Jameson K. Hirsch

A Review of the Literature on Rural Suicide Risk and Protective Factors, Incidence, and Prevention

BACKGROUND Suicide is a major cause of mortality worldwide. Differences in rates of suicide exist between urban and rural areas; however, little rigorous research has examined the phenomena of rural suicide. OBJECTIVE This review examines the current body of literature on rural suicide and investigates differences between rural and urban suicide, including socioeconomic, psychological, and cultural variables. Prevention and intervention strategies specific to rural communities are discussed. DESCRIPTION OF STUDIES: All empirical and epidemiological studies of rural suicide were included in the review regardless of study design or methodology. RESULTS Although findings are mixed, research and epidemiological data indicate that suicide is a public health concern in rural areas, with suicide rates often greater than in urban areas. DISCUSSION Rural locale may create geographic, psychological, and sociocultural barriers to treatment of suicide. A better understanding of the role of rurality in the development and maintenance of suicidal thoughts and behaviors is needed and may inform prevention and intervention efforts.

Health status and suicide in the second half of life

To examine the associations of suicide in the second half of life with medical and psychiatric illness, functional limitations, and reported use of inpatient, ambulatory, and home health care services.

Dispositional Optimism as a Moderator of the Relationship Between Negative Life Events and Suicide Ideation and Attempts

Relatively little research has focused on the role that positive psychological characteristics, such as optimism, might play in the mitigation of stressors and reduction of psychopathology. Dispositional optimism is a trait-like characteristic reflecting a positive attitude or mood regarding the future. This study examined the moderating effect of dispositional optimism on the relationship between negative life experiences and suicide ideation and attempts in a college student sample. Negative life events were associated with current suicide ideation and previous suicide attempts, and dispositional optimism moderated these relationships, after controlling for hopelessness and severity of depression. Individuals with greater optimism have reduced risk for suicide ideation and attempts in the face of low to moderate negative life events; however, this association is changed at the highest levels of negative life events. Implications for treatment include strengthening active and future-focused coping in patients who have experienced negative or potentially traumatic life events to protect against suicidal thoughts and behaviors.

Future orientation and suicide ideation and attempts in depressed adults ages 50 and over.

OBJECTIVE The objective of this study was to test the hypothesis that future orientation is associated with lower levels of suicide ideation and lower likelihood of suicide attempt in a sample of patients in treatment for major depression. METHODS Two hundred two participants (116 female, 57%) ages 50-88 years were recruited from inpatient and outpatient settings. All were diagnosed with major depression using a structured diagnostic interview. Suicide ideation was assessed with the Scale for Suicide Ideation (both current and worst point ratings), and a measure of future orientation was created to assess future expectancies. The authors predicted that greater future orientation would be associated with less current and worst point suicide ideation, and would distinguish current and lifetime suicide attempters from nonattempters. Hypotheses were tested using multivariate logistic regression and linear regression analyses that accounted for age, gender, hopelessness, and depression. RESULTS As hypothesized, higher future orientation scores were associated with lower current suicidal ideation, less intense suicidal ideation at its worst point, and lower probability of a history of attempted suicide after accounting for covariates. Future orientation was not associated with current attempt status. CONCLUSIONS Future orientation holds promise as a cognitive variable associated with decreased suicide risk; a better understanding of its putative protective role is needed. Treatments designed to enhance future orientation might decrease suicide risk.

Optimism and suicide ideation among young adult college students.

Given that college students may be at increased risk for suicide, it is important to conduct research that could guide suicide prevention efforts on college campuses. Although much research has been conducted on the role of hopelessness and depression in suicide ideation, the role of dispositional optimism is unclear. Subjects were 284 college students (185 female, 65%), ages 18 and over. Optimism was assessed with the Life Orientation Test–Revised. The outcome measure was the Beck Scale for Suicide Ideation. A hierarchical, multivariate regression was used to test the hypothesis that optimism is inversely associated with suicide ideation, even after controlling for age, gender, depressive symptoms, and hopelessness. The hypothesis was supported. Optimism holds promise as a cognitive characteristic associated with decreased thoughts of suicide in college students; a better understanding of its putative protective role in this group, and cross-culturally, is needed. Prevention programs designed to enhance optimism in the college setting might decrease suicide risk.

