OBJECTIVE:The goal of this paper was to test a mobile health intervention designed to reduce self-injurious thoughts and behaviors in LGBTQ+ individuals. The intervention consisted of brief messages aimed at increasing feelings of belongingness and meaning. METHOD:We recruited LGBTQ+ individuals (N = 55) with past-month self-injurious thoughts and/or behaviors. Participants completed 14 days of ecological momentary assessment (EMA) of minority stress, thwarted belongingness, perceived burdensomeness, and self-injurious thoughts and behaviors. Then, participants were randomly assigned to receive brief messages designed to instill belongingness and meaning/purpose, or no intervention for 14 days. Then, participants completed an additional 14 days of EMA. RESULTS:Our results showed that participants in the control condition had significant increases in self-injurious thoughts and planning over time, whereas those in the intervention condition showed no significant change. For self-injurious behavior, thwarted belongingness, and perceived burdensomeness, there were significant decreases in the intervention condition, but no changes in the control condition. CONCLUSIONS:These results provide support for the interpersonal theory of suicide and indicate a potentially scalable mobile health intervention. PUBLIC HEALTH SIGNIFICANCE:This paper found evidence that a brief mobile health intervention reduced suicidal and non-suicidal self-injurious thoughts and behaviors among LGBTQ+ individuals.
INTRODUCTION:Suicide risk assessment during psychiatric admission may benefit from clinically observable information beyond overall depressive symptom severity. This study examined whether clinician-documented nighttime sensory-behavioral activation was associated with admission suicidality in young inpatients with major depressive disorder (MDD). METHODS:This retrospective study included 406 inpatients aged 15-35 years with moderate-to-severe MDD. Nighttime sensory-behavioral activation was coded as none, recurrent, or marked. The primary outcome was admission suicidality, defined as suicidal ideation or behavior during the index depressive episode. Logistic regression models adjusted for age, sex, HAMD-17 score excluding suicide and insomnia items (Items 3-6), and documented precipitating stressor type. Severe social role impairment and thyroid indicators were secondary and exploratory outcomes. RESULTS:After adjustment, recurrent activation (OR = 2.00, 95% CI 1.17-3.43) and marked activation (OR = 1.96, 95% CI 1.12-3.43) were associated with higher odds of admission suicidality. Marked activation was associated with severe social role impairment (OR = 2.47, 95% CI 1.42-4.30). Thyroid indicators did not account for these associations. CONCLUSION:Nighttime sensory-behavioral activation was associated with admission suicidality and, at the marked level, severe social role impairment. These findings are preliminary and warrant prospective validation using standardized measures.
PURPOSE:Violence victimization is a known risk factor for adolescent suicidal ideation, yet moderating factors remain poorly understood. This study examined whether aerobic and muscle-strengthening physical activity (PA) differentially moderated the violence victimization-suicidal ideation association. METHODS:Four waves of the Korea Youth Risk Behavior Survey (KYRBS 2021-2024; n = 214,218) were analyzed using complex sample logistic regression. Aerobic PA (0-7 days/week) and muscle-strengthening PA (0-5+ days/week) were modeled continuously, with linear and quadratic terms to test interactions with violence victimization, adjusting for psychosocial and sociodemographic covariates. Sex- and SES-stratified analyses and formal three-way interaction tests were conducted. RESULTS:Overall, 13.3% reported suicidal ideation, versus 38.9% among violence-victimized adolescents (OR = 3.43). Aerobic PA showed a non-monotonic interaction with violence: odds of suicidal ideation were elevated at 1-3 days/week (ORs 1.4-1.8) but attenuated at ≥ 4 days/week, a pattern nominally strongest among males. Muscle-strengthening PA showed elevated odds at higher frequencies (≥ 3 days/week; ORs 1.4-1.9) rather than low frequencies, though this association was not statistically significant in continuous models. DISCUSSION:Both PA types showed frequency-dependent, nonlinear associations inconsistent with single-threshold framing. Findings are associational and hypothesis-generating, requiring prospective confirmation.
