Hope and Suicidal Ideation Among Older Adults Living in the Rural Mid-Hills of Nepal

OBJECTIVES

The current study investigated whether hope and its two components (agency and pathways) weakened the relations between perceived burdensomeness, thwarted belongingness, and fearlessness about death and suicidal ideation among older adults living in rural Nepal.

METHODS

A community sample of 300 people aged from 60 to 90 years (Mage = 67.07, SDage = 6.23) who resided in the rural mid-hills of Nepal completed standardized measures.

RESULTS

Hope and agency moderated the relationship between perceived burdensomeness and suicidal ideation and pathways moderated the relationship between thwarted belongingness and suicidal ideation.

CONCLUSIONS

Hope, and particularly agency, may play a protective role in reducing suicidal ideation among older Nepali adults living in rural areas who experience perceived burdensomeness. In contrast, pathways may be an additional risk factor for older adults experiencing unmet belongingness needs. Research is required to understand fearlessness about death and suicidality among older Nepali adults.

CLINICAL IMPLICATIONS

Increasing hope and particularly agency may be associated with a reduction in suicidal ideation among older Nepali adults who experience feelings of being a burden. However, increasing pathways may be associated with an increase in suicidal ideation among those who experience unmet belongingness needs. Research is needed to understand how to accurately assess suicide risk among Nepali older adults.

Effects of social deprivation on risk factors for suicidal ideation and suicide attempts in commercially insured US youth and adults

We used US nationwide commercial insurance claims data (2011-2015) to study the effect of social deprivation on clinical and demographic risk factors for suicidal ideation (SI) and suicide attempts (SA) among US youth and adults < 65 years, after having a mental health or substance use disorder-related outpatient encounter. Neighborhood social deprivation level was summarized by the quintile of social deprivation index (SDI) at individuals' zip code level. Cox proportional hazard models were used to evaluate the effect of social deprivation on demographic and clinical risk factors for SI and SA. The study cohort consisted of 317,383 individuals < 65 years, with 124,424 aged < 25 (youth) and 192,959 aged between 25 and 64 (adults). Neighborhood social deprivation impacted risk factors for SI and SA differently for youth and adults. Among youth, SDI interacted with multiple risk factors for both SI and SA. The effects of the risk factors were larger on youth from middle socioeconomic neighborhoods. Among adults, risk of SI was the strongest in the most deprived neighborhoods, but risk of SA did not vary by neighborhood deprivation level. Our findings suggest community-based suicide prevention initiatives should be tailored according to neighborhood deprivation level and the targeted individual's age to maximize the impact.

The Color of Death; An Exploration of the Effect of Race and Religion Dimensions on Attitudes toward Euthanasia

We examined the moderating role of race on the relationship between religion and euthanasia attitudes in the United States. Understanding the role of religion in attitudes toward euthanasia requires viewing religion as a multidimensional construct. In this study, four dimensions operationalized religion: religiosity, spirituality, afterlife beliefs (afterlife, heaven, and hell), and religious denomination. Using data from 1066 adults interviewed in the 2018 General Social Survey, a logistic regression showed that the impact of each dimension of religion varies across racial groups. Adding race as an interaction term moderated the effect of religion dimensions on people's attitudes toward euthanasia. Although most studies have shown a negative influence of religion, we found that not all dimensions of religion have a negative association with opposition to euthanasia and the role of each dimension differs based on individuals' race. We also found that any comprehensive understanding of the role of religion in shaping euthanasia attitudes should consider the moderating effect of race.

