Concurrent changes in nonsuicidal self-injury and suicide thoughts and behaviors.

BACKGROUND: Nonsuicidal self-injury (NSSI) is a risk factor for suicide, yet how changes in NSSI engagement relate to suicide ideation, planning, and attempts remains largely unknown. The current study aims to fill this gap by examining how changes in NSSI frequency over time related to concurrent changes in suicide thoughts and behaviors. METHODS: Data came from a sample of 403 self-injuring young adults who completed assessments of NSSI and suicide thoughts and behaviors at baseline, 6, and 12 months. Bivariate latent growth modeling, adjusting for covariates of lifetime NSSI frequency and treatment status, was used to examine the extent to which changes in NSSI frequency related to suicide ideation and suicide planning. RESULTS: The frequency of NSSI declined across the study period. The slopes of NSSI and suicide ideation were significantly correlated, suggesting individuals with sharper declines in NSSI across time also showed sharper declines in suicide ideation. The intercepts between NSSI and suicide planning were significantly correlated, suggesting those with high NSSI frequency at baseline tended to report higher suicide planning across time. After covariate adjustment, the intercept of suicide planning marginally (p = 0.08) correlated with the slope of NSSI, tentatively suggesting that those who had less reductions in NSSI tended to have higher frequencies of suicide planning. CONCLUSION: These results provide new evidence that changes in NSSI are related to subsequent changes in suicide thoughts and behaviors. Monitoring suicide risk among those with NSSI is important and treatment aiming to reduce NSSI may also reduce suicide risk.

A controlled examination of acute warning signs for suicide attempts among hospitalized patients.

BACKGROUND: Near-term risk factors for suicidal behavior, referred to as 'warning signs' (WS), distinguish periods of acute heightened risk from periods of lower risk within an individual. No prior published study has examined, using a controlled study design, a broad set of hypothesized WS for suicide attempt. This study addressed this gap through examination of hypothesized behavioral/experiential, cognitive, and affective WS among patients recently hospitalized following a suicide attempt. METHODS: Participants were recruited during hospitalization from five medical centers across the USA including two civilian hospitals and three Veterans Health Administration facilities (n = 349). A within-person case-crossover study design was used, where each patient served as her/his own control. WS were measured by the Timeline Follow-back for Suicide Attempts Interview and were operationalized as factors that were present (v. absent) or that increased in frequency/intensity within an individual during the 6 h preceding the suicide attempt (case period) compared to the corresponding 6 h on the day before (control period). RESULTS: Select WS were associated with near-term risk for suicide attempt including suicide-related communications, preparing personal affairs, drinking alcohol, experiencing a negative interpersonal event, and increases in key affective (e.g. emptiness) and cognitive (e.g. burdensomeness) responses. CONCLUSIONS: The identification of WS for suicidal behavior can enhance risk recognition efforts by medical providers, patients, their families, and other stakeholders that can serve to inform acute risk management decisions.

A life span developmental investigation of marriage and problem-drinking reduction.

While prior literature has largely focused on marriage effects during young adulthood, it is less clear whether these effects are as strong in middle adulthood. Thus, we investigated age differences in marriage effects on problem-drinking reduction. We employed parallel analyses with two independent samples (analytic-sample Ns of 577 and 441, respectively). Both are high-risk samples by design, with about 50% of participants having a parent with lifetime alcohol use disorder. Both samples have been assessed longitudinally from early young adulthood to the mid-to-late 30s. Separate parallel analyses with these two samples allowed evaluation of the reproducibility of results. Growth models of problem drinking tested marriage as a time-varying predictor and thereby assessed age differences in marriage effects. For both samples, results consistently showed marriage effects to be strongest in early young adulthood and to decrease somewhat monotonically thereafter with age, reaching very small (and nonsignificant) magnitudes by the 30s. Results may reflect that role transitions like marriage have more impact on problem drinking in earlier versus later adulthood, thereby highlighting the importance of life span developmental research for understanding problem-drinking desistance. Our findings can inform intervention strategies aimed at reducing problem drinking by jumpstarting or amplifying natural processes of adult role adaptation.

Identifying Specific Emotion Regulation Deficits that Associate with Nonsuicidal Self-injury and Suicide Ideation in Adolescents.