BACKGROUND:The Interpersonal Needs Questionnaire (INQ) is a 15-item self-report assessment of perceived burdensomeness (PB) and thwarted belongingness (TB), conceptualized as proximal risk factors for suicide ideation (SI). The INQ-15 has strong psychometric properties; however, PB has demonstrated more robust associations with SI than TB. METHOD:To assess the possible influence of INQ-15 item sequencing, confirmatory factor analyses (CFAs) were conducted to examine the two-factor structure of the INQ-15 (TB and PB) among participants (N = 600, 50.5% women, 66.8% White, Mage = 38.8 years) recruited via Amazon Mechanical Turk who were randomized into three item sequence conditions (standard-order, n = 192; reversed-order, n = 210; random-order, n = 198). RESULTS:Across all conditions, TB items 9, 11, and 12 raised model-fit concerns. Model fit improved after correlating residuals and removing those items across conditions. The TB-PB correlations were weaker than those reported in prior literature, even after removing those items. The conditions and models did not differ in their associations with TB and PB, or with SI-related variables. CONCLUSIONS:Removing TB items 9, 11, and 12 could optimize the INQ-15 factor structure and improve its concurrent validity; however, replication in additional populations and with other sampling methods is necessary.
INTRODUCTION:Firearm access increases suicide risk and lethal means safety (LMS) counseling is widely promoted to reduce this risk by encouraging voluntary limitations on firearm access during crises. Although LMS has been shown to increase secure in-home firearm storage, less is known regarding its ability to promote temporary out-of-home storage-an approach that may more clearly prevent suicide. This study evaluated whether Project Safe Guard (PSG), a brief LMS intervention, increases willingness to store firearms outside the home during periods of heightened distress. METHOD:Participants were 232 Mississippi National Guard members with home firearm access enrolled in the original PSG randomized trial. Individuals received either a single session of PSG or a time-matched control condition. Willingness to store firearms outside the home during personal or household distress was assessed pre-intervention, post-intervention, and at 3 and 6-month follow-ups. Repeated-measures ANOVAs tested change over time and the impact of condition. RESULTS:Participants receiving PSG showed significantly greater increases in willingness to store firearms outside the home when distressed, with effects more robust immediately post-treatment and in analyses focused on participants' own distress. CONCLUSION:PSG increases openness to temporary out-of-home storage and may represent a promising firearm suicide prevention strategy. TRIAL REGISTRATION:ClinicalTrials.gov ID: NCT03375099.
INTRODUCTION:The Session Rating Scale (SRS) is widely used to assess therapeutic alliance in clinical settings, yet its application in paraprofessional-delivered interventions for older adults remains underexplored. This study examined whether therapeutic alliance predicted improvements in suicide desire among community-dwelling older adults participating in a warm-calling intervention. METHODS:Binomial generalized linear mixed-effects models were used with dichotomized high-score responses for thwarted belongingness (TB) and perceived burdensomeness (PB) to evaluate the role of therapeutic alliance (SRS) over time. Participants were assigned to one of two 8-week conditions: (1) BE, emphasizing empathy and connection through befriending and reminiscence; or (2) BE + ASIST, which incorporated an aging-adapted LivingWorks Applied Suicide Intervention Skills Training (ASIST). Trained paraprofessionals delivered all sessions. RESULTS:For PB, the odds of being classified as elevated decreased over time, and this decrease was statistically significant. For TB, a three-way interaction among condition, time, and SRS further showed that higher SRS scores predicted greater reductions in the odds of elevated TB within the BE + ASIST condition. CONCLUSION:Findings underscore the importance of therapeutic alliance in enhancing paraprofessional-led interventions for late-life suicide prevention.
OBJECTIVES:Primal world beliefs (primals) are fundamental assumptions about the world that may serve as suicide risk factors. This study examined relationships between primals and suicidal thoughts and behaviors in three samples of adults with recent suicidal ideation (SI). METHOD:Study 1 analyzed cross-sectional data (N = 304 undergraduates; N = 390 Prolific participants) involving measures of primals, SI, wish to live (WTL), wish to die (WTD), and coping self-efficacy. Study 2 included Prolific participants (N = 174) who completed measures of primals and SI at baseline and 1-month follow-up. Cross-lagged panel analyses examined temporal relationships between primals and SI. RESULTS:Positive primals were associated with lower SI, greater WTL, lower WTD, and higher suicidal coping self-efficacy. Believing the world is meaningful, needs me, and good at baseline predicted lower SI at 1-month follow up, whereas SI at baseline did not predict primals at follow up. Primals were inconsistently related to past suicide attempts. CONCLUSION:Findings support a relationship between primals and SI both cross-sectionally and over time. Positive primals may play a protective role against SI over time and may serve as a promising treatment target for adapting existing interventions.