"A New Hope" for Positive Psychology: A Dynamic Systems Reconceptualization of Hope Theory

In this review of the central tenets of hope theory, we examine the meta-theoretical, theoretical, and methodological foundations of the literature base. Our analysis moves from a broad examination of the research landscape in hope theory across disciplines, to a deeper investigation of the empirical literature in university students. This review highlights the significant impact of this body of research in advancing our understanding of aspects of thriving characterized by hope. However, we also evidence several limitations that may impede the advancement of the next wave of growth in this field. To address these limitations, we argue for an interdisciplinary approach to expanding the meta-theoretical, theoretical, and methodological horizons, enabling a more dynamic systems approach to the study of hope. Drawing on the intersection of positive psychology with systems thinking, we describe a methodological approach that enables a deeper examination of the processes and interactions through which hope emerges, using an analysis of the lived experience of young people. It is proposed that this research agenda will bring to life an alternate story about the resourcefulness of our youth through their own voice, enabling us to leverage this in the design of more effective strategies to facilitate hope in the future. This research agenda provides a roadmap that will provide alternative methodologies that address the current limitations in the field of hope research and, importantly, can provide fuel to spur on the acceleration of the next wave of research and practice in the field of positive psychology more broadly.

Suicide in African American Adolescents: Understanding Risk by Studying Resilience

Historically, suicide rates for African American adolescents have been low,relative to rates for youth of other racial-ethnic backgrounds. Since 2001, however, suicide rates among African American adolescents have escalated: Suicide is now the third leading cause of death for African American adolescents. This disturbing trend warrants focused research on suicide etiology and manifestation in African American adolescents, along with culturally sensitive and effective prevention efforts. First, we revisit leading suicide theories and their relevance for African American adolescents. Next, we discuss health promotive and protective factors within the context of African American youth development. We also critique the current status of suicide risk assessment and prevention for African American adolescents. Then, we present a heuristic model of suicide risk and resilience for African American adolescents that considers their development within a hegemonic society. Finally, we recommend future directions for African American adolescent suicidology. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Suicidal ideation across race in a justice-involved sample: An item response theory approach

OBJECTIVES

Compared to community samples, rates of suicide are much higher in forensic and correctional settings, yet limited research has focused on the development and improvement of suicide assessment methods used in such contexts. Moreover, despite evidence that suicide assessment varies across Caucasians and African Americans, to our knowledge this important issue has received little attention within higher risk correctional samples. We used Item Response Theory and Differential Item Functioning analyses to address this gap within the literature.

METHOD

Specifically, we examined the psychometric properties of the Suicidal Ideation scale of the Personality Assessment Inventory (Morey, 2007) in a large sample of justice-involved individuals.

RESULTS

Caucasians report greater suicidal ideation compared to African American participants on average. However, after controlling for mean differences, Caucasians and African Americans differentially endorsed symptoms of suicidal ideation. If the level of suicidal ideation is held constant across racial categories, Caucasians underreported suicidal ideation relative to African Americans.

CONCLUSION

Results suggest a nuanced picture of suicidal ideation across racial categories that can be informed by Item Response Theory approaches to scale construction and refinement.

An examination of the Entrapment Scale: Factor structure, correlates, and implications for suicide prevention

Entrapment is an emerging theoretical and empirical factor associated with suicide. The current study expanded our understanding of entrapment by examining the Entrapment Scale factor structure, demographic correlates, and association with suicidal thoughts and behaviors (STBs). Data from an online cross-national study of suicide were analyzed from two samples of young adults aged 18-34 (United Kingdom [U.K.] sample N = 418; United States [U.S.] N = 414). Primary findings included: (1) factor-analytic support for a two factor (i.e., internal and external) Entrapment Scale structure; (2) variation in external entrapment subscale factor loadings by sample; (3) significant demographic correlates of elevated entrapment of younger age, female gender, and U.S. sample; (4) significant convergent positive associations for both entrapment types with cognitive (e.g., perceived burdensomeness), mental health (e.g., anxiety), and STB correlates; and (5) significant, robust associations of internal entrapment and perceived burdensomeness with STBs in the U.K. sample. Implications are reviewed for suicide prevention theory, research and practice.

Handgrip strength is associated with suicidal thoughts in men: Cross-sectional analyses from NHANES

OBJECTIVE

To investigate the association between handgrip strength and suicidal thoughts in a representative sample of the US adult population using data from the National Health and Nutrition Examination Survey (NHANES).

