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Showing papers in "Suicide and Life Threatening Behavior in 2017"


Journal ArticleDOI
TL;DR: There was a higher frequency of suicide Attempts in TG youth with a desire for weight change, and more female-to-male youth reported a history of suicide attempts and self-harm behaviors than male- to-female youth.
Abstract: Prevalence of suicide attempts, self-injurious behaviors, and associated psychosocial factors were examined in a clinical sample of transgender (TG) adolescents and emerging adults (n = 96). Twenty-seven (30.3%) TG youth reported a history of at least one suicide attempt and 40 (41.8%) reported a history of self-injurious behaviors. There was a higher frequency of suicide attempts in TG youth with a desire for weight change, and more female-to-male youth reported a history of suicide attempts and self-harm behaviors than male-to-female youth. Findings indicate that this population is at a high risk for psychiatric comorbidities and life-threatening behaviors.

141 citations


Journal ArticleDOI
TL;DR: It is demonstrated that risk of suicidal behaviors among those exposed to the suicide is significantly higher than those unexposed.
Abstract: Suicide bereavement and postvention literature often espouses risk for subsequent suicidal behavior among those previously exposed to a suicide death Most often risk is discussed in relation to kin; however, many more individuals are exposed to suicide, and the impact of this exposure is important to understand in relation to targeting postvention This review examined the research literature (1990–2014) to determine the evidence base for risk among those exposed to suicide The findings demonstrate that risk of suicidal behaviors among those exposed to the suicide is significantly higher than those unexposed These results are discussed within the context of current research in the field of postvention, and suggestions for future research are suggested

108 citations


Journal ArticleDOI
TL;DR: This novel prospective, multimodal, multicenter, mixed demographic study used machine learning to measure and fuse two classes of suicidal thought markers: verbal and nonverbal, and provides insight into how advanced technology can be used for suicide assessment and prevention.
Abstract: Death by suicide demonstrates profound personal suffering and societal failure. While basic sciences provide the opportunity to understand biological markers related to suicide, computer science provides opportunities to understand suicide thought markers. In this novel prospective, multimodal, multicenter, mixed demographic study, we used machine learning to measure and fuse two classes of suicidal thought markers: verbal and nonverbal. Machine learning algorithms were used with the subjects' words and vocal characteristics to classify 379 subjects recruited from two academic medical centers and a rural community hospital into one of three groups: suicidal, mentally ill but not suicidal, or controls. By combining linguistic and acoustic characteristics, subjects could be classified into one of the three groups with up to 85% accuracy. The results provide insight into how advanced technology can be used for suicide assessment and prevention.

104 citations


Journal ArticleDOI
TL;DR: Although the median onset for suicidal ideation occurs 1 to 5 years prior to attempting, the median for 6 of the 10 steps measured was within 6 hours of attempting, overall, 86.5% of proximal planning steps took place within 1 week of attempting and 66.6% occurred within 12 hours.
Abstract: To die by suicide, one must think about suicide, make a plan, and then carry it out. Prior research has examined the presence and predictors of these outcomes; however, virtually no studies have characterized how these steps unfold along the pathway to suicide. A novel instrument was administered to 30 recent suicide attempters. Results revealed that although the median onset for suicidal ideation occurs 1 to 5 years prior to attempting, the median for 6 of the 10 steps measured was within 6 hours of attempting. Overall, 86.5% of proximal planning steps took place within 1 week of attempting and 66.6% occurred within 12 hours.

100 citations


Journal ArticleDOI
TL;DR: Positive‐expectation hopelessness was the only significant predictor of depressive symptoms and suicidal behavior over a 2‐ to 4‐year period and clinical interventions may benefit from bolstering positive expectations and building optimism.
Abstract: The relationship between hopelessness and depression in predicting suicide-related outcomes varies based on the anticipation of positive versus negative events. In this prospective study of adolescents at elevated risk for suicide, we used two Beck Hopelessness Scale subscales to assess the impact of positive and negative expectations in predicting depression, suicidal ideation, and suicidal behavior over a 2- to 4-year period. In multivariate regressions controlling for depression, suicidal ideation, and negative-expectation hopelessness, positive-expectation hopelessness was the only significant predictor of depressive symptoms and suicidal behavior. Clinical interventions may benefit from bolstering positive expectations and building optimism.

