Courtney L. Bagge

The Suicidal Behaviors Questionnaire-Revised (SBQ-R):Validation with Clinical and Nonclinical Samples

Past suicidal behaviors including ideation and attempts have been identified as significant risk factors for subsequent suicidal behavior. However, inadequate attention has been given to the development or validation of measures of past suicidal behavior. The present study examined the reliability and validity of a brief self-report measure of past suicidal behavior, the Suicidal Behaviors Questionnaire-Revised (SBQ-R). Participants included psychiatric inpatient adolescents, high school students, psychiatric inpatient adults, and undergraduates. Logistic regression analyses provided empirical support for the usefulness of the SBQ-R as a risk measure of suicide to differentiate between suicide-risk and nonsuicidal study participants. Receiver operating characteristic (ROC) analyses indicated that the most useful cutoff scores on the SBQ-R were 7 for nonsuicidal samples, and 8 for clinical samples. Both the single SBQ-R Item 1 and SBQ-R total scores are recommended for use in clinical and nonclinical settings.

Reliability and validity of the Beck depression inventory--II with adolescent psychiatric inpatients.

This investigation was conducted to validate the Beck Depression Inventory--II (BDI-II; A. T. Beck, R. A. Steer, & G. K. Brown, 1996) in samples of adolescent psychiatric inpatients. The sample in each substudy was primarily Caucasian. In Study 1, expert raters (N=7) and adolescent psychiatric inpatients (N=13) evaluated the BDI-II items to assess content validity. In Study 2, confirmatory factor analyses of several first-order solutions failed to provide adequate fit estimates to data for 205 boys, 203 girls, and the combined sample. Exploratory factor analyses identified new item-factor solutions. Reliability estimates were good (range =.72 to.91) for the BDI-II total and scale scores. In Study 3 (N=161 boys and 158 girls from Study 2), preliminary evidence for estimates of concurrent, convergent, and discriminant validity were established for the BDI-II.

Clarifying the role of emotion dysregulation in the interpersonal-psychological theory of suicidal behavior in an undergraduate sample

The interpersonal-psychological theory of suicidal behavior (IPTS; Joiner, 2005) has been subjected to a number of rigorous investigations and has shown to be a promising lens through which to understand suicide. One area thus far left unstudied with respect to the IPTS is emotion dysregulation. The bulk of the work examining the role of emotion dysregulation in suicidality has focused on suicidal ideation rather than behavior, with a number of studies reporting that emotion dysregulation is predictive of suicidal ideation (e.g., Lynch et al., 2004; Orbach et al., 2007). Studies examining suicide attempts have produced more ambiguous results. One way to clarify the nature of this relationship is to consider the construct of emotion dysregulation through an examination of specific subcomponents. In this study, we examined two specific components of emotion dysregulation - negative urgency and distress tolerance - and their relationships to all three components of the IPTS, thereby providing clarity for an otherwise poorly understood relationship. Results indicated that emotionally dysregulated individuals - those with low distress tolerance and high negative urgency - exhibited higher levels of suicidal desire, as indexed by perceived burdensomeness and thwarted belongingness. In contrast, emotionally dysregulated individuals exhibited lower levels of the acquired capability for suicide and physiological pain tolerance. As such, a complicated but theoretically cogent picture emerged indicating that, although emotion dysregulation may drastically increase the likelihood of suicidal desire, it simultaneously serves as a form protection against lethal self-harm.

Borderline personality disorder features predict negative outcomes 2 years later.

In a sample of 351 young adults, the authors assessed whether borderline personality disorder (BPD) features prospectively predicted negative outcomes (poorer academic achievement and social maladjustment) over the subsequent 2 years, over and above gender and both Axis I and Axis II psychopathology. Borderline traits were significantly related to these outcomes, with impulsivity and affective instability the most highly associated. The present findings suggest that the impulsivity and affective instability associated with BPD leads to impairment in relating well with others, in meeting social role obligations, and in academic or occupational achievement. Therefore, these may be especially important features to target in interventions for BPD.

Validation of the Adult Suicidal Ideation Questionnaire and the Reasons for Living Inventory in an adult psychiatric inpatient sample

This study investigated the factor structure of the Adult Suicidal Ideation Questionnaire (ASIQ) and the Linehan Reasons for Living Inventory (LRFL) in a sample of 205 adult psychiatric inpatients. Confirmatory factor analyses provided moderate support for the construct validity of each instrument. Coefficient alphas for the ASIQ (.98) and LRFL (.93) were high. In addition, a range of different clinical cutoff points was derived for each instrument. Both instruments were also better than chance in differentiating between the suicide attempter and psychiartic control groups. High ASIQ and low LRFL scores were significantly associated with scores on selected Minnesota Multiphasic Personality Inventory-2 Content scales. The analyses also indicated that only the ASIQ added to the symptoms of hopelessness and negative affect in differentiating between the suicide attempter and psychiatric control groups. Results suggest that both instruments may be useful screening tests for suicidal behavior in psychiatric long-term care inpatient samples.

