Examining the interpersonal theory of suicide in acutely suicidal psychiatric inpatients.

The current study examined hypotheses related to the development of suicidal ideation as directed by the interpersonal theory within a sample of acutely suicidal psychiatric inpatients. Consistent with ideation-to-action models, we distinguished suicidal desire from resolved plans and preparations. Although thwarted belongingness and perceived burdensomeness were correlated with suicidal desire, only perceived burdensomeness was associated with suicidal desire controlling for depression and thwarted belongingness. Depression alone was related to plans and preparations. Findings are interpreted as challenging the mechanisms hypothesis of the interpersonal theory and suggest that alternative conceptualizations of the development of suicidal desire may be warranted.

Intention to Enact and Enactment of Gatekeeper Behaviors for Suicide Prevention: an Application of the Theory of Planned Behavior.

Gatekeeper training for suicide prevention was evaluated on a college campus to examine the impact of training on gatekeeper enactment of behaviors in support of suicide prevention and identify predictors of enactment of gatekeeper behaviors. Trained gatekeepers (N = 216) displayed greater perceived knowledge and self-efficacy for suicide prevention and reported higher rates of self-reported actual gatekeeper behaviors, including inquiring about suicidal ideation and referring for mental health treatment when they encountered someone in distress, compared to their untrained counterparts (N = 169). Consistent with the Theory of Planned Behavior, SEM results indicated that attitudes, self-efficacy, and perceived knowledge explained intentions to engage in gatekeeper behaviors, accounting for 59% of the variance in intentions to inquire about suicidal ideation and supporting the role of attitudes and perceived behavioral control in intentions to act. These intentions explained self-reported actual gatekeeper behaviors among participants who encountered someone in distress, with each one-point increase in intention associated with nearly twice the likelihood of both inquiring about suicidal ideation and referring someone for mental health care. On the other hand, self-reported situational barriers were associated with a decreased likelihood of referral behavior, indicating the role of actual behavioral control over volitional actions. Findings support the value of gatekeeper training for promoting factors that influence the likelihood of action on behalf of suicide prevention.

Life experiences and the acquired capability for suicide in incarcerated men.

Suicide is a leading cause of death in U.S. prisons. Prisoners may be at risk for suicide due to their greater likelihood of experiencing events that promote the acquired capability for suicide. The current study examined the associations of 10 domains of life experiences with the acquired capability for suicide in 399 male prisoners. All life experience domains were associated with acquired capability with certain domains evidencing relatively stronger relations. Results support that aggression, thrill seeking, suicidal thoughts and behaviors, and accidental injury may be particularly important to the development of the acquired capability for suicide in prisoners.

A Pilot Randomized Controlled Trial of the Alliance Project Gatekeeper Training for Suicide Prevention.

Gatekeeper trainings are an approach intended to increase help seeking for suicide prevention. However, little is known of gatekeeper training's function in increasing gatekeeper intent to intervene with those in distress. The current study utilized the theory of planned behavior as a guide to predict gatekeeper's intention to intervene over a six-month period in a pilot randomized controlled trial of the Alliance Project gatekeeper training. Results suggested that the Alliance Project, predicted the growth curve of trainees' intention to intervene better than a control training from pretest through six months. Attitudes toward completing gatekeeper behaviors and perceived behavioral control over gatekeeper behaviors approached significance in a less parsimonious model. These findings suggest the Alliance Project produces changes in gatekeeper's intent to intervene through three months' time.

Suicide Risk and Restricted Emotions in Women: The Diverging Effects of Masculine Gender Norms and Suicide Capability.

This study investigated whether gender moderated the association between masculine socialization pressures of restrictive emotionality and suicide risk through suicide capability (i.e., fearlessness about death). A sample of inpatients admitted for recent suicidality (n = 194) completed validated measures of restrictive emotionality, fearlessness about death, and current suicide risk. A moderated mediation effect was found opposite the hypothesized direction: fearlessness about death mediated the relationship between endorsement of the masculine gender norm of restrictive emotionality and suicide risk in women, but not men. Gender did not moderate the association between restrictive emotionality and fearlessness about death. The diverging gender effects suggest that the masculine gender norm of restrictive emotionality is associated with suicide capability in men and women, while acquired fearlessness about death is more informative of risk for suicide in women than men.

Validation of the Suicidal Behavior Exposure Scale in First Responders.