98 citations


Journal ArticleDOI
TL;DR: Examining a framework for how perceived racial discrimination contributes to symptoms of depression and anxiety as well as subsequent suicide ideation and morbid ideation revealed both a direct effect and mediated effects of perceived racism on later suicide and morbid Ideation.
Abstract: Although multiple studies have found that African Americans commonly experience racial discrimination, available studies have yet to examine how perceived racism might be related to suicide vulnerability in African American youth. The purpose of this study was to examine a framework for how perceived racial discrimination contributes to symptoms of depression and anxiety as well as subsequent suicide ideation and morbid ideation. Data were obtained from 722 African American youth at mean age 10.56 years (SD = 0.64); a second wave of data was obtained 2 years later. Results revealed both a direct effect and mediated effects of perceived racism on later suicide and morbid ideation. For boys and girls, the effect of perceived racism was mediated by symptoms of depression. However, the association was mediated by anxiety for girls, but not for boys in the current sample. Implications for future research and interventions are discussed.

82 citations


Journal ArticleDOI
TL;DR: Youth NSSI is associated with persistent, elevated SA risk in adulthood, and participants who had both youth and adult NSSi attempted suicide significantly earlier than participants who began N SSI as an adult.
Abstract: Nonsuicidal self-injury (NSSI) prior to age 18 was evaluated as a risk factor for adulthood suicide attempt (SA). Archival data from 222 mood-disordered participants were analyzed using multivariate Cox proportional hazards analysis. Participants with a youth SA were excluded. The hazards of SA among adult participants with a history of youth NSSI were twice than those of mood-disordered participants without youth NSSI (hazard ratio = 2.00, 95% confidence interval = 1.16-3.44, p = .01). Moreover, participants who had both youth and adult NSSI attempted suicide significantly earlier than participants who began NSSI as an adult. Youth NSSI is associated with persistent, elevated SA risk in adulthood.

61 citations


Journal ArticleDOI
TL;DR: It is suggested hopelessness is best conceptualized as a risk factor for suicide ideation but not progression from ideation to attempts, taken together with results from previous studies.
Abstract: Hopelessness is one of the most commonly cited risk factors for suicidal behaviors. However, several retrospective studies suggest that hopelessness, while strongly correlated with suicide ideation, does not distinguish attempters from ideators without attempts. This study is the first to utilize a prospective design to disambiguate the relationship of hopelessness to ideation versus attempts. Participants were 142 depressed patients followed up over 10 years. Hopelessness and suicidality (ideation and attempts) were assessed using validated questionnaires and structured interviews. Both retrospective and prospective analyses revealed that hopelessness was higher among those reporting any suicidality (ideation or attempts) compared with nonsuicidal individuals. However, hopelessness failed to meaningfully distinguish attempters from ideators in both retrospective and prospective analyses. Taken together with results from previous studies, our findings suggest hopelessness is best conceptualized as a risk factor for suicide ideation but not progression from ideation to attempts.

59 citations


Journal ArticleDOI
TL;DR: A positive effect of the 113Online chat service is found, to be enhanced by practice standards addressing an apparent lack of focus on the central issue of suicidality during chats, as well as by the development of best practices specific for online crisis intervention.
Abstract: Recognizing the importance of digital communication, major suicide prevention helplines have started offering crisis intervention by chat. To date there is little evidence supporting the effectiveness of crisis chat services. To evaluate the reach and outcomes of the 113Online volunteer-operated crisis chat service, 526 crisis chat logs were studied, replicating the use of measures that were developed to study telephone crisis calls. Reaching a relatively young population of predominantly females with severe suicidality and (mental) health problems, chat outcomes for this group were found to be comparable to those found for crisis calls to U.S. Lifeline Centers in 2003-2004, with similar but not identical associations with specific helpers' styles and attitudes. Our findings support a positive effect of the 113Online chat service, to be enhanced by practice standards addressing an apparent lack of focus on the central issue of suicidality during chats, as well as by the development of best practices specific for online crisis intervention.