BACKGROUND:Over 70% of global suicides occur in low- and middle-income countries (LMICs), yet cultural mechanisms of suicide risk remain underexplored. Collectivism is often assumed protective, but emerging evidence from vertically collectivist settings suggests a more complex relationship. METHODS:Qualitative interviews were conducted with 29 community stakeholders across health, education, religious, and social service sectors in Toledo District, southern Belize. Data were analyzed using reflexive thematic analysis with deductive alignment to the Interpersonal Theory of Suicide (IPTS) and inductive attention to collectivist cultural dynamics. RESULTS:Findings mapped onto all three IPTS constructs. Acquired capability emerged through repeated lifespan exposure to violence, including corporal punishment, intimate partner violence, alcohol-related harm, and community violence. Thwarted belongingness was shaped by stigma, ethnic exclusion, family conflict, and Toledo's structural marginalization as a "forgotten district." Perceived burdensomeness reflected poverty, unemployment, aging-related dependence, and limited access to care. Across constructs, vertical collectivist norms governing privacy, reputation, and emotional restraint appeared to shape how distress was expressed and managed. CONCLUSIONS:These findings extend IPTS by demonstrating how collectivist norms and structural scarcity intersect to shape suicide risk in an LMIC context, underscoring the need for culturally grounded, structurally informed prevention approaches.
INTRO:Associations of negative affect and nonsuicidal self-injury (NSSI) are well-characterized. However, relationships between discrete negative emotions and NSSI are less well understood. An association between anger and NSSI is supported by contemporary models and growing evidence from studies across diverse populations. METHODS:The goal of this meta-analysis was to systematically review the literature and to calculate the effect size of the relationship between NSSI and anger. RESULTS:The relationship between NSSI and anger constructs was examined with data from 25 studies (total N = 9148). Results of the meta-analysis showed an overall moderate association between NSSI and anger (pooled Hedges' g = 0.55) based on 31 individual effect sizes. There were no significant differences in effect size estimates across anger constructs. There were no significant moderators of the relationship between NSSI and anger. DISCUSSION:Findings highlight the important role of the discrete emotion of anger in NSSI among adults. Findings may inform clinical recommendations such as the assessment for potential NSSI when individuals present with anger. Additionally, anger is likely related to the functions of NSSI and may play a role in maintaining this behavior. CONCLUSION:Future research is needed to examine the relationship between anger and NSSI utilizing longitudinal designs.
INTRODUCTION:Passive suicidal ideation (SI) is a well-established risk factor for suicidal behavior but has received less attention than active SI. Although recent work has leveraged intensive longitudinal data and machine learning (ML) to forecast short-term risk for active SI, passive SI remains understudied as a prediction target. METHODS:Seventy-eight psychiatrically hospitalized youth (ages 13-17 years) completed baseline assessments and daily ratings of risk and protective factors for 28 days post-discharge. Multiple ML models were trained to predict the presence of next-day passive SI. Models with and without baseline variables were compared to assess the relative predictive value of time-varying versus baseline features. RESULTS:ML models predicted next-day passive SI with high accuracy (AUC = 0.90). The strongest predictors were within-person 7-day moving averages of passive SI duration and frequency. Including baseline variables had negligible performance impact, even during initial days post-discharge. CONCLUSIONS:Short-term passive SI remains an underutilized but important target for suicide prevention. Forecasting next-day passive SI using ML is feasible and highly accurate. Within-person, time-varying features outperformed baseline factors, even in early days post-discharge. Additional research on SI facets, such as duration, is needed. Integrating passive SI into personalized intervention frameworks may enhance the precision of suicide prevention efforts.
