Verbal Response Latency as a Behavioral Indicator of Diminished Wish to Live in a Clinical Sample of Active Duty Army Personnel with Recent Suicidal Ideation.

OBJECTIVE: Research on risk factors of suicide attempt has yielded little improvement in imminent risk detection for clinicians, due in part to the inherent limitations of self-report methodologies. Therefore, objective behavioral indicators of suicide risk that can be implemented practically with little cost in clinical settings are needed. METHOD: The current study examined verbal response latency, measured as the length of time to answer a question asking about reasons for living (i.e., What are your reasons for living or not killing yourself?), as a potential indicator of suicide risk among 97 active duty Army personnel presenting to an emergency department or behavioral health clinic for current suicide ideation and/or a recent suicide attempt. RESULTS: Verbal response latency was significantly correlated with diminished wish to live at the participant level but was not significantly correlated with wish to die or overall severity of suicidal ideation. CONCLUSION: Verbal response latency may serve as an objective indicator of suicide risk. HighlightsResponse latency to a life construct may be an objective indicator of suicide riskDelayed response latency is indicative of diminished wish to livePathological mechanisms may manifest within dyadic interactions via verbal behaviors.

Internal entrapment and fearlessness about death as precipitants of suicidal thoughts and planning in the context of post-traumatic stress disorder.

BACKGROUND: The relationship between post-traumatic stress disorder (PTSD) and suicidal thoughts and behaviors (STB) has been extensively studied but explanatory mechanisms remain inconclusive. Entrapment is one variable that evinces a mechanistic relationship with PTSD and STB. The current study examined the indirect effect of PTSD screen on suicide ideation (SI), planning, and likelihood of future suicide attempt through internal (IE) and external entrapment (EE), moderated by levels of fearlessness about death (FAD). METHOD: The cross-sectional sample consisted of military service members and civilians recruited from primary care clinics across the United States (N = 2690). RESULTS: Moderated mediation models indicated an indirect relationship between a positive PTSD screen, past-month SI, and past-month suicide planning through IE but not EE at low, moderate, and high levels of FAD. These relationships were replicated for the association between positive PTSD screen and concurrent self-rated likelihood of a future suicide attempt through both IE and EE at moderate and high levels of FAD. CONCLUSIONS: Phenomenological implications are discussed, including IE as a mechanism of action in the PTSD/SI pathway and FAD as necessary to potentiate suicidal planning for those experiencing IE.

Psychometric evaluation of the Suicide Cognitions Scale-Revised (SCS-R).

The measurement of self-reported suicide risk can be complicated in medical settings due to patient apprehension about the potential consequences of self-disclosure. The Suicide Cognitions Scale (SCS) was designed to assess suicide risk by measuring a range of suicidogenic cognitions (e.g., hopelessness, perceived burdensomeness) collectively referred to as the suicidal belief system. The SCS's concurrent, known groups, and prospective validity for suicidal thoughts and behaviors have previously been supported. The present study examined the factor structure, known-groups, and concurrent validity of a revised, 16-item version of the SCS (SCS-R), which removed two items that explicitly used the word "suicide" and changed item scoring from a 1-5 to 0-4 scale, thereby improving the interpretation of scores. In a sample of 2,690 primary care patients presenting for routine medical care at one of six US military clinics, results of bifactor analysis supported the scale's unidimensionality. The SCS-R significantly differentiated participants with a history of suicide attempts and was significantly correlated with frequency of thoughts about death and self-harm during the previous 2 weeks. Results align with earlier research and provide psychometric support for the SCS-R.

Improving Suicide Risk Screening to Identify the Highest Risk Patients: Results From the PRImary Care Screening Methods (PRISM) Study.

PURPOSE: Over 95% of patients who screen positive on the Patient Health Questionnaire-9 (PHQ-9) suicide risk item do not attempt or die by suicide, which could lead to unnecessary treatment and/or misallocation of limited resources. The present study seeks to determine if suicide risk screening can be meaningfully improved to identify the highest-risk patients. METHODS: Patients eligible to receive medical treatment from the US Department of Defense medical system were recruited from 6 military primary care clinics located at 5 military installations around the United States. Patients completed self-report measures including the PHQ-9 and 16 items from the Suicide Cognitions Scale (SCS) during routine primary care clinic visits. Postbaseline suicidal behaviors (suicide attempts, interrupted attempts, and aborted attempts) were assessed by evaluators who were blind to screening results using the Self-Injurious Thoughts and Behaviors Interview. RESULTS: Among 2,744 patients, 13 (0.5%) engaged in suicidal behavior in the 30 days after screening and 28 (1.0%) displayed suicidal behavior in the 90 days after screening. Multiple SCS items differentiated patients with suicidal behavior less than 30 days after screening positive for suicide risk. Augmenting the PHQ-9 suicide risk item with SCS items improved the identification of patients who were most likely to have suicidal behavior within a month of screening positive without sacrificing sensitivity. CONCLUSION: Among primary care patients who screen positive for suicide risk on the PHQ-9, SCS items improved screening efficiency by identifying those patients who are most likely to engage in suicidal behavior within the next 30 days.

