Suicide While Locked Up in Texas: Risk Factors for Death by Suicide in Custody.

In the United States, suicide is a leading cause of death in prisons and jails, with incarcerated individuals being nine times more likely to die by suicide than the general population. Identifying vulnerabilities at each stage of custody (prebooking, jail, prison) and factors that increase suicide risk can improve prevention efforts. A hierarchical binary logistic regression was conducted on data from the Texas Justice Initiative's Deaths in Custody Report. Variables included race/ethnicity, sex, age at death, days in custody, classification of crime as violent or nonviolent, and custody type of prebooking, jail, or prison. Among main effects, when compared to suicide rates in prison, jail suicide deaths were over three and a half times more likely (OR = 3.61), and the period of prebooking emerged as a period of staggering risk of suicide death, with suicides being over 5,000% more likely than at other stages of custody (OR = 50.86). When interactions were entered, Latinx individuals were at a particularly increased risk of suicide death (OR = 10.46), likelihood of suicide death decreased with each year of age (OR = .89), nonviolent offenders were just under three and a half times more likely to die by suicide when compared to violent offenders (OR = 3.45), and each stage of custody was shown to affect the relationship between age-related rates of suicide in different ways. Results call for further investigation into suicide among understudied populations in corrections, such as Latinx individuals, juveniles in the prison system, and nonviolent offenders, to identify the groups at the highest risk of premature death in correctional systems.

Perseveration on suicidal thoughts and images in daily life: An examination of the cognitive model of suicide through a dynamic systems lens.

According to the cognitive model of suicide, interactions between hopelessness and attentional biases toward suicidal information create a narrowed attentional focus on suicide as a viable solution, particularly in the presence of life stress, leading to increased suicide risk. This study used a dynamic systems approach to examine the short-term temporal patterns between stress, hopelessness, suicide-specific rumination, and suicidal intent. Adults (N = 237; M = 27.12 years; 62% cisgender women; 87% White/European American) with elevated suicidal ideation completed ecological momentary assessments six times a day for 14 days. A multilevel model approach informed by dynamic systems theory was used to simultaneously assess stable and dynamic temporal processes underlying perceived stress, hopelessness, suicide-specific rumination, and suicidal intent. Each variable demonstrated temporal stability. In support of the cognitive model of suicide, we observed (1) a reciprocal relationship between stress and hopelessness such that stress and hopelessness amplified each other (early-stage processes), and (2) reinforcing loops such that hopelessness, suicide-specific rumination, and suicidal intent amplified each other (later-stage processes). A dynamic systems modeling approach underscored the negative impact of a perpetuating cycle of suicide-specific rumination, deepening hopelessness, and escalating suicidal intent on increasing suicide risk, which may be targets for intervention.

The impact of different neurobehavioral symptoms on suicidal ideation and perceived likelihood of future suicidality.

Existing literature suggests that psychological and functional impairment, independent of head injury severity, can increase suicide risk. This study explores the impacts of self-perceived dysfunction within four neurobehavioral symptom clusters-vestibular (e.g., dizziness, balance), somatosensory (e.g., headaches, nausea, vision), affective (e.g., anxious, irritable mood), and cognitive (e.g., concentration, memory, indecision)-on current suicidal ideation and the perceived likelihood of future suicidal ideation and attempts. Community participants (n = 309; Mage = 36.88; 51.6% female; 79.6% White) completed the Neurobehavioral Symptom Inventory (NSI) and the Self-Injurious Thoughts and Behaviors-Short Form (SITBI-SF). Quantile regression analysis was used to explore the effects of the four neurobehavioral symptom clusters at different levels of suicidal ideation intensity, perceived likelihood of future suicidal ideation, and self-perceived likelihood of future suicide attempt. Controlling for past head injuries and suicide attempts, affective symptoms were significantly associated with a moderate and high average intensity of current suicidal ideation. Somatosensory symptoms were significantly associated with a moderate perceived likelihood of future suicidal ideation. Finally, vestibular symptoms were significantly associated with a moderate perceived likelihood of a future suicide attempt. These findings highlight the critical need to consider a broader spectrum of symptoms, including chronic physical symptoms, when assessing suicide risk. Furthermore, they underscore the need to expand beyond affective symptoms as an explanation for increased suicidality and examine additional mechanisms through which chronic physical symptoms can increase suicide risk.

Do Crisis Details Differentiate Suicide-Related 911 Call Outcomes?

Background The outcomes of calling 911 for suicide crises remain largely unexplored. Aims To investigate how characteristics of individuals in a suicidal crisis (e.g., age, gender identity, help-seeking source, means, disclosure of historical suicidality, or self-harm) may differentiate outcomes when contacting 911. Method The authors analyzed 1,073 Washington State Police 911 call logs, coding for characteristics and outcome (unknown, monitoring, intervention, adverse outcome). Descriptive and inferential statistics, including multinomial logistic regressions, were used to explore associations. Results When individuals experiencing a suicidal crisis were referred by bystander or associates' observations, there was a greater likelihood of adverse outcome. Self-referral led to a greater likelihood of intervention. Referral from the suicidal individual contacting a known associate led to a greater likelihood of monitoring. Any disclosure of means led to a greater likelihood of intervention or adverse outcomes. Positive disclosure of historical suicidality or self-harm was more likely to result in monitoring. Limitations The dataset was intended for operational use in acute suicidality triage rather than research purposes. Conclusion This study highlights the importance of supporting first responders with research to enhance their triage of people experiencing suicidal crises.

Nonsuicidal self-injury characteristics: A mixed methods analysis of differences between veterans and civilians.

