Examining Blunted Initial Response to Reward and Recent Suicidal Ideation in Children and Adolescents Using Event-Related Potentials: Failure to Conceptually Replicate Across Two Independent Samples.

A recent study by Tsypes and colleagues (2019) found that children with recent suicidal ideation had blunted neural reward processing, as measured by the reward positivity (RewP), compared to matched controls, and that this difference was driven by reduced neural responses to monetary loss, rather than to reward. Here, we aimed to conceptually replicate and extend these findings in two samples (n = 264, 27 with suicidal ideation; and n = 314, 49 with suicidal ideation at baseline) of children and adolescents (11 to 15 years and 8 to 15 years, respectively). Results from both samples showed no evidence that children and adolescents with suicidal ideation have abnormal reward or loss processing, nor that reward processing predicts suicidal ideation two years later. The results highlight the need for greater statistical power, as well as continued research examining the neural underpinnings of suicidal thoughts and behaviors.

Are all pain tolerance tasks the same? Convergent validity of four behavioral pain tolerance tasks, self-reported capability for suicide, and lifetime self-injurious behaviors.

OBJECTIVES: Discrepancies persist regarding the extent to which different pain measures provide similar information and relate to capability for suicide and self-injurious behaviors. This study examined pain threshold, tolerance, and persistence across four modalities (cold, heat, pressure, shock) and assessed associations with self-reported capability for suicide, non-suicidal self-injury (NSSI), and suicide attempts. METHODS: A sample of 211 students who reported lifetime suicidal ideation completed four behavioral pain tasks and self-reported on capability for suicide, NSSI, and self-injurious behaviors. RESULTS: All pain thresholds, tolerances, and persistences were positively correlated across the four tasks. Pain facets were related to self-reported capability for suicide with small effect sizes but generally did not differ across suicide attempt or NSSI histories. CONCLUSIONS: Pain thresholds, tolerances, and persistences demonstrated convergent validity across the four modalities, suggesting that these tasks provide similar information. Although the relation between pain and self-injurious behaviors remains unclear, these tasks can generally be used interchangeably.

Suicidal thoughts, behaviors, and event-related potentials: A systematic review and meta-analysis.

Suicidal thoughts and behaviors (STBs) are thought to result from, at least in part, abnormalities in various neural systems. Event-related potentials (ERPs) are a useful method for studying neural activity and can be leveraged to study neural deficits related to STBs; however, it is unknown how effective ERPs are at differentiating various STB groups. The present meta-analysis examined how well ERPs can differentiate (a) those with and without suicidal ideation, (b) those with and without suicide attempts, (c) those with different levels of suicide risk, and (d) differences between those with suicide attempts versus those with suicidal ideation only. This meta-analysis included 208 effect sizes from 2,517 participants from 27 studies. We used a random-effects meta-analysis using a restricted maximum likelihood estimator with robust variance estimation. We meta-analyzed ERP-STB combinations that had at least three effect sizes across two or more studies. A qualitative review found that for each ERP and STB combination, the literature is highly mixed. Our meta-analyses largely did not find significant relationships between STBs and ERPs. We also found that the literature is likely severely underpowered, with most studies only being sufficiently powered to detect unrealistically large effect sizes. Our results provided little-to-no support for a reliable relationship between the ERPs assessed and STBs. However, the current literature is severely underpowered, and there are many methodological weaknesses that must be resolved before making this determination. We recommend large-scale collaboration and improvements in measurement practices to combat the issues in this literature.

Underreporting on the MMPI-2-RF extends to extra-test measures of suicide risk.

Detection of underreporting in suicide risk assessment remains a significant concern in clinical practice. The aim of this research is to examine whether underreporting based on elevated Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) K-r and L-r scale scores may aid in identifying patients with suppressed scores on the Suicide/Death Ideation scale (SUI) and extra-test measures of suicide risk. We anticipated that, in voluntarily admitted psychiatric inpatients (N = 1,011) and individuals receiving outpatient services in a university-affiliated psychology clinic (N = 521), those indicated as underreporting would produce lower mean scores across SUI and extra-test measures of suicide risk, and that the magnitudes of the associations between SUI and extra-test scores would be strongest for those underreporting. A series of t tests and correlational analyses were conducted in both samples. Although those classified as underreporting consistently produced lower mean scores for SUI and extra-test measures of suicide risk, the magnitudes of the associations were consistently significant and stronger only in outpatients without K-r or L-r scale elevations. Clinical implications for this research include examining K-r elevations when assessing suicide risk and incorporating a therapeutic assessment approach to suicide risk assessment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The relationship between suicide-specific rumination and suicidal intent above and beyond suicidal ideation and other suicide risk factors: A multilevel modeling approach.