Depression, suicide risk, and declining to answer firearm-related survey items among military personnel and veterans.

OBJECTIVES: To describe the characteristics of military personnel and veterans who decline to answer survey items asking about firearm availability at home, and to determine how these characteristics compare to those of military personnel and veterans who answered these items. METHODS: Self-report surveys were administered to 2025 military personnel and veterans visiting a primary care clinic located at five military installations across the United States for a routine visit. Multinomial logistic regression was used to identify factors that distinguished participants with firearms at home, participants without firearms at home, and participants who declined answering. RESULTS: In univariate analyses, participants who selected "refuse to answer" in response to an item asking about firearm access at home did not differ demographically from participants who selected "yes," but were significantly more likely to screen positive for depression and recent thoughts of death or self-harm. These differences were not statistically significant in multivariate analyses, however. Participants who selected "refuse to answer" or "yes" were significantly more likely than participants who selected "no" to be male, white, and previously deployed. CONCLUSIONS: Military personnel and veterans who decline answering firearm-related survey items are indistinguishable from those who report having a firearm at home. Declining to answer firearm-related items is more common among those who screen positive for depression or recent thoughts of death or self-harm, but this association is statistically accounted for by demographic factors (i.e., male gender, white race).

Inconsistencies in self-reports of suicidal ideation and attempts across assessment methods.

Suicide researchers commonly use a variety of assessment methods (e.g., surveys and interviews) to enroll participants into studies and assign them to study conditions. However, prior studies suggest that different assessment methods and items may yield different responses from participants. This study examines potential inconsistencies in participants' reports of suicidal ideation (SI) and suicide attempt (SA) across commonly used assessment methods: phone screen interview, in-person interview, self-report survey, and confidential exit survey. To test the reliability of the effects, we replicated the study across two samples. In both samples, we observed a notable degree of inconsistent reporting. Importantly, the highest endorsement rates for SI/SA were on a confidential exit survey. Follow-up assessments and analyses did not provide strong support for the roles of purposeful inaccuracy, random responding, or differences in participant experiences/conceptualizations of SI. Although the reasons for such inconsistencies remain inconclusive, results suggest that classification of suicidal/control participants that uses multiple items to capture a single construct, that uses a Graded Scale to capture a broad spectrum of thoughts and behaviors, and that takes into account consistency of responding across such items may provide clearer and more homogenous groups and is recommended for future study. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Treating Veterans at Risk for Suicide: An Examination of the Safety, Tolerability, and Outcomes of Cognitive Processing Therapy.

Individuals with posttraumatic stress disorder (PTSD) are at increased risk for suicidal thoughts and behaviors; however, clinicians often report apprehension about recommending trauma-focused therapy to patients with an increased risk of suicide. The present study aimed to evaluate the safety, tolerability, and response to cognitive processing therapy (CPT) among a sample of military veterans with PTSD and increased suicide risk. A secondary aim was to provide a clinically useful definition of high suicide risk. Chart review was used to classify the suicide risk level of 290 veterans who participated in CPT at a Veterans Affairs clinic. Treatment outcomes in veterans with different suicide risk levels were also gathered and compared. Over 50% (n = 155) of the sample demonstrated increased suicide risk, and 1.0% (n = 3) engaged in suicidal behavior after initiating treatment. To date, hospital records show no suicide deaths since 2016 among clinic patients who received CPT. Suicide risk level was not associated with CPT tolerability, and PTSD symptom change was equivalent across groups, ps = .085-.976. Veterans across groups reported clinically significant reductions in PTSD symptoms. The tested suicide risk categorization schemes performed similarly in differentiating the odds of CPT completion and PTSD symptom reduction. These results suggest that veterans with PTSD and an increased risk of suicide, including those with previous suicide attempts and current ideation, can tolerate and benefit from CPT. Additional variables must be considered to truly determine the acute and imminent suicide risk that would deem CPT to be contraindicated.

Self-Injurious Thoughts and Behaviors Interview-Revised: Development, reliability, and validity.