BACKGROUND:International students frequently report suicidal thoughts, yet often do not access support. Bud is a co-designed, self-guided mobile app developed as an upstream suicide-prevention intervention targeting transdiagnostic mechanisms related to suicide risk. AIM:To evaluate the effectiveness, acceptability, engagement, and safety of Bud compared with an active and structured psychoeducational comparator. MATERIALS AND METHODS:A two-arm, parallel-group randomized controlled trial was conducted with international students in Australia. Participants were randomized 1:1 to Bud (n = 156) or psychoeducational fact sheets (n = 156), completing assessments at baseline, 2 weeks and 4 weeks. The primary outcome was psychological distress (K10). Secondary outcomes included help-seeking intentions, interpersonal risk processes, emotion regulation, suicidal ideation, and mental health literacy. Analyses used intention-to-treat mixed-effects models. RESULTS:Contrary to the hypotheses, psychological distress decreased from baseline to 4 weeks (Bud: -2.23; Comparator: -2.15), with no group × time interaction (F(2,342.45) = 0.43, p = 0.652); emotion regulation and suicidal ideation showed similar patterns across groups, and other secondary outcomes remained stable across groups. As expected, Bud was rated as enjoyable, worthwhile, and usable. Engagement was moderate (median 10 activities), and no iatrogenic effects occurred. CONCLUSION:Bud was feasible, acceptable, and safe but did not outperform an active psychoeducational comparator over 4 weeks. TRIAL REGISTRATION:ClinicalTrials.gov identifier: ACTRN12625000584437.
INTRODUCTION:Adolescents engage in non-suicidal self-injury (NSSI) and social media more than any other age group. To understand the role of adolescents' subjective social media experiences in NSSI, this study examined the relationships between emotional responses to social media and NSSI urges and engagement. METHODS:Data were collected from two studies, which included a cross-sectional study (N = 408) and an 8-week intensive-longitudinal study (N = 80) with ecological momentary assessment (3 surveys/day). RESULTS:The cross-sectional study revealed that positive responses to social media were associated with the presence of NSSI urges across all time points and frequency of NSSI engagement in the past year and lifetime. Negative responses to social media were associated with the presence of NSSI urges and engagement across all time points and frequency of NSSI engagement in the past week, month, and year. The intensive-longitudinal study revealed that positive responses to social media were not associated with daily NSSI urge intensity or presence of engagement, although negative responses to social media were associated with both daily NSSI urge intensity and presence of engagement. DISCUSSION:Interventions aiming to reduce adolescent NSSI may benefit from addressing ways to cope with negative social media experiences and promoting positive experiences.
INTRODUCTION:This study advances a frustration-suicidality thesis, conceptualizing suicidality as an anomic adaptation to frustrations experienced by Indigenous adolescents. METHODS:Using a subsample from the Aboriginal People's Survey 2017 (released 2023), we examine suicidal ideation among Indigenous adolescents aged 15 to 18 years in Canada with weighted least squares regression. Frustration is operationalized through indicators of unfulfilled life conditions, including school dropouts, functional disability, residential instability, and unmet medical needs. RESULTS:The regression model explains 32.2% of the variance in suicidality. Consistent with expectations, frustration, proxied by school dropouts, functional disability, residential instability, and unmet medical needs, is significantly associated with suicidal ideation. Self-rated mental health emerges as the strongest correlate. Food insecurity, smoking, and alcohol use are also linked to higher levels of suicidal ideation. CONCLUSION:This is the first systematic analysis of suicidality among teenage Indigenous Canadians. The findings highlight the central role of frustration in adolescent suicidality. Effective prevention strategies should address both mental health and physical disability, while also reducing structural barriers such as school dropout and unmet healthcare needs. Policy implications are considered in light of the study's data limitations.