Background: First responders (e.g., emergency medical technicians, firefighters) may be at higher suicide risk than the general population due to frequent exposure to suicidal behaviors of others. Aims: We aimed to confirm the factor structure, scale reliability, and convergent validity of a new measure of suicidal exposure, the Suicidal Behaviors Exposure Scale, in first responders. Method: Using a cross-sectional web-based survey, we recruited 862 participants (81.3% male, mean age = 40.23, SD = 11.88) from a national database and southeastern state-based organization of first responders. Results: Confirmatory factor analysis resulted in a generally poor fit for the three-factor structure (exposure to suicidal communication, indirect exposure to suicide attempts/deaths, direct exposure to suicide attempts/deaths). However, good scale reliability and convergent validity were demonstrated. Limitations: The cross-sectional design, a convenience sample, and the low percentage of women comprise the limitations of this study. Conclusion: The Suicidal Behavior Exposure Scale requires additional development and validation before use in a first-responder sample. Future work should also examine other aspects of reliability and validity, namely, measurement invariance across groups and time.

College students' peer-helping behaviors and stigma of seeking help: Testing a moderated mediation model.

Objective: College students are most likely to seek psychological help from their peers. Internalized public stigma (ie, personal stigma) may prevent peer-helpers from aiding others, and such help-negating effects may depend on contextual factors such as race and gender. The current study examined a moderated mediation model in which the relationship between public stigma and peer intervention behaviors was mediated by personal stigma and moderated by race and gender categories. Method: Undergraduate students (N = 5,183) from the national Healthy Minds Study completed measures of help-seeking stigma and peer-helping behaviors. Results: Conditional Process Modeling revealed that personal stigma fully mediated the link between public stigma and peer-helping behaviors. Gender (but not race) moderated these associations such that the indirect and direct effects were stronger from men than women. Conclusions: Peer-helper interventions may benefit from culture-specific re-norming messages and by addressing the role of gender in peer-helping.

A Preliminary Validation of the Suicidal Behavior Exposure Scale.

OBJECTIVE: Research on suicide contagion has suggested that exposure to suicide-related thoughts and behaviors of others promotes one's personal risk for suicide. However, our understanding of the role suicidal exposure plays in the development of suicide risk is underdeveloped. This limited understanding may be due, in part, to the lack of a validated measure of exposure to suicidal behavior. The present study aimed to develop and validate a comprehensive self-report instrument of exposure to suicidal behaviors. METHOD: Using two independent convenience samples of undergraduate students, exploratory structural equation modeling (ESEM) was performed on a newly developed measure of suicidal exposure. RESULTS: Data supported a three-factor model of suicidal exposure: exposure to suicidal communication, direct exposure to suicide deaths and attempts, and indirect exposure to suicide deaths and attempts. Each factor demonstrated positive bivariate associations with depressive symptoms, posttraumatic stress disorder symptoms, suicide ideation, and suicide attempt history, suggesting convergent validity. Analyses demonstrated generally acceptable internal consistency. CONCLUSION: This instrument will facilitate the study of suicidal exposure. Further validation of this scale, with attention to its reliability and invariance across gender and other demographic variables in clinically relevant samples, will be important for advancing the assessment of suicidal exposure and understanding its relation to suicide risk.

A Preliminary Test of the Interpersonal-Psychological Theory of Suicide in Women Seeking Shelter From Intimate Partner Violence.

Women seeking shelter from intimate partner violence (IPV) are at greater risk of suicide ideation and attempts compared with women in the general population. A theoretically grounded understanding of suicide risk in shelter-seeking women is critical to improve assessment and management of suicide risk in this population. The interpersonal-psychological theory of suicide (IPTS) proposes that suicide ideation results from hopelessness about thwarted belongingness and perceived burdensomeness. However, suicide ideation does not progress to death by suicide unless one has acquired the capability for suicide (i.e., pain tolerance and fearlessness about death) via repeated exposure to painful and fearsome events. The present study provides a preliminary test of the IPTS in a sample of 134 women seeking shelter from IPV. First, we examined factors theoretically related to suicide ideation, demonstrating that only at high levels of hopelessness was perceived burdensomeness associated with suicide ideation. The study also examined factors theoretically related to the acquired capability for suicide (ACS), indicating that physical partner violence perpetration was associated with ACS. These findings suggest that perceived burdensomeness, particularly in the context of increased hopelessness, is important in the assessment and treatment of suicide ideation. Furthermore, violence perpetration may indicate greater risk of the capability to die by suicide among women seeking shelter from IPV.