The Self-Injurious Thoughts and Behaviors Interview (SITBI) is a widely used measure of the presence, frequency, and characteristics of suicide and self-harming thoughts and behaviors. In response to advances in the conceptualization of these outcomes, and the potential for online data collection, we created a revised version of the SITBI (SITBI-R) and tested its psychometric properties via in-person interview and online self-report formats. Across two studies, the SITBI-R demonstrated strong psychometric properties for both assessment formats. In Study 1, outcomes measured via the SITBI-R showed convergent validity with those assessed with the Columbia Suicide Severity Rating Scale, another interview assessing suicidal thoughts and behaviors. The SITBI-R also showed strong alternate-forms reliability across nearly all outcomes assessed via both assessment formats. In Study 2, the SITBI-R showed strong test-retest reliability via the online assessment format. Across both studies, reliability was strongest for more recent outcomes (e.g., past year vs. lifetime) and for more commonly assessed outcomes of suicidal thoughts, plans, and attempts than for other, less commonly assessed behaviors (e.g., suicide gestures, interrupted suicide attempts, and aborted suicide attempts). The results of these two studies suggest that the SITBI-R provides reliable and valid measurement of key self-injurious outcomes both in person and online. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The PRImary care Screening Methods (PRISM) study: Rationale and design considerations.

BACKGROUND: Primary care is the most frequently visited clinic type immediately prior to suicidal behavior, with nearly half of suicide decedents visiting a primary care provider within a month of their death. Data supporting the efficacy of suicide risk screening in this setting is lacking, however. Improved suicide risk screening in primary care could lead to earlier intervention and treatment. PURPOSE: The PRImary care Screening Methods (PRISM) study is designed to develop and evaluate the efficacy of an alert algorithm that can be used by military primary care providers to accurately identify high-risk patients, to improve the identification of high-risk patients who deny suicidal thoughts, and to quantify patient subgroups who are more likely to be missed by existing screening methods (i.e., false negatives). METHODS: The rationale of the PRISM study is discussed, along with ethical and design considerations related to the conduct of suicide prevention research. The PRISM study enrolled 2690 patients from six primary care clinics across the U.S. Patients were enrolled during routine visits to a primary care clinic, and completed a battery of self-report scales in clinic waiting rooms. Follow-up phone interviews are conducted 1, 6, and 12 months after enrollment. The primary outcome is suicide attempt. CONCLUSIONS: PRISM is the first study to prospectively examine multiple suicide risk screening methods in "real-world" military primary care clinics. Ethical and design issues were considered to ensure that human participants, especially suicidal patients, were adequately protected while minimizing the potential confounding effect of risk management protocols.

Positive and detached reappraisal in older adulthood: A temporal examination of gaze patterns.

Objectives: Cognitive reappraisal is an emotion regulation strategy that involves the adaptive restructuring of one's thoughts surrounding an emotionally evocative stimulus. Previous studies have produced mixed results on how distinct reappraisal and attentional processes are, but few studies have teased apart specific reappraisal methods. This is of particular interest in aging as older adults' regulation success may vary by reappraisal type. The current study examined whether detached and positive reappraisal are associated with distinct temporal patterns of attention in a sample of older adults. Method: 29 older adult participants viewed negative IAPS images and were instructed to implement both positive and detached reappraisal while eye movements were monitored. Participants also reported on their mood before and after viewing the images. Results: Participants fixated on negative areas early on and looked at them less over time, however their attention was oriented specifically towards the most negative region during reappraisal. They also re-fixated on the negative areas of the images during the last second of viewing during detached reappraisal, and reported feeling best while using this strategy. Conclusion: These findings provide information about the temporal nature of visual attention while utilizing distinct cognitive reappraisal strategies. Results highlight the importance of further teasing apart differences between detached and positive reappraisal as regulatory success and attentional shifts differ between these reappraisal types in older adulthood.

Military sexual trauma and suicidal behavior among National Guard personnel.

BACKGROUND: Preliminary evidence suggests military sexual trauma (MST) may be associated with increased risk for suicidal behaviors among active duty military personnel and veterans. Among National Guard personnel, a high-risk subgroup, MST and suicide risk have not received much empirical attention. PURPOSE: To examine the association of MST with suicide ideation and suicide attempts among National Guard personnel. PROCEDURES: N = 997 National Guard personnel from Idaho and Utah participated in an anonymous online survey. Weighted analyses were conducted to minimize sampling bias. MAIN FINDINGS: 9% of participants had a history of MST (6% of men, 28% of women). Among participants reporting MST, 68% reported a service member perpetrator and 44% reported a civilian perpetrator (12% reported both). A history of MST was associated with significantly increased risk for lifetime suicide attempt. MST remained a significant predictor of lifetime suicide attempt even when restricting the sample to the subgroup with a history of suicidal thoughts (n = 257, 27% of full sample). When adjusting for premilitary sexual victimization, MST was no longer significantly associated with lifetime suicide attempts, but premilitary sexual victimization was. CONCLUSIONS: The rate of MST among National Guard personnel is comparable to rates among active duty military personnel, although the perpetrators of MST are less likely to be service members. MST is a risk factor for suicide attempts, but premilitary sexual victimization is a relatively stronger risk factor.