POPULATION AND METHODS

Data from two waves of NHANES (2011-2014) were aggregated. Handgrip strength in kilogram (kg) was defined as the maximum value from the dominant hand. Suicidal thoughts were assessed using one question "Over the last 2 weeks, how often have you been bothered by the following problem: Thoughts that you would be better off dead or of hurting yourself in some way?" and dichotomized to no (not at all) and yes (several days/ more than half the days/ nearly every day). Sex-specific logistic regressions were carried out to analyze associations between handgrip strength and suicidal thoughts.

RESULTS

Data on total of 8903 adults (mean age 47.4 ± 0.4 years) were analyzed. Each 5kg increase in handgrip strength was associated with a 16% reduced odds of having suicidal thoughts (0.84, 95% CI: 0.74-0.95) among the overall male population. These associations were stronger in male aged 20-39 years (0.83, 95% CI: 0.70-0.98), and 40-64 years (0.73, 95% CI: 0.63-0.85). In contrast, no associations were observed in females of all age groups.

CONCLUSIONS

Males younger than 65 years old with low handgrip strength are significantly more likely to have suicidal thoughts demonstrating a dose-response relationship. Future research is required to confirm/refute our findings and establish if strength interventions can reduce suicidal thoughts.

Race, Offense Type, and Suicide Ideation: Tests of the Interpersonal-Psychological Theory in Juvenile Offenders

This study evaluated the synergy hypothesis of the Interpersonal-Psychological Theory of Suicide (IPTS), which argues thwarted belongingness and perceived burdensomeness are positively interactive in their association with suicide ideation, in a group of juvenile offenders. It also examined whether this prediction is differentially applicable across race/ethnicity or offense type. Participants included 590 adjudicated and confined male juveniles. Regression was used to test the association between suicide ideation and thwarted belongingness, perceived burdensomeness, and their interaction term. Subsequent analyses included tests of group interactions related to race/ethnicity and offense type. No interaction between thwarted belongingness and perceived burdensomeness was observed, despite adequate power. No significant group interactions were observed for race/ethnicity or offense type. However, results did show significant linear relationships between thwarted belongingness, perceived burdensomeness, and ideation, highlighting their potential utility as intervention targets in this at-risk population. Thus, although the current results are the first to show the basic IPTS risk factors generalize across race/ethnicity and offense type, they also failed to support that those factors were interactive, a primary IPTS claim. The absence of an interaction between thwarted belongingness and perceived burdensomeness suggests their role in suicide ideation for juvenile offenders may be more parsimonious than the IPTS proposes.

Spiritual Well-Being and Psychological Adjustment: Mediated by Interpersonal Needs?

Spiritual well-being has been shown to reduce suicidal behavior, depressive symptoms, and hopelessness. Thwarted interpersonal needs have been shown to increase risk of suicidal behavior. This paper aims to explore the interrelationships among spiritual well-being, thwarted interpersonal needs, and negative outcomes including suicidal ideation, hopelessness, and depressive symptoms among African American women. Sixty-six African American women (M = 36.18; SD = 11.70), from a larger study of women who had experienced interpersonal violence within the past year, completed self-report questionnaires. Mediation analyses revealed that thwarted belongingness, but not perceived burdensomeness, significantly mediated the relations between spiritual well-being and the three outcomes. This study provides the first examination of the role of thwarted interpersonal needs on the link between spiritual well-being and negative psychological outcomes. Spiritual well-being serves a protective role against feelings of social isolation, which may reduce one's risk of negative psychological outcomes. Treatments that bolster a sense of spirituality and social connectedness may reduce suicidal ideation, hopelessness, and depressive symptoms.

