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.

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.

Influence of changes in occupational status during the COVID-19 pandemic on suicidal narrative, suicide crisis syndrome, and suicidal ideation in Brazil.

This article aims to examine differences in suicidal narrative and suicide crisis syndrome symptoms, and suicidal ideation among those who maintained, lost, and gained employment or student status during the COVID-19 pandemic. It is a cross-sectional study based on an online and anonymous self-report questionnaire. Participants were recruited through social media platforms between November 2020 and October 2021. Changes in occupational status were assessed in 2,259 individuals. The sample was divided into four groups according to work (full-time/part-time) and study status (1) maintained, (2) lost, (3) gained, and (4) unemployed. Suicide outcomes were investigated by the Suicidal Narrative Inventory, Suicide Crisis Inventory, and Columbia - Suicide Severity Rating Scale Screener version. Changes in occupational status influenced symptoms of the suicide crisis syndrome and suicidal narrative, but not suicidal ideation. Those who maintained their work, such as full-time/part-time scored lower on the total scores of the Suicidal Narrative Inventory and Suicide Crisis Inventory-2 compared to those who lost their employed status and unemployed. Our findings suggest that it is appropriate to consider changes in employed status as a mental health risk factor during pandemics.

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.

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.

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.

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.

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.