It is not known how emotion regulation deficits and strategies may differentially relate to nonsuicidal self-injury (NSSI) and suicide ideation in samples of community-based adolescents. The current study examined emotion regulation using comprehensive multi-method assessment to identify which specific deficits are uniquely related to NSSI and suicide ideation in a sample of high school students. Regarding specific deficits, it was expected that lack of emotional awareness, lack of access to emotion regulation strategies, poor cognitive reappraisal, and poorer automatic emotion processing would uniquely associate with past-year NSSI engagement. It was also predicted that lack of access to strategies, lack of impulse control, lack of awareness, and nonacceptance of emotion would uniquely associate with past-year presence of suicide ideation and suicide ideation severity. The sample included 696 adolescents (54.8% female; ages 14-17; mean age = 15.5) recruited from public high schools. Self-report measures were administered assessing suicide ideation, NSSI engagement, dimensions of emotion regulation, and automatic emotion processing (Emotion Stroop). Emotion suppression was the only unique and significant predictor of past-year NSSI engagement, and lack of access to emotion regulation strategies was the strongest predictor of both past-year presence of suicide ideation and recent suicide ideation severity when accounting for all deficits in the same model. Acquiring emotion regulation skills during the period of adolescence has great potential to buffer from occurrence of NSSI and severity of suicide ideation.

Delineating Developmental Periods in Adulthood Suggests Age-Related Shifts in the Correlates of Alcohol Use and Problems.

BACKGROUND: Developmental context is related to the propensity to engage in alcohol use, the rate at which alcohol use changes, and the relevance of different risk factors to alcohol use disorder (AUD). Therefore, studies of change should consider developmental nuances, but change is often modeled to follow a uniform pattern, even across distinct developmental periods. METHODS: This study implemented a novel analytic approach to delineate developmental periods of alcohol behavior (n = 478, ages 18 to 35). This approach was further leveraged to examine age-related shifts in the association of impulsivity risk factors (lack of planning, general sensation seeking, alcohol enhancement expectancies) with alcohol behavior (alcohol quantity*frequency, heavy drinking, AUD). RESULTS: A sequence of exploratory and confirmatory latent growth models (LGMs) suggested modeling separate linear change factors for alcohol behavior during the primary college (ages 18 to 21) and postcollege years (21 to 35). Bivariate LGMs estimated correlations for alcohol behavior changes with lack of planning, sensation seeking, and enhancement expectancies during these periods. The rate at which heavy drinking changed during the college years was positively correlated with general sensation seeking and lack of planning during this period (rs = 0.61 to 0.63). These correlations were significantly weaker during the postcollege years (rs = 0.29 to 0.34). Notably, the rate of change in alcohol behavior was strongly correlated with enhancement expectancies during the college (r = 0.45 to 0.70) and postcollege years (r = 0.45 to 0.61). CONCLUSIONS: These findings highlight the importance of sensation seeking and lack of planning with regard to adult alcohol use, particularly in a college environment. There was also a strong link between the rates of change in alcohol behavior and enhancement expectancies across all waves. This study supports the utility of exploratory LGMs for delineating developmental periods of alcohol behavior, which are characterized by different processes.

Alcohol and Cannabis Cross Motives, Class Analysis, and Substance Use among Concurrent Users.

Background: Substance use motives refer to an individual's reasons for engaging in substance use. Although the respective alcohol and cannabis literatures have linked specific substance-use motives to indices of use, less is known about motives in concurrent users, particularly examination of cross-motives (e.g., cannabis motives predicting alcohol use). Methods: The present work examined motives for use in a sample of concurrent users to assess relations between motives and alcohol and cannabis outcomes (quantity, frequency, and use disorder symptoms) using both variable- and person-centered approaches. Finally, the present work aimed to discern the impact of timeframe selection for defining concurrent use (i.e., past year, past two weeks). Participants (N = 524) consisted of individuals that endorsed having used both alcohol and cannabis in the past year with subsample (N = 192) of individuals endorsing past two-week concurrent use. Results: Univariate linear regression analyses revealed small to medium positive relations between all alcohol motives and alcohol outcomes and small to medium positive relations between cannabis social, coping, enhancement, and expansion motives and cannabis use. Regressions examining cross-motives and multivariate models revealed wide variability in relations. Mixture analyses revealed a three-class solution (i.e., High Motives, Positive Alcohol, and Low Conformity) for past year concurrent users and a two-class solution (i.e., Low Motives and High Motives) for past two-week concurrent users. Discussion: Examination of motive classes revealed differences in substance, particularly cannabis, outcomes as a function of class membership. Findings are useful in classifying concurrent users' motives and highlight the importance of timeframe selection.

