomeness in the development of suicide ideation, including in youth. There is a critical need to identify and evaluate variables that foster perceived burdensomeness in youth, with an eye toward advancing etiological models and informing prevention approaches for at-risk youth who are not yet actively suicidal. The current study examined and replicated a conceptual model wherein the association between low parental warmth and burdensomeness is moderated by youth impairment. Participants were 75 and 150 clinic referred youths in Study 1 and Study 2, respectively, with anxiety-related difficulties. Youth impairment significantly moderated the association between low parental warmth and youth perceived burdensomeness such that the association was negative and statistically significant at high levels of impairment, but not at low levels of impairment. The moderation effect was statistically significant in both studies while controlling for anxiety and depressive symptoms. These findings provide insight into variables that are associated with a sense of burdensomeness toward others in youth, and identify potential targets for preventing or intervening to reduce perceived burdensomeness in clinic-referred youth.

Interpersonal Risk Factors for Suicide in Cocaine Dependence: Association with Self-Esteem, Personality Traits, and Childhood Abuse

OBJECTIVE

Studies have linked cocaine dependence to suicidality. According to the Interpersonal Theory of Suicide, suicidal behavior becomes likely with the simultaneous presence of perceived burdensomeness (PB), lack of (or thwarted) belongingness (TB), and acquired fearlessness about death (FAD). Here, we examined personality and other variables, including depression, self-esteem, childhood abuse, and substance use, as predictors of these risk factors in cocaine-dependent individuals (CDs).

METHODS

Seventy CDs and 70 healthy controls (HCs) participated. We examined group differences in a group-by-sex analysis of variance and identified predictors of PB, TB, and FAD in stepwise regressions.

RESULTS

CDs exhibited elevated PB and TB but not FAD, compared to HCs. CDs also exhibited elevated harm avoidance, novelty seeking, depression, and lower self-esteem and reward dependence. Females reported elevated sexual abuse, harm avoidance, reward dependence, depression, but lower FAD, relative to males, among CDs and HCs. Among CDs, PB was predicted by lower self-esteem and greater emotional abuse; TB was predicted by lower self-esteem and reward dependence, as well as greater emotional and sexual abuse; and FAD was predicted by lower harm avoidance and greater physical abuse.

CONCLUSIONS

Interventions targeting suicidality in cocaine dependence should take into consideration self-esteem, personality traits, and childhood abuse.

Psychache, unmet interpersonal needs, childhood trauma and suicide ideation in young adults

This 5-month, 2-wave study evaluated the mediating effects of psychache and unmet interpersonal needs on the relationship between childhood trauma and suicide ideation in 208 young adults, controlling for depression. Path analysis demonstrated that changes in depression, perceived burdensomeness, and thwarted belongingness mediated the relationship between childhood trauma and changes in positive suicide ideation, and that changes in depression and perceived burdensomeness mediated the relationship between childhood trauma and changes in negative suicide ideation. Results indicated the importance of assessing interpersonal needs, in addition to depression, for understanding the mechanism linking childhood trauma to suicide ideation in young adults.

Early life stress and glutamate neurotransmission in major depressive disorder

Early life stress (ELS) and glutamate neurotransmission have been implicated in the pathophysiology of major depressive disorder (MDD). In non-human primates, ELS was positively correlated with cortical Glx (i.e., glutamate + glutamine). However, the relationship between ELS and cortical glutamate in adult patients with MDD is not fully known. Using ¹H Magnetic Resonance Spectroscopy (MRS), we conducted exploratory analyses measuring occipital cortical glutamate and glutamine levels in 36 medication-free patients with MDD. In a subsample (n=11), we measured dynamic glutamate/glutamine cycling (V_cycle) using advanced ¹³C MRS methods. ELS history was assessed using Early-life Trauma Inventory (ETI). Exploratory analyses suggest a relationship between ETI and glutamine as reflected by a significant positive correlation between ETI scores and occipital glutamine (r_s=0.39, p=0.017) but not glutamate. Post-hoc analyses showed that the association with glutamine was driven by the ETI emotional abuse (ETI-EA) subscale (r_s=0.39, p=0.02). V_cycle correlation with ETI was at trend level (r_s=0.55, p=0.087) and significantly correlated with ETI-EA (r_s=0.67, p=0.03). In this small sample of patients with MDD, those with childhood emotional abuse appear to have increased occipital glutamate neurotransmission as reflected by increased glutamate/glutamine cycling and glutamine level. Future studies would be needed to confirm this pilot evidence and to examine whether ELS effects on glutamate neurotransmission underlie the relationship between ELS and psychopathology.