OBJECTIVE:Exposure to mass public shootings is associated with adverse mental health outcomes, yet little is known about suicidal thoughts and behaviors among survivors. This study examines the prevalence and timing of suicidal ideation, preparation, and suicide attempts, as well as variation across subgroups. METHODS:Data were drawn from a survey of 167 individuals directly and indirectly exposed to mass public shootings in the United States. Suicidal ideation, preparation, and suicide attempts were assessed using items from the Self-Injurious Thoughts and Behaviors Interview. Descriptive analyses examined prevalence, timing, and subgroup variation. RESULTS:Half of respondents reported suicidal ideation (50.9%), while 16.8% reported preparation and 7.8% reported suicide attempts. The more common time frame for all three outcomes was more than 1 year prior, although some respondents reported recent experiences. Variation across exposure and victimization groups was observed descriptively, while differences by race/ethnicity were limited. CONCLUSIONS:Suicidal thoughts and behaviors are present among a substantial proportion of mass shooting survivors, with respondents reporting experiences across multiple timeframes. Findings highlight the importance of ongoing identification and intervention efforts.
INTRODUCTION:Most suicide interventions focus on the individual and exclude a relationship partner. This is despite substantial evidence from other mental health conditions that including family members in care improves outcomes. The present study is a pilot randomized controlled trial of a partner-involved adaptation of CRP examining feasibility, acceptability, and impact. METHODS:Ninety-one active-duty service members and their romantic partners were recruited from an inpatient psychiatric unit. Couples were randomized to: (1) the Couples Crisis Response Plan (CCRP) condition or (2) a couples psychoeducation (CPE) condition and completed 1, 3, and 6 month follow up assessments. RESULTS:Feasibility analyses show that participants and their partners were recruited and retained. Acceptability analyses showed over 90% of patients and 70%-96% of partners were satisfied with the interventions. No differences emerged between the CCRP and the CPE in suicide ideation or suicidal behavior, but patients in CCRP reported significantly fewer negative communication patterns throughout follow up and fewer suicidal cognitions at 6 month follow-up compared to those in CPE. CONCLUSIONS:Partner-involved brief suicide prevention interventions are feasible and acceptable. The skills-based CCRP intervention may reduce destructive communication patterns and degrade suicidal cognitions more than a couples psychoeducation session.
INTRODUCTION:We compare suicidal behavior outcomes for adolescents who select "no response" on Ask Suicide-Screening Questions (ASQ) items in the emergency department (ED) with those of adolescents who screen negative or positive. METHODS:The multisite Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) study prospectively enrolled adolescents at ED visits, randomizing a subset to follow-up of six-month duration. Participants and parents/guardians completed mental health surveys during the ED encounter and (if applicable) at 3- and 6-month. Risk group was assigned based on ED ASQ score (positive, negative, or nonresponse). Primary outcomes were suicidal ideation, suicide attempt, and mental health service use within 6 months. RESULTS:There were 6411 participants assigned to an ASQ group; 2296 participated in follow-up. Nonresponse was associated with intermediate risk for suicidal ideation (nonresponse group adjusted odds ratio [OR] 2.14 [95% CI 1.33-3.41]; positive group 4.35 [2.93-6.51]), attempt (nonresponse group adjusted OR 2.82 [0.97-8.41]; positive group 5.35 [2.25-14.33]), and mental health care receipt (nonresponse group unadjusted OR 3.42 [1.56-7.59]; positive group 9.88 [5.60-17.79]). CONCLUSIONS:Youth choosing nonresponse on suicide screening questions may be at elevated risk for suicidal ideation and behavior; ED clinicians should not default to treating these youth as negative screens.
INTRODUCTION:Previous research has identified a high need for suicide risk management in primary care settings among adolescents. This randomized controlled trial examined the efficacy and feasibility of BRITEpath, a smartphone-based application and clinician portal designed to help youth in reducing suicide risk. METHODS:Participants (n = 101, ages 12-26, 85.1% female) that were either referred to or were receiving mental health services in primary care were randomly assigned (2:1 allocation) to BRITEpath + TAU (n = 68) or TAU alone (n = 33). Independent evaluators, blinded to treatment, assessed outcomes at baseline, Week 4, and Week 12. Primary outcomes included suicidal thoughts and behaviors, depression, mental health service use, and quality of life; secondary outcomes examined usability and satisfaction. RESULTS:No significant differences were found between BRITEpath + TAU and TAU for primary outcomes overall. However, BRITEpath participants reported lower suicidal thoughts over time. History of inpatient and outpatient care moderated the effect of BRITEpath on depression. Participants reported high satisfaction and perceived usefulness of the app. CONCLUSIONS:BRITEpath shows promising effects on suicidal thoughts and depression, particularly among those with prior psychiatric care. Future research should explore strategies to enhance engagement, such as integration with ongoing care, which may strengthen the impact on clinical outcomes. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT04672798.