Child Abuse - Suicide Resilience Link in African American Women: Interpersonal Psychological Mediators

The interpersonal-psychological theory of suicidal behavior (IPTS) is an exemplary model for understanding the desire for suicidal behavior. As such, it is important to explore its applicability in ethnoracial minority groups at increasing risk for suicidal behavior, such as low-income African American women. Guided by the IPTS, the current study used five parallel mediation models to examine if there are links between individual types of childhood abuse (physical, sexual, emotional) and suicide resilience and between cumulative abuse (higher levels of abuse inclusive of all three types, more types of severe levels of abuse) and suicide resilience, and whether the three components of the model (thwarted belongingness, perceived burdensomeness, acquired capability for suicide) mediate these associations. In a sample of low-income, African American women (n = 179), higher levels of each of the three types of childhood abuse and cumulative abuse correlated with lower levels of suicide resilience. Parallel mediation analyses using bootstrapping techniques revealed that increased acquired capability for suicide mediated all five associations and perceived burdensomeness mediated three of the links (emotional abuse, cumulative abuse, and cumulative abuse-severe with suicide resilience). Attention is paid to the clinical implications of the findings in terms of attending to the acquired capability for suicide and suicide resilience in the assessment and treatment of low-income, suicidal, African American women.

Spatial Patterns and Neighborhood Characteristics of Overall Suicide Clusters in Florida From 2001 to 2010

INTRODUCTION

Although spatial examination of mortality and morbidity is becoming more common in health studies, the investigation of suicide death clusters within the neighborhood context is underutilized. The purpose of this ecological study is to detect high- and low-risk clusters of suicide deaths in Florida and determine which neighborhood characteristics distinguish clusters from non-clusters.

METHODS

The scan statistic method was used to detect overall clusters of completed suicides in Florida from 2001 to 2010. Regression analysis was used to investigate the association of neighborhood characteristics with identified clusters. All data synthesis and statistical analyses were conducted in 2015.

RESULTS

Twenty-four high-risk and 25 low-risk clusters were identified. The risk of suicide was up to 3.4 times higher in high-risk clusters than in areas outside of clusters (relative risk ranged from 1.36 to 3.44, p≤0.05). Low-risk clusters were associated with 30%-94% decreased risk of suicide (relative risk ranged from 0.06 to 0.70, p≤0.05). Areas with high levels of elderly concentration and household singularity were more likely to be in high-risk clusters, whereas areas with higher economic deprivation and residential density were more likely to be in low-risk clusters.

CONCLUSIONS

This study identified general suicide patterns across space in the state of Florida and described the characteristics of those areas.

Seemingly Harmless Racial Communications Are Not So Harmless: Racial Microaggressions Lead to Suicidal Ideation by Way of Depression Symptoms

Racial microaggressions, a contemporary form of subtle discrimination that occurs in everyday interactions, are associated with a variety of negative mental health outcomes. Research has not extended the connection between racial microaggressions and negative mental health to include suicide risk. Given the well-known association between negative mental health outcomes and suicide risk, the current study examined whether racial microaggressions predicted suicidal ideation through depression symptoms among 405 young adults of color. Depression symptoms mediated the relationship between racial microaggressions and suicidal ideation. This is the first study to associate racial microaggressions to suicide risk. Societal and clinical implications are discussed.

Autonomy as a Prospective Predictor of Perceived Burdensomeness and Thwarted Belongingness Through Symptoms of Depression

This study examined the relationship between sociotropy, autonomy, depression symptoms, perceived burdensomeness, and thwarted belongingness in a sample of 113 undergraduate students. A prospective design with three time points was utilized to determine whether personality styles and depression symptoms play a role in the development of perceived burdensomeness and thwarted belongingness, two interpersonal suicide risk factors. Time 1 autonomy predicted depression symptoms at Time 2; Time 2 depression symptoms predicted thwarted belongingness and perceived burdensomeness at Time 3. Results suggest depression symptoms mediate the relationship between autonomy and thwarted belongingness, and autonomy and perceived burdensomeness. This study contributes to understanding how the presence of specific personality traits may lead to depression symptoms, which in turn leads to perceived burdensomeness and thwarted belongingness. Clinical implications, including assessment of autonomy, and perceived burdensomeness and thwarted belongingness, are discussed.

