Objective: This pre-registered randomized controlled trial tested the effects of a four-session, online interoceptive awareness intervention relative to an active comparator, matched for time and attention on interoception and suicidal ideation. Method: Participants (N = 195; 69% male; mean age = 37) were active duty service members (62%) and Veterans (38%) who completed measures of interoceptive sensibility, interoceptive accuracy, and suicidal ideation at baseline. They were randomized to either the interoceptive awareness intervention, Reconnecting to Internal Sensations and Experiences (RISE), or the comparator, Healthy Habits. Participants completed the assessment battery again at post-test as well as a one- and three-month follow-up. Results: RISE was rated as acceptable and demonstrated excellent feasibility per completion rates (85% completed all four modules). RISE improved the majority of interoceptive sensibility domains assessed (noticing body sensations, not worrying about sensations of pain or discomfort, emotional awareness, self-regulation, body listening, and body trust), and most of these gains remained at one- and three-month follow-ups. There were no differences between conditions on suicidal ideation, perhaps due to the low levels of ideation reported, or interoceptive accuracy. Conclusions: RISE is a disseminable, cost-effective, and transdiagnostic intervention that improves interoceptive sensibility up to three months.
*Denotes Auburn student co-author
Objective: Veterinarians are at higher risk for suicide than the general population, and 1 reason for this may be veterinarians' access to and knowledge of pentobarbital-a common suicide method in this population. One possible approach to reducing suicide risk is means safety. This study examined the acceptability and feasibility of means safety protocols in the veterinary workplace. Sample: 43 veterinarians from a mix of specialty areas aged 26 to 53 years, currently practicing in the United States, recruited via social media and listservs. Methods: Participants completed a 60- to 90-minute focus group with pre- and post-test surveys. Focus group content was qualitatively analyzed. Results: Survey responses indicated that that 30% (n = 13) of veterinarians reported storing their pentobarbital unlocked at least part of the time. During focus group discussion, participants perceived work/life balance or being overwhelmed as the most common suicide risk factor in veterinarians, with normalizing mental health emerging as a primary way to improve mental health in veterinarians. Additionally, adding an extra lockbox for pentobarbital/firearms emerged as the most acceptable and feasible means safety method. Finally, at post-test, veterinarians increased in willingness to implement storage protocol changes (P = .02) and were more likely to endorse concern about a coworker's suicide risk than concern about their own suicide risk (P < .01) as a reason to change pentobarbital storage methods. Clinical relevance: Results from this study will inform public messaging campaigns and policy changes for pentobarbital storage and suicide prevention efforts in the veterinary workplace at the individual and organizational level.
Objective: Explore the relationship between highly stressful events in veterinary medicine and mental health outcomes such as posttraumatic stress disorder (PTSD). Method: Using narratives of highly stressful work events from 359 veterinary professionals, we calculated the prevalence of PTSD using both the standard Criterion A from DSM-5-TR and an expanded definition of a traumatic event that included animals as victims. Bivariate correlations were performed to probe for relationships between exposure to highly stressful events and other negative mental health outcomes. Results: Seventy-six (21.1%) veterinary professionals reported exposure to a Criterion A work-related event, and 141 (39.3%) reported exposure under the expanded definition. Further, 13 (3.6%) to 50 (13.9%) veterinary professionals screened positive for PTSD, depending on how the traumatic stressor was defined and whether PTSD symptoms were linked to the same event or multiple events. Screening positive for PTSD was positively associated with suicidal ideation, psychological distress, and burnout. Defining traumatic stressors broadly and linking PTSD symptoms to multiple events resulted in more robust correlations and revealed positive associations with depression, suicide attempt, and problematic alcohol and drug abuse. The number of exposures to highly stressful work events was also positively associated with depression, suicidal ideation, psychological distress, and burnout and negatively associated with job satisfaction. Conclusion: Future research should consider strategies to mitigate the negative consequences that result from unavoidable exposure to highly stressful events in the veterinary workplace. Moreover, the types of events specific to veterinary medicine should be considered when assessing for traumatic events and post-exposure symptoms in veterinary professionals.
Introduction: This project tested whether Service Members (SM) and Veterans with current suicidal ideation or a history of suicide attempt had greater interoceptive dysfunction than SM and Veterans with past or no suicidal ideation. Method: Participants (N = 195; 69% male) were SM (62%) and Veterans (38%) who completed measures of suicidal thoughts and behaviors and subjective and objective interoceptive dysfunction. Participants were split into the following suicide groups: no suicidality, lifetime ideation, current ideation, and past attempt. Planned orthogonal contrasts tested for differences. Results: The combined suicidality group (lifetime ideation, current ideation, or past attempt) had worse body trust relative to the no suicidality group, and the current ideation group had worse body trust relative to those with lifetime ideation. Those with a history of suicide attempt had worse body appreciation than the combined group of ideators, and those with current ideation had worse body appreciation relative to those with lifetime ideation. The groups did not differ on objective interoception. Conclusion: Interoception is disrupted among individuals with suicidality histories within a predominantly male-identified military sample. Individuals with current suicidal ideation had both worse body trust and appreciation relative to those with past ideation. Suicide risk assessments may benefit from including questions related to body trust.