Does Stress Mediate the Relation between Caregivers' Victimization and Child Behavioral Outcomes? A Prospective Examination.

Children with internalizing and externalizing difficulties are at risk for long-term negative effects in adulthood and are impacted by several caregiver factors. Findings of the present study are consistent with previous studies that found direct associations between caregiver victimization history (e.g., physical and sexual abuse) and child behavior problems. Examination of potential mechanisms revealed that caregiver everyday stress related to relationships/responsibilities (RR) served as a mediator between caregiver victimization history and increased children's internalizing symptoms. Though there may be other pathways that contribute to this relation, there does seem to be clinical and policy utility of this knowledge, particularly for at-risk families that are faced with high levels of everyday RR stress. Attenuation of this impact may be accomplished through connection to community resources such as access to family counseling to mitigate relational stress and policy addressing disparities.

Relations between cannabis use, socioeconomic status, and risk perceptions in a Hispanic/Latinx population.

Socioeconomic status (SES) and risk perceptions are indicative of cannabis use and subjective social status (SSS) may have utility in predicting cannabis use. This work examined relations between these indicators of cannabis use and use in a Hispanic/Latinx sample. Results found negative relations between risk perceptions and cannabis use. SES was unrelated to cannabis outcomes and risk perceptions but SSS had a negative relation with lifetime use. SSS positively related to risk assimilation in the full sample. Findings demonstrate how risk perceptions relate to cannabis use and suggest SES and SSS may not be indicative of use among Hispanic/Latinx populations.

E-cigarette use among Asian Americans: a systematic review.

The use of electronic cigarettes (e-cigarettes) has been rising among adolescents and adults in the United States, including among Asian Americans. However, despite being one of the largest racial/ethnic minority groups, the specific trends and patterns of e-cigarette use among Asian Americans are understudied and unclear. This review aimed to summarize relevant information in the last two decades. This systematic review followed the a priori guide outlined by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Articles were gathered from PsycINFO, PubMed, Sage Journals Online, ScienceDirect, and SpringerLink. Forty articles were reviewed and analyzed. Most articles reviewed only reported on the prevalence rate of e-cigarettes among Asian Americans and indicated regional differences. Results noted between- and within-group differences among racial/ethnic groups that warrant further examination. There is a dearth of information regarding health outcomes and correlates or predictors of e-cigarette use among Asian Americans. Despite its popularity and prevalence among Asian Americans, the use of e-cigarettes and related factors or outcomes deserves more nuanced studies and analyses. It is important to delineate subgroup differences by adjusting study designs and data analytic methods to glean meaningful information regarding Asian American's e-cigarette use in the future.

Algorithm Analysis of the DSM-5 Alcohol Withdrawal Symptom.

BACKGROUND: Alcohol withdrawal (AW) is an important clinical and diagnostic feature of alcohol dependence. AW has been found to predict a worsened course of illness in clinical samples, but in some community studies, AW endorsement rates are strikingly high, suggesting false-positive symptom assignments. Little research has examined the validity of the DSM-5 algorithm for AW, which requires either the presence of at least 2 of 8 subcriteria (i.e., autonomic hyperactivity, tremulousness, insomnia, nausea, hallucinations, psychomotor agitation, anxiety, and grand mal seizures), or, the use of alcohol to avoid or relieve these symptoms. METHODS: We used item and algorithm analyses of data from waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (current drinkers, n = 26,946 at wave 1) to study the validity of DSM-5 AW as operationalized by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV (AUDADIS-IV). RESULTS: A substantial proportion of individuals given the AW symptom reported only modest to moderate levels of alcohol use and alcohol problems. Alternative AW algorithms were superior to DSM-5 in terms of levels of alcohol use and alcohol problem severity among those with AW, group difference effect sizes, and predictive validity at a 3-year follow-up. The superior alternative algorithms included those that excluded the nausea subcriterion; required withdrawal-related distress or impairment; increased the AW subcriteria threshold from 2 to 3 items; and required tremulousness for AW symptom assignment. CONCLUSIONS: The results indicate that the DSM-5 definition of AW, as assessed by the AUDADIS-IV, has low specificity. This shortcoming can be addressed by making the algorithm for symptom assignment more stringent.

