Caroline Silva

Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military

BACKGROUND Sleep problems appear to represent an underappreciated and important warning sign and risk factor for suicidal behaviors. Given past research indicating that disturbed sleep may confer such risk independent of depressed mood, in the present report we compared self-reported insomnia symptoms to several more traditional, well-established suicide risk factors: depression severity, hopelessness, PTSD diagnosis, as well as anxiety, drug abuse, and alcohol abuse symptoms. METHODS Using multiple regression, we examined the cross-sectional and longitudinal relationships between insomnia symptoms and suicidal ideation and behavior, controlling for depressive symptom severity, hopelessness, PTSD diagnosis, anxiety symptoms, and drug and alcohol abuse symptoms in a sample of military personnel (N=311). RESULTS In support of a priori hypotheses, self-reported insomnia symptoms were cross-sectionally associated with suicidal ideation, even after accounting for symptoms of depression, hopelessness, PTSD diagnosis, anxiety symptoms and drug and alcohol abuse. Self-reported insomnia symptoms also predicted suicide attempts prospectively at one-month follow up at the level of a non-significant trend, when controlling for baseline self-reported insomnia symptoms, depression, hopelessness, PTSD diagnosis and anxiety, drug and alcohol abuse symptoms. Insomnia symptoms were unique predictors of suicide attempt longitudinally when only baseline self-reported insomnia symptoms, depressive symptoms and hopelessness were controlled. LIMITATIONS The assessment of insomnia symptoms consisted of only three self-report items. Findings may not generalize outside of populations at severe suicide risk. CONCLUSIONS These findings suggest that insomnia symptoms may be an important target for suicide risk assessment and the treatment development of interventions to prevent suicide.

Nonsuicidal Self-Injury, Suicidal Behavior, and Their Co-occurrence as Viewed Through the Lens of the Interpersonal Theory of Suicide

Suicidal and nonsuicidal self-injurious behaviors represent perplexing yet highly prevalent public health problems. Though the behaviors are differentiable, they frequently co-occur. The nature of the association between them, however, remains poorly understood. The interpersonal theory of suicide (Joiner, 2005; Van Orden et al., 2010) offers one viable framework for enhancing our understanding in this domain. In this review, we provide an overview of the literature on nonsuicidal self-injury, its relation to suicidal behavior, and how the interpersonal theory of suicide conceptualizes this relationship. Alternative perspectives and future directions are also discussed.

Mental disorders and thwarted belongingness, perceived burdensomeness, and acquired capability for suicide.

Nearly all mental disorders increase suicide risk; however, some better predict ideation versus attempts. The interpersonal theory of suicide provides a framework to understand these relationships, via the constructs of thwarted belongingness, perceived burdensomeness, and acquired capability. The current study examined the relationships between various mental disorders and theory constructs among 997 adult outpatients, controlling for sex and age. Disorders generally symptomatically associated with social withdrawal or potential liability to others (i.e., depressive and bipolar disorders, social phobia, borderline personality disorder, schizophrenia and other psychotic disorders, certain drug dependence) were uniquely positively associated with thwarted belongingness and perceived burdensomeness. Disorders associated with potential exposure to painful and provocative events (i.e., posttraumatic stress disorder, schizophrenia and other psychotic disorders, certain drug use) were associated with increased acquired capability. Notably, alcohol use disorders, attention-deficit/hyperactivity disorder subtypes, and panic/agoraphobia were negatively associated with thwarted belongingness or perceived burdensomeness; avoidant personality disorder, and certain anxiety disorders and drug use disorders, were associated with decreased acquired capability. Importantly, disorders associated with both thwarted belongingness and perceived burdensomeness may place individuals at greatest risk for suicide if acquired capability develops. Implications for comorbidity and suicide risk assessment and treatment are discussed.

Suicide as a derangement of the self-sacrificial aspect of eusociality.

Building upon the idea that humans may be a eusocial species (i.e., rely on multigenerational and cooperative care of young, utilize division of labor for successful survival), we conjecture that suicide among humans represents a derangement of the self-sacrificial aspect of eusociality. In this article, we outline the characteristics of eusociality, particularly the self-sacrificial behavior seen among other eusocial species (e.g., insects, shrimp, mole rats). We then discuss parallels between eusocial self-sacrificial behavior in nonhumans and suicide in humans, particularly with regard to overarousal states, withdrawal phenomena, and perceptions of burdensomeness. In so doing, we make the argument that death by suicide among humans is an exemplar of psychopathology and is due to a derangement of the self-sacrificial behavioral suite found among eusocial species. Implications and future directions for research are also presented.

Overarousal interacts with a sense of fearlessness about death to predict suicide risk in a sample of clinical outpatients

Converging evidence suggests that acute states of overarousal are common prior to suicidal behavior. Yet, there has been very little theory-driven research of these phenomena. We consider two competing theoretical perspectives. The first is consistent with the interpersonal theory of suicide, which suggests that the prospect of engaging in lethal suicidal behavior should elicit some degree of arousal; however, the effect of arousal will be particularly relevant when considered in the context of an individual׳s capability for suicide. The second perspective draws from escape-based models, which would suggest that arousal alone should result in increased suicide risk, given the distress associated with high arousal states. Results indicated that the interaction of overarousal and capability for suicide was associated with suicidal symptoms. As overarousal increased, suicidal symptoms increased among high capability individuals and decreased among low capability individuals. These effects were observed beyond the effects of depression, anxiety, age, gender, and marital status. There was no significant main effect of overarousal. Results support a perspective in line with the interpersonal theory, suggesting that overarousal states may be particularly dangerous for individuals who have developed the capability for suicide.