Data collected in a 2016 survey of veterinary students and professionals from the United States and the United Kingdom who identified as lesbian, gay, bisexual, transgender, queer, questioning, and asexual (LGBTQ+) indicated that 34.5% (152/440) had experienced difficulties related to their sexual orientation or gender identity at school or work. This study's objective was to examine narrative responses collected in the 2016 survey and utilize content analysis to explore the research questions: What are the concerns of the LGBTQ+ veterinary population, and how do they attempt to resolve difficulties at work and school? To address these questions, we developed two taxonomies that cataloged (a) the difficulties reported by veterinary professionals and students in the 2016 survey sample and (b) the outcomes of their attempts to resolve these difficulties. The themes related to difficulties that occurred most frequently were exposure to homophobic or transphobic language (n = 69; 45.4%), outness/staying in the closet (45, 29.6%), and negative emotional outcomes (32, 21.2%). The most common themes that described the outcomes of their attempts to resolve those difficulties were unresolved (n = 41, 27.0%), changed jobs or graduated (22, 14.5%), and found self-acceptance of acceptance from others (21, 13.8%). Our findings can inform the efforts of schools and colleges of veterinary medicine, professional organizations, and workplaces in targeting improvements to support LGBTQ+ students and professionals and the development of measures tailored to this population.
For decades, the field of psychology has been calling for culturally responsive interventions, developed with and for diverse populations. COVID-19 has highlighted the utility of digital and scalable minimally guided mental health interventions for helping individuals who lack access to or desire traditional face-to-face services. However, many of these interventions lack research that supports their efficacy. Moreover, the interventions with empirical support tend to derive that support from studies with small sample sizes and limited diversity. These limitations may lend to more cultural mistrust regarding mental health services in communities that are already underserved. In this paper we argue for specific considerations when developing and adapting minimally guided digital scalable mental health interventions as well as propose some frameworks that may be helpful for those developing and adapting these interventions.
BACKGROUND: As self-injurious thoughts and behaviors (SITB) remain a pressing public health concern, research continues to focus on risk factors, such as posttraumatic stress disorder (PTSD). Network analysis provides a novel approach to examining the PTSD-SITB relationship. This study utilized the network approach to elucidate how individual PTSD symptoms may drive and maintain SITB. METHODS: We estimated cross-sectional networks in two samples of trauma-exposed adults (Sample 1: N = 349 adults; Sample 2: N = 1307 Veterans) to identify PTSD symptoms that may act as bridges to SITB. Additionally, we conducted a cross-lagged panel network in Sample 2 to further clarify the temporal relationship between PTSD symptoms and SITB during a 2-year follow-up. Finally, in both samples, we conducted logistic regressions to examine the utility of PTSD symptoms in prospectively predicting SITB, over a 15-day period (Sample 1) and over a 2-year period (Sample 2), allowing us to examine both short- and long-term prediction. RESULTS: Two PTSD symptoms (i.e. negative beliefs and risky behaviors) emerged as highly influential on SITB in both cross-sectional networks. In the cross-lagged panel network, distorted blame emerged as highly influential on SITB over time. Finally, risky behaviors, unwanted memories, and psychological distress served as the strongest predictors of SITB across the two samples. CONCLUSIONS: Overall, our results suggest that treatments targeting negative beliefs and risky behaviors may prevent SITB in community and Veteran populations, whereas treatments targeting distorted blame and unwanted memories may help reduce SITB for individuals with a history of combat trauma.
Objective: Establish the feasibility and acceptability of Sleep Scholar, a single-session, self-guided, internet-based insomnia intervention. Participants: College students with a lifetime history of suicide ideation and at least subclinical insomnia symptoms. Methods: Participants (N = 38) completed pretreatment sleep diaries, Sleep Scholar, and post-treatment feasibility, acceptability, and clinical measures. Results: Approximately 33 students could be recruited per semester, the overall attrition rate was 47%, Sleep Scholar was completed in approximately 30minutes, and the majority of treatment information was retained. Participants reported positive acceptability and satisfaction, and approximately half of participants adhered to their prescribed time in bed recommendations. Most clinical measures had adequate variability and internal consistency, and post-hoc analyses revealed clinically significant reductions in several mental health symptoms. Conclusions: Sleep Scholar is feasible in college settings, acceptable for college students, and produced reductions in mental health symptoms during an uncontrolled trial. Implications for a randomized-controlled trial are discussed.
Risk factors that are strongly associated with suicide and are amenable to intervention are in need of discovery. This three-study investigation demonstrates that an intervention designed to improve interoception-one potential suicide risk factor-may reduce suicide-related outcomes. Study 1 included 136 undergraduate participants and found that relative to a control condition, participating in a progressive muscle relaxation exercise was associated with reduced implicit identification with suicide through greater body trust, which is one domain of interoception that is consistently linked to suicide-related outcomes. Study 2 included 97 MTurk participants and found that relative to a control condition, participating in a body functionality writing exercise was associated with greater awareness of the body as a whole. Study 3 was a pilot study of a four-session online intervention designed to increase interoception. Study 3 included a sample of 22 clinical participants who completed pre- and postintervention assessments. Participants rated the intervention as highly acceptable and moderately effective. Moreover, the intervention was associated with improvements in interoception and reductions in suicidal ideation, general psychological symptoms, and disordered-eating symptoms. Overall, these findings indicate that our online interoceptive awareness training is acceptable and may be associated with improvements in clinical outcomes. Randomized controlled trials are needed to explore whether the intervention's purported mechanism-improved interoception-leads to changes in clinical outcomes.