Testing the Efficacy of Attention Bias Modification for Suicidal Thoughts: Findings From Two Experiments.

This study explores whether four sessions of attention bias modification (ABM) decreases suicide-specific attentional bias. We conducted two experiments where suicide ideators completed either a Training or Control version of ABM, a computer-based intervention intended to target attentional bias. Suicide-specific attentional bias was measured using adapted Stroop and probe discrimination tasks. The first experiment with community-based suicide ideators did not show that ABM impacts attentional bias or suicidal ideation. The second experiment with clinically severe suicidal inpatients yielded similar results. Post-hoc findings suggest that the type of attentional bias targeted by the current intervention may differ from the type that marks suicide risk. There remains little to no evidence that the ABM intervention changes suicide-specific attentional bias or suicidal ideation.

Venous Thromboembolism in Physically Active People: Considerations for Risk Assessment, Mainstream Awareness and Future Research.

The global healthcare burden of venous thromboembolism (VTE) and associated comorbidities (e.g., obesity, heart disease and cancer) is significant. Physical activity-especially cardiovascular exercise-is popularly acclaimed for gold-standard prevention. Paradoxically, intensive training can expose athletes to several potentially thrombogenic risk factors (e.g., heat stress, dehydration, blood vessel injury and inflammation). However, awareness regarding the risk of VTE in physically active people is generally lacking. Given that the overall incidence of asymptomatic and/or occult blood clots that resolve spontaneously is uncharted, and because symptoms and sequelae are not always 'textbook', triage evaluation and diagnosis of VTE at large can be challenging. Front-line clinical evaluations, including the major Wells scoring criteria, are (versus the total number of possible factors and diagnoses) comparably reductionist, and the point at which a minor risk might be considered significant in one person-but not in another-is subjective. Considering the popular associations between VTE and inactivity, athletes might be at greater risk of a missed diagnosis quite simply because their cardiovascular conditioning presents as the polar opposite to standard assessment criteria. Undoubtedly, risk factors for VTE associated with exercise are not unique to cardiovascular training or athletes, but the extent to which they might increase the chances of blood clot precipitation in certain participants warrants attention. A multi-agency approach, including research to inform mainstream understanding and awareness about risk factors for VTE in patient groups across age, comorbidity and activity spectra, is required. In this article, the potential for pre-participatory thrombophilia screening, haemostatic monitoring and personalized prophylactic guidelines is discussed.

Mobile eye tracking reveals little evidence for age differences in attentional selection for mood regulation.

Two studies are reported representing the first use of mobile eye tracking to study emotion regulation across adulthood. Past research on age differences in attentional deployment using stationary eye tracking has revealed older adults show relatively more positive looking and seem to benefit more moodwise from this looking pattern, compared with younger adults. However, these past studies have greatly constrained the stimuli participants can look at, despite real-world settings providing numerous possibilities for what we choose to look at. The authors therefore used mobile eye tracking to study age differences in attentional selection, as indicated by fixation patterns to stimuli of different valence freely chosen by the participant. In contrast to stationary eye-tracking studies of attentional deployment, Study 1 showed that younger and older individuals generally selected similar proportions of valenced stimuli, and attentional selection had similar effects on mood across age groups. Study 2 replicated this pattern with an adult life span sample including middle-aged individuals. Emotion regulation-relevant attention may thus differ depending on whether stimuli are freely chosen or not. (PsycINFO Database Record

Middle-aged adults facing skin cancer information: fixation, mood, and behavior.

Older adults fixate less on negative parts of skin cancer videos than younger adults, leading them to feel better (Isaacowitz & Choi, 2012). We extended this paradigm to middle-aged adults (ages 35-59, n = 63), whose fixation patterns were measured as they viewed skin cancer videos; mood and behavior were also assessed. Middle-aged adults looked even less at the videos than the other age groups, especially at the negative clips. They also reported the best moods but relatively low levels of learning and positive skin cancer behavior. In some cases, middle-aged adults may show larger "age-related positivity effects" than older adults.