Measuring Self-Efficacy in the Context of Pediatric Diabetes Management: Psychometric Properties of the Self-Efficacy for Diabetes Scale.

Objective: The Self-Efficacy for Diabetes Scale (SED) is a widely used measure of diabetes-specific self-efficacy with three subscales: diabetes-specific self-efficacy (SED-D), medical self-efficacy (SED-M), and general self-efficacy (SED-G). The present study examined the factor structure and construct validity of the SED in 116 youth, aged 10-16 years (13.60 ± 1.87), with type 1 diabetes mellitus. Methods: Confirmatory factor analysis (CFA) was used to examine the factor structure of the SED. Correlational and regression analyses examined relations between subscales and select outcomes. Results: CFA of the original three-factor structure provided a poor fit to the data. Factor models using rescaled items were tested. Results provided preliminary evidence for the SED-D as an independent one-factor model, and for a reduced one-factor model. Significant associations were found between the SED subscales, responsibility for diabetes management, and glycated hemoglobin. Conclusions: Results provide limited support for the SED-D as a reliable and valid measure of diabetes-specific self-efficacy.

Phosphatidylethanol (PEth) as a Biomarker of Alcohol Consumption in HIV-Infected Young Russian Women: Comparison to Self-Report Assessments of Alcohol Use.

Alcohol use is particularly deleterious for HIV-infected individuals and thus accurate assessment of alcohol consumption is crucial in this population. Phosphatidylethanol (PEth) provides an objective assessment of drinking and can be compared to self-reported alcohol assessments to detect underreporting. The purpose of this study was to identify underreporting and its potential predictors in an HIV-infected sample of young Russian women. The current study examined the concordance between a quantitative measure of PEth and self-reported recent alcohol consumption in a prospective sample of HIV-infected young women (N = 204) receiving medical care in Saint Petersburg, Russia. At baseline, 53% of participants who denied drinking in the prior 30 days tested positive for PEth (i.e., underreporters), although this rate decreased significantly at a three-month follow-up assessment. Further exploration did not identify consistent predictors of underreporting status. Quantitative PEth levels showed, at best, modest overlap to self-reported alcohol consumption among those reporting alcohol use (e.g., Spearman's r = 0.27 between PEth and total drinks past-30 days at baseline). Objective measures of alcohol consumption demonstrate modest overlap with self-report measures of use in HIV-infected young Russian women. Incorporating objective and quantifiable biological markers are essential for valid assessments of alcohol use.

Does Reading Cause Later Intelligence? Accounting for Stability in Models of Change.

This study reanalyzes data presented by Ritchie, Bates, and Plomin (2015) who used a cross-lagged monozygotic twin differences design to test whether reading ability caused changes in intelligence. The authors used data from a sample of 1,890 monozygotic twin pairs tested on reading ability and intelligence at five occasions between the ages of 7 and 16, regressing twin differences in intelligence on twin differences in prior intelligence and twin differences in prior reading ability. Results from a state-trait model suggest that reported effects of reading ability on later intelligence may be artifacts of previously uncontrolled factors, both environmental in origin and stable during this developmental period, influencing both constructs throughout development. Implications for cognitive developmental theory and methods are discussed.

The clinical application of suicide risk assessment: A theory-driven approach.