An Assessment of Suicide-Related Knowledge and Skills Among Health Professionals

OBJECTIVE The present studies sought to examine the association between gatekeeper training and suicide knowledge among a diverse set of health care workers (case managers, clinicians, administrators, nurses, physicians, support staff). An additional aim of the current studies was to investigate knowledge about suicide among health care workers as well as their confidence in their training and skills. METHOD A naturalistic and uncontrolled group comparison study of two large groups (n = 1,336 and 1,507) of community health workers was conducted by having participants complete a brief online survey that assessed suicide-related knowledge, as well as confidence in training, skills, and support. RESULTS In Study 1, participants with Applied Suicide Intervention Skills Training (ASIST) outperformed those without ASIST training in terms of their knowledge about suicidal behavior and their confidence in their skills. In Study 2, participants with Question, Persuade, and Refer (QPR) training outperformed those with Essential Learnings Suicide Prevention (Online) training and those with No Training on suicide knowledge items; both QPR and Online trained workers reported greater confidence in their skills than workers with No Training. Across both studies, physicians and clinicians tended to score the highest on suicide knowledge and skills items. CONCLUSIONS Overall, health care workers appear to be knowledgeable about suicidal behavior, but there are some specific gaps in their knowledge, such as the rates of suicide in special populations. Participants with ASIST and QPR training demonstrated greater knowledge and skills related to suicidal behavior as compared with participants without gatekeeper training.

A Trait-Interpersonal Perspective on Suicide Risk in Criminal Offenders

Despite elevated rates of suicide among offenders, research has yet to adequately address theoretically driven risk models in this population. The present study addresses such a gap by investigating a synthesized framework using 2 well-developed theoretical models, the Five-Factor Model (FFM) of personality and the interpersonal-psychological theory of suicide (IPTS). Archival data from mitigation evaluations for pre-sentenced criminal offenders (n = 307) were analyzed using structural equation modeling (SEM). Results supported a hypothesized personality-IPTS-suicide framework in which neuroticism and extraversion predict IPTS components, namely perceived burdensomeness, thwarted belongingness, and acquired capability. IPTS constructs subsequently directly and indirectly (via suicidal ideation) predicted suicide potential. Findings have important implications for suicide theory, research, and risk assessment with offenders.

Evidence for the Propositions of the Interpersonal Theory of Suicide Among a Military Sample.

OBJECTIVE Although the interpersonal theory of suicide may explain the elevated suicide risk among military service members, past explorations have been equivocal. This study aimed to investigate the propositions of the interpersonal theory in a sample of U.S. Army recruiters. METHOD Participants (N = 3,428) completed self-report measures assessing the interpersonal theorys constructs (i.e., thwarted belongingness (TB), perceived burdensomeness (PB), acquired capability for suicide), current suicidal ideation, agitation, and insomnia. History of depression was obtained from medical records. RESULTS Hierarchical multiple regression analyses revealed that the interaction between TB and PB was associated with current suicidal ideation, controlling for depression, agitation, and insomnia. This effect was especially notable among those with high capability for suicide. CONCLUSION Findings provide support for the interpersonal theory in a large, diverse military sample. It may be advantageous to assess and therapeutically address TB and PB among at-risk service members.

Investigating correlates of suicide among male youth: questioning the close affinity between suicide attempts and deaths

This study was based on a sample of male high school students who completed National Longitudinal Adolescent Health Surveys in 1994, 1995, and 2001. We studied these students prospectively, comparing those who later died by suicide (n = 21) with those who were still living (n = 10,101). We employed chi-square and analysis of variance tests for statistical significance between suicide decedents and living respondents. Results showed suicide decedents were more likely to have experienced the suicide loss of another family member, to have been expelled from school, to have engaged in more delinquent actions including fighting, and to have greater involvement with the criminal justice system. Although one might have expected suicide casualties to have exhibited a greater amount of suicidal thoughts, attempts, and higher incidences of suicidality among their friends, our analyses did not find that these factors were associated with actual suicides. Should these findings be replicated, this would point to a need to refine youth suicide risk assessments. Collecting life histories, as well as identifying patterns of delinquency and fighting, may serve as more potentially fruitful means for assessing genuine suicide risk than some traditional risk assessment methods.z.

Examining longer-term effects of parental death in adolescents and young adults: Evidence from the national longitudinal survey of adolescent to adult health

ABSTRACT Using longitudinal data spanning a 7-year period, we investigated the behavioral and psycho-social effects resulting from a parent’s death during early childhood or teenage years on adolescent and early adulthood functioning. Findings confirmed previous work demonstrating various behavioral problems and social-psychological adjustment deficits during adolescence. Results suggested that most detrimental adjustment behaviors among parentally bereaved youth fade as they entered into young adulthood. Yet, premature school withdrawals and diminished interests in college attendance at Wave 1 left many of these young adults with diminished academic accomplishments, lingering economic disadvantages and for females a hesitancy to marry as their lives progressed into adulthood.