Suicide-specific rumination, characterized by perseveration on and difficulties disengaging from suicidal thoughts and ideas, has been linked to increased suicide risk; however, previous studies were limited by the use of a cross-sectional design and relatively lower risk samples. This study aimed to replicate and extend previous findings by examining the short-term longitudinal association between suicide-specific rumination and suicidal intent, controlling for numerous robust covariates, in a sample of community-based adults at high risk for suicide, who were recruited from suicide-related forums online. Ninety-one adults with significant suicidal ideation (Mage = 27.03, SD = 8.64; 53.8% female, 44.0% male, 1.1% non-binary, 1.1% transgender female) completed brief online self-report measures at six time-points, each three days apart. Multilevel modeling analyses indicated that suicide-specific rumination was associated with suicidal intent, above and beyond suicidal ideation, perceived burdensomeness, thwarted belongingness, agitation, insomnia, nightmares, and sociodemographic characteristics. Further, a lagged model demonstrated that suicide-specific rumination predicted subsequent time-point suicidal intent, controlling for current suicidal intent and all other covariates. Overall, these findings suggest that perseverating on one's suicidal thoughts may serve as a proximal factor that increases suicide risk. Future investigations should explore potential mechanisms of this association, as well as interventions that may reduce suicide-specific rumination.

Autism-related traits and suicide risk among active duty U.S. military service members.

Suicide rates within the U.S. military are elevated. The interpersonal theory of suicide, supported within military samples, suggests that social disconnectedness confers risk for suicide. Autism spectrum disorder (ASD) is characterized by symptoms-difficulties in social communication/interaction (SCI) and restricted and repetitive behaviors (RRBs)-that contribute to social disconnectedness. To our knowledge, no study has examined ASD-related traits and suicide risk among active duty U.S. military service members. Participants included 292 active duty U.S. military service members (M [SD] age = 28.67 [7.40] years, 68.5% male, 78.1% White). The Autism Spectrum Quotient, Repetitive Behaviours Questionnaire-2 for Adults, Self-Injurious Thoughts and Behaviors Interview-Short Form, and Interpersonal Needs Questionnaire assessed for SCI difficulties, RRBs, suicidal symptoms, and interpersonal theory of suicide constructs (i.e., perceived burdensomeness, thwarted belongingness), respectively. Elevated levels of SCI difficulties and RRBs were associated with increased odds of reporting suicidal thoughts and behaviors occurring since joining the military, controlling for the number of years of service and suicidal symptoms occurring prior to joining the military. Perceived burdensomeness and thwarted belongingness statistically accounted for the relationship between ASD-related traits and suicidal ideation occurring since joining the military; a rival mediator, emotion dysregulation, was not a significant mediator. Among active duty U.S. military service members, greater ASD-related traits were associated with an increased likelihood of reporting suicidal thoughts and behaviors occurring since joining the military. Clinical efforts targeting perceived burdensomeness and thwarted belongingness might reduce suicide risk among military service members with elevated ASD-related traits. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Routinized categorization of suicide risk into actionable strata: Establishing the validity of an existing suicide risk assessment framework in an outpatient sample.

OBJECTIVE: The Suicide Risk Assessment and Management Decision Tree (DT) is a clinician-administered assessment that leads to risk categorizations that correspond with actionable strata. This study investigated the construct validity and test-retest reliability of the DT risk categories across two time points. METHOD: Outpatients (N = 731) completed a battery of self-report measures. Spearman's correlations were used to examine the relationships between DT suicide risk level and suicidal symptoms, theory-based risk factors, psychiatric correlates, and DT suicide risk level at Timepoint 2. Correlations were analyzed for significant differences to examine the divergent validity of the DT. RESULTS: Results, overall, were in line with hypotheses, with the exception of depression and thwarted belongingness. CONCLUSIONS: Findings provide evidence for the reliability, convergent validity, and discriminant validity of the DT. This clinician-administered suicide risk assessment may be useful for standardization of the assessment and management of suicide risk in outpatient clinical settings.

