Megan S. Chesin

Pathways to High-Lethality Suicide Attempts in Individuals with Borderline Personality Disorder

The purpose of this study was to develop and test a model of high-lethality suicide attempts (HLSA) in individuals with Borderline Personality Disorder (BPD). An increased number of prior suicide attempts, substance use immediately prior to the attempt, and objective planning were proposed to lead directly to a HLSA, while aggression and impulsivity were hypothesized to lead indirectly to a HLSA through their associations with prior attempts. Path analysis revealed a revised model in which impulsivity was found to be significantly associated with both the lethality of the most recent attempt and the number of prior attempts. These results are discussed in terms of trait and crescendo models of suicidal behavior and their implications for suicide risk assessment among individuals with BPD.

Brief Intervention and Follow-Up for Suicidal Patients With Repeat Emergency Department Visits Enhances Treatment Engagement

We implemented an innovative, brief, easy-to-administer 2-part intervention to enhance coping and treatment engagement. The intervention consisted of safety planning and structured telephone follow-up postdischarge with 95 veterans who had 2 or more emergency department (ED) visits within 6 months for suicide-related concerns (i.e., suicide ideation or behavior). The intervention significantly increased behavioral health treatment attendance 3 months after intervention, compared with treatment attendance in the 3 months after a previous ED visit without intervention. The trend was for a decreasing hospitalization rate.

Familial transmission of parental mood disorders: unipolar and bipolar disorders in offspring

Offspring of depressed parents are at increased risk for psychiatric disorders. Although bipolar disorder (BD) and major depressive disorder (MDD) are both found in the same families, it is not clear whether transmission to offspring of BD or MDD tends to occur from parents with the same mood disorder subtype. Our primary hypothesis was that the offspring of parents with BD would be at increased risk for BD and other comorbid disorders common to BD, such as anxiety and substance use, relative to the offspring of parents with MDD. The offspring of parents with BD versus those with MDD were also hypothesized to be at greater risk for externalizing disorders (i.e., conduct disorder, attention‐deficit hyperactivity disorder, or antisocial personality disorder).

Risk assessment and psychosocial interventions for suicidal patients

Suicide is a leading cause of death in the USA. Although factors elevating long‐term risk for suicide are known and include bipolar disorder, signs of imminent suicide risk are difficult to study and not well specified. Acute risk determinations must be made to determine the appropriate level of care to safeguard patients. To increase safety among at‐risk patients in the short term and to decrease risk over time, psychosocial interventions to prevent suicide have been developed and tested in acute care and outpatient settings.

Suicidal Behavior Among Latina College Students

Latina college students are one of the fastest-growing segments of the college student population. Although there is evidence suggesting Latina high school students are at increased risk of engaging in suicidal behavior, it is unclear whether this risk continues in college. Over the course of 3 years, 554 Latina college students, the majority of whom were Dominican American or Puerto Rican, completed a series of self-report questionnaires assessing suicidal behavior, depression, hopelessness, loneliness, social problem solving, ethnic identity, and delinquent behavior. Twenty percent of Latinas reported current suicidal ideation and 15% reported a past suicide attempt. Multivariate regression analyses showed depression, loneliness, a less positive social problem-solving orientation, hopelessness, and delinquency, but not ethnic identification, were significant predictors of suicidality among Latina college students. Results are discussed as they pertain to prevention and intervention with distressed and suicidal Latina college students.

The Interaction between Rejection Sensitivity and Emotional Maltreatment in Borderline Personality Disorder

Background: Borderline personality disorder (BPD) is a prevalent psychiatric disorder associated with significant distress, dysfunction, and treatment utilization. Though, theoretically, BPD is posited to arise from a combination of trait and environmental risk factors, few studies have tested trait-by-environment interactions in BPD. We investigated the roles of rejection sensitivity (RS) and childhood emotional neglect and abuse (ENA) as well as their interaction in BPD. Sampling and Methods: Eighty-five adults with a lifetime mood disorder who were recruited for outpatient studies in a psychiatric clinic were assessed for ENA using the Childhood Trauma Questionnaire and for RS with the Adult Rejection Sensitivity Questionnaire. BPD diagnoses were made by consensus using data collected on the Structured Clinical Interview for DSM-IV. Hierarchical logistic regression was used to test associations between RS, ENA, their interaction and BPD. Results: RS and ENA interacted to predict co-occurring BPD in our sample of mood-disordered patients, with the strength of the relationship between RS and BPD depending on the severity of ENA. In the context of little or no ENA, RS and BPD were more strongly related than when ENA was more severe. Conclusions: Our results extend previous findings suggesting RS and ENA are risk factors for BPD. They also provide preliminary support for contemporary theories of BPD positing trait-by-environment interactions in the development of BPD. Prospective studies are needed to confirm these findings.