A central question in psychological science concerns whether psychological constructs are best conceptualized as dimensional or consist of one or more categories. The present study uses contemporary taxometric procedures to examine the latent structure of suicidal thoughts, with implications for how suicidal thoughts and behavior (STB) ought to be conceptualized, assessed, measured, and managed. Three nonredundant taxometric procedures (MAMBAC, MAXEIG, and L-Mode) were performed on various sets of indicators, and analyses were replicated across two large samples that included large numbers of individuals reporting current and recent STB. Results provide further evidence that the latent structure of suicidal thoughts is best understood as dimensional. However, inconsistent findings across studies and the relatively small number of taxometric studies conducted to date both suggest that it is premature to draw clear or definitive conclusions about the latent structure of STB being dimensional or categorical based on taxometric evidence. We report a meta-analysis of the current literature which evidences this ambiguity. We provide a detailed, critical discussion of the STB taxometric literature and outline key directions for future taxometric studies in this area, particularly how taxometric analysis relates to testing "ideation to action" theoretical models, which hypothesize that the development of suicidal ideation and the progression from suicide desire to attempting suicide are distinct processes with distinct explanations/mechanisms. It remains entirely possible that qualitatively distinct types of STB (e.g., representing ideation vs. action) or populations have different latent structures indicating different levels of risk.
Although individuals with posttraumatic stress disorder (PTSD) are at an increased risk for suicidal ideation (SI), it is unclear what factors might influence this association. Investigators have hypothesized that posttraumatic cognitions (PTCs), such as self-blame (SB) or negative cognitions about the self (NCAS) or world (NCAW), would play a role, but this has not been investigated empirically. Accordingly, we evaluated a model in which the association between PTSD symptoms and SI was moderated by PTCs in a sample of trauma-exposed undergraduate students (N = 410). To identify the specific source of this hypothesized moderation effect, we ran the moderation model separately for PTSD total severity, PTSD total severity without the cognition-related items, and each of four DSM PTSD symptom clusters in combination with each of three types of PTCs (i.e., NCAS, NCAW, SB), accounting for quadratic effects. The results revealed that NCAW moderated the positive association between all six of the PTSD variables and SI, f2 s < .01 to .04. Analyses of simple slopes generally revealed strong positive associations between PTSD symptoms with SI at high levels of NCAW, no associations at moderate levels, and negative associations at low levels. We also found one statistically significant quadratic effect when examining avoidance and NCAW. In contrast, neither NCAS nor SB emerged as a significant moderator in any of our regression models. These findings highlight the importance of addressing PTCs-particularly NCAW-in trauma survivors.
The definition of a traumatic event in Criterion A for posttraumatic stress disorder (PTSD) was narrowed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5) for events involving indirect exposure to the death of a loved one. Whereas the DSM–IV definition encompassed the sudden, unexpected death of a loved one regardless of the circumstances, the DSM–5 definition now requires the death to be violent or accidental. At present, the effects of this more restrictive definition are relatively unknown. As such, the present study examined the impact of the DSM–5 definition on the prevalence of Criterion A and the symptom profiles of individuals meeting the DSM–IV versus the DSM–5 definition. In 2 samples of trauma-exposed college students (N = 299 and N = 387, respectively), ordinal logistic regression compared individuals with either indirect exposure to a sudden, unexpected death, indirect exposure to a violent or accidental death, or direct exposure to a severe motor vehicle accident. PTSD symptoms were assessed using DSM–IV criteria in Sample 1 and DSM–5 criteria in Sample 2. Results indicated that the more restrictive DSM–5 definition reduced the prevalence of those meeting Criterion A for events involving the death of a loved one. However, few significant differences were found between sudden, unexpected death and the 2 trauma groups meeting DSM–5 Criterion A (i.e., violent or accidental death and motor vehicle accident) when compared on individual PTSD symptoms and PTSD symptom clusters. Diagnostic and research implications regarding the Criterion A change are discussed.
Research has examined suicide-related behaviors following exposure to suicide news articles, yet only a handful of studies utilized experimental designs. We aimed to address the limitations of these prior experimental studies by utilizing more realistic suicide articles and more empirically sound measures. 420 participants were randomly assigned to read a series of either suicide-related or neutral news articles, then complete a battery of questionnaires and the Death/Suicide Implicit Association Task. Overall, no significant differences between groups were observed, nor did we observe any moderation effect of individual vulnerabilities (e.g., lifetime suicidal ideation/behavior). We did not observe any immediate effects of exposure to suicide news articles. Further research examining potential mechanisms for imitative effects remains critically needed.
Background: Over half of individuals with eating disorders experience suicidal ideation at some point in their lives, yet few longitudinal studies have examined predictors of ideation in this at-risk group. Moreover, prospective research has focused on relatively distal or trait-level factors that are informative for distinguishing who is most at risk but not when. Little is known about more proximal or state-level risk factors that fluctuate within an individual, which is critical for determining when a person is most likely to engage in suicidal behaviors. Methods: Women (N = 97) receiving treatment for their eating disorder completed questionnaires weekly to assess suicidal ideation and interpersonal constructs (i.e. perceived burdensomeness, thwarted belongingness) theorized to be proximal predictors of suicidal desire. Longitudinal multilevel models were conducted to examine both within- and between-person predictors of suicidal ideation across 12 weeks of treatment. Results: Statistically significant within-person effects for burdensomeness (β = 0.06; p < 0.001) indicate that when individuals have greater feelings of burdensomeness compared to their own average, they also experience higher suicidal ideation. We did not find any significant influence of thwarted belongingness or the interaction between burdensomeness and belongingness on suicidal ideation. Conclusions: This study was the first to examine dynamic associations between interpersonal constructs and suicidal ideation in individuals with eating disorders. Results are only partially consistent with the Interpersonal Theory of Suicide and suggest that short-term changes in burdensomeness may impact suicidal behavior in individuals with eating disorders.