Examining the interaction of autism spectrum disorder-related traits and unit cohesion on suicide risk among military personnel.

BACKGROUND: Suicide rates are elevated among United States (U.S.) military service members. Research has found that service members with autism spectrum disorder-related (ASD-related) traits are at increased risk for suicide. Complementary lines of inquiry have suggested that unit cohesion is a protective factor against developing suicidal ideation in military service members. However, given the social difficulties inherent in ASD, it is unclear whether unit cohesion might protect against suicide risk in this population. METHOD: Our sample consisted of 285 active duty U.S. military service members recruited online. We examined the interaction between ASD-related traits (as measured by the Autism Spectrum Quotient [AQ]), unit cohesion, and suicide risk (as measured by the Suicidal Behaviors Questionnaire-Revised [SBQ-R]). We also conducted exploratory analyses to examine whether unit cohesion attenuates the association between ASD-related traits and suicidal intent. RESULTS: Elevated ASD-related traits were independently associated with higher levels of global suicide risk; however, unit cohesion was not independently associated with suicide risk. Unit cohesion did not significantly interact with ASD-related traits to predict suicide risk. Finally, we found that elevated ASD-related traits and unit cohesion have an independent effect on current suicidal intent. DISCUSSION: Our findings suggest that unit cohesion might not buffer the effect of ASD-related traits on suicide risk. However, our results do show that greater unit cohesion may be independently associated with decreased suicidal intent. This study is limited by a cross-sectional design and use of self-report measures.

Military Suicide Research Consortium common data elements: Bifactor analysis and longitudinal predictive ability of suicidal ideation and suicide attempts within a clinical sample.

To enhance and standardize the assessment of suicidal self-directed violence (SDV) in military populations, the Military Suicide Research Consortium developed the Common Data Elements (CDEs). Previous research supported the CDEs as assessing a higher-order factor of suicidal SDV in military populations. The present study had two aims: 1) confirm the bifactor structure of the CDEs in a high-risk sample, and 2) assess the ability of the factorially derived suicidal SDV factor to predict suicide attempts and return to care for suicidal ideation over 3-month follow-up. Utilizing a sample of service members referred for a psychiatric evaluation (N = 1,044), the CDE structure was assessed with confirmatory bifactor modeling. Logistic regressions and receiver operating characteristic (ROC) analyses were used to assess the suicidal SDV risk factor's prediction of suicide attempts and return to care for suicidal ideation during follow-up (n = 758). Bifactor modeling suggested adequate fit for the overarching suicidal SDV risk factor. Logistic regressions supported the overarching suicidal SDV risk factor as a predictor of suicide attempts (OR = 4.07, p < .001) and return to care for suicidal ideation (OR = 2.81, p < .001) over follow-up. However, ROC analyses suggested that the model including the suicidal SDV risk factor was only significantly better at classifying suicide attempts over follow-up (not return to care for suicidal ideation) than the model that did not include it (AUC difference = 0.15, p < .001). Findings suggest that the shared variance assessed across CDEs better predicts future suicide attempts beyond any individual suicide-related constructs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Urinalysis-Assessed and Self-Reported Substance Use as Correlates of Multiple Indicators of Suicide Risk Among Acute Care Psychiatric Inpatients.

Nonalcohol substance use is a robust correlate of suicide risk. However, few data exist regarding the degree to which nonalcohol substance use, as measured by objective indicators (e.g., urinalysis toxicology screen), is related to suicide risk. This study examined the associations of a multimodal assessment of nonalcohol substance use and multiple indicators of suicide risk. Overall, 168 acute care psychiatric inpatients participated and provided data spanning urinalysis toxicology screen and self-report instruments. Substance use per urinalysis toxicology screen and self-report was not related to current suicidal ideation severity. However, substance use per urinalysis toxicology screen was significantly associated with a suicide attempt history and suicidality as a primary reason for admission. Substance use is an important variable to consider in suicide risk conceptualization. Findings underscore the importance of leveraging, when possible, objective indicators of substance use (e.g., urinalysis toxicology screen) in suicide risk formulations.

