A cultural script for suicide among White men in the Mountain West Region of the United States.

The states of the Mountain West region of the United States consistently have the highest rates of suicide in the country, a pattern particularly pronounced in older White men. Although multiple constructs have been proposed to explain this long-standing pattern, including social isolation, cultural values, and psychopathology, relatively little research has been conducted to directly examine the predictive role of these risk factors and how they interact. We review the extant research for these constructs to establish (a) whether the risk factor occurs at a higher rate or is otherwise more influential in this region compared to the rest of the country and (b) whether the risk factor may account for specific effects in older White men in order to determine whether the evidence supports the role of each risk factor in understanding the high rates of suicide among older White men in this region. Using the results of this review, we then present a possible cultural script for suicide based on cultural scripts of gender and suicide theory (Canetto, 1997, 2017, 2021) that describes who dies by suicide, the methods they use, their emotions and motives, and the cultural understanding of the causes and acceptability of their suicidal behaviors within the Mountain West. This cultural script can serve as a guide for researchers investigating the complex mechanisms that account for elevated rates of suicide in this region. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Bisexual-specific minority stress in nonsuicidal self-injury: The mediating role of perceived burdensomeness.

Background: Bisexual-identifying individuals are at heightened risk for engaging in non-suicidal self-injury (NSSI), with the odds up to six times higher compared to heterosexual individuals and up to four times higher compared to lesbian/gay (L/G) individuals. While research has established that sexual minorities may be at increased risk because minority stressors exacerbate psychological processes associated with NSSI, little research has examined bisexual-specific pathways of risk. In this study, we replicated findings that suggest Interpersonal Theory of Suicide (IPTS) variables (i.e., perceived burdensomeness and thwarted belongingness) mediate the association between minority stress and NSSI and extended these findings by examining whether such mediation is moderated by sexual minority identity. Furthermore, we explored whether IPTS variables mediate the association between bisexual-specific minority stress and NSSI. Method: A sample of 259 cisgender L/G (n = 93) and bisexual (n = 166) MTurk workers completed measures assessing minority stress, NSSI, and IPTS variables. Results: Mediation analyses replicated findings that experiences of minority stress increase NSSI by increasing perceived burdensomeness [PB], though moderated mediation analyzes failed to provide evidence that sexual minority identity moderated this indirect effect. Rather, minority stress from both heterosexual and L/G individuals increased NSSI through increased PB for bisexual individuals. Limitations: The use of cross-sectional data does not allow conclusions of causal relationships. Conclusions: These results suggest that for bisexual individuals, minority stress from both heterosexual and L/G individuals increases NSSI by increasing PB. Future researchers and clinicians should consider the additive burden of minority stress in bisexual individuals.

Reliability and Validity of the Self-Rating Scale as a Measure of Self-Criticism.

The Self-Rating Scale (SRS; Hooley et al., 2010), a widely used measure of self-criticism in self-injury research, did not utilize conventional test development methods and has limited psychometric data. We examined the internal consistency, test-retest reliability, and convergent and discriminant validity of the SRS. Participants were 295 psychology undergraduate students. The SRS demonstrated good internal consistency (α = .93), adequate test-retest reliability (r = .76), and satisfactory convergent validity with other measures of self-criticism. Convergent validity was also adequate for expected dimensions of perfectionism (socially prescribed, self-oriented, concerns about mistakes, and doubts about actions), depressive symptoms, and negative and positive affect. The SRS demonstrated adequate discriminant validity with expected constructs of perfectionism (other-oriented, personal standards, and organizational perfectionism). Although the SRS appears to be a psychometrically sound measure of self-criticism, high correlations with depression and perfectionism raise questions regarding the overlap of these constructs.

Masculine gender-related personality traits and acquired capability for suicide.