57 citations


Journal ArticleDOI
TL;DR: For behavioral outcomes, mass media campaigns appear to be most effective when delivered as part of a multicomponent suicide prevention strategy, while "standalone campaigns" were modestly useful for increasing suicide literacy.
Abstract: Mass media campaigns are increasingly seen as an important part of suicide prevention; however, despite their popularity, their efficacy is not well understood. The current review aimed to address key knowledge gaps regarding how mass media campaigns can be optimized to prevent suicide, by looking at their global efficacy, and mechanisms related to successful outcomes. A systematic review of the international literature examined studies which evaluated mass media campaigns targeted at suicide prevention, where suicide behaviors (mortality, attempts) or suicide literacy (knowledge, attitudes, help-seeking) was identified as a primary outcome. Thirteen articles describing 12 unique campaigns met eligibility criteria. For behavioral outcomes, mass media campaigns appear to be most effective when delivered as part of a multicomponent suicide prevention strategy, while "standalone campaigns" were modestly useful for increasing suicide literacy. Level of exposure, repeat exposure, and community engagement appeared to be fundamental to the success of these campaigns; however, these constructs were poorly adhered to in the development and implementation of campaigns. Overall, the mixed quality of the included studies highlights a need for increased quantity, consistency, and quality of evaluations to advance the evidence base.

53 citations


Journal ArticleDOI
TL;DR: Female sex, younger age, and multiple exposures to suicide were associated with greater risk for poorer outcomes and suicide exposed with high impact was more likely to have depression, anxiety, posttraumatic stress disorder, prolonged grief, and suicide ideation.
Abstract: Recent studies of people exposed to suicide point to a continuum of effects moderated by a perception of closeness to the deceased. We investigated the importance of perception of impact of the death on mental health outcomes of those exposed to suicide. Female sex, younger age, and multiple exposures to suicide were associated with greater risk for poorer outcomes. Suicide exposed with high impact was more likely to have depression, anxiety, posttraumatic stress disorder, prolonged grief, and suicide ideation. Findings can help focus postvention resources for suicide-exposed individuals.

Journal ArticleDOI
TL;DR: Impulsive responses to positive emotions related to suicide ideation, attempts, and self‐harm within the bipolar group were significantly more common in the bipolar disorder group compared with the control group.
Abstract: A growing body of research suggests that impulsive responses to emotion more robustly predict suicidality than do other forms of impulsivity. This issue has not yet been examined within bipolar disorder, however. Participants diagnosed with bipolar I disorder (n = 133) and control participants (n = 110) diagnosed with no mood or psychotic disorder completed self-report measures of emotion-triggered impulsivity (Negative and Positive Urgency Scales) and interviews concerning lifetime suicidality. Analyses examined the effects of emotion-triggered impulsivity alone and in combination with gender, age of onset, depression severity, comorbid anxiety, comorbid substance use, and medication. A history of suicide ideation and attempts, as well as self-harm, were significantly more common in the bipolar disorder group compared with the control group. Impulsive responses to positive emotions related to suicide ideation, attempts, and self-harm within the bipolar group. Findings extend research on the importance of emotion-triggered impulsivity to a broad range of key outcomes within bipolar disorder. The discussion focuses on limitations and potential clinical implications.

Journal ArticleDOI
TL;DR: The predictive validity of an objective measure, the death/suicide Implicit Association Test (d/sIAT), was tested among psychiatrically hospitalized veterans and may augment the accuracy of suicide risk assessment.
Abstract: Reliance on self-report limits clinicians' ability to accurately predict suicidal behavior. In this study the predictive validity of an objective measure, the death/suicide Implicit Association Test (d/sIAT), was tested among psychiatrically hospitalized veterans. Following acute stabilization, 176 participants completed the d/sIAT and traditional suicide risk assessments. Participants had similar d/sIAT scores regardless of whether they had recently attempted suicide. However, d/sIAT scores significantly predicted suicide attempts during the 6-month follow-up above and beyond other known risk factors for suicidal behavior (OR = 1.89; 95% CI: 1.15-3.12; based on 1SD increase). The d/sIAT may augment the accuracy of suicide risk assessment.