A brief analysis of suicide methods and trends in Virginia from 2003 to 2012

BACKGROUND

The objective is to analyze and compare Virginia suicide data from 2003 to 2012 to US suicide data.

METHODS

Suicide trends by method, age, gender, and race were obtained from Virginia's Office of the Chief Medical Examiner's annual reports.

RESULTS

Similar to US suicide rates, suicide rates in Virginia increased between 2003 and 2012 from 10.9/100,000 people to 12.9/100,000 people. The most common methods were firearm, asphyxia, and intentional drug overdose, respectively. The increase in asphyxia (r = 0.77, P ≤ 0.01) and decrease in CO poisoning (r = -0.89, P ≤ 0.01) were significant. Unlike national trends, intentional drug overdoses decreased (r = -0.55, P = 0.10). Handgun suicides increased (r = 0.61, P = 0.06) and are the most common method of firearm suicide. Hanging was the most common method of asphyxia. Helium suicides also increased (r = 0.75, P = 0.05). Middle age females and males comprise the largest percentage of suicide. Unlike national data, the increase in middle age male suicides occurred only in the 55-64-year-old age group (r = 0.79, P ≤ 0.01) and decreased in the 35-44-year-old age group (r = -0.60, P = 0.07) and 10-14-year-old age group (r = -0.73, P = 0.02). Suicide in all female age ranges remained stable. Caucasians represent the highest percentage of suicide.

CONCLUSION

There has been a rise in suicide in Virginia and suicide rates and trends have closely resembled the national average albeit some differences. Suicide prevention needs to be enhanced.

A comparison of risk factors associated with suicide ideation/attempts in American Indian and White youth in Montana

We examined racial/ethnic and gender-specific associations between suicide ideation/attempts and risky behaviors, sadness/hopelessness, and victimization in Montana American Indian and White youth using 1999-2011 Youth Risk Behavior Survey data. Logistic regression was used to calculate odds ratios and 95% confidence intervals in stratified racial/ethnic-gender groups. The primary results of this study show that although the American Indian youth had more statistically significant suicidal thoughts and attempts than the White youth, they had fewer statistically significant predictors compared to the White youth. Sadness/hopelessness was the strongest, and the only statistically significant, predictor of suicide ideation/attempts common across all four groups. The unhealthy weight control cluster was a significant predictor for the White youth and the American Indian/Alaska Native girls; the alcohol/tobacco/marijuana cluster was a significant predictor for the American Indian boys only. Results show important differences across the groups and indicate directions for future research targeting prevention and intervention.

Hope as a Moderator of the Relationship Between Interpersonal Predictors of Suicide and Suicidal Thinking in African Americans

Suicide is currently the third leading cause of death of African Americans between the ages of 15 and 24 years. Possible risk factors of suicidal ideation for this population include the two interpersonal constructs of the Interpersonal Theory of Suicide, perceived burdensomeness and thwarted belongingness. Past research has demonstrated that hope is negatively associated with each of these two constructs of the Interpersonal Theory of Suicide and suicidal ideation. The aim of the current study was to investigate hope as a moderator between both thwarted belongingness and perceived burdensomeness and suicidal ideation in a sample of 107 African American college students. Results supported the hypotheses, as hope moderated the relationship between thwarted belongingness and suicidal ideation and perceived burdensomeness and suicidal ideation. This study suggests that African Americans who endorse high levels of hope are at a lower risk for suicidal thoughts when having perceptions of being a burden and not belonging. Clinical implications are discussed.