Nonsuicidal self-injury (NSSI) is a well-established risk factor for suicidal behavior, with certain NSSI characteristics being associated with increased risk. In the United States (U.S.), the veteran suicide rate is elevated, though lifetime prevalence rates of NSSI appear similar between veterans and civilians. There is limited research that directly compares veterans and civilians across multiple NSSI characteristics to examine between-group differences in NSSI behavior and provide important context for the application of NSSI research with the veteran population. This study examined differences between U.S. veterans and civilians with a history of suicidal ideation across several NSSI characteristics, including method, severity, age of onset, shame, distress, and reason for initial NSSI engagement. A sample of 527 veterans and civilians completed measures of direct and indirect NSSI behaviors along with supplemental questions designed to further assess endorsed NSSI behaviors. Additionally, respondents provided written responses to an open-ended question about their reasons for initial engagement in NSSI, which were coded for post-hoc analysis. Chi-square difference tests and t-tests were conducted, revealing significant group differences between veterans and civilians in NSSI method, lifetime versatility, age of onset, age at last occurrence, and reasons for initial engagement. No significant differences were found in NSSI frequency, severity, shame, or distress. These findings provide valuable information on similarities and differences in NSSI behavior characteristics between U.S. veterans and civilians with lifetime suicidal ideation to inform future research and the assessment of NSSI in these populations.

Moderating roles of grit and locus of control on rumination and suicidality.

Cognitive factors constitute an important risk factor to the development of suicidal thoughts and behaviors (STBs). Engaging in depressive and anger rumination are uniquely associated with elevated vulnerabilities to STBs. Variations in attentional focus and control may further modify the impacts of rumination. For one, grit resembles the inflexible thinking patterns inherent in rumination, potentially contributing to one's capability of persisting in carrying out suicidal behaviors despite fears of pain or death. In the context of rumination, locus of control may alter the perspectives to which individuals attribute negative experiences. The current study examines the moderating roles of grit and locus of control on the impact of depressive and anger rumination on suicidality. Participants (N = 322) completed a battery of self-report questionnaires measuring depressive rumination, anger rumination, grit, locus of control, and suicidal history (a history of suicidal ideation, history of suicidal attempts, or neither). Using hierarchical multinomial logistic regression in R, results revealed that, as opposed to working together, the proposed variables are more independently informative in distinguishing those with a history of suicidal ideation, suicidal attempts, or neither. Findings provide unique contribution to the suicide literature pertaining to how individuals may perceive of their own internal locus of control and grit following suicidal thoughts and beliefs. Clinical implications and future directions are provided as recommendations in line with current findings.

Effects of sexual orientation and NSSI severity on suicide risk.

INTRODUCTION: People who identify as sexual minorities are at increased risk for suicide. Non-suicidal self-injury (NSSI) is also a risk factor for suicide and NSSI severity may contribute to development of capability for lethal self-injury. Further research is needed to understand how NSSI severity increases suicide risk, specifically in high-risk populations like sexual minorities. The current study seeks to examine whether sexual minority adults exhibit greater NSSI severity and suicide risk than heterosexuals, and if NSSI severity moderates the relationship between sexual orientation and suicide risk. METHODS: Undergraduate students (N = 1,994) who reported five or more acts of NSSI in their lifetime completed online self-report questionnaires including sexual orientation, NSSI severity, and suicide risk. RESULTS: A factorial ANOVA demonstrated main effects of sexual orientation and NSSI severity on suicide risk. DISCUSSION: The lack of significant interaction effect indicates NSSI severity does not amplify the effect of on sexual orientation on suicide risk; rather, it predicts the same level of increased risk across orientations. Therefore, suicidality related to both sexual orientation and NSSI severity are equally important treatment targets.

Association between race and socioeconomic factors and suicide-related 911 call rate.

The American 911 emergency call system fulfills a unique role in preventing suicide and is universally available to all residents suffering a mental health crisis. Previous studies have found disparities between socioeconomic and racial groups in mental health treatment and in help-seeking behaviors. However, very few studies have analyzed disparities in the use of the 911 system for mental health or suicidal crises. The present study conducted negative binomial regression analyses to determine if an increase in suicide-related 911 call rate is associated with race and socioeconomic characteristics in Western King County, Washington. We used the geographic locations of 4823 suicide-related calls from January 2019 to June 2020 to contrast against 2019 demographic data from the Census Bureau. We found increased percentage of Black, Indigenous and People of Color (BIPOC), residents relying on private health insurance, and lower education levels were associated with a decreased suicide-related 911 call rate. We found residents relying on public health insurance to be associated with an increased suicide-related 911 call rate. Future research should explore how residents use 911 in mental health crises to further improve public suicide prevention efforts. Our findings demonstrate how areas with poor health care options may rely more on the 911 system amidst a suicidal crisis.

Using intensive time sampling methods to capture daily suicidal ideation: A systematic review.

INTRODUCTION: There has been an increased emphasis on understanding suicidal thoughts and behaviors as they occur in real-time, resulting in a proliferation of studies utilizing intensive time sampling methods. Given the continued growth in this area, there is a need to synthesize the feasibility of these methods in capturing suicidal ideation at the daily level, in addition to an examination of study factors that may impact suicidal ideation detection, to guide future research. METHOD: Online databases (i.e., PsychINFO, ERIC, PubMed, MEDLINE) were systematically searched for articles published through December 2020 that assessed suicidal ideation at the daily level. RESULTS: Twenty-six articles presenting data from sixteen independent datasets met inclusion criteria. Across included articles, suicidal ideation detection ranged from approximately 1-92% of participant-completed surveys, with 18-100% of unique study participants reporting suicidal ideation during the study period. Assessment-based factors (i.e., number of daily assessments, duration of daily assessment period) did not appear to be meaningfully associated with suicidal ideation detection rates. Rather, participant characteristