Intentions to use mental health and suicide prevention resources among individuals with symptoms of the suicide crisis syndrome and/or suicidal ideation.

INTRODUCTION: The suicide crisis syndrome (SCS) has demonstrated efficacy in predicting suicide attempts, showing potential utility in detecting at-risk individuals who may not be willing to disclose suicidal ideation (SI). The present international study examined differences in intentions to utilize mental health and suicide prevention resources among community-based adults with varying suicide risk (i.e., presence/absence of SCS and/or SI). METHODS: A sample of 16,934 community-based adults from 13 countries completed measures about the SCS and SI. Mental health and suicide prevention resources were provided to all participants, who indicated their intentions to use these resources. RESULTS: Individuals with SCS (55.7%) were just as likely as those with SI alone (54.0%), and more likely than those with no suicide-related symptoms (45.7%), to report willingness to utilize mental health resources. Those with SI (both with and without SCS) were more likely to seek suicide prevention resources (52.6% and 50.5%, respectively) than those without SI (41.7% and 41.8%); however, when examining endorsements for personal use, those with SCS (21.6%) were more likely to use resources than individuals not at risk (15.1%). CONCLUSIONS: These findings provide insight into individuals' willingness to use resources across configurations of explicitly disclosed (SI) and indirect (SCS) suicide risk.

Abbreviated Suicidal Narrative Inventory: Factor Structure, Internal Consistency, and Validity in a Brazilian Sample.

AIM: To investigate the factor structure, reliability, and validity of the Brazilian version of the Abbreviated Suicidal Narrative Inventory (SNI-38). METHODS: We used an anonymous online questionnaire of the SNI-38 and self-report measures administered between November 2020 and October 2021 in the Brazilian community. Participants were recruited through social media advertisements. Confirmatory factor analysis was carried out to test the factor structure of the SNI-38. In addition, we examined internal consistency, and convergent validity against stressful life events, the suicide crisis syndrome, suicidal ideation, and suicide attempts. RESULTS: 2660 participants were included. The eight-factor model SNI-38 had a good model fit (χ2[637] = 7,473.98, p < .001, CFI = .99, TLI = .99, RMSEA = .07, SRMR = .06); all items were significantly and positively loaded onto their respective factors (factor loadings ≥ .45). Reliability was good to high in all subscales except goal disengagement. Additionally, all subscales - except goal disengagement - were correlated positively which the suicide crisis syndrome, stressful life events, lifetime/past-month suicidal ideation, and lifetime suicide attempts. CONCLUSIONS: These findings provide preliminary support for the validity of the Brazilian version of the SNI-38, being an appropriate and valid tool for measuring suicidal narrative among Brazilian samples.

The Revised Suicide Crisis Inventory (SCI-2): Factor Structure, Internal Consistency, and Validity in a Brazilian Sample.

OBJECTIVE: To examine the factor structure, reliability, and validity of the Brazilian version of the Suicide Crisis Inventory (SCI-2) among Brazilian adults. METHODS: The SCI-2 was cross-culturally adapted into Portuguese and administered to 2,265 individuals in the Brazilian community. Confirmatory factor analyses, internal consistency, and convergent and criterion validity against the suicidal narrative, stressful life events, suicidal ideation, and suicide attempts were examined. RESULTS: The revised one-factor model of the SCI-2 resulted in adequate, but not optimal, model fit (χ2[1539] = 31,442.79, p < .001, CFI = .99, TLI = .99, RMSEA = .09, SRMR = .05). The revised five-factor model, on the other hand, demonstrated good fit (χ2[1529] = 14,174.86, p < .001, CFI = 1.00, TLI = 1.00, RMSEA = .06, SRMR = .04). Comparison of these two models indicated that the five-factor exhibited a superior model fit to the one-factor model. The SCI-2 total and subscales showed strong internal consistency, good convergent, and criterion validity in relation to stressful life events, suicidal narrative (except goal disengagement subscale), suicidal ideation, and suicide attempts. CONCLUSIONS: These findings indicate that the Brazilian version of the SCI-2 is a valid tool for measuring symptoms of the Suicide Crisis Syndrome.

Suicide Risk Moderates the Relationship Between Stressful Life Events, the Suicidal Narrative, and the Suicide Crisis Syndrome: A Brazilian Cross-Sectional Study.

