A Psychometric Evaluation of the Interpersonal Hopelessness Scale Among Individuals With Elevated Suicide Risk.

The interpersonal theory of suicide hypothesizes that suicide ideation (SI) emerges specifically in the context of hopelessness about the immutability of thwarted belongingness (TB) and perceived burdensomeness (PB; i.e., interpersonal hopelessness). The psychometrics of the Interpersonal Hopelessness Scale (IHS), which could be used to test this hypothesis directly, have not been rigorously evaluated. Participants (U.S. adults reporting past-year SI) completed online self-report assessments at Waves 1 (W1; N = 595) and 2 (W2; N = 215), 1 week apart. Confirmatory factor analyses supported a two-factor structure, IHS-TB and IHS-PB. Correlations indicated strong concurrent validity. Hurdle negative binomial regressions indicated that W1 IHS-TB and IHS-PB scores were associated with SI presence and severity at both waves, but this was inconsistent when adjusting for other W1 variables. IHS-TB and IHS-PB demonstrated excellent internal consistency and moderate to good test-retest reliability. The IHS could improve theory testing and suicide risk assessment and management.

Development of a Questionnaire to Measure Public Perceptions of the Role of Community Pharmacy in Public Health (PubPharmQ).

BACKGROUND: Community pharmacies are well placed to provide public-health interventions within primary care settings. This study aimed to establish the general public's perceptions of community pharmacy-based public-health services in the UK by designing a structured questionnaire to assess the barriers and facilitators to optimizing this role. METHODS: A standardized questionnaire was developed informed by the literature, additional semi-structured interviews, and synthesis of key findings with the authors' previous research based on data generated from eight focus groups. The original 42-item questionnaire was distributed online from May to June 2021 via social media platforms to capture the views of non-regular pharmacy users. Following exploratory factor analysis, and Cronbach's alpha analysis, total Likert scale response scores were calculated. RESULTS: Of the 306 responders, 76.8% were female with a mean age of 34.5 years (SD = 15.09). The most prevalent pharmacy use reported was 1-2 times a year (28.1%). Exploratory factor analysis revealed four scales: Expertise, Role in Public Health, Privacy, and Relationship (18 items) with acceptable internal consistency and good face and content validity. Awareness of well-established pharmacy services was high; however, responders demonstrated poor awareness of public-health-related services and low recognition of pharmacy expertise for this role. A lack of an established relationship with community pharmacies and privacy concerns were also perceived barriers. CONCLUSIONS: Based on these findings, considerable effort is needed to increase public awareness and address these concerns if strategic plans to utilize community pharmacy in the delivery of public-health policy are to be successful. The PubPharmQ provides a novel, structured questionnaire to measure the public's perceptions of community pharmacy's role in public health.

Examining sleep disturbance components as near-term predictors of suicide ideation in daily life.

Suicide ideation emerges and fluctuates over short timeframes (minutes, hours, days); however, near-term predictors of such fluctuations have not been well-elucidated. Sleep disturbance is a distal suicide risk factor, but less work has examined whether daily sleep disturbance predicts near-term changes in suicide ideation. We examined subjective sleep disturbance components as predictors of passive and active suicide ideation at the within-person (i.e., day-to-day changes within individuals relative to their own mean) and between-persons (individual differences relative to the sample mean) levels. A transdiagnostic sample of 102 at-risk young adults ages 18-35 completed a 21-day ecological momentary assessment protocol, during which they reported on sleep and passive and active suicide ideation. At the within-persons level, nightmares, sleep quality, and wake after sleep onset predicted passive suicide ideation, and sleep quality and wake after sleep onset predicted active suicide ideation. At the between-persons level, nightmares, sleep onset latency, and sleep quality were associated with passive suicide ideation, and sleep onset latency was associated with active suicide ideation. In contrast, suicide ideation did not predict subsequent sleep at the within-person level. Specific sleep disturbance components are near-term predictors of intraindividual increases in suicide ideation and may hold promise for suicide prevention and intervention.

Personal growth initiative as a buffer against suicide ideation severity in psychotherapy outpatients with depressive symptoms.