INTRODUCTION:The Columbia Suicide Severity Rating Scale (C-SSRS) is widely used for assessing suicidal thoughts and behaviors, yet evidence on the validity of its scoring outputs in community-based samples from low- and middle-income countries remains scarce. METHODS:Participants included 2076 young adults (mean age 23.45, 47% female) from the Brazilian High-Risk Cohort Study at 15-year follow-up. We evaluated C-SSRS Ideation Severity (0-5) and Intensity (0-25) scores using internal consistency, confirmatory factor analysis, item response theory, Guttman scalability, convergent/discriminant validity, known-groups comparisons, ROC analysis, and longitudinal associations with childhood risk factors via adjusted count regression. RESULTS:37% endorsed lifetime suicidal ideation; 16% reported attempts. Internal consistency was low for severity (KR-20 = 0.57) and intensity (ω = 0.67). A two-factor model improved fit over a unidimensional structure (CFI = 0.997 vs. 0.954). Guttman scalability was acceptable (CR = 0.940) but with violations at higher severity levels. C-SSRS severity discriminated attempt history (AUC = 0.93). Prior self-harm was the strongest longitudinal predictor (IRR = 2.06), with a dose-response across risk categories. CONCLUSION:C-SSRS scores show low internal consistency and multidimensional structure, yet strong clinical discrimination and robust 15-year longitudinal associations. Caution is warranted when using these scores as continuous indices.
OBJECTIVES:Understanding suicide risk remains a global health challenge, yet one under-researched avenue involves examining internalized cognitions related to suicide. This study examined cognitive reactivity and ego depletion in relation to participants' suicide history and the frequency, duration, and intensity of suicidal ideation. METHODS:A cross-sectional online survey of UK adults was conducted between October and December 2021 using opportunity sampling. Measures included self-reported cognitive reactivity, ego depletion, impulsivity, entrapment, stress, depression, and resilience. RESULTS:Among 312 participants (Mage = 28.44, SD = 10.0; 80.4% White; 64.7% female), univariate logistic regression analyses indicated that cognitive reactivity and ego depletion significantly differentiated between individuals with no suicide history, suicidal ideation only, and prior suicide attempts. After controlling for other risk factors, only impulsivity and depression independently distinguished those with ideation history from those with attempts. Beyond depression, negative urgency and entrapment predicted ideation frequency; cognitive reactivity and stress predicted duration; ego depletion, entrapment, and stress predicted intensity. The hopelessness/suicidality component of cognitive reactivity predicted all three ideation parameters. CONCLUSIONS:Cognitive reactivity and ego depletion may represent risk factors for suicidality. Findings support a multidimensional framework for conceptualizing suicidal ideation to improve risk assessment and prediction.
INTRODUCTION:Belief in a caring God and in a punitive afterlife (Heaven and Hell) is observed across diverse cultural and religious contexts. Yet it remains unclear whether these beliefs are differently associated with suicide mortality. METHODS:In the present study, we combined data from the World Values Survey (over 73,834 individuals in 57 countries) with age-standardized suicide mortality from the World Health Organization to evaluate whether national levels of belief in God, importance of God, belief in Heaven, belief in Hell, and religious attendance were associated with lower suicide mortality. RESULTS:In separate analyses, each belief measure and attendance were associated with lower suicide mortality, even after controlling for the per capita availability of psychiatrists and psychologists. However, when economic factors (GDP per capita, income inequality, and unemployment) were included, only the reported importance of God and belief in Heaven remained statistically significant. In contrast, belief in God, belief in Hell, and religious attendance showed attenuated or nonsignificant associations. CONCLUSION:These findings suggest that both belief in Heaven and the perceived importance of God are associated with lower national suicide mortality, highlighting potentially relevant dimensions of religiosity that may inform culturally sensitive public-health strategies.