OBJECTIVE: Our primary aim was to test the Interpersonal Theory of Suicide’s synergy hypothesis (i.e., the interaction between perceived burdensomeness and thwarted belonginess) in the proximal prediction of suicide ideation, while accounting for quadratic effects. METHOD: We used MTurk to recruit participants (N = 478) with a lifetime history of suicidal thoughts and behaviors; they completed two batteries of self-report questionnaires three days apart. RESULTS: Contrary to the synergy hypothesis, only suicide ideation and the quadratic effect of perceived burdensomeness at Time 1 were significant predictors of suicide ideation at Time 2. The quadratic effect of perceived burdensomeness indicated a u-shaped function whereby scores at or above the 80th percentile on perceived burdensomeness at Time 1 had increasingly strong, positive associations with suicide ideation at Time 2, while scores under the 80th percentile were not predictive of suicide ideation at Time 2. Also, thwarted belongingness and suicide ideation at Time 1 were significant predictors of perceived burdensomeness at Time 2. CONCLUSIONS: These findings add to a growing literature that does not support the synergy hypothesis and suggests the importance of including nonlinear terms when examining the Interpersonal Theory of Suicide’s constructs.
OBJECTIVE: To compare the prevalence of negative mental health outcomes among les- bian, gay, bisexual, transgender, queer, questioning, and asexual (LGBTQ+) veterinary professionals and students with the prevalence reported in a previous study of veterinarians; compare LGBTQ+ veterinary professionals and students in regard to access to LGBTQ+ policies and resources, work- place or school climate, and identity disclosure; and examine whether these variables were associated with mental health (eg, psychological distress) or work- and school-related (eg, emotional labor) outcomes. SAMPLE:440 LGBTQ+ veterinary professionals and students in the United States and United Kingdom. PROCEDURES:Between July and December 2016, a web-based questionnaire was distrib- uted through email messages to members of LGBTQ+ veterinary groups and announcements at general veterinary and LGBTQ+-focused confer- ences and in newsletters. RESULTS:Nonheterosexual cis men, nonheterosexual cis women, and transgender and nonbinary individuals all had higher lifetime prevalences of suicidal ide- ation and attempted suicide, compared with previously reported preva- lences for male and female veterinarians in general. Professionals reported more welcoming climates than did students (eg, lower frequency of ex- posure to homophobic language and more supportive environments) and greater identity disclosure; however, students reported greater access to institutional resources and policies. Climate variables had a more robust relationship with negative outcomes than did access to LGBTQ+ policies or identity disclosure variables. CONCLUSIONS AND CLINICAL RELEVANCE: Comparatively high rates of suicidal ideation and suicide attempts among LGBTQ+ professionals and students and the relationship between climate variables and negative mental health outcomes suggested enhanced efforts are needed to improve the climates in veterinary workplaces and colleges. (J Am Vet Med Assoc 2020;257:417–431)
Since the turn of the century, interdisciplinary research on networks-their formation, structure, and influence-has advanced so rapidly, it is now a science unto itself, offering new and powerful quantitative tools for studying human behavior, whose potential psychologists are just beginning to glimpse. Among these tools is a formula for quantifying assortativity, the propensity of similar people to be socially connected with one another more often than their dissimilar counterparts. With this formula, this investigation establishes a foundation for examining assortative patterns in suicidal behavior and highlights how they can be exploited for improved prevention. Specifically, the established clustering of suicide fatalities in time and space implies such fatalities have assortative features. This suggests other forms of suicide-related behavior may as well. Thus, the assortativity of suicide-related verbalizations (SRVs) was examined by machine coding 64 million posts from 17 million users of a large social media platform-Twitter-over 2 distinct 28-day periods. Users were defined as socially linked in the network if they mutually replied to each other at least once. Results show SRVs were significantly more assortative than chance, through 6 degrees of separation. This implies that if a person posts SRVs, their friends' friends' friends' friends' friends' friends are more likely than chance to do the same even though they have never met. SRVs also remained significantly assortative through 2 degrees, even when mood was controlled. Discussion illustrates how these assortative patterns can be exploited to improve the true-positive rate of suicide risk screenings.
OBJECTIVE: To analyze data for death of veterinary professionals and veterinary students, with manner of death characterized as suicide or undetermined intent from 2003 through 2014. SAMPLE: Death records for 202 veterinary professionals and veterinary students. PROCEDURES: Decedents employed as veterinarians, veterinary technicians or technologists, or veterinary assistants or laboratory animal caretakers and veterinary students who died by suicide or of undetermined intent were identified through retrospective review of National Violent Death Reporting System records. Standardized mortality ratios (SMRs) and 95% confidence intervals were calculated, and mechanisms and circumstances of death were compared among veterinary occupational groups. RESULTS:197 veterinary professionals and 5 veterinary students had deaths by suicide or of undetermined intent. Among decedents employed at the time of death, SMRs for suicide of male and female veterinarians (1.6 and 2.4, respectively) and male and female veterinary technicians or technologists (5.0 and 2.3, respectively) were significantly greater than those for the general US population, whereas SMRs for suicide of male and female veterinary assistants or laboratory animal caretakers were not. Poisoning was the most common mechanism of death among veterinarians; the drug most commonly used was pentobarbital. For most (13/18) veterinarians who died of pentobarbital poisoning, the death-related injury occurred at home. When decedents with pentobarbital poisoning were excluded from analyses, SMRs for suicide of male and female veterinarians, but not veterinary technicians or technologists, did not differ significantly from results for the general population. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested higher SMRs for suicide among veterinarians might be attributable to pentobarbital access. Improving administrative controls for pentobarbital might be a promising suicide prevention strategy among veterinarians; however, different strategies are likely needed for veterinary technicians or technologists.