Journal ArticleDOI
TL;DR: Patients with severe sleep complaints at the time of clinic entry endorsed significantly more engagement in nonsuicidal self-injury, and middle insomnia and circadian reversal were both significant predictors of suicide attempts.
Abstract: The relationship between different sleep disturbances and self-harm thoughts and behaviors was examined among 223 adolescents presenting to a community clinic for mood disorders and suicidal and nonsuicidal self-injurious behaviors Two-thirds of the adolescents reported nightly, severe sleep complaints Relative to adolescents without significant sleep complaints, patients with severe sleep complaints at the time of clinic entry endorsed significantly more engagement in nonsuicidal self-injury Middle insomnia and circadian reversal were both significant predictors of suicide attempts Terminal insomnia was significantly associated with suicidal ideation Results support the importance of assessing sleep difficulties among adolescents at risk for suicide

Journal ArticleDOI
TL;DR: It is proposed that current suicidality treatment efforts trail current suICidality theories in their lack of focus on the extent to which individuals thinking about suicide are capable of transitioning from ideation to attempt.
Abstract: Current efforts at suicide prevention center largely on reducing suicidal desire among individuals hospitalized for suicidality or being treated for related psychopathology. Such efforts have yielded evidence-based treatments, and yet the national suicide rate has continued to climb. We propose that this disconnect is heavily influenced by an unmet need to consider population-level interventions aimed at reducing the capability for suicide. Drawing on lessons learned from other public health phenomena that have seen drastic declines in frequency in recent decades (HIV, lung cancer, motor vehicle accidents), we propose that current suicidality treatment efforts trail current suicidality theories in their lack of focus on the extent to which individuals thinking about suicide are capable of transitioning from ideation to attempt. We summarize extant evidence for specific capability-centered approaches (e.g., means safety) and propose other options for improving our ability to address this largely overlooked variable. We also note that population-level approaches in this regard would represent an important opportunity to decrease risk in individuals who either lack access to evidence-based care or underreport suicidal ideation, as a reduced capability for suicide would theoretically diminish the potency of suicidal desire and, in this sense, lower the odds of a transition from ideation to attempt.

Journal ArticleDOI
TL;DR: Current screening procedures identify only one in seven Soldiers experiencing suicide ideation and highlight the need for alternative risk-detection strategies.
Abstract: Previous research in US Army Soldiers shows rates of mental health concerns as two to four times higher on anonymous surveys than on postdeployment health assessments. In this study, Soldiers presenting for health reassessment completed two questionnaires on suicide risk factors: one linked to the health assessment and one anonymous. About 5.1% of respondents reported suicide ideation on the anonymous questionnaire, 3.0% on the linked questionnaire, and 0.9% on the health reassessment. About 56.4% who reported suicide ideation anonymously told nobody of their thoughts. Current screening procedures identify only one in seven Soldiers experiencing suicide ideation and highlight the need for alternative risk-detection strategies.

Journal ArticleDOI
TL;DR: Overall, shame and guilt were positively associated with suicide ideation and these relations were mediated by thwarted belongingness and PB in parallel adjusting for depressive symptoms; however, there were some differences between demographic subgroups.
Abstract: To date, no study has examined rates of suicide ideation or theory-based risk factors for suicide ideation among bondage and discipline, dominance and submission, and sadomasochism (BDSM) practitioners. Participants were 321 adults that endorsed BDSM involvement. Thirty-seven percent of the sample indicated a nonzero level of suicide ideation. Thwarted belongingness and perceived burdensomeness (PB) were positively associated with suicide ideation and their interactive effect predicted additional variance in suicide ideation after adjusting for depressive symptoms. Overall, shame and guilt were positively associated with suicide ideation and these relations were mediated by thwarted belongingness and PB in parallel adjusting for depressive symptoms; however, there were some differences between demographic subgroups. Among BDSM practitioners, stigma-related internalized feelings (i.e., shame and guilt) may be associated with increased thwarted belongingness and PB, which are associated with suicide ideation.