Optimistic Explanatory Style as a Moderator of the Association Between Negative Life Events and Suicide Ideation

BACKGROUND Individuals experiencing negative and potentially traumatic life events are at increased risk for suicidal thoughts and behaviors; however, suicidal outcomes are not inevitable. Individuals who attribute negative life events to external, transient, and specific factors, rather than internal, stable, and global self-characteristics, may experience fewer deleterious outcomes, including suicidal behavior. AIMS This study examines the moderating effect of explanatory style on the relationship between negative life experiences and suicide ideation in a college student sample. METHODS A total of 138 participants (73% female) were recruited from a rural, Eastern college and completed a self-report psychosocial assessment. RESULTS Optimistic explanatory style mitigates the influence of negative and potentially traumatic life events on thoughts of suicide, above and beyond the effects of hopelessness and depression. CONCLUSIONS Beliefs about the origin, pervasiveness, and potential recurrence of a negative life event may affect psychological outcomes. Optimistic explanatory style was associated with reduced suicide ideation, whereas pessimistic explanatory style was associated with increased thoughts of suicide. Optimistic reframing of negative life events for clients may have treatment implications for the prevention of suicidal activity.

Positive social support, negative social exchanges, and suicidal behavior in college students

Abstract Objective: Risk for suicide is often higher among college students, compared to same-age noncollegiate peers, and may be exacerbated by quality of social support and interactions. The authors examined the independent contributions of positive social support and negative social exchanges to suicide ideation and attempts in college students. Participants: Participants were 439 volunteer undergraduate students, who were primarily female (71%). Methods: Cross-sectional, survey design. Participants completed measures assessing positive social support, including emotional, informational, and tangible support; negative social exchanges; and suicidal behavior, including ideation and attempts. Results: Positive social support, particularly tangible support, and negative social exchanges were significantly predictive of greater suicidal behavior. Conclusions: Practical manifestations of support may buffer against suicide risk for college students, whereas conflict-based interactions may contribute to increased risk. At the institutional, parental, and peer levels, promotion of supportive relationships may be an important suicide prevention strategy.

Loneliness and negative life events as predictors of hopelessness and suicidal behaviors in hispanics: evidence for a diathesis-stress model

In the present study, we examined loneliness and negative life events as predictors of suicide risk (viz., hopelessness and suicidal behaviors) in a sample of 160 Hispanic adults. Consistent with expectations, we found loneliness and negative life events to be positively associated with both hopelessness and suicidal behaviors. In addition, results of conducting hierarchical regression analyses indicated that loneliness accounted for significant amounts of variance in both measures of suicide risk, ranging from 24% to 29% of the variance. The inclusion of negative life events as a predictor was found to account for additional unique variance in hopelessness (3%), but not in suicidal behaviors, beyond what was predicted by loneliness. Finally, consistent with a diathesis-stress model, the Loneliness × Negative Life Events interaction was found to account for an additional 3% of the variance in both suicide risk measures. Implications of the present findings for future research on suicide risk in Hispanics are discussed.

Self-compassion, affect, and health-promoting behaviors.

OBJECTIVE Emerging theory and research suggest that self-compassion promotes the practice of health behaviors, and implicates self-regulation as an explanatory factor. However, previous investigations focused only on behavior intentions or health risk behaviors, and did not investigate the role of emotions. This study expands on this research using a small-scale meta-analysis approach with our own data sets to examine the associations of self-compassion with a set of health-promoting behaviors, and test the roles of high positive affect and low negative affect as potential explanatory mechanisms. METHOD Fifteen independent samples (N = 3,252) with correlations of self-compassion with the frequency of self-reported health-promoting behaviors (eating habits, exercise, sleep behaviors, and stress management) were meta-analyzed. Eight of these samples completed measures of positive and negative affect. RESULTS Self-compassion was positively associated with the practice of health-promoting behaviors across all 15 samples. The meta-analysis revealed a small effect size (average r = .25; p < .001) of self-compassion and health behaviors, with low variability. Tests of the indirect effects of self-compassion on health behaviors through positive and negative affect with multiple mediator analyses revealed small effects for each. Separate meta-analyses of the indirect effects (IE) were significant for positive (average IE = .08; p < .001) and negative affect (average IE = .06; p < .001), and their combined indirect effects (average IE = .15; p < .0001). CONCLUSION Self-compassion may be an important quality to cultivate for promoting positive health behaviors, due in part to its association with adaptive emotions.

Forgiveness, depression, and suicidal behavior among a diverse sample of college students.

Depression and suicide are significant public health concerns for college-age young adults. Meaning-based characteristics, such as forgiveness, a voluntary coping process involving offering, feeling, or seeking a change from negative to positive cognitions, behaviors, and affect toward a transgressor, may buffer such poor mental health outcomes. Utilizing mediation analyses, we examined cross-sectional associations between forgiveness, depression, and suicidal behavior in a diverse student sample reporting mild to severe depressive symptoms. The effect of self-forgiveness on suicidal behavior was fully mediated by depression; self-forgiveness was associated with depression and, in turn, with suicidal behavior. Forgiveness of others was directly associated with suicidal behavior. Prospective research is needed, yet self and other-forgiveness may be appropriate targets for promotion in suicide prevention efforts.