According to the Interpersonal-Psychological Theory of Suicide, fearlessness about death is proposed to increase monotonically (i.e., either increasing or remaining stable) and thus, not be amenable to intervention; however, this assumption has not been explicitly tested. We utilized latent class growth modeling to examine the trajectory of this construct over a brief interval (i.e., data collected every three days over a 15-day time period) among college students (N = 716), and found evidence that fearlessness does not monotonically increase. Specifically, our analyses revealed three classes, each with distinct trajectories over time: a High/Increasing class (i.e., high intercept, significantly increasing slope), Average/Stable class (i.e., average intercept, flat and non-significant slope), and Low/Decreasing class (i.e., low intercept, significantly decreasing slope). The emergence of a Low/Decreasing group is in contrast to the assertion that fearlessness cannot decrease over time. Exploratory results also indicated that lifetime exposure to certain events (e.g., abuse, injury) was associated with membership in the Low/Decreasing class, suggesting that some individuals may be responding differently to painful and/or fear-inducing stimuli than the IPTS predicts. Our findings contradict the current conceptualization of fearlessness about death, and suggest instead that this construct fluctuates upward and downward over a brief interval.
We evaluated the effects of exposure to a suicide news article on a variety of outcome variables and whether adhering to one specific media guideline (i.e., including psychoeducational information and preventative resources) buffered any of the negative effects of exposure. Participants were randomly assigned to read one of three articles and then asked to complete a battery of self-report questionnaires. Overall, we found no effect of exposure to a suicide news article, regardless of the inclusion of resources and information, with a few minor exceptions. Although researchers have demonstrated the effectiveness of media guidelines in the aggregate at reducing imitative suicidal behavior, it remains unclear which guidelines in particular are responsible for this effect.
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.
The current study used the interpersonal-psychological theory of suicide to explore the relationships among DSM-5 PTSD symptom clusters derived from the six-factor anhedonia model and facets of the acquired capability for suicide (ACS). In a sample of 373 trauma-exposed undergraduates, most PTSD symptom clusters were negatively associated with facets of ACS in bivariate correlations, but the anhedonia cluster was positively associated with ACS in regression models. Structure coefficients and commonality analysis indicated that anhedonia served as a suppressor variable for the other symptom clusters. Our findings further elucidate the complex relationship between specific PTSD symptom clusters and ACS.
OBJECTIVE: Our primary objective was to determine the potency of externalizing psychopathology as a risk factor for suicidal thoughts and behaviors (STBs). METHOD: We conducted a random effects meta-analysis of 174 prospective studies (839 unique statistical tests) examining externalizing psychopathology and suicidal thoughts and behaviors (STBs) published prior to December 8, 2017. The weighted mean odds ratios for the overall relationship between externalizing psychopathology and STBs were below 2.00 in magnitude, and all risk factor subcategories were also fairly modest predictors of STBs. Taking publication bias into account reduced the magnitude of these associations, particularly for death. Although externalizing psychopathology modestly predicts STBs, this may be due to design limitations of existing studies. Future research should employ shorter follow-up periods, consider risk factors in combination, and focus on forms of externalizing psychopathology that have not been studied extensively. RESULTS: The weighted mean odds ratios for the overall relationship between externalizing psychopathology and STBs were below 2.00 in magnitude, and all risk factor subcategories were also fairly modest predictors of STBs. Taking publication bias into account reduced the magnitude of these associations, particularly for death. Additionally, our results were mostly consistent regardless of sample age, sample severity, follow-up length, and predictor scale. CONCLUSIONS: Although externalizing psychopathology modestly predicts STBs, this may be due to design limitations of existing studies. Future research should employ shorter follow-up periods, consider risk factors in combination, and focus on forms of externalizing psychopathology that have not been studied extensively.
Insomnia is robustly associated with suicidal behavior, but methodological limitations in existing studies hinder nuanced understanding of this relationship. The current study addressed these limitations by utilizing a longitudinal design and advanced statistical modeling. Participants who endorsed lifetime experience of suicidal behavior were recruited through Amazon's Mechanical Turk (N = 589) and completed self-report online surveys at 6 time points over a 15-day period. Latent difference score modeling was utilized to investigate whether levels and/or changes in insomnia symptoms drive subsequent changes in suicide ideation, or vice versa. Results revealed that previous level of insomnia symptoms was predictive of positive changes in suicide ideation (i.e., level of insomnia symptoms predicted lagged increases in suicide ideation). This relationship was not bidirectional (i.e., suicide ideation exerted no effects on insomnia symptoms). Additionally, only previous level, and not previous changes, in insomnia symptoms were predictive of changes in suicide ideation. Our results help clarify the nature of the relationship between insomnia symptoms and suicide ideation as one that is unidirectional, thereby offering evidence of insomnia symptoms as a variable risk factor for suicide ideation. These findings yield clinical implications, including the importance of screening for insomnia symptoms, and provide support for exploring the potential effectiveness of insomnia treatments to target suicide ideation. Moreover, our study design and methodology establish a foundation for more rigorous and nuanced investigations of imminent suicide risk in future studies, which can ultimately promote better clinical practice in the reduction of suicidal behavior.