In most countries, substantially more men than women die by suicide, implicating masculine gender-related personality (MGP) traits as a risk factor for suicide. The Interpersonal Theory of Suicide posits that acquired capability for suicide (ACS) is needed to end one's life. To investigate MGP traits and ACS, college students (N = 149) completed measures of stoicism, sensation seeking, physical aggression, and ACS. For both genders, most MGP traits were associated with increased ACS. Physical aggression mediated relations between both stoicism and sensation seeking and ACS, but gender did not moderate these associations, suggesting similar patterns for men and women.

The effects of blood in self-injurious cutting: Positive and negative affect regulation.

OBJECTIVE: Seeing one's own blood may be a factor in affect regulation in nonsuicidal self-injury (NSSI). This study examined changes in a negative (NA) and positive affect (PA) in response to a finger prick eliciting a small drop of participants' blood. METHODS: Two groups (NSSI; N = 56 and Control; N = 70) of undergraduate students were randomly assigned to receive a finger prick and look at blood, receive a finger prick and not look at blood, or receive a sham finger prick. Following a mood induction, participants completed the PANAS three times: Time 1 (pre mood-induction, baseline), Time 2 (post-mood induction), and Time 3 (post-finger prick condition), and a Pain Severity Scale. RESULTS: A significant three-way interaction revealed that the NSSI: Blood Group had an increased positive effect between Time 2 and Time 3. CONCLUSION: Blood serves an important function in NSSI and requires additional research to fully understand the relationship.

Differential suicide risk factors in rural middle and high school students.

Few studies have examined risk factors associated with suicidal ideation and attempts among younger adolescents compared to their high-school aged counterparts. To gain a better understanding of unique risk factors associated with suicidal ideation and attempts among middle-school aged students, the current study employed secondary data analyses on a statewide sample of middle school (6th and 8th grade; n = 7,453) and high school students (10th and 12th grade; n = 5,996) in the United States. Logistic regression analyses were used to determine the effects of fourteen empirically derived risk factors on odds of reporting suicidal ideation (SI) and suicide attempts (SA) in the past year. Results indicated unique factors associated with risk for SI and SA among middle and high school students. For middle-school aged students, female sex, lower perceptions of school safety, sensation seeking, psychological distress, bullying victimization, early initiation of drug use, and community disorganization predicted past year SI. Female sex, white race, perceptions of school safety, bullying victimization, aggregate drugs used, psychological distress, and community disorganization predicted SA. Conversely, sex, age, perceptions of school safety, and community disorganization were not associated with suicidal behavior in high school students. Developmental explanations and avenues for future research are discussed.

A Daily Diary Investigation of the Defective Self Model Among College Students With Recent Self-Injury.

The Defective Self Model of self-injury (Hooley, Ho, Slater, & Lockshin, 2010) asserts that individuals choose to self-injure to gratify the desire for self-punishment associated with a self-critical cognitive style. Specifically, self-injury is used to regulate negative self-directed thoughts and emotions and is made accessible via the belief that the individual deserves punishment. This study sought to test primary assumptions of the Defective Self Model using a 2-week daily diary protocol. It was hypothesized that trait self-criticism would predict daily self-injury urge intensity and behaviors directly, as well as indirectly, through daily thoughts about deserving punishment. We also posited that guilt would predict self-injury urge intensity and behaviors beyond sadness, hostility, and fear. Support for primary hypotheses was mixed. Self-criticism did not directly predict self-injury outcomes, but did indirectly predict urge intensity through daily thoughts about punishment. Daily guilt predicted self-injury urge intensity beyond daily sadness, hostility and fear and was the only type of negative affect associated with self-injury behavior. Results are primarily contextualized through a social cognitive lens in which self-injury urge is precipitated by the activation of a self-critical schema in daily life. Alternatively, self-criticism may serve as a gateway to initial self-injury but lack the sensitivity to predict individual self-injury episodes. Treatments designed to reduce self-critical thoughts and bolster self-compassion may decrease self-injury urge intensity, thereby affecting the frequency of self-injury episodes.