A pilot randomized clinical trial of a lethal means safety intervention for young adults with firearm familiarity at risk for suicide.

OBJECTIVE: Firearms are the most common method of suicide in the United States. The provision of firearm-specific lethal means safety interventions is a best practice for the prevention and management of suicide risk. However, few data exist to inform firearm-specific lethal means safety interventions. This study tested four different lethal means safety interventions that varied on two dimensions salient to health behavior change (i.e., fear appeals and emphasis on temporariness). METHOD: Overall, 96 college-enrolled young adults with a history of suicidal ideation and current firearm familiarity (i.e., firearm ownership, access, and/or a desire/intention to obtain a firearm) were randomized to one of four different firearm-specific lethal means safety interventions occurring in the context of the Safety Planning Intervention. Assessments occurred at preintervention, postintervention, and 1-month follow-up. RESULTS: Participants who received the firearm-specific lethal means safety intervention that deemphasized fear and emphasized temporariness reported significantly greater intentions to adhere to clinician recommendations to limit their access to firearms for safety purposes compared to individuals randomized to the other groups (Intervention × Time), F(6, 184) = 2.300, p = .036, corresponding to a medium effect size (ηp² = .070). Across groups, 35.4% of participants reported an increase in engagement in firearm safety thoughts/behaviors from preintervention to 1-month follow-up; there were no significant group differences. All four intervention approaches were rated as similarly highly acceptable. CONCLUSIONS: Findings underscore the potential importance of deemphasizing fear and emphasizing temporariness in firearm-specific lethal means safety interventions. Future studies leveraging these pilot data are needed to replicate and extend findings. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Body Trust and Agitation: Pathways to Suicidal Thoughts and Behaviors.

Research has linked agitation and low body trust to suicidal thoughts and behaviors. We investigated a pathway with agitation accounting for the relationship between body trust and suicidality. 511 individuals recruited via MTurk (Study 1) and 167 undergraduate students (62.9% with suicide attempt history) (Study 2) completed measures of study variables. For ideation, the proposed pathway was significant across samples, as was a pathway with agitation predicting and body trust mediating. In Study 1, agitation explained the relationship between body trust and attempt history. In Study 2, neither independent variable was related to attempt history. Results suggest body trust is independently associated with suicidal ideation. Results were discrepant regarding suicide attempt history, necessitating future studies.

Comparing Suicide Risk Factors Among Individuals with a History of Aborted, Interrupted, and Actual Suicide Attempts.

Recent standardized nomenclature has suggested distinctions among aborted, interrupted, and actual suicide attempts. This study examined differences in self-reported symptoms among individuals with a history of aborted, interrupted, and actual suicide attempts. 167 young adults with a history of suicidality completed self-report measures of suicide attempt history and current symptoms, a clinical interview assessing past suicidal behavior, and a pain tolerance task. Only 78.8% of participants who initially reported a suicide attempt history were classified as suicide attempters following the clinical interview. Individuals who reported only aborted attempts during the clinical interview reported less severe clinical symptoms than those reporting a history of at least one actual attempt. Individuals with a history of actual suicide attempts may represent a more clinically severe group than those with a history of aborted attempts only.

Suicidal behaviors among American Indian/Alaska Native firefighters: Evidence for the role of painful and provocative events.

Firefighters represent a group at elevated suicide risk. Identifying segments of the fire service at increased risk may facilitate the targeted provision of suicide prevention initiatives. Among the general population, American Indian/Alaska Native (AI/AN) individuals report higher rates of suicide attempts. This study sought to examine suicide attempt rates among AI/AN firefighters and to determine if greater exposure to painful and provocative events and/or fearlessness about death explains the relationship between AI/AN identity and suicidal behaviors. A total of 917 US firefighters completed a web-based mental health survey (6.2% AI/AN). Participants completed a modified version of the Self-Injurious Thoughts and Behaviors Interview-Short Form, the Painful and Provocative Events Scale, and the Acquired Capability for Suicide Scale-Fearlessness About Death scale. Bootstrap mediation analyses were conducted, controlling for years of service as a firefighter. Although AI/AN firefighters accounted for only 6.2% of the sample, they accounted for 34.4% of the career suicide attempts. AI/AN firefighters were 16.31 (95% CI = 7.96, 33.42) times more likely to report a career suicide attempt history than non-AI/AN firefighters, adjusting for years of service as a firefighter. Painful and provocative events, but not fearlessness about death, was a statistically significant mediator of the relationship between AI/AN identity and suicide attempts. Firefighters identifying as AI/AN represent a subgroup within the fire service at increased risk for suicide. Findings suggest that greater exposure to painful and provocative events among AI/AN firefighters may explain the elevated suicide risk among this population.