BACKGROUND: Stressful life events are associated with higher odds of suicidal thoughts and behaviors. Furthermore, stressful life events can trigger specific symptoms, including the suicidal narrative and suicide crisis syndrome, resulting in an increased risk of suicidal thoughts and behaviors. This study examined the moderating role of suicide risk in the relationship between stressful life events, the suicidal narrative, and the suicide crisis syndrome. METHODS: 2,260 adults completed an online survey recruited through advertisements on social media. The level of emotional distress was assessed through the Suicide Narrative Inventory, Suicide Crisis Inventory-2, Stressful Life Events Questionnaire, and Mini International Neuropsychiatric Interview. The PROCESS macro (Hayes) was used to analyze the moderation models. RESULTS: Stressful life events were positively correlated with the suicidal narrative and suicide crisis syndrome. The effects of stressful life events on suicidal narrative and suicide crisis syndrome were strongest when suicide risk was low and weakest when suicide risk was high. CONCLUSIONS: These findings suggest that including stressful life events as part of suicide risk assessment in general and clinical settings is critical to managing treatment for suicidal thoughts and developing adaptive coping.

The Columbia-suicide severity rating scale: validity and psychometric properties of an online Spanish-language version in a Mexican population sample.

The aim of this study was to evaluate the validity and psychometric properties in a Mexican sample of a Spanish-language online version of the Columbia-Suicide Severity Rating Scale (C-SSRS). Data were collected between May and October 2021 from 3,645 participants aged 18 years and over, who agreed to complete the questionnaire. Reliability analysis, confirmatory factor analysis (CFA), and psychometric properties were calculated using a two-parameter model. The results showed a reasonable level of reliability with a Cronbach's alpha of 0.814, and evidence of unidimensionality, and construct validity for suicide risk at three risk levels: low, medium, and high. Analysis of the items suggests that they are consistent with the proposed theoretical model. Our results also demonstrate that the parameters are stable and able to efficiently discriminate individuals at high risk of suicide. We propose the use of this version of the C-SSRS in the Spanish-speaking population, since it is a multifactorial assessment of suicide risk and the inclusion of other clinical and risk factor assessments for a more comprehensive evaluation.

Stressful Life Events and Near-term Suicidal Risk in a Clinical Population.

The present study examined 22 specific stressful life events (SLEs) in relation to recent and prospective suicidal thoughts and behaviors (STBs). The effect of assessment method (self-report vs. chart-based ratings) and inpatient/outpatient status was also investigated. Past 3-month STBs and SLEs were assessed for 1,058 psychiatric patients; 696 completed one-month follow-up assessments. SLEs were common, with 684 participants (64.7%) reporting at least one. Total number of SLEs correlated with recent and prospective STB. A higher incidence of SLE's was found with self-report vs. chart-based measures (on 20 SLEs) and inpatients vs. outpatients (on 7 SLEs). SLEs of interpersonal rejection and loss, homelessness and academic failure offered elevated risk. In sum, SLEs are common and associated with STBs in psychiatric patients. SLEs of interpersonal rejection and loss, homelessness and academic failure may merit increased clinical attention.

Two sides of the same coin? Empirical examination of two proposed characterizations of acute suicidal crises: Suicide crisis syndrome and acute suicidal affective disturbance.

Two proposed suicide-specific diagnoses, with accumulating research support, characterize the phenomenology of acute suicidal crises: Suicide Crisis Syndrome (SCS) and Acute Suicidal Affective Disturbance (ASAD). Despite conceptual overlap and some similar criteria, the two syndromes have never been compared empirically. The present study addressed this gap by examining SCS and ASAD utilizing a network analysis approach. A sample of 1568 community-based adults (87.6% cisgender women, 90.7% White, Mage = 25.60 years, SD = 6.59) in the United States completed an online battery of self-report measures. SCS and ASAD were first examined in individual network models, followed by a combined network to determine changes in network structure, as well as identify bridge symptoms that connected SCS and ASAD. The proposed criteria of SCS and ASAD formed sparse network structures that were largely unaffected by the influence of the other syndrome in a combined network. Social disconnection/withdrawal and manifestations of overarousal-particularly agitation, insomnia, and irritability-emerged as bridge symptoms that may connect SCS and ASAD. Our findings indicate the network structures of SCS and ASAD exhibit patterns of independence, alongside interdependence between overlapping symptom domains (i.e., social withdrawal, overarousal). Future work should examine SCS and ASAD prospectively to better understand their temporal dynamics and predictive utility in relation to imminent suicide risk.