Direct and indirect associations between perception of childhood trauma and suicidal ideation through emotion dysregulation in males who use heroin

Emotion dysregulation is considered as one of the factors related to suicide in individuals with childhood trauma (CT). However, no research has been performed on the role of emotion dysregulation in the relationship between perception of CT and suicidal ideation in individuals who use heroin. This study aimed to evaluate direct and indirect relationships between perception of CT and suicidal ideation through emotion regulation difficulties (ERD) and cognitive emotion regulation strategies (CERSs) in males with a DSM diagnosis of heroin dependence. In a cross-sectional design, 310 males with a DSM diagnosis of heroin dependence completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Cognitive Emotion Regulation Questionnaire-Short version (CERQ-Short), the Obsessive-Compulsive Drug Use Scale-Form Heroin (OCDUS-Form Heroin), and the Depression Anxiety Stress Scales (DASS). The results revealed that perception of CT had no direct relation to suicidal ideation. Perception of CT was indirectly associated with suicidal ideation through some ERD dimensions [e.g., non-acceptance of emotional responses (Non-acceptance), limited access to emotion regulation strategies (Strategies), lack of emotional awareness (Awareness)] and the CERS of positive reappraisal. The findings suggest that high suicidal ideation may stem from a perception of CT and subsequently emotion dysregulation in individuals who use heroin. Also, the findings of this research may have implications for the prevention and treatment of suicidal ideation in individuals using heroin with a perception of CT. The results of the present study require further examination through longitudinal studies.

Validation of a Chinese Version of the Acquired Capability for Suicide Scale

This study aimed to revise and validate a Chinese Version of the Acquired Capability for Suicide Scale (ACSS-CV). In study 1 of 395 Chinese college students, a two-factor model comprising fearlessness about death and pain tolerance achieved satisfactory model fit. In study 2 of 491 different students, the ACSS-CV had good internal consistency, test-retest reliability, convergent validity, and discriminant validity. The ACSS-CV may be considered a useful instrument for measuring the acquired capability for suicide in Chinese college students.

Evaluating the Interpersonal-Psychological Theory of Suicide among Latina Adolescents using Qualitative Comparative Analysis

The Interpersonal-Psychological Theory of Suicide (IPTS) has emerged as an empirically supported theory of suicide risk, yet few studies have utilized IPTS to examine the suicidal behaviors of Latina adolescents. In this study, we explore the cultural and developmental appropriateness, as well as the explanatory fit, of IPTS within a sample of Latina adolescents. Data for this project were drawn from qualitative interviews conducted with Latina adolescents with (n=30) and without (n=30) histories of attempted suicide. We employed a deductive qualitative approach to define and compare core constructs of IPTS (perceived burdensomeness, thwarted belongingness, and acquired capability), and then use qualitative comparative analysis to evaluate how core constructs were linked with the occurrence of a suicide attempt. Consistent with IPTS, perceived burdensomeness, thwarted belongingness, and acquired capability were present in 20 of the 30 adolescents who had attempted suicide, and absent in 22 of the 30 adolescents with no lifetime history of suicidal behaviors. Notably, alternative combinations of IPTS constructs were found in 10 cases of adolescents who attempted suicide, suggesting a need to adjust IPTS to fit the developmental and cultural contexts of Latina teens. Although our results suggest predominantly positive support for IPTS, participants varied in terms of how their experiences resonated with the conceptual definitions put forward by the theory. Ultimately, our findings point to the ways in which developmental tensions are exacerbated by broader sociocultural dynamics, contributing to a broader understanding of suicide risk among ethnic minority adolescents.

Mother-Daughter Interpersonal Processes Underlying the Association Between Child Maltreatment and Adolescent Suicide Ideation

OBJECTIVE

The aim of the present study was to investigate whether mother-daughter relationship quality and mother-daughter conflict represent mechanisms underlying the association between child maltreatment and adolescent passive or active suicide ideation.

METHOD

The sample included 164 socioeconomically disadvantaged depressed adolescent girls and their mothers (adolescents: mean age = 14.00 years; 66.3% African-American, 21.3% white, 14.0% Latina). Structural equation modeling was used to test three simultaneous and distinct mediating pathways linking child maltreatment to adolescent suicide ideation: (1) mother-daughter relationship quality, (2) mother-daughter conflict, and 3) adolescent depressive symptoms.

RESULTS

Consistent with the interpersonal-psychological theory of suicide (Joiner, Why people die by suicide, 2005, Harvard University Press, Cambridge, MA), both mother-daughter relationship quality and mother-daughter conflict mediated the effect of child maltreatment on adolescent suicide ideation, over and above the significant depressive symptoms mediational pathway.

CONCLUSIONS

These findings advance our understanding of why individuals who experienced child maltreatment are at risk for suicide ideation and highlight the importance of relationship-based interventions for these vulnerable youths.

Examining the Association between Weapon Carrying on School Property and Suicide Attempt among Adolescents in the United States

Suicidal behaviors among adolescents in the United States are the second leading cause of death and has been steadily increasing over the years. Although access to and possession of a weapon may facilitate the transition from suicidal ideation to a suicide attempt, few studies have examined the association between weapon carrying and suicide attempts among adolescents. The objective of this study was to examine the association between weapon carrying on school property and suicide attempt among adolescents. Data for this study came from the 2017 Youth Risk Behavior Surveillance System. A sample of 14,547 adolescents aged 14-18 years old (50.5% female) was analyzed using logistic regression. Of the 14,547 adolescents, 4% carried a weapon on school property, and 7.7% attempted suicide during the past 12 months. In the multivariate logistic regression, adolescents who reported carrying a weapon on school property had more than double the odds of attempting suicide when compared to their counterparts who did not carry a weapon on school property. Other significant predictors of suicide attempt include sexual minority, history of forced sexual intercourse, school bullying and cyberbullying victimization, feeling sad or hopeless, and substance use. Examining the association between weapon carrying and suicide attempt among adolescents would contribute to early identification of adolescents who are likely to engage in suicidal behaviors.