Journal ArticleDOI
TL;DR: Results underscore the importance of both prior suicide attempts and nonsuicidal self-harm as risk indicators for future and potentially lethal suicide attempts.
Abstract: This prospective study of suicidal emergency department (ED) patients (ages 10–18) examined the timing, cumulative probability, and predictors of suicide attempts through 18 months of follow-up. The cumulative probability of attempts was as follows: .15 at 6 months, .22 at 1 year, and .24 by 18 months. One attempt was fatal, yielding a death rate of .006. Significant predictors of suicide attempt risk included a suicide attempt at ED presentation (vs. suicidal ideation only), nonsuicidal self-injurious behavior, and low levels of delinquent symptoms. Results underscore the importance of both prior suicide attempts and nonsuicidal self-harm as risk indicators for future and potentially lethal suicide attempts.

Journal ArticleDOI
TL;DR: The review provides a high-quality update of risk factor literature that could be applied to emergency health care settings; however, further research is needed to confirm emerging risk factors.
Abstract: Suicide is a global public health problem, and with recent economic and societal changes, there may be emerging risk factors unrecognized by health care professionals. The aim of this systematic review was to update existing suicide risk factor literature applicable to emergency health care settings. A total of 35 articles identified from PsycINFO, CINAHL, and Medline met the inclusion criteria. Results supported the significance of existing suicide risk factors and identified emerging risk factors. The review provides a high-quality update of risk factor literature that could be applied to emergency health care settings; however, further research is needed to confirm emerging risk factors.

Journal ArticleDOI
TL;DR: In the adjusted model, the effect of friendship on suicide attempts was largely explained by self-reported depression severity, and its effect on suicidal behavior appears to occur through its relationship with depression.
Abstract: Social support is thought to protect against the risk of suicidal behavior in young people and late life, but less is known about the role of friendship in adults. We explored the effect of friendship on suicide attempt risk during 1-year follow-up of 132 adults presenting with major depressive episode (MDE). Items from the Social Adjustment Scale-Self-Report were used as an index of frequency and quality of recent friendship contacts. Survival methods tested associations of friendship with risk of suicide attempt, recurrent MDE, and related outcomes during follow-up. Impaired friendship predicted greater risk of suicide attempt in an unadjusted Cox model. This association was stronger for quality (p = .009) than frequency (p = .081) of friendship contacts. In the adjusted model, the effect of friendship on suicide attempts was largely explained by self-reported depression severity. Friendship has a potentially bidirectional relationship with depression, and its effect on suicidal behavior appears to occur through its relationship with depression. Future research should examine the effect of antidepressant treatment on friendship and be designed to test mediation models of relationships between friendship, depression, and suicidal behavior.

Journal ArticleDOI
TL;DR: Preliminary support for the use of the modified emotional Stroop task as part of a suicide risk screening battery that could add to the detection of suicide risk is provided.
Abstract: Detecting suicide risk among nonclinical populations is challenging due to low base rates and the help-negation tendency of at-risk individuals. The current longitudinal study investigated the predictive validity of the modified emotional Stroop task (EST) by conducting a follow-up study of 197 students who participated in a study by Chung and Jeglic (2016). The EST latencies for suicide-related cues and past suicidal behaviors were the only significant predictors of suicide risk. The findings of this study provide preliminary support for the use of the EST as part of a suicide risk screening battery that could add to the detection of suicide risk.

Journal ArticleDOI
TL;DR: The positive association between PTSD symptom clusters and suicidal ideation was inconsistent and modest, with mixed support for the ITS model, and results indicated that numbing symptoms are positively associated with both perceived burdensomeness and thwarted belongingness and hyperarousal symptoms are negatively associated with fearlessness about death.
Abstract: Prior studies examining posttraumatic stress disorder (PTSD) symptom clusters and the components of the interpersonal theory of suicide (ITS) have yielded mixed results, likely stemming in part from the use of divergent samples and measurement techniques. This study aimed to expand on these findings by utilizing a large military sample, gold standard ITS measures, and multiple PTSD factor structures. Utilizing a sample of 935 military personnel, hierarchical multiple regression analyses were used to test the association between PTSD symptom clusters and the ITS variables. Additionally, we tested for indirect effects of PTSD symptom clusters on suicidal ideation through thwarted belongingness, conditional on levels of perceived burdensomeness. Results indicated that numbing symptoms are positively associated with both perceived burdensomeness and thwarted belongingness and hyperarousal symptoms (dysphoric arousal in the 5-factor model) are positively associated with thwarted belongingness. Results also indicated that hyperarousal symptoms (anxious arousal in the 5-factor model) were positively associated with fearlessness about death. The positive association between PTSD symptom clusters and suicidal ideation was inconsistent and modest, with mixed support for the ITS model. Overall, these results provide further clarity regarding the association between specific PTSD symptom clusters and suicide risk factors.

Journal ArticleDOI
TL;DR: A considerable proportion of sites expressed mixed or neutral suicide attitudes, and 1% were explicitly pro-suicide, highlight a need for suicide prevention organization websites to be made more easily accessible.
Abstract: It is unclear whether individuals searching the Internet for assistance with thoughts of suicide are likely to encounter predominantly helpful or harmful resources. This study investigated websites retrieved by searching Google for information and support for suicidal thoughts. Google searches retrieved a high percentage of irrelevant websites (26%, n = 136). Of the 329 relevant websites retrieved, the majority were suicide preventive (68%); however, a considerable proportion of sites expressed mixed (22%) or neutral (8%) suicide attitudes, and 1% were explicitly pro-suicide. The results highlight a need for suicide prevention organization websites to be made more easily accessible. In the meantime, clinicians should be aware of appropriate websites to recommend to clients.

Journal ArticleDOI
TL;DR: Targeting perceived burdensomeness and thwarted belongingness may be useful for decreasing suicide risk among undergraduates with eating disorder symptoms.
Abstract: Suicide attempts and premature mortality due to suicide are elevated in people with eating disorders. Informed by the interpersonal theory of suicide, two studies examined the role of perceived burdensomeness and thwarted belongingness in explaining the association between eating disorder symptoms and suicide risk. Results indicated that various eating disorder symptoms had an indirect effect on suicide risk through perceived burdensomeness and thwarted belongingness. Targeting perceived burdensomeness and thwarted belongingness may be useful for decreasing suicide risk among undergraduates with eating disorder symptoms.

Journal ArticleDOI
TL;DR: A conceptual model in which the associations between perceived burdensomeness and suicide Ideation, and between thwarted belongingness and suicide ideation, are moderated by mindfulness was examined, and implications for intervention and elaboration of the interpersonal psychological theory of suicide are discussed.
Abstract: A conceptual model in which the associations between perceived burdensomeness and suicide ideation, and between thwarted belongingness and suicide ideation, are moderated by mindfulness was examined. Participants were 218 undergraduates (mean age = 20.81) with moderate-to-severe depressive symptoms. Mindfulness significantly moderated the association between perceived burdensomeness and suicide ideation; participants with thoughts of burdensomeness experienced lower levels of suicide ideation if they were high, as opposed to low, in mindfulness. Mindfulness did not significantly moderate the association between thwarted belongingness and suicide ideation. Implications for intervention and elaboration of the interpersonal psychological theory of suicide are discussed.