Impaired Conflict Detection Differentiates Suicide Attempters From Ideating Nonattempters: Evidence From Event-Related Potentials.

BACKGROUND: Existing research suggests that inhibitory control deficits may differentiate individuals who think about suicide from those who make a suicide attempt. However, no available research, to our knowledge, has examined whether suicidal behaviors are associated with disruptions in the ability to determine when inhibitory control is needed or the ability to engage inhibition of an inappropriate or maladaptive behavior. The current study utilized event-related potentials to investigate specific facets of inhibitory control and their associations with suicide attempt history among a heterogeneous clinical sample who reported current suicidal ideation. METHODS: Ideators with no past suicide attempts (n = 46) and those with a history of suicide attempts (n = 22) completed a complex go/no-go task. Raw waveforms and temporospatial principal components analysis were used to index conflict detection (i.e., ΔN2) and motor inhibition (i.e., ΔP3a). Behavioral performance indices were also examined. RESULTS: Suicide attempters exhibited deficits in detecting the need for inhibitory control, as indexed by a more positive ΔN2 factor, than did ideating nonattempters, even when accounting for psychiatric comorbidity and age. However, these results only emerged in the principal components analysis-derived latent factor. No differences in behavioral performance or ΔP3a amplitude emerged. CONCLUSIONS: A relative inability to detect when to inhibit a maladaptive behavior, but not the ability to engage motor inhibition to stop that behavior, may distinguish suicide ideators who make a suicide attempt from those who do not. However, future research with prospective designs are needed to determine how conflict detection deficits may contribute to the emergence or escalation of a suicidal crisis.

Perceptions of belongingness and social support attenuate PTSD symptom severity among firefighters: A multistudy investigation.

Firefighters experience high rates of posttraumatic stress disorder (PTSD). It is imperative to identify malleable factors that protect against the development of PTSD symptoms among this population. We examined whether perceptions of belongingness broadly (Study 1) and social support from supervisors, coworkers, and family/friends specifically (Study 2) are associated with lower PTSD symptom severity among firefighters. Study 1 included 840 U.S. firefighters (91.1% male); participants completed the Interpersonal Needs Questionnaire and PTSD Checklist-Civilian Version. Study 2 included 200 U.S. women firefighters exposed to a Criterion A traumatic event; participants completed the Generic Job Stress Questionnaire, Life Events Checklist for Diagnostic and Statistical Manual of Mental Disorders-5, and PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-5. Linear regression analyses were conducted, adjusting for the number of years participants served as firefighters. Greater belongingness broadly (Study 1; b = -0.740, p < .001) as well as social support specifically (Study 2) from supervisors (b = -4.615, p < .001), coworkers (b = -4.465, p = .001), and family/friends (b = -3.206, p = .021) were associated with less severe PTSD symptoms. When all sources of social support were entered into a single model, only support from supervisors was significantly associated with lower overall PTSD symptom severity (b = -4.222, p = .004). Belongingness and social support may protect against the development of PTSD among firefighters. Supervisor social support may be particularly salubrious, suggesting that top-down mental wellness promotion within the fire service may be indicated to protect firefighters against PTSD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Insomnia predicts increased perceived burdensomeness and decreased desire for emotional support following an in-laboratory social exclusion paradigm.