OBJECTIVE: Many people who die by suicide experience major depressive disorder (MDD), but most people with MDD do not die by suicide and many do not report thoughts of death or suicide. This cross-sectional study examined the potential of personal growth initiative (PGI) skills to protect against suicide ideation among adult psychotherapy outpatients. METHOD: Adult outpatients (N = 178) completed measures of suicide ideation severity (SI), depressive symptom severity (DEP), and PGI skills (PGI) at intake. RESULTS: Although higher DEP significantly correlated with higher suicide ideation, a significant DEP × PGI interaction, indicated significant positive relations between DEP and SI only when PGI was at or below the mean for this sample. CONCLUSIONS: PGI skills may function as a protective factor against the development of suicide ideation even in the presence of severe depressive symptoms. This suggests that training PGI skills might prevent or reduce suicide ideation among depressed patients.

Interpersonal Risk Factors, Sexual and Gender Minority Status, and Suicidal Ideation: Is BDSM Disclosure Protective?

Suicidal ideation is elevated among individuals who engage in BDSM practices and those with sexual and gender minority (SGM) identities. There is limited research on the intersectionality of these identities and how they relate to suicidal ideation, especially within a theoretical framework of suicide risk, such as the interpersonal theory of suicide. Thus, we tested the indirect relation between BDSM disclosure and suicidal ideation through thwarted belongingness and perceived burdensomeness, as well as the moderating role of SGM identity on these indirect associations. Participants were 125 (Mage = 28.27 years; 64% cisgender men) individuals recruited via online BDSM-related forums who endorsed BDSM involvement and recent suicidal ideation. Results indicated significant moderated mediation, such that BDSM disclosure was indirectly negatively related to suicidal ideation through lower thwarted belongingness, but not perceived burdensomeness, among SGM individuals. This was due to the significant relation between BDSM disclosure and thwarted belongingness. There were no significant moderated mediation or indirect effects related to perceived burdensomeness. We also provide supplemental analyses with positive ideation (i.e., positive thoughts toward life) as the criterion variable. In conclusion, BDSM disclosure appears to be protective against suicidal ideation through thwarted belongingness but only for SGM individuals. This work furthers our understanding of the impact of intersecting marginalized identities on suicide risk and resilience. Implications, limitations, and future directions are further discussed.

Interpersonal Trauma and Suicide Ideation: The Indirect Effects of Depressive Symptoms, Thwarted Belongingness, and Perceived Burden.

Suicide risk is elevated among college-aged students and individuals exposed to cumulative interpersonal trauma. This study used the interpersonal theory of suicide as a framework to test the relation between cumulative interpersonal trauma and suicide ideation through the indirect effects of cumulative interpersonal trauma via depression, thwarted belongingness (TB), and perceived burdensomeness (PB), in serial. Participants were 261 college students who endorsed prior trauma and completed cross-sectional study measures online. An atemporal serial mediation model indicated that cumulative interpersonal trauma significantly and indirectly related to suicide ideation through depressive symptoms, TB, and PB. The relation between cumulative interpersonal trauma and suicide ideation was explained by greater depressive symptoms, TB, and PB, in serial. Therefore, depressive symptoms, TB, and PB may be important modifiable clinical targets for college students with a history of cumulative interpersonal trauma.

The moderating role of pessimism in the association between retrospective relational peer victimization, interpersonal risk factors, and suicide ideation.

Peer victimization (PV) is a serious concern for youth and is associated with subsequent suicide ideation in young adulthood. The interpersonal theory of suicide may provide a framework for understanding suicide ideation in this population. Specifically, thwarted belongingness (TB) and perceived burdensomeness (PB) have been significantly associated with suicide ideation among young adults with a history of peer victimization. Additionally, the personality trait of pessimism is associated with elevated suicide ideation. Thus, this study tested the association between self-reported frequency of retrospective relational (i.e., verbal and indirect) PV in primary and secondary school, thwarted interpersonal needs (TB and PB), and current suicide ideation, as well as how these relations may vary based on current pessimism. Participants were 330 undergraduate students. Nonparametric bootstrap moderated mediation procedures were used to test hypotheses. Results indicated significant indirect effects of frequency of retrospective relational PV and suicide ideation through PB and TB. Contrary to predictions, results did not indicate significant moderated mediation; however, the association between PB and suicide ideation was stronger at lower pessimism levels. We also provide supplemental analysis with optimism as the moderator. These findings suggest that clinicians may consider targeting TB, PB, as well as pessimism and optimism among those with a history of relational PV when assessing and intervening on current suicide ideation. Implications, limitations, and future directions are further discussed.

Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS): performance in a clinical sample in relation to PHQ-9 and GAD-7.

PURPOSE: This study assesses the construct validity and sensitivity to change of the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) as an outcome measure in the treatment of common mental disorders (CMD) in primary care settings. METHODS: 127 participants attending up to 5 sessions of therapy for CMD in primary care self-rated the SWEMWBS, the Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) scales. SWEMWBS's construct validity and sensitivity to change was evaluated against the PHQ-9 and GAD-7 across multiple time points in two ways: correlation coefficients were calculated between the measures at each time point; and sensitivity to change over time was assessed using repeated measures ANOVA. RESULTS: Score distributions on SWEMWBS, but not PHQ-9 and GAD-7, met criteria for normality. At baseline, 92.9% (118/127) of participants scored above clinical threshold on either PHQ-9 or GAD-7. Correlations between SWEMWBS and PHQ-9 scores were calculated at each respective time point and ranged from 0.601 to 0.793. Correlations between SWEMWBS and GAD-7 scores were calculated similarly and ranged from 0.630 to 0.743. Significant improvements were seen on all three scales over time. Changes in PHQ-9 and GAD-7 were curvilinear with greatest improvement between sessions 1 and 2. Change in SWEMWBS was linear over the five sessions. CONCLUSIONS: This exploratory study suggests that SWEMWBS is acceptable as a CMD outcome measure in primary care settings, both in terms of construct validity and sensitivity to change. Given patient preference for positively over negatively framed measures and statistical advantages of measures which are normally distributed, SWEMWBS could be used as an alternative to PHQ-9 and GAD-7 in monitoring and evaluating CMD treatment.

Prospective and Concurrent Affective Dynamics in Self-Injurious Thoughts and Behaviors: An Examination in Young Adult Women.

Affective dynamics, assessed using ecological momentary assessment (EMA), provide a nuanced understanding of within-person fluctuations of negative affect (NA) and positive affect (PA) in daily life. NA and PA dynamics have been associated with psychopathology and response to psychological treatments. NA and PA dynamics have been rarely studied concurrently in association with self-injurious thoughts and behaviors (SITB), transdiagnostic difficulties encountered regularly in clinical and community settings. Here we present EMA data from a large, diverse sample of young adult women with high rates of SITB to examine NA and PA dynamics (mean intensity, variability, and inertia). Specifically, we considered the prospective associations between past-year suicidal thoughts and past-year nonsuicidal self-injury and affective dynamics, as well as the concurrent associations between affective dynamics, EMA-reported suicidal thoughts, and EMA-reported urges for nonsuicidal self-injury. Results demonstrate that elevated mean NA and NA variability are robustly associated with all types of SITB assessed prospectively or concurrently. Interestingly, these associations were weakest for past-year nonsuicidal self-injurious behaviors, relative to past-year and concurrent suicidal or nonsuicidal self-injurious thoughts. Past-year suicidal thoughts further predicted increased NA inertia. Decreased PA inertia was associated with past-year nonsuicidal self-injury behavior, as well as concurrent EMA suicidal thoughts. We found no associations (prospective or concurrent) between SITB and mean PA intensity or PA variability. These results highlight the importance of understanding affective processes to develop real-world interventions to prevent nonsuicidal self-injury and suicidal behavior in daily life.

Temporal sequences of suicidal and nonsuicidal self-injurious thoughts and behaviors among inpatient and community-residing military veterans.