Interpersonal needs and suicide risk: The moderating roles of sex and brooding.

OBJECTIVES: This paper tested two moderators, brooding and participant sex, on the respective relations between thwarted belongingness (TB), perceived burdensomeness (PB), and suicide risk. METHOD: Using a cross-sectional design in a sample of undergraduates (N = 278), two hierarchical regression models examining the three-way interaction between brooding, sex, and either TB or PB on suicide risk were conducted. RESULTS: A significant two-way interaction of brooding and TB was detected, but no moderating effect of sex was observed. There was a significant three-way interaction of brooding, sex, and PB on suicide risk. CONCLUSIONS: High levels of TB and brooding produce increased suicide risk across sexes. The relation between PB and suicide risk is dependent on brooding for females but not males.

Before, During, and After Self Injury: The Practice Patterns of Nonsuicidal Self Injury.

Little is currently known about the repetitive behaviors that take place before, during, and after nonsuicidal self-injury (NSSI). These practice patterns surrounding repetitive self-injury may be part of a habituation process in NSSI. Congruent with the opponent process theory (OPT), the mechanisms through which NSSI is reinforced may include preparation, engagement, and follow-up practice patterns to achieve the desired effect. This may result in increased habituation leading to a change in method and resulting NSSI severity. College students with a history of NSSI (N = 80) completed questionnaires, including an instrument to assess practice patterns around NSSI. High levels of NSSI practice patterns were positively related to various NSSI characteristics and clinical correlates, suggesting higher levels of NSSI severity. Further, NSSI versatility partially explained the relationship between NSSI practice patterns and habituation. Consistent with OPT, practice patterns associated with repetitive NSSI may lead an individual to change methods, fostering habituation to self-injury.

Impulsivity and Response Latency in Non-Suicidal Self-Injury: The Role of Negative Urgency in Emotion Regulation.

Impulsivity is thought to be a contributing factor in non-suicidal self-injury (NSSI), yet the research is limited and inconsistent. In particular, little is known about how impulsivity is associated with response latency between initial urge and later self-injury, emotion regulation processes, or severity of NSSI. In this study, we tested group differences between participants with and without a history of NSSI on a questionnaire measure of impulsivity. In addition, we tested hypothesized correlations between impulsivity and relevant variables within the NSSI sample using questionnaires and self-reported response latency between urge and injury. Participants included 159 undergraduate students, 84 with an NSSI history and 75 without an NSSI history. Results indicated greater impulsivity on facets of Urgency and (lack of) Perseverance for the NSSI group. Within the NSSI sample, facets of impulsivity were associated with difficulties in emotion regulation and NSSI severity, but not response latency. In addition, response latency, a possible behavioral marker of impulsivity, was not associated with emotion regulation processes or NSSI frequency. These results suggest that higher scores on self-report measures of impulsivity, but not behavioral response latency measures, are associated with emotion regulation processes in individuals who self-injure.

Interpersonal needs and psychological pain: The role of brooding and rejection sensitivity.

The interpersonal theory of suicide proposes that thwarted belongingness (TB) and perceived burdensomeness (PB) predict psychological pain and desire for suicide. Brooding may be a mechanism in explaining how TB and PB predict pain. The conceptual similarity between rejection sensitivity (RS) and TB suggests that individuals with high RS may be likely to experience psychological pain in the context of TB. To test this model, 155 college students completed measures of psychological pain, TB, PB, brooding, and RS. As predicted, brooding mediated the relations between both TB and PB and psychological pain. RS interacted with TB in predicting psychological pain.

Suicide in the Mountain West Region of the United States.