Though suicide risk is often thought of as existing on a graded continuum, its latent structure (i.e., whether it is categorical or dimensional) has not been empirically determined. Knowledge about the latent structure of suicide risk holds implications for suicide risk assessments, targeted suicide interventions, and suicide research. Our objectives were to determine whether suicide risk can best be understood as a categorical (i.e., taxonic) or dimensional entity, and to validate the nature of any obtained taxon. We conducted taxometric analyses of cross-sectional, baseline data from 16 independent studies funded by the Military Suicide Research Consortium. Participants (N = 1,773) primarily consisted of military personnel, and most had a history of suicidal behavior. The Comparison Curve Fit Index (CCFI) values for MAMBAC (.85), MAXEIG (.77), and L-Mode (.62) all strongly supported categorical (i.e., taxonic) structure for suicide risk. Follow-up analyses comparing the taxon and complement groups revealed substantially larger effect sizes for the variables most conceptually similar to suicide risk compared to variables indicating general distress. Pending replication and establishment of the predictive validity of the taxon, our results suggest the need for a fundamental shift in suicide risk assessment, treatment, and research. Specifically, suicide risk assessments could be shortened without sacrificing validity, the most potent suicide interventions could be allocated to individuals in the high-risk group, and research could generally be conducted on individuals in the high-risk group.
The current study applied a non-linear indirect effects framework to investigate potential interpersonal indirect effects (i.e., perceived burden and thwarted belonging) accounting for the non-linear relationship between body mass index (BMI) and suicide ideation. Using a sample of 338 undergraduates, results revealed a significant quadratic effect of BMI on suicide ideation via perceived burden only, which became significant as BMI fell below 18.00 kg/m2 and above 28.00 kg/m2. Our results provide novel information relevant for suicide risk screening in the context of weight- and health-related interventions, and provide justification for future longitudinal trials assessing suicide risk across the BMI spectrum.
Previous findings on the relationship between suicide ideation (SI) and alcohol misuse among college students are inconsistent, leading to conflicting clinical implications. We aimed to clarify this relationship, in order to determine the utility of regarding alcohol misuse as a risk factor for SI in this population. Unselected college students (N = 545) completed an online survey including measures of alcohol consumption, problems, drinking motives, SI, and related variables. Our results suggest alcohol misuse is not a correlate of SI among college students; therefore, one should not assume that students who misuse alcohol are necessarily at increased risk for SI.
Although Facebook has a peer-initiated suicide prevention protocol, little is known about users' abilities to notice, recognize, and appropriately interpret suicidal content or about their willingness to intervene. In this study, 468 college students were randomly assigned to interact with a simulated Facebook newsfeed containing content reflecting various suicide risk levels. A larger proportion of those exposed to content reflecting moderate and severe suicide risk noticed, recognized, appropriately interpreted, and endorsed taking action to intervene, as compared to those exposed to content representing no or low risk. Overall, results indicate that college students are responsive to suicidal content on Facebook.
Research within the framework of the Interpersonal-Psychological Theory of Suicide has suggested that the elevated suicide risk among those with anorexia nervosa (AN) can be explained by the presence of severe restrictive eating, which is proposed to affect an individual's acquired capability for suicide (i.e., heightened physical pain tolerance and fearlessness about death). We investigated this postulation in a sample (N = 100) of women receiving residential treatment for an eating disorder. We hypothesized that several restrictive eating variables would be associated with history of suicide attempts and acquired capability for suicide, even when accounting for presence of non-restrictive disordered eating. Results revealed partial support for our hypotheses. Fasting was robustly associated with history of suicide attempts. In addition, fasting and dietary restraint were associated with one or both facets of acquired capability for suicide. Nevertheless, these associations were weaker compared to self-induced vomiting and laxative use and became non-significant after controlling for self-induced vomiting and laxative use. Taken together, our results, in combination with other recent studies, are inconsistent with the postulation that restrictive eating accounts for the high suicide rate in AN through the mechanism of acquired capability for suicide.
Objective. To evaluate the prevalence of suicide risk factors, attitudes toward mental illness, and practice-related stressors among US veterinarians. Design. Cross-sectional survey. Sample. 11,627 US veterinarians. Procedures. Between July 1 and October 20, 2014, a web-based questionnaire was made available through the Veterinary Information Network (VIN), Vin News Service, JAVMA News, and monthly email messages to US veterinarians sent by the veterinary medical association, agriculture or livestock department, or health department of each state (except Maine) and Puerto Rico. Results. Of 11,627 respondents, 3,628 (31%) were male. Modal age category was 30 to 39 years, and modal range for years practicing veterinary medicine was 10 to 19 years. There were 7,460 (64%) with a primary practice of small animal medicine, and 4,224 (36%) were practice owners. There were 1,075 (9%) respondents with current serious psychological distress. Since leaving veterinary school, 3,655 (31%) respondents experienced depressive episodes, 1,952 (17%) experienced suicidal ideation, and 157 (1%) attempted suicide. Currently, 2,225 (19%) respondents were receiving treatment for a mental health condition or emotional problem. Only 32% of respondents somewhat or strongly agreed that people are sympathetic toward persons with mental illness. The most commonly reported practice-related stressor was demands of practice (e.g., long work hours or work overload). Conclusions and Clinical Relevance. In this survey, approximately 1 in 11 veterinarians had serious psychological distress and 1 in 6 experienced suicidal ideation since leaving veterinary school. Implementing measures to help veterinarians cope with practice-related stressors and reducing barriers veterinarians face in seeking mental health treatment might reduce the risk for suicide among veterinarians.