The interpersonal theory of suicide posits that thwarted belongingness (TB) and perceived burdensomeness (PB) increase suicide ideation; however, studies have found mixed results regarding this hypothesis among psychiatric inpatients. This study aimed to (a) demonstrate how assessing TB and PB using the Interpersonal Needs Questionnaire (INQ) can provide clinically useful information and (b) investigate how statistical methodology may impact the clinical application of the INQ. Participants were 139 (Sample 1) and 104 (Sample 2) psychiatric inpatients. In both samples, ordinal logistic regression results indicated TB and PB, separately, were significant predictors of suicide ideation-related outcomes; however, when examined as simultaneous predictors, TB was no longer a significant predictor. The interaction between TB and PB was not significant for either sample. Despite this, TB and PB scores provided clinically relevant information about suicide ideation-related outcomes. For example, the highest scores on TB and PB indicated a 93% and 95% chance of having some level of distress due to suicide ideation (Sample 1), a 91% and 92% chance of having some level of desire for death, and a 79% and 84% chance of having some level of desire for suicide, respectively (Sample 2). This study also proposes clinical cutoff scores for the INQ (for TB and PB, respectively, cutoff scores were 22 and 17 for distress due to suicide ideation, 33 and 17 for desire for death, and 31 and 22 for desire for suicide). Although these results indicate that multicollinearity between TB and PB may create interpretational ambiguity for clinicians, TB and PB may each be useful separate predictors of suicide ideation-related outcomes in psychiatric inpatient settings and should be incorporated into suicide risk assessment. KEY PRACTITIONER MESSAGE: The 15-item Interpersonal Needs Questionnaire (an assessment of thwarted belongingness and perceived burdensomeness) should be incorporated into suicide risk assessment. Among psychiatric inpatients, greater thwarted belongingness and perceived burdensomeness, as separate predictors, were associated with increased levels of distress due to suicide ideation, desire for death, and desire for suicide. The highest scores on thwarted belongingness and perceived burdensomeness indicated a 79% to 95% chance of experiencing an elevated level of distress due to suicide ideation, desire for death, or desire for suicide. Recommended clinical cutoff scores were provided. For example, thwarted belongingness cutoff score of 31 and perceived burdensomeness cutoff score of 22 maximized the sensitivity and specificity of the INQ to detect some level of desire for suicide.

Young women's alcohol expectancies for sexual risk-taking mediate the link between sexual enhancement motives and condomless sex when drinking.

Alcohol use is prevalent among young women. Alcohol expectancies for sexual risk-taking and sexual enhancement motives have been associated with decreased condom use. This study investigated whether alcohol expectancies for sexual risk-taking mediated the association between sexual enhancement motives and condom use. Young women (N = 287, M age = 20.1) completed a survey assessing alcohol expectancies for sexual risk-taking, sexual enhancement motives, and characteristics of their most recent sexual encounter involving alcohol. Most participants (66.9 %) reported unprotected sex during their last sexual encounter involving alcohol. Higher sexual enhancement motives (OR = 1.35, p = .019) and alcohol expectancies for sexual risk-taking (OR = 1.89, p < .001) were associated with increased likelihood of condomless sex. Alcohol expectancies for sexual risk-taking mediated the association between sexual enhancement motives and condomless vaginal sex. Within the context of sexual encounters involving alcohol, expectancies that drinking may result in sexual risk-taking may account for why sexual enhancement motives relate to decreased condom use.

Changes in negative urgency, positive urgency, and sensation seeking across adolescence.

The development and potential co-development of traits related to impulsivity and sensation seeking across adolescence has garnered substantial attention within the extant literature. Some prior research suggests that facets show distinct patterns of change across adolescence and that intraindividual changes in these traits may be unrelated. However, the extant literature is somewhat hampered by measurement issues and inconsistent findings. Using an accelerated longitudinal design in a sample of adolescents (n = 1018; ages 11-16), changes in negative urgency, positive urgency, and sensation seeking were examined. The three facets showed similar trajectories across time (i.e., increasing during early adolescence before leveling off). Across all facets, there was strong evidence of correlated change, suggesting these traits are, developmentally, strongly related phenomena.

State and trait effects on individual differences in children's mathematical development.

Substantial longitudinal relations between children's early mathematics achievement and their much later mathematics achievement are firmly established. These findings are seemingly at odds with studies showing that early educational interventions have diminishing effects on children's mathematics achievement across time. We hypothesized that individual differences in children's later mathematical knowledge are more an indicator of stable, underlying characteristics related to mathematics learning throughout development than of direct effects of early mathematical competency on later mathematical competency. We tested this hypothesis in two longitudinal data sets, by simultaneously modeling effects of latent traits (stable characteristics that influence learning across time) and states (e.g., prior knowledge) on children's mathematics achievement over time. Latent trait effects on children's mathematical development were substantially larger than state effects. Approximately 60% of the variance in trait mathematics achievement was accounted for by commonly used control variables, such as working memory, but residual trait effects remained larger than state effects. Implications for research and practice are discussed.