Factor Structure and Validation of the Revised Suicide Crisis Inventory in a Korean Population.

OBJECTIVE: Because of the exceptionally high suicide rates in South Korea, new assessment methods are needed to improve suicide prevention. The current study aims to validate the revised Suicide Crisis Inventory-2 (SCI-2), a self-report measure that assesses a cognitiveaffective pre-suicidal state in a Korean sample. METHODS: With data from 1,061 community adults in South Korea, confirmatory factor analyses were first conducted to test the proposed one-factor and five-factor structures of the SCI-2. Also, an exploratory factor analysis (EFA) was performed to examine possible alternative factor structure of the inventory. RESULTS: The one-factor model of the SCI-2 resulted in good model fit and similarly, the five-factor model also exhibited strong fit. Comparing the two models, the five-factor was evaluated as the superior model fit. An alternative 4-factor model derived from EFA exhibited a comparable model fit. The Korean version of the SCI-2 had high internal consistency and strong concurrent validity in relation to symptoms of suicidal ideation, depression, and anxiety. CONCLUSION: The SCI-2 is an appropriate and a valid tool for measuring one's proximity to imminent suicide risk. However, the exact factor structure of the SCI-2 may be culture-sensitive and warrants further study.

Cross-national presence and sociodemographic correlates of the suicide crisis syndrome.

BACKGROUND: The Suicide Crisis Syndrome (SCS) has been proposed as an acute, pre-suicidal mental state that precedes imminent suicidal behavior; however, its cross-national applicability and sociodemographic correlates have not yet been determined. The present study assessed the presence and severity of the SCS in ten countries and examined several potential sociodemographic correlates (i.e., age, gender, marital status, race/ethnicity) of the SCS. METHODS: 5528 community-based adults across 10 participating countries provided information on their SCS symptoms and sociodemographic characteristics in an anonymous online survey obtained via convenience sampling during the first year of the COVID-19 pandemic. RESULTS: The SCS occurred cross-nationally, with rates ranging from 3.6% (Israel) to 16.2% (Poland). Those in the United States, South Korea, Poland, and Turkey had the highest severity of symptoms. Participants who were older, identified as cisgender men, and married tended to have lower rates of the SCS than their respective counterparts. There were minimal differences in the SCS by race/ethnicity. LIMITATIONS: These data were both cross-sectional and collected via convenience sampling, limiting generalizability of findings and information about the SCS's predictive utility. CONCLUSIONS: These findings support the cross-national presence of the SCS during the COVID-19 pandemic. Sociodemographic correlates aligned with those of suicidal behavior more generally, providing additional evidence for the concurrent/predictive validity of the SCS.

Factor Structure and Validity of the Suicidal Narrative Inventory Among Indian Adults.

Background: The suicidal narrative is a presuicidal state comprising several risk factors for suicide and is assessed using the Suicidal Narrative Inventory (SNI). Aims To assess the internal structure, reliability, and validity of SNI among Indian adults. Methods Between August 2020 and January 2021, the SNI, together with other self-report measures, was administered to adult respondents using an online anonymized questionnaire. Confirmatory factor analysis (CFA) was carried out to test the factor structure of the SNI. Results Usable responses were obtained from 302 participants (Mage = 43.5 ± 17.9 years, 53.6% female). The results of an eight-factor CFA of the SNI resulted in good model fit (χ2 [637] = 969.73, p < .001, comparative fit index = 1.00, root mean square error of approximation = .04). Internal consistencies of SNI subscale scores ranged from acceptable to excellent (range α = .67-.92). Most subscales significantly converged with other measures although these associations were minimal for the goal disengagement and reengagement subscales. Limitations The use of an online survey method to collect data introduced sampling bias. Conclusion The eight-factor CFA of the SNI, among Indian adults, was consistent with prior data. Our findings provide preliminary support for the use of SNI to assess the suicidal narrative construct among Indian adults.

Factor structure and validity of the Revised Suicide Crisis Inventory (SCI-2) among Indian adults.