Factor analytic research has demonstrated consistently that the 3-factor DSM-IV model of posttraumatic stress disorder (PTSD) symptom structure provides a poorer fit than alternative 4- and 5-factor models. In the current study we examined whether order of item presentation accounts for these findings. IN a large sample (N = 1,311) of trauma-exposed undergraduates we conducted a series of confirmatory factor analyses using the PTSD Checklist and Posttraumatic Stress Diagnostic Scale, which present symptom items in the same order as DSM-IV, and the Detailed Assessment of Posttraumatic Stress, which presents items in a different order. Across all 3 measures, the 3-factor DSM-IV model provided a relatively worse fit and the 5-factor dysphoric arousal model provided a relatively better fit compared with other tested models. We also examined the distinctiveness of 2 pairs of symptom clusters that appear in the dysphoric arousal model -- avoidance versus numbing and dysphoric arousal versus anxious arousal -- by comparing their patterns of associations with external correlates. Avoidance and numbing demonstrated differential associations with external correlates, as did dysphoric arousal and anxious arousal. Taken together, results indicate that order effects are unlikely to account for differences in relative fit between leading models of PTSD symptom structure. We discuss the need for future research in this area, especially studies designed to evaluate order effects more directly.
The interpersonal-psychological theory of suicide (IPTS) proposes that suicide ideation is caused by the interaction of perceived burdensomeness and thwarted belongingness, in which each predictor amplifies the harm of the other. Though several studies support this synergy hypothesis, research has not considered potential quadratic effects of perceived burdensomeness and thwarted belongingness, which can distort the sign, size, and significance of interactions, if mistakenly neglected in a model. This investigation examined the synergy hypothesis in samples of university undergraduates and psychiatric inpatients, this time controlling for quadratic effects. Despite adequate power, results showed no interaction between perceived burdensomeness and thwarted belongingness in either sample, regardless of the presence of quadratic effects. Additionally, no quadratic effects were observed. The lower-order, linear perceived burdensomeness term was positively associated with suicide ideation in both samples, but the thwarted belongingness term was not associated with suicide ideation in either sample. The discussion considers implications of current findings for the IPTS, highlighting the need to formally test the impact of sample characteristics on the estimation of theory parameters. Recommendations for systematic evaluation of such sample and theory parameters are offered and their clinical implications are discussed.
Though some preliminary research within the framework of the interpersonal-psychological theory of suicide (IPTS; Joiner, 2005) has postulated that restrictive eating may contribute to increased risk for suicide through its effect on the acquired capability for suicide (ACS; i.e., increased fearlessness about death and heightened pain tolerance), existing studies have not conducted direct tests of this relationship. To enhance understanding of this relationship, we compared undergraduates who endorsed one form of restrictive eating, fasting (n = 99) to controls endorsing no form of eating pathology over the lifetime (n = 94). We hypothesized that the fasting group would have higher ACS and higher likelihood of suicide attempt history. Contrary to hypotheses, no differences emerged between groups on ACS, and frequency of fasting within the fasting group was not significantly associated with ACS. Consistent with hypotheses, the fasting group was more likely to have suicide attempt history. Though results were not entirely consistent with hypotheses, the current study represents the first attempt at isolating and examining one form of restrictive eating (i.e., fasting) within the context of the IPTS. Results suggest that, in isolation, fasting may not be directly contributing to increases in ACS.
Hazardous alcohol consumption among medical students appears to occur at a level comparable to the general population; however, among this population, it has been found that the motivation to use alcohol partially stems from unique stressors related to their professional training. Although veterinary students may also experience psychological distress in association with their training, little work has focused on the way that these students use alcohol to cope with their distress. The current study sought to examine the severity of depressive symptoms and alcohol consumption among veterinary students, as well as students' specific motives for drinking alcohol. The majority of our sample reported experiencing at least one depressive symptom, and a significant proportion engage in high-risk drinking, with men reporting more harmful alcohol use patterns. Drinking motives related to managing internal bodily and emotional states accounted for variance in drinking patterns. Further, the relationship between psychological distress and high-risk drinking was partially accounted for by drinking to ameliorate negative emotions. The results of this study suggest that depressive symptoms among veterinary students may be related to harmful drinking patterns, due to alcohol being used as a coping mechanism to regulate emotions. The findings from this study can be used to develop targeted interventions to promote psychological wellbeing among veterinary students.
According to the Interpersonal-Psychological Theory of Suicide (IPTS), individuals become capable of withstanding the pain and fear associated with a suicide attempt through habituation to painful and/or frightening stimuli. This capability, referred to as the acquired capability for suicide, is composed of both pain tolerance and fearlessness about death. Although most often these two components have been confounded in the literature, recent investigations utilizing the IPTS have found differential relationships between these components and specific life experiences. In the current study, we investigated the relationship between exposure to violent video games and both components of acquired capability. Given that a limited number of studies have found relationships between suicide ideation and excessive video game play, we also investigated the relationships among violent video game exposure, thwarted belongingness, perceived burdensomeness, and passive suicide ideation. We hypothesized that exposure to violent video games would be positively associated with fearlessness about death, but not pain tolerance; additionally we explored the notion that violent video game exposure is associated with the other constructs of the IPTS. In a sample of 781 undergraduate students, we found an association between violent video game exposure and fearlessness about death; no other meaningful significant results were found.
Previous research has established the link between posttraumatic stress disorder (PTSD) and suicidal behavior. In the current study, constructs pro- posed to explain this relationship were examined, applying the framework of the interpersonal-psychological theory of suicide (IPTS). Relationships between acquired capability for suicide (ACS; i.e., fearlessness about death [FAD] and pain tolerance) and specific PTSD symptom clusters were explored. In a sample of 334 trauma-exposed undergraduates, anxious arousal and FAD were negatively associated, and numbing and pain tolerance were positively associated. Results establish a foundation for investigating the role of ACS in understand- ing observed relationships between suicidal behavior and PTSD symptoms.
