A conditional process analysis of suicidal thoughts and behaviors in outpatient parents: Examining the Narrative Crisis Model by parenthood status.

No study to date has examined the moderating effect of parenthood on suicidal states and outcomes using a conditional process model. The Narrative Crisis Model, a multi-stage model from interpersonal distress to suicidal outcomes mediated by Suicide Crisis Syndrome severity, was assessed (H1). The present study tested whether (H2) parenthood moderates the indirect association between interpersonal distress and suicidality to reduce suicide risk. Psychiatric outpatients (N = 466) completed measures assessing the severity of interpersonal distress and Suicide Crisis Syndrome, as well as a clinical interview of suicidal thoughts and behaviors. The sample was predominantly female (65.7%), with ages ranging from 18 to 84 years. Mediation was conducted on the total sample (H1) and a conditional process analysis compared parents (n = 170) and non-parents (H2). Suicide Crisis Syndrome severity mediated the relationship between interpersonal distress and suicidal outcomes. Parenthood moderated the indirect relationship between interpersonal distress and suicidal outcomes through Suicide Crisis Syndrome such that parents had a significantly higher suicide risk than non-parents (index = 0.058; 95% CI [0.005, 0.139]). In the context of an outpatient population, parents appear to be more at risk for developing a suicidal crisis and engaging in suicidal thoughts and behaviors than non-parents. Parenthood may act as a pile-up stressor for this population, outweighing the protective effects of having children. In this way, the Narrative Crisis Model is a theoretical model suitable for the examination of complex factors impacting risk for near-term suicidal thoughts and behaviors.

Associations between clinicians' emotion regulation, treatment recommendations, and patient suicidal ideation.

OBJECTIVE: This study examines how clinicians' emotional responses to suicidal patients and their emotion regulation abilities are related to their treatment recommendations for these patients and to patients' concurrent suicidal ideation and at one-month follow-up. METHODS: Adult psychiatric outpatients (N = 361) and the mental health professionals evaluating them for treatment (N = 43) completed self-report assessments following their first clinical meeting. Clinician emotion regulation traits, emotional responses to individual patients, and the recommended intensity of treatment were assessed. Patients were assessed for suicidal ideation immediately following the initial meeting and at a one-month follow-up. Moderation and mediation analyses were performed to examine the relationships between study variables. RESULTS: Patient suicidal ideation at the initial clinical encounter was associated with increased negative emotions in clinicians with lower emotion regulation. Further, recommended treatment intensity was associated with clinicians' negative emotional responses but not with patient suicidal ideation among clinicians with lower emotion regulation. CONCLUSIONS: Treatment intensification is related to clinicians' emotion regulation abilities. Clinicians' attention to their emotional responses may facilitate improved treatment process and ultimately may improve suicidal outcomes.

How do distal and proximal risk factors combine to predict suicidal ideation and behaviors? A prospective study of the narrative crisis model of suicide.

AIM: The Narrative Crisis Model of suicide posits that when individuals with trait vulnerabilities for suicide face stressful life events, they may develop distorted perceptions of themselves and society that culminate in a sense of no future. Referred to as the suicide narrative, these perceptions makes them more likely to experience the Suicidal Crisis Syndrome, an acute affective condition that increases the risk of engaging in suicidal ideation behaviors. The goal of this study was to assess the stage components of this model. METHODS: The stage components of the NCM were assessed among adult psychiatric inpatients (N = 223; listwise N = 85) aged 18-65 years old and admitted for suicidal ideation or attempts. Suicidal outcomes were assessed at one month follow-up. Structural equation modeling (SEM) was used to assess the model and its prediction of prospective suicidal outcomes. RESULTS: The model was supported by the SEM and proved to be a good fit for the data. Each temporal stage was significantly predicted by the precedent stage in the model and 13% of the variance in suicidal ideation and behaviors (when assessed conjointly) were explained by the model. When suicidal ideation and attempts were assessed separately, the amount of variance explained was 10.8% for suicidal ideation and 40.7% for suicidal attempts. DISCUSSION: The progression from trait vulnerabilities to suicidal outcomes proposed by the NCM was supported by our findings. These findings have clinical implications in the assessment and treatment of suicide risk and will need replication with larger samples.

Multi-informant prediction of near-term suicidal behavior independent of suicidal ideation.

BACKGROUND: Both the Suicide Crisis Syndrome (SCS) and clinicians' emotional responses to suicidal patients are predictive of near-term suicidal behaviors. Thus, we tested predictive validity of a combination of the proposed Diagnostic and Statistical Manual SCS criteria and the Therapist Response Questionnaire Suicide Form (TRQ-SF) for near-term suicidal behavior. METHODS: The presence of SCS in adult psychiatric outpatients (N=451) was assessed using relevant items from validated psychometric assessments. Clinicians completed the TRQ-SF immediately after patient intake. Suicide attempts (SA) and a combination of suicide plans and attempts (SPA) were measured at one month follow-up (N=359). RESULTS: At follow-up nine patients reported having SPA and seven reported SA. Meeting the SCS criteria were associated with near-term SA (χ2=5.987, p<0.01), while high TRQ-SF scores were associated with both near-term SA (χ2=5.971, p<0.05) and SPA (χ2=7.069, p<0.01). Meeting either the SCS or having high TRQ-SF scores, but not both, was associated with near-term SA (χ2=11.893, p<0.01) and SPA (χ2=11.449, p<0.01). Incremental predictive validity over standard suicide risk factors and individual scales was demonstrated in logistic regressions. CONCLUSIONS: Multi-informant risk assessment not reliant on patient self-reported ideation appear to enhance predictive power of traditional risk assessments in identifying imminent suicide risk.