BACKGROUND: Suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) are major health concerns among military veterans yet little is known about the temporal relations among these outcomes. This study examined the temporal relations between suicidal and nonsuicidal SITBs among higher-risk veterans. Specifically, we identified when SITBs emerged and evaluated the role of nonsuicidal self-injury (NSSI) in the medical lethality of suicide attempts (SA), relative risk, and survival time of suicidal SITBs (i.e., suicide ideation [SI], suicide plan, SA). METHOD: Cross-sectional data were collected from two samples examining suicide risk among veterans receiving inpatient psychiatric care (n = 157) and community-residing veterans with current depression and/or past month SI (n = 200). Participants completed an interview to assess SITBs. RESULTS: SITBs emerged between ages 14-28 years with behaviors emerging, on average, earlier among inpatient veterans. The time lag between SITBs was not significantly different between groups. Inpatient veterans had a significantly shorter time lag from SI to SA. NSSI history predicted an increase in relative risk for all suicidal SITBs and shorter survival time. There was no association between NSSI history and medical lethality of the most serious SA for both groups. LIMITATIONS: Limitations included use of cross-sectional, retrospective self-report with age-of-onset endorsed in years and not all SITBs were assessed (e.g., passive SI). CONCLUSIONS: Veterans with a NSSI history are at high risk for suicidal SITBs and have a shorter survival time. Results showed thoughts (i.e., NSSI thoughts, SI) emerged before behavior (i.e., NSSI, SA) and NSSI emerged before SA.

Substance use, current criminal justice involvement, and lifetime suicidal thoughts and behaviors history: The moderating role of thwarted belonging.

OBJECTIVE: Criminal justice involvement, substance use, and suicide pose significant public health concerns; however, the unique and synergistic effects of these experiences among high-risk individuals remain understudied. We hypothesized positive main effects for alcohol-related severity, drug-related severity, current criminal justice involvement, and thwarted belonging (TB) on suicide ideation history (SIH) and suicide attempt history (SAH) and that TB would moderate these associations. METHOD: We report on cross-sectional analyses of self-report assessments completed by 824 adult residential substance use patients. RESULTS: Multinomial logistic regression analyses indicated that as alcohol- and drug-related severity increases, the probability of SIH and SAH increases; however, TB was only associated with a higher SIH probability. Significant two-way interactions (current criminal justice involvement*TB; alcohol-related severity*TB) indicated that (1) those high in TB with current criminal justice involvement were more likely to report a SIH than those without current criminal justice involvement; and (2) those low in TB and alcohol-related severity had the lowest SAH probability, whereas those low in TB and high in alcohol-related severity had the highest SAH probability. CONCLUSION: The unique and combined effects of interpersonal and contextual risk factors may improve suicide risk conceptualization and assessment, and allow for tailored treatments for this high-risk population.

Using categorical data analyses in suicide research: Considering clinical utility and practicality.

OBJECTIVE: Categorical data analysis is relevant to suicide risk and prevention research that focuses on discrete outcomes (e.g., suicide attempt status). Unfortunately, results from these analyses are often misinterpreted and not presented in a clinically tangible manner. We aimed to address these issues and highlight the relevance and utility of categorical methods in suicide research and clinical assessment. Additionally, we introduce relevant basic machine learning methods concepts and address the distinct utility of the current methods. METHOD: We review relevant background concepts and pertinent issues with references to helpful resources. We also provide non-technical descriptions and tutorials of how to convey categorical statistical results (logistic regression, receiver operating characteristic [ROC] curves, area under the curve [AUC] statistics, clinical cutoff scores) for clinical context and more intuitive use. RESULTS: We provide comprehensive examples, using simulated data, and interpret results. We also note important considerations for conducting and interpreting these analyses. We provide a walk-through demonstrating how to convert logistic regression estimates into predicted probability values, which is accompanied by Appendices demonstrating how to produce publication-ready figures in R and Microsoft Excel. CONCLUSION: Improving the translation of statistical estimates to practical, clinically tangible information may narrow the divide between research and clinical practice.

Examining the relations between hopelessness, thwarted interpersonal needs, and passive suicide ideation among older adults: does meaning in life matter?

Older adults are at an elevated risk for passive suicide ideation. The interpersonal theory of suicide and the 3-step theory may provide a framework to better understand factors that contribute to passive suicide ideation among older adults. Specifically, this study aimed to test components of prominent suicide theories and examine the role of meaning in life in the associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation among older adults. Participants were 243 adults aged 60 and older recruited from primary care settings in the southwest United States. We hypothesized that high meaning in life would weaken the associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation. Results from moderation analyses indicate that meaning in life was a significant moderator of the associations between hopelessness and passive suicide ideation, thwarted belongingness and passive suicide ideation, and perceived burdensomeness and passive suicide ideation. These findings suggest that when meaning in life is low there are significant negative associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation among older adults. Implications, limitations, and future directions are discussed.