BACKGROUND: Research suggests that insomnia is associated with elevated perceptions of loneliness and social disconnection; however, few quasi-experimental studies have tested the relationship between these constructs. This study examined whether insomnia symptom severity predicts changes in perceptions of interpersonal connectedness and desire for emotional support following in-laboratory participation in a social exclusion paradigm. METHODS: Young adults (N = 70) completed self-report measures assessing constructs of interest before and after engaging in a social exclusion paradigm (Cyberball). Linear regression analyses were used to evaluate whether baseline insomnia symptom severity predicted perceived burdensomeness, desire for emotional support, and thwarted belongingness after playing Cyberball; analyses controlled for baseline perceived burdensomeness, desire for emotional support, and thwarted belongingness, respectively, as well as baseline social anxiety and depression symptoms. RESULTS: Greater insomnia symptom severity significantly predicted greater feelings of perceived burdensomeness following Cyberball participation, beyond baseline perceived burdensomeness, social anxiety symptoms, and depression symptoms (ß= .24, p = .001). More severe insomnia symptoms also significantly predicted lower desire for emotional support after playing Cyberball, beyond baseline desire for emotional support and social anxiety symptoms (ß= -.14, p = .03) but not beyond baseline depression symptoms (ß= -.16, p = .07). Insomnia symptoms were not significantly associated with thwarted belongingness after Cyberball (ß= -.05-.08, p = .27-.57). LIMITATIONS: Replication in larger samples and using other sleep disturbance indices is needed. CONCLUSIONS: Findings suggest that individuals with more severe insomnia symptoms in the past two weeks experience greater perceptions of being a burden on others and less desire for emotional support in response to social exclusion.

Problematic alcohol use and suicidal ideation among firefighters: A multi-study investigation of the explanatory roles of perceived burdensomeness and thwarted belongingness.

BACKGROUND: Firefighters are at increased risk for both problematic alcohol use and suicidality. Research has found that problematic alcohol use is related to suicidality among this population; however, limited data exist regarding what might account for this association. The present two-study investigation (1) examined the association between suicidality and problematic alcohol use among two large samples of firefighters and (2) tested whether interpersonal theory of suicide constructs-perceived burdensomeness (PB) and thwarted belongingness (TB)-serve as indirect indicators of this relationship. METHODS: Participants in Study 1 were 944 U.S. firefighters (12.5% female); participants in Study 2 were 241 U.S. women firefighters. Participants completed the Interpersonal Needs Questionnaire, Alcohol Use Disorders Identification Test, and the Depressive Symptom Inventory-Suicidality Subscale (Study 1) or the Self-Injurious Thoughts and Behaviors Interview-Short Form (Study 2). Bias-corrected bootstrap indirect effects path analyses were utilized. RESULTS: In Study 1, more problematic alcohol use was significantly associated with more severe career suicidal ideation via PB but not TB. In Study 2, problematic alcohol use was associated with career suicidal ideation via both PB and TB. PB seems to account for the relationship between problematic alcohol use and career suicidal ideation among male and female firefighters. LIMITATIONS: Limitations include use of a cross-sectional design, use of retrospective measures of suicidal ideation, and our findings derived from subsamples of two existing datasets. CONCLUSIONS: Findings suggest that PB and TB may explain the relationship between problematic alcohol use and suicidal ideation, but that this effect is discrepant based on gender.

Investigating the iatrogenic effects of repeated suicidal ideation screening on suicidal and depression symptoms: A staggered sequential study.

BACKGROUND: Research suggests that screening for suicidality does not have iatrogenic effects; however, less is known regarding the impact of repeatedly screening for suicidal ideation among individuals with varying levels of exposure to these screenings. This staggered sequential study evaluated whether suicidal ideation severity increases with repeated screening for suicidal ideation and depression symptoms. METHODS: Undergraduates (N = 207) were recruited at one of four time points (baseline [n = 37], 1 month later [n = 61], 4 months later [n = 55], and 12 months later [n = 54]) to complete the self-report Beck Depression Inventory (BDI). Participants completed the BDI at the time point at which they were recruited and all subsequent study time points. Non-parametric tests were employed to compare suicidal ideation severity (BDI Item 9) and depression symptom severity (BDI total score): (1) within each group across time points and (2) within each time point across groups. RESULTS: Suicidal ideation severity did not significantly differ within any group across time points, and for two groups, depression symptom severity decreased over time. For analyses between groups, suicidal ideation and depression symptom scores were, at times, significantly lower during subsequent BDI completion time points. LIMITATIONS: This study utilized a relatively small sample size and participants of low clinical severity. CONCLUSIONS: Findings align with prior research indicating that suicidality screening is not iatrogenic. This study also expanded upon previous studies by leveraging a staggered sequential design to compare suicidal ideation and depression symptom severity among individuals with varying exposure to suicidal ideation screenings.