Repeated diagnoses of lifetime alcohol use disorders in a prospective study: insights into the extent and nature of the reliability and validity problem.

BACKGROUND: Prior research indicates that assessments of lifetime alcohol use disorders (AUDs) show low sensitivity and are unreliable when assessed by a single, retrospective interview. This study sought to replicate and extend previous research by calculating the lifetime prevalence rate of AUDs using both single retrospective assessments of lifetime diagnosis and repeated assessments of both lifetime and past-year diagnoses over a 16-year period within the same high-risk sample. In addition, this study examined factors that contributed to the consistency in reporting lifetime AUDs over time. METHODS: Using prospective data, the reliability and validity of lifetime estimates of alcohol dependence and AUD were examined in several ways. Data were drawn from a cohort of young adults at high and low risk for alcoholism, originally ascertained as first-time college freshmen (N = 489 at baseline) at a large, public university and assessed over 16 years. RESULTS: Compared with using a single, lifetime retrospective assessment of DSM-III disorders assessed at approximately age 34, lifetime estimates derived from using multiple, prospective assessments of both past-year and lifetime AUD were substantially higher (25% single lifetime vs. 41% cumulative past-year vs. 46% cumulative lifetime). This pattern of findings was also found when conducting these comparisons at the symptom level. Further, these results suggest that some factors (e.g., symptoms endorsed, prior consistency in reporting of a lifetime AUD, and family history status) are associated with the consistency in reporting lifetime AUDs over time. CONCLUSIONS: Based on these findings, lifetime diagnoses using a single measurement occasion should be interpreted with considerable caution given they appear to produce potentially large prevalence underestimates. These results provide further insight into the extent and nature of the reliability and validity problem with lifetime AUDs.

A comparison of retrospectively reported and ecological momentary assessment-reported perceived social support in predicting ecological momentary assessment-reported non-suicidal self-injury.

INTRODUCTION: Non-suicidal self-injury (NSSI) urges and behaviors are associated with lower perceived social support and related constructs (e.g., perceived rejection). However, no studies have examined the concordance of retrospective (baseline) and ecological momentary assessment (EMA) perceived social support assessments. Retrospective and EMA reports are often only weakly to moderately correlated; measurement approaches may, therefore, impact observed associations between variables. We tested whether average EMA-reported perceived emotional social support uniquely predicts EMA-reported NSSI urges and behaviors above baseline-reported retrospective self-report of perceived emotional social support alone. METHODS: 93 young adults (ages 18-34) with past-month NSSI urges or behaviors and lifetime NSSI behaviors completed a semi-structured interview, self-report surveys, and a 2-week EMA protocol. RESULTS: Baseline- and EMA-reported perceived emotional social support were positively correlated (Kendall's tau-b = 0.51). Average EMA-reported social support was uniquely associated with EMA-reported NSSI urges but not NSSI behaviors. CONCLUSIONS: EMA-reported perceived emotional social support captured information not represented by baseline reports alone, but improvement in model fit was modest. EMA-reported social support may further improve the estimation of EMA-reported NSSI urges if modeled as a proximal predictor of NSSI. Further work is needed to clarify temporal directions between social support and NSSI urges. Limitations are discussed.

Warning signs in a period of acute risk for suicide attempt: The utility of count- and combination-based classification.

OBJECTIVE: This study sought to establish if models involving the specific combinations of identifiable behavioral warning signs (WS; i.e., alcohol use, suicidal communications, preparation of personal affairs, experiencing negative interpersonal life events) for a suicide attempt outperformed a simpler count model of WS to distinguish an acute risk period (the six hours prior to a suicide attempt) from a control period (a matched six-hour period the day prior). METHOD: Generalized linear mixed models tested all logical combinations of four behavioral WS in addition to a count variable of the number of behavioral warning signs. For the count variable, receiver operating characteristic curve analysis was utilized to determine the optimal cut point for the number of endorsed WS. RESULTS: Area under the curve (AUC) compared classification across all models, with the count model demonstrating similar classification performance to the best multivariate model (AUCs of 0.72 and 0.73, respectively), with an optimal cut point of endorsing one or more WS. CONCLUSION: Although determinations of acute risk should be informed by multiple sources of information, this study suggests a relatively simple count-based approach that considers the presence of one (or more) behavioral WS may be used as a potential indication of increased acute risk for suicide attempt.