BACKGROUND: The Mountain West region of the United States consistently reports the highest rates of suicide in the country. This pattern could reflect a regional culture-of-suicide script in support of suicide that implicitly influences individual's behavior. AIMS: The primary aim of this study was to investigate whether suicide rates are elevated in the Mountain West across a wide range of demographic groups, thereby supporting a regional cultural script. METHOD: Suicide rates in the Mountain West between 1999 and 2014 were compared to the rest of the country across a wide range of demographic categories and levels of population density using the Center for Disease Control Multiple Causes of Death dataset published on the WONDER online database. RESULTS: Suicide rates are elevated in the Mountain West for men and women, all racial groups, all age groups, and at every level of population density compared to the rest of the country. LIMITATIONS: Missing and suppressed data, the use of coroner reports, and the arbitrary nature of state and regional boundaries are all discussed as possible limitations to this study. CONCLUSION: These findings support a broad culture-of-suicide script that is pervasive in this region across demographic groups and all levels of population density.

Self-Concept Clarity and Emotion Dysregulation in Nonsuicidal Self-Injury.

Recent research has linked identity instability with engagement in nonsuicidal self-injury (NSSI; Claes, Luyckx, & Bijttebier, 2014; Claes et al., 2015). This study examined the relationship between self-concept clarity (SCC), an index of identity stability, and NSSI in a sample of 147 college students, using a cross-sectional survey design. The relationship between SCC and emotion dysregulation in NSSI severity was also examined. SCC was significantly negatively associated with NSSI engagement, as well as NSSI frequency and versatility, above negative affect or age. SCC fully accounted for the variance originally explained by emotion dysregulation in NSSI versatility. NSSI frequency was not significantly predicted by emotion regulation, but self-concept clarity reached marginal significance. These findings provide preliminary support for identity instability as a contributing factor to a relationship between emotion dysregulation and NSSI severity. Possible explanations and future research directions are discussed.

The Physical Results of Nonsuicidal Self-Injury: The Meaning Behind the Scars.

The psychological meaning of scars from nonsuicidal self-injury (NSSI) has been examined in case studies, but descriptive studies are needed to better understand the meaning of NSSI scars. College students with NSSI scars (n = 49) completed questionnaires concerning the interpretive meaning of their scars, emotions associated with their scars, and clinical symptoms. Levels of scar-related growth were positively correlated with interpersonal functions of NSSI (e.g., autonomy, self-care) and negatively correlated with likelihood of future self-injury, self-disgust, self-injury regret, and self-injury scar regret. Conversely, higher levels of scar-related shame were associated with higher likelihood of future self-injury, depressive and borderline personality disorder symptoms, self-disgust, NSSI scar-related regret, and intrapersonal functions of NSSI (e.g., marking distress, self-punishment). Individuals finding shame or guilt may be a more clinically severe group than those finding growth from their scars.

Functions, Consequences, and Frequency of Non-suicidal Self-Injury.

We examined the correspondence between reported reasons and consequences for a specific act of non-suicidal self-injury (NSSI), and their relationship with lifetime NSSI frequency. College students with a history of NSSI (n = 52) indicated reasons for and consequences from their most recent NSSI episode. A match was coded when a reason and its corresponding consequence(s) were both endorsed by the participant. Reasons and consequences were significantly correlated, but their correspondence was not related to lifetime NSSI frequency. Automatic negative reasons explained lifetime NSSI frequency, but consequences and match between reasons and consequences did not. Reported reasons for NSSI may be more important in understanding maintenance of NSSI than either consequences or match.

Family centered brief intensive treatment: a pilot study of an outpatient treatment for acute suicidal ideation.

Family Centered Brief Intensive Treatment (FC BIT), a hospital diversion treatment program for individuals with acute suicidal ideation, was developed to treat suicidal clients and their families. Individuals who met criteria for hospitalization were treated as outpatients using FC BIT (n = 19) or an intensive outpatient treatment without the family component (IOP; n = 24). Clients receiving FC BIT identified family members or supportive others to participate in therapy. FC BIT clients had significantly greater improvement at the end of treatment compared to IOP clients on measures of depression, hopelessness, and suicidality. Further research is needed to test the efficacy of FC BIT.