BACKGROUND: There is a dearth of cross-cultural data on the psychometric properties of the revised Suicide Crisis Inventory (SCI)- 2. Our objective was to examine the factor structure, reliability, and validity of the SCI-2 among Indian adults. METHODS: Using an online survey method, between August 20, 2020 and January 31, 2021, an anonymous questionnaire containing general sociodemographic information and self-report measures was circulated over email and social media. Confirmatory factor analyses (CFA) of the SCI-2 was carried out. We also examined the internal consistency of the SCI-2 and tested its convergent validity against the Suicide Narrative Inventory (SNI) and the Perceived Stress Scale (PSS-10). RESULTS: A total of 302 participants (Mean age = 43.5 ± 17.9 years, 53.6% female) were obtained. Results of the one-factor CFA indicated good model fit (χ2[1769] = 5368.75, p < 0.001, Comparative Fit Index [CFI] =0.99, Root mean square error of approximation [RMSEA] =0.08). Similarly, the five-factor CFA also exhibited strong model fit (χ2[1759] = 4215.54, p < 0.001, CFI = 1.00, RMSEA =0.07). Comparison of these models indicated that the five-factor model demonstrated superior model fit (Δχ2[10] = 278.88, p < 0.001). The SCI-2 total and subscale scores showed excellent internal consistency and good convergent validity against most domains of the SNI and PSS-10. CONCLUSION: Among Indian adults, the SCI-2 demonstrated good psychometric properties with the proposed five-factor solution providing the best fit. These findings provide support for the SCI construct and its assessment with the SCI-2 in an Asian setting.

The Narrative-Crisis Model of suicide and its prediction of near-term suicide risk.

Despite decades of research, much remains unknown about the transition from chronic to imminent suicidal risk. In the context of COVID-19, this question is even more urgent. The present study tests a novel, stepwise model of this transition, termed the Narrative-Crisis Model. This model proposes that, in people with chronic risk factors, stressful life events can trigger a specific progression of cognitive-affective responses (the suicidal narrative and the suicide crisis syndrome), resulting in increased near-term risk of suicidal thoughts and behavior (STB). Identification of each step in this progression provides opportunities for more precise interventions. Concurrent validity was tested with 732 psychiatric patients and predictive validity with 524 participants, assessed one to two months later. Chronic risk factors were measured with the Childhood Trauma Questionnaire, Relationship Styles Questionnaire, and UPPS-P Impulsive Behavior Scale; acute risk factors with the Stressful Life Events Questionnaire, Suicide Narrative Inventory, and Suicide Crisis Inventory. The Columbia Suicide Severity Rating Scale was administered at the initial research assessment and follow-up. Indirect effects were significant for the full model and most pathways, in both concurrent and prospective analyses. In sum, this study provides empirical support for a novel, stepwise model of the progression from chronic to near-term suicidal risk.

The revised suicide crisis inventory (SCI-2): Validation and assessment of prospective suicidal outcomes at one month follow-up.

BACKGROUND AND AIM: The Suicide Crisis Syndrome (SCS) is an evidence-based pre-suicidal cognitive and affective state predictive of short-term suicide risk. The most recent SCS formulation, proposed as a suicide-specific DSM diagnosis, features a feeling of Entrapment accompanied by four additional symptom clusters: Affective Disturbance; Loss of Cognitive Control; Hyperarousal; and Social Withdrawal. The aim of the present study was to revise the Suicide Crisis Inventory (SCI; Barzilay et al., 2020), a self-report measure assessing the presence of the SCS,in accordance with the current SCS formulation, as well as to assess the psychometric properties and clinical utility of its revised version, the Suicide Crisis Inventory-2 (SCI-2). METHODS: The SCI-2, a 61-item self-report questionnaire, was administered to 421 psychiatric inpatients and outpatients at baseline. Prospective suicidal outcomes including suicidal ideation, preparatory acts, and suicidal attempts were assessed after one month. Internal structure and consistency were assessed with confirmatory factor analysis, convergent, discriminant, and current criterion validity. Receiver-operating characteristic (ROC) curves with Area under the Curve (AUC) were used to examine the predictive validity of the SCI-2 to prospective outcomes. Exploratory analyses assessed the predictive validity of the five SCI-2 dimensions. RESULTS: The SCI-2 demonstrated excellent internal consistency (Cronbach's α = 0.971), good convergent, discriminant, and current criterion validity. The SCI-2 significantly predicted all three outcomes, and was the only significant predictor of suicidal attempts with AUC = 0.883. DISCUSSION: The results of this study indicate that the SCI-2 is a valid and reliable tool to assess the presence and intensity of the Suicide Crisis Syndrome and to predict short-term prospective suicidal behaviors and attempts among psychiatric outpatients and inpatients regardless of patients' readiness to disclose suicidal ideation.