Suicide Ideation and Thwarted Interpersonal Needs among Psychiatric Inpatients: A Network Approach.

We aimed to demonstrate the utility of an item-level network analysis approach to suicide risk by testing the interpersonal psychological theory of suicide (IPTS) among 402 psychiatric inpatients. We hypothesized specific thwarted belongingness (TB) or perceived burdensomeness (PB; Interpersonal Needs Questionnaire items) facets would positively relate to passive or active suicide ideation, and these facets would positively relate to each other and form distinct clusters. We also tested TB and PB facets central to the networks as predictors of suicide ideation compared to the full TB and PB subscales. Face-valid items congruent with latent constructs proposed by the IPTS (i.e., feelings of burden on society, feeling that one does not belong) were the only two facets uniquely predictive of passive and active suicide ideation. Facets of TB and PB did not form distinct clusters. Item-level network analysis may have important conceptual, assessment, predictive, and clinical implications for understanding suicide risk.

Lifetime History of Suicide Attempts among Not Guilty by Reason of Insanity State Hospital Inpatients: The Roles of past Harmful Substance Use and Current Social Support.

This study tested current perceived social support (CPSS) as a moderator of the relation between previous substance use (PSU) and lifetime suicide attempt (SA) history among 200 NGRI inpatients. Results indicated no significant CPSS main effect. PSU was associated with greater odds of multiple prior lifetime SA. Moderation indicated those low in PSU but high in CPSS were least likely to report multiple prior lifetime SA. Conversely, NGRI inpatients with high CPSS and high PSU were most likely to report multiple lifetime SA. Our study suggests CPSS and PSU assessments may inform suicide risk assessments and interventions among NGRI inpatients.

Suicide-Related Training, Self-Efficacy, and Mental Health Care Providers' Reactions Toward Suicidal Individuals.

Background: Mental health care providers commonly encounter suicide ideation and suicidal behaviors among their patients despite a frequent lack of adequate knowledge and competence regarding suicide risk management. Aims: This study examined the associations among self-perceived sufficiency of training, self-efficacy, anxiety, and attitudes related to working with suicidal individuals. Method: Participants were 289 mental health care providers who completed a self-report survey. Results: Path analysis results indicated that perceived sufficiency of training was indirectly associated with negative attitudes (i.e., avoidance and discomfort) and cognitive and somatic anxiety about working with suicidal individuals through assessment self-efficacy. Limitations: The current study utilized cross-sectional data, and there were occupational heterogeneity and geographical homogeneity among the mental health care providers sampled. Conclusion: These findings suggest that sufficient suicide-related training focused on risk assessment may decrease mental health professionals' negative and anxious reactions toward suicidal individuals and enhance confidence in suicide risk management.

The Intervening Roles of Psychological Inflexibility and Functional Impairment in the Relation between Cancer-related Pain and Psychological Distress.

BACKGROUND: Psychological distress is a significant problem among patients with a diagnosis of cancer and is associated with elevated risk for mortality; however, not all patients with a diagnosis of cancer experience significant psychological distress. Cancer-related pain has been associated with greater psychological distress among patients with a cancer diagnosis (current or previous). The current study aimed to examine potential theoretical mechanisms (i.e., cognitive fusion, experiential avoidance, and functional impairment) as proposed by the psychological flexibility model, for the association between cancer-related pain and psychological distress. We hypothesized that cancer-related pain would be indirectly positively associated with psychological distress among patients with a cancer diagnosis (current or previous) through psychological inflexibility (i.e., cognitive fusion and experiential avoidance) related to pain and functional impairment, in serial. METHOD: Sixty-one adult outpatients diagnosed with cancer completed self-report assessments of cancer-related pain, psychological inflexibility related to pain, pain-related functional impairment, and psychological distress. RESULTS: Cancer-related pain was positively associated with psychological distress indirectly through greater pain-related psychological inflexibility (i.e., cognitive fusion and experiential avoidance) and functional impairment, in serial. Alternative models were explored but unsupported. CONCLUSION: Consistent with the psychological flexibility model, psychological inflexibility and functional impairment may be potential mechanisms underlying the association between cancer-related pain and psychological distress among patients with a cancer diagnosis (current or previous).