The influence of intersecting identities on self-harm, suicidal behaviors, and depression among lesbian, gay, and bisexual individuals

Individuals with lesbian, gay, and bisexual (LGB) identities have higher prevalence of self-directed violence, but very little is known about racial/ethnic differences between LGB populations. This study aimed to examine racial/ethnic differences in self-harm, suicidal ideation, suicide attempt, and depression among LGB and heterosexual emerging adults. Data are compiled from the Fall 2008 and Spring 2009 National College Health Assessment and limited to respondents within emerging adulthood (ages 18–24) who indicated their sexual orientation and racial/ethnic identities (n = 89,199). Within each racial/ethnic group, LGB individuals were significantly more likely to report self-harm, suicidal ideation, suicide attempt, and depression than non-LGB individuals.

The associations of race/ethnicity and suicidal ideation among college students: a latent class analysis examining precipitating events and disclosure patterns

The aim of this paper was to examine precipitating events for suicidal ideation and how these experiences relate to disclosure in a diverse sample of college students were examined. Among non-Hispanic White students, relationship/academic problems were most associated with ideation. A romantic break-up increased the odds of getting help. Among racial/ethnic minority students, family/academic problems were most associated with ideation and students who reported multiple events were less likely to get help compared with those not reporting events. Future research should examine the reasons for interpersonal conflict among this high-risk group and their attitudes about help-seeking, and identify cultural norms associated with disclosure.

Cross-Cultural and Cognitive-Affective Models of Suicide Risk

Only a handful of empirical investigations have identified culturally salient markers of suicide risk within samples of African American young adults. To address this gap, our study examined the intercorrelations among cultural congruity, defectiveness schemas, and multiple indices of suicide risk for African American ( n = 207) and European American ( n = 208) students attending a primary White institution. Cultural congruity was negatively associated with reports of interpersonal and behavioral suicide risk for both African and European American students. However, ethnic differences in the magnitude of these relationships emerged. Specifically, as predicted, for African Americans, lower levels of cultural congruity were more strongly related to greater interpersonal factors associated with a desire to die. Finally, the relationships between cultural congruity and multiple indices of suicide risk were partially mediated by defectiveness schemas for both African and European American students, suggesting a useful intervention target for students. These results also have implications for suicide screening, prevention, and intervention strategies directed toward African American students.

The role of hope and optimism in suicide risk for American Indians/Alaska Natives

There are some American Indian/Alaska Native communities that exhibit high rates of suicide. The interpersonal theory of suicide (Joiner, 2005) posits that lethal suicidal behavior is likely preceded by the simultaneous presence of thwarted belongingness, perceived burdensomeness, and acquired capability. Past research has shown that hope and optimism are negatively related to suicidal ideation, some of the constructs in the interpersonal theory of suicide, and suicide risk for the general population. This is the first study to investigate hope and optimism in relation to suicidal ideation, thwarted belongingness, perceived burdensomeness, and acquired capability for American Indians/Alaska Natives. Results showed that hope and optimism negatively predicted thwarted belongingness, perceived burdensomeness, and suicidal ideation. However, these results were not found for acquired capability. Overall, this study suggests that higher levels of hope and optimism are associated with lower levels of suicidal ideation, thwarted belongingness, and perceived burdensomeness in this American Indian/Alaska Native sample.

Hope as a moderator of negative life events and depressive symptoms in a diverse sample

Depression is a significant public health problem for young adults of college age, and negative life events exacerbate risk. Not all individuals who experience negative life events, however, report depressive symptoms, perhaps owing to protective characteristics. We examined one such characteristic, trait hope, a goal-oriented construct, as a potential moderator of the association between negative life events and depressive symptoms in an ethnically diverse sample of 386 college students. In support of our hypotheses, negative life events were significantly associated with greater levels of depressive symptoms, and higher levels of hope attenuated this relationship, such that those with greater hope reported fewer depressive symptoms related to potentially traumatic events. The moderating effect of hope did not differ across ethnic groups. Our findings have implications for managing the sequelae of negative life events, including depression. Cognitive-behavioural interventions tailored to help young adults identify and attain important life goals might help to overcome psychopathology associated with life stress.