This study examined the relationship between posttraumatic stress disorder symptom clusters and passive suicidal ideation in a sample of trauma-exposed college students (N = 334), using the interpersonal-psychological theory of suicide as a framework. All symptom clusters had indirect relationships with passive suicidal ideation, partially mediated by perceived burdensomeness and thwarted belongingness. Further, the numbing cluster had the strongest bivariate relationship with passive suicidal ideation, and both numbing and reexperiencing were directly related to passive suicidal ideation in structural models. Results are consistent with the interpersonal-psychological theory of suicide and suggest a unique relationship between numbing and passive suicidal ideation.
Posttraumatic stress disorder (PTSD) has been linked consistently with suicidal ideation (SI). However, research in this area has focused on PTSD at the diagnostic or syndrome level rather than at the symptom level. In the present study we examined the relationship between individual PTSD symptoms and SI, deriving hypotheses from the interpersonal-psychological theory of suicide (IPTS) as well as the conceptual and empirical literature regarding the nature and factor structure of PTSD symptoms. We predicted that the strongest relationship between PTSD symptoms and SI would be found for the emotional numbing symptoms, especially detachment or estrangement from others. Trauma-exposed female undergraduates (N = 434) completed a battery of self-report measures, including the PTSD Checklist and Personality Assessment Inventory. As hypothesized, detachment/estrangement had the highest zero-order correlation with SI. Further, in regression analysis, detachment/estrangement was the only PTSD symptom that was positively associated with SI after controlling for negative response bias, depression, type of trauma, and all other PTSD symptoms. These results are consistent with the IPTS and highlight the relationship between detachment/estrangement and SI among those with PTSD.
The Interpersonal Theory of Suicide proposes that suicidal behavior is so frightening that in order for an individual to engage in suicidal behavior, desire for suicide must be accompanied by the capability to do so. The capability for suicide is characterized by both a sense of fearlessness about death and elevated physiological pain tolerance. The primary aim of the current project was to reevaluate and revise the Acquired Capability for Suicide Scale (ACSS) and offer a revision to the scale. Expert review of the scale items resulted in retaining seven items assessing fearlessness about death. The recommendation is made to refer to the revised scale as the ACSS-Fearlessness about Death (ACSS-FAD) to reflect its content more specifically. A model with the 7 retained items provided good fit to the data across three independent samples of young adults. Multiple group analyses examining measurement invariance across men and women found that the latent structure of the scale is comparable across gender. Data are also presented demonstrating convergent and discriminant validity for the scale in young adults and an inpatient psychiatric sample. Findings support the viability of the ACSS-FAD, indicating the scale has a replicable factor structure that generalizes across males and females and is substantively related to the construct of fearlessness about death. Taken together, the present work extends our knowledge of the psychometrics of the ACSS-FAD in particular and the nature of fearlessness about death in general.
Veterinarians have an increased risk for suicide compared with the general population, yet there is little consensus regarding why this might be. We hypothesized that veterinarians become relatively fearless about death due to their repeated exposure to euthanasia. Accordingly, we predicted that there would be a positive relationship between experience with euthanasia and fearlessness about death, due to emotional habituation to the process of euthanasia. In a sample of 130 veterinary students, results conformed to expectation and indicated that the relationship with fearlessness about death was specific to euthanasia and did not generalize to experience with surgery or necropsy.
The present study examines the psychometric properties and construct validity of scores derived from the Interpersonal Needs Questionnaire (INQ) using latent variable modeling with five independent samples varying in age and level of psychopathology. The INQ was derived from the Interpersonal Theory of Suicide and was developed to measure thwarted belongingness and perceived burdensomeness—both proximal causes of desire for suicide. Results support that thwarted belongingness and perceived burdensomeness are distinct, but related constructs and that they can be reliably measured. Further, multiple group analyses were consistent with invariance for younger vs. older adults and non-clinical versus clinical populations thereby supporting the relevance of these constructs to diverse populations. Finally, both constructs demonstrated convergent associations with related interpersonal constructs—including loneliness and social support for belongingness and social worth and death ideation for burdensomeness—as well as prospective associations with suicidal ideation.
Suicidal behavior is a major problem worldwide and at the same time has received relatively little empirical attention. This relative lack of empirical attention may be due in part to a relative absence of theory development regarding suicidal behavior. The current paper presents the Interpersonal Theory of Suicidal Behavior. We propose that the most dangerous form of suicidal desire is caused by the simultaneous presence of two interpersonal constructs—thwarted belongingness and perceived burdensomeness (and hopelessness about these states)—and further, that the capability to engage in suicidal behavior is separate from the desire to engage in suicidal behavior. According to the theory, the capability for suicidal behavior emerges, via habituation and opponent processes, in response to repeated exposure to physically painful and/or fear-inducing experiences. In the current paper, the theory's hypotheses are more precisely delineated than in previous presentations (Joiner, 2005), with the aim of inviting scientific inquiry and potential falsification of the theory's hypotheses.
The interpersonal-psychological theory of suicidal behavior (Joiner, 2005) proposes that an individual will not die by suicide unless he/she has both the desire to die by suicide and the ability to do so. Three studies test the theory's hypotheses. In Study 1, the interaction of thwarted belongingness and perceived burdensomeness predicted current suicidal ideation. In Study 2, greater levels of acquired capability were found among individuals with greater numbers of past attempts. Results also indicated that painful and provocative experiences significantly predicted acquired capability scores. In Study 3, the interaction of acquired capability and perceived burdensomeness predicted clinician-rated risk for suicidal behavior. Implications for the etiology, assessment, and treatment of suicidal behavior are discussed.