Functions, lifetime frequency, and variety of methods of non-suicidal self-injury among college students.

Borderline Personality Disorder (BPD) and intrapersonal functions of non-suicidal self-injury (NSSI) have both been found to have strong relationships with NSSI. The present study examines their role in the lifetime frequency and variety of NSSI methods, taken as indicators of severity of NSSI. We hypothesized that intrapersonal functions would explain frequency and variety of NSSI beyond the effects of interpersonal functions. Further we hypothesized that intrapersonal functions would moderate the effect of BPD characteristics on frequency of NSSI. College students (n=52) who endorsed at least one lifetime act of NSSI completed self-report measures and semi-structured interviews about NSSI behaviors, frequency, variety and functions, and BPD symptoms. Results supported the hypotheses that intrapersonal functions play a role in the lifetime frequency and variety of NSSI behaviors in addition to that of interpersonal functions, but did not support the role of intrapersonal functions as a moderator. Findings are discussed in terms of relative importance of all factors involved in explaining severity of NSSI, measured as lifetime frequency and variety.

Indigenous perspectives on depression in rural regions of India and the United States.

Depression is a major health concern in India, yet indigenous Indian perspectives on depression have often been disregarded in favor of Western conceptualizations. The present study used quantitative and qualitative measures modeled on the Explanatory Model Interview Catalogue (EMIC) to elicit beliefs about the symptoms, causes, treatments, and stigma associated with depression. Data were collected from 92 students at a university in the Himalayan region of Northern India and from 97 students at a university in the Rocky Mountain region of the United States. U.S. participants in this study were included primarily to approximate a "Western baseline" (in which professional conceptions of depression are predominantly rooted) from which to elucidate Indian perspectives. Compared to U.S. participants, Indian participants were more likely to view restive symptoms (e.g., irritation, anxiety, difficulty thinking) as common features of depression, to view depression as the result of personally controllable causes (e.g., failure), to endorse social support and spiritual reflection or relaxation (e.g., yoga, meditation) as useful means for dealing with depression, and to associate stigma with depression. Efforts aimed at reducing depression among Indians should focus more on implementing effective and culturally acceptable interventions, such as yoga, meditation, and increasing social support.

Negative life experiences and the development of cluster C personality disorders: a cognitive perspective.

Early negative experiences have long been thought to play an important role in the development of personality disorders. Most of the literature regarding these early life experiences has focused on borderline personality disorder, with only occasional focus on other personality disorders. Utilizing cognitive theory of personality disorders (Beck et al., 2004), the authors conceptualize cluster C personality disorders (avoidant, dependent, and obsessive-compulsive). They then critically review the relevant literature on early negative life experiences and later development of these disorders to determine whether the theory is supported by the empirical data. The theory regarding avoidant and dependent personality disorders has limited support, whereas data relating to obsessive-compulsive personality disorder are much weaker. Implications and future research suggestions are discussed.

Recruiting and retaining physicians in very rural areas.

CONTEXT: Recruiting and retaining physicians is a challenge in rural areas. Growing up in a rural area and completing medical training in a rural area have been shown to predict decisions to practice in rural areas. Little is known, though, about factors that contribute to physicians' decisions to locate in very sparsely populated areas. PURPOSE: In this study, we investigated whether variables associated with rural background and training predicted physicians' decisions to practice in very rural areas. We also examined reasons given for plans to leave the study state. METHODS: Physicians in the State of Wyoming (N = 693) completed a questionnaire assessing their background, current practice, and future practice plans. FINDINGS: Being raised in a rural area and training in nearby states predicted practicing in very rural areas. High malpractice insurance rates predicted planning to move one's practice out of state rather than within state. CONCLUSIONS: Rural backgrounds and training independently predict practice location decisions, but high malpractice rates are the most crucial factor in future plans to leave the state.