Suicide risk assessment in a college student population

A group of 211 students at a midwestem university completed the Suicidal Behaviors Questionnaire (M. M. Linehan & S. L. Nielsen, 1981), Adult Suicidal Ideation Questionnaire (W. M. Reynolds, 1991a), Multi-Attitude Suicide Tendency Scale (I. Orbach et al., 1991), Beck Helplessness Scale (A. T. Beck, A. Weissman, D. Lester, & L. Trexler, 1974), and the Reasons for Living Inventory (M. M. Linehan, L. J. Goodstein, S. L. Nielsen, & J. A. Chiles, 1983) to determine if this group of commonly used self-report measures can distinguish between individuals with high and low levels of suicidal ideation and history of self-harmful behaviors. Exploratory principal-axis factor analysis resulted in an interpretable 2-factor solution accounting for 36.2% of the variance in suicidality. Support for convergent validity of the chosen measures was also found. It appears that rapid, accurate assessment of university student suicide risk is possible. Implications for reduction of suicide risk in this segment of the population are discussed.

Quantifying the impact of recent negative life events on suicide attempts.

The extent to which a specific negative life event (NLE) is a triggering factor for a suicide attempt is unknown. The current study used a case-crossover design, an innovative within-subjects design, to quantify the unique effects of recent NLEs on suicide attempts. In an adult sample of 110 recent suicide attempters, a timeline follow-back methodology was used to assess NLEs within the 48 hours prior to the suicide attempt. Results indicated that individuals were at increased odds of attempting suicide soon after experiencing a NLE and that this effect was driven by the presence of an interpersonal NLE, particularly those involving a romantic partner. Moreover, the relation between interpersonal NLEs and suicide attempts was moderated by current suicide planning. Interpersonal NLEs served as triggers for suicide attempts only among patients who were not currently planning their attempt. Findings suggest the importance of considering potential interpersonal NLEs when evaluating imminent risk for suicide attempts.

Adolescent alcohol involvement and suicide attempts: Toward the development of a conceptual framework

The present article provides a conceptual framework of the relation between alcohol involvement (A) and suicide attempts (S). This framework can be broadly construed to reflect two dimensions: directionality (direction of causality; A-->S, S-->A, or a spurious relation) and temporality (distinguishing between proximal and distal effects of both behaviors). We review and evaluate the evidence on the association between A and S among adolescents using this conceptual framework as a guide. The extant data suggest that this relation is complex and not fully understood. Further, it seems unlikely that a single approach will be found to determine direction of causality, and the specification and validation of hypothesized mechanisms will involve a variety of different types of evidence. Suggestions for additional research using informative designs are discussed.

The moderating role of distress tolerance in the relationship between posttraumatic stress disorder symptom clusters and suicidal behavior among trauma-exposed substance users in residential treatment

The co-occurrence of posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) is associated with greater risk for suicidal behavior than either disorder alone. Research highlights the relevance of PTSD symptoms in particular to suicide risk within this population. Research has also provided support for an association between distress tolerance (DT) and both PTSD symptoms and suicidal behavior. This study examined the role of DT in the relationship between PTSD symptom severity and suicidal behavior in a sample of 164 SUD inpatients with a history of Criterion A traumatic exposure. Results indicated that DT moderated the relationship between PTSD symptoms (overall, re-experiencing, and hyperarousal) and medically attended suicide attempts, with the magnitude of the relationship increasing at higher levels of DT.

The interactive role of distress tolerance and borderline personality disorder in suicide attempts among substance users in residential treatment

The primary purpose of this study was to examine the interactive effect of borderline personality disorder (BPD) and distress tolerance (DT) on suicidal behavior across levels of intent to die (clear vs ambiguous) and medical severity. One hundred seventy-six adult patients in residential substance use disorder treatment were administered a series of structured interviews, behavioral assessments, and self-report questionnaires. A series of analyses of covariance and multiple regression analyses were conducted to test hypotheses using both categorical and dimensional measures of BPD and DT. Analyses supported hypotheses, indicating that patients with BPD who exhibit high DT are at the greatest risk for engaging in chronic and medically serious suicidal behavior. Although high DT is unlikely to be inherently problematic, results suggest that within the context of severe psychopathology (eg, co-occurring BPD-substance use disorder), the ability to withstand aversive internal states in pursuit of a goal (eg, ones own death) may enable individuals to persist in otherwise unsustainable behavior. In this sense, DT may function in a manner consistent with the acquired capability for suicide (a component of the interpersonal-psychological theory of suicidal behavior defined by a diminished fear of death and enhanced tolerance for pain that, in the presence of suicidal desire, enables individuals to enact lethal self-injury).