Journal ArticleDOI
TL;DR: The Interpersonal Needs Questionnaire for assessing thwarted belongingness (TB) and perceived burdensomeness (PB) has not been validated with community adolescents and the 15-item version (INQ-15) did not fit without modification.
Abstract: The Interpersonal Needs Questionnaire (INQ) for assessing thwarted belongingness (TB) and perceived burdensomeness (PB) has not been validated with community adolescents. We translated and administered the INQ to 307 Slovenian adolescents twice over 2-3 months and found that the 15-item version (INQ-15) did not fit without modification. TB and PB scales correlated with concurrent and later suicide ideation and lifetime suicide attempt history. The latent PB factor was associated with concurrent and later ideation controlling for TB, age, gender, depressive symptoms, binge drinking, and peer victimization. Suicide ideation and binge drinking were independently related to attempt history. Assessing and intervening on PB and binge drinking may be promising approaches to suicide prevention with community adolescents.

Journal ArticleDOI
TL;DR: Examining predictors of inpatient hospitalization and service use outcomes associated with hospitalization in 181 youths drawn from consecutive ED admissions for suicidality found hospitalization was associated with improved linkage to outpatient treatment and more intensive service use.
Abstract: Youth suicide attempters presenting to the emergency department (ED) are frequently admitted to psychiatric inpatient hospitals, yet little is known about how clinicians decide which youths to admit versus discharge to outpatient care. We examine predictors of inpatient hospitalization and describe service use outcomes associated with hospitalization in 181 youths drawn from consecutive ED admissions for suicidality. Predictors of hospitalization include ED site, suicide plan, and parent report of problems. Hospitalization was associated with improved linkage to outpatient treatment and more intensive service use. Future research is needed to understand the best service delivery and treatments for these high-risk youth.

Journal ArticleDOI
TL;DR: Test attitudes toward suicide prevention, self-efficacy, and behavioral intentions as mediators/moderators of clinical skill development over time following suicide intervention training support a direct effect of attitudes on practice behaviors and self-efficiency, but no moderating effect.
Abstract: The purpose of this study was to use a longitudinal path analysis to test attitudes toward suicide prevention, self-efficacy, and behavioral intentions as mediators/moderators of clinical skill development over time following suicide intervention training. Results support a direct effect of attitudes on practice behaviors and self-efficacy, but no moderating effect. Self-efficacy performed as a mediator of practice behaviors over time. Behavioral intention had a direct effect on practice behaviors and mediated the relationship between attitudes and practice behaviors. Implications for research and practice are discussed.

Journal ArticleDOI
TL;DR: The characteristics of Japanese crisis hotline callers and the features of suicidal ideation revealed in the present study are expected to be useful in developing telephone crisis hotline strategies.
Abstract: Hotline callers do not always have suicidal ideation and previous studies have noted that the rate of such callers is limited. Crisis hotline counselors must be able to identify high-risk callers in order to provide appropriate support. This study investigated the characteristics of Japanese crisis hotline callers in 2012 (N = 541,694) and is the first to analyze crisis hotline data for all parts of Japan over 1 year. About 14% of the callers had suicidal ideation and 6% had a history of attempted suicide. The odds ratio for suicidal ideation among those with a history of attempted suicide was 15.5. The suicidal ideation rate was much smaller compared to previous studies in other countries. There is a psychological barrier that must be broken for high-risk people to use support hotlines. In addition, attempted suicide is a strong exclusive predisposing factor for death due to suicide; therefore, counselors should pay careful attention to callers with a history of attempted suicide. The characteristics of Japanese crisis hotline callers and the features of suicidal ideation revealed in the present study are expected to be useful in developing telephone crisis hotline strategies.

Journal ArticleDOI
TL;DR: This prospective, naturalistic study examined the association between major loss life experiences, other psychiatric risk factors (depression, hopelessness, and anxiety), and suicidal thoughts and behaviors among adolescents followed through young adulthood for up to 14 years.
Abstract: This prospective, naturalistic study examined the association between major loss life experiences, other psychiatric risk factors (depression, hopelessness, and anxiety), and suicidal thoughts and behaviors (STBs) among adolescents followed through young adulthood for up to 14 years. Major loss life events were related to subsequent increases in STBs. Major loss life events were primarily related to increases in suicide ideation in the presence of lower levels of other risk factors. There was a bidirectional relationship between major losses and other risk factors. Implications for the association between loss experiences, other risk factors, and future STBs are discussed.