Depression, Delinquency, and Suicidal Behaviors Among College Students

BACKGROUND Liu (2004) investigated the interaction between delinquency and depression among adolescents and found that delinquency moderated the relationship between depression and suicidal behaviors. AIMS This study also explored the relationship between depression, delinquency, and suicidal behaviors, although delinquency was expected to mediate, as opposed to moderate, the relationship between depression and suicidal behaviors. METHOD The participants comprised 354 college students. The students completed a series of questionnaires measuring delinquent behavior, depressive symptoms, and suicidal thoughts and behaviors. RESULTS Contrary to Lius (2004) findings, delinquency was found not to moderate but rather to partially mediate the relationship between depression and suicidal behaviors. CONCLUSION The findings suggest that for some college students, depression is associated with delinquent behaviors, which, in turn, are associated with suicidal behaviors.

Factors Associated with Recurrent Suicidal Ideation among Racially and Ethnically Diverse College Students with a History of Suicide Attempt: The Role of Mindfulness

Although one-third of enrolled U.S. undergraduate college students are non-White, little is known about risk factors for suicidal behavior among racial and ethnic minority students. Thus, we set out to determine psychosocial factors associated with recurrent suicidal ideation among racially and ethnically diverse college students with a history of suicide attempt. From 2012–2013, 1,734 racially and ethnically diverse college students completed an on-line survey of suicidal behavior and associated factors. Depression, hopelessness, rejection sensitivity, and mindfulness, as well as past-year discrimination, ethnic identification, and acculturative stress were measured using well-validated self-report instruments. The Beck Scale for Suicide Ideation was used to assess current suicidal ideation. A subsample of 118 college students who self-reported a past suicide attempt were selected for the current analysis. Logistic regression analysis was used to test associations between risk factors and the presence of suicidal ideation, and linear regression analysis was used to test factors associated with suicidal ideation severity among those who reported current suicidal ideation. Depression was significantly related to both the presence and severity of current suicidal ideation. Mindfulness, and in particular awareness of present moment experience, was also inversely associated with ideation severity. We found depression and mindlessness were associated with suicidal ideation severity among a sample of diverse college students at high risk for suicidal behavior due to a past suicide attempt. Factors unique to the minority experience, such as acculturative stress, were not associated with current suicidal ideation. Implications for suicide prevention are discussed.

Heart rate variability and suicidal behavior

Identification of biological indicators of suicide risk is important given advantages of biomarker-based models. Decreased high frequency heart rate variability (HF HRV) may be a biomarker of suicide risk. The aim of this research was to determine whether HF HRV differs between suicide attempters and non-attempters. Using the Trier Social Stress Test (TSST), we compared HF HRV between females with and without a history of suicide attempt, all with a lifetime diagnosis of a mood disorder. To investigate a potential mechanism explaining association between HF HRV and suicide, we examined the association between self-reported anger and HF HRV. Results of an Area under the Curve (AUC) analysis showed attempters had a lower cumulative HF HRV during the TSST than non-attempters. In addition, while there was no difference in self-reported anger at baseline, the increase in anger was greater in attempters, and negatively associated with HF HRV. Results suggest that suicide attempters have a reduced capacity to regulate their response to stress, and that reduced capacity to regulate anger may be a mechanism through which decreased HF HRV can lead to an increase in suicide risk. Our results have implications for the prevention of suicidal behavior in at-risk populations.

An Emergency Department Intervention and Follow-Up to Reduce Suicide Risk in the VA: Acceptability and Effectiveness

OBJECTIVE Emergency departments (EDs) are often the primary contact point for suicidal individuals. The post-ED visit period is a high suicide risk time. To address the need for support during this time, a novel intervention was implemented in five Department of Veterans Affairs medical center EDs. The intervention combined the Safety Planning Intervention (SPI) with structured follow-up and monitoring (SFU) by telephone for suicidal individuals who did not require hospitalization. This study assessed the interventions acceptability and perceived usefulness. METHODS A selected sample of 100 intervention participants completed a semistructured interview consisting of open-ended questions about the interventions acceptability, usefulness, and helpfulness. Satisfaction with the SPI and SFU was separately evaluated. RESULTS Nearly all participants found the SAFE VET intervention to be acceptable, reporting that it was helpful in preventing further suicidal behavior and fostering treatment engagement. CONCLUSIONS The SAFE VET intervention showed promise as an ED intervention for suicidal patients.