The Interpersonal Needs Questionnaire: Statistical Considerations for Improved Clinical Application.

The interpersonal theory of suicide (ITS) has accumulated empirical support; however, less research has investigated the clinical utility of ITS constructs in suicide risk assessment. The current study sought to increase the clinical utility of the Interpersonal Needs Questionnaire (INQ), an assessment of thwarted belongingness (TB) and perceived burdensomeness (PB), among 318 adult psychiatric outpatients while considering statistical methodology (i.e., multicollinearity and partialling). Results emphasized PB in the prediction of concurrent desire for death/suicide when TB was simultaneously considered. The interaction between TB and PB did not enhance prediction of concurrent desire for death/suicide. Independently, PB was a stronger predictor than TB of concurrent desire for death/suicide in the total sample and gender subsamples. Estimated probabilities of concurrent desire for death/suicide across INQ scores and preliminary INQ clinical cutoff scores are provided to enhance clinical application. These findings suggest the INQ could provide valuable information for suicide risk assessment and conceptualization.

Thwarted Interpersonal Needs and Suicide Ideation Distress Among Psychiatric Inpatients: The Moderating Role of Criminal Associates.

Psychiatric inpatients are at elevated risk of suicide, and approximately half are criminal justice-involved. Their involvement with criminal associates may be linked to increased suicide ideation distress; however, this has not been examined. This study tested main effects of, and interactions between, thwarted belongingness (TB) or perceived burdensomeness (PB), time spent with associates, and associates' criminal involvement predicting suicide ideation distress. In our study, psychiatric inpatients (n = 139) completed assessments cross-sectionally. Results indicated that TB, PB, and associates' criminal involvement were significantly related to greater suicide ideation distress. A significant three-way interaction indicated participants who endorsed high TB, spent more time with associates, and had associates high in criminal involvement had the greatest probability of "Extreme" suicide ideation distress. These findings suggest that spending time with criminal associates may increase suicide ideation distress more than not having social interactions. Implications and limitations of this study are discussed.

Experiential avoidance, cognitive fusion, and suicide ideation among psychiatric inpatients: The role of thwarted interpersonal needs.

OBJECTIVE: The interpersonal theory of suicide posits the simultaneous presence of thwarted belongingness and perceived burdensomeness (i.e., thwarted interpersonal needs) leads to active suicide ideation. According to the psychological flexibility model, psychological inflexibility is in part a product of cognitive fusion (i.e., becoming entangled or wrapped up in one's thoughts) and experiential avoidance (i.e., avoidance of internal private experiences, which include thoughts and feelings). We hypothesized that thwarted belongingness and perceived burdensomeness, in parallel, would mediate the positive relation between experiential avoidance and suicide ideation and between cognitive fusion and suicide ideation. METHOD: Participants were 118 adult psychiatric inpatients who completed self-report assessments of thwarted interpersonal needs, cognitive fusion, experiential avoidance, and suicide ideation. RESULTS: Using bootstrapped parallel mediation regression procedures, results indicated thwarted belongingness and perceived burdensomeness mediated, in parallel, the positive relation between experiential avoidance and suicide ideation and between cognitive fusion and suicide ideation. Additionally, thwarted belongingness, but not perceived burdensomeness, independently mediated the relation between cognitive fusion and suicide ideation. CONCLUSION: The current findings indicate that psychological inflexibility variables are associated with increased thwarted interpersonal needs and suicide ideation. The findings of this study provide support for the integration of the interpersonal theory of suicide and psychological flexibility model to improve our conceptualization of suicide risk among psychiatric inpatients. Clinical or methodological significance summary: The findings of this study provide support for the integration of the interpersonal theory of suicide and psychological flexibility model to improve our conceptualization of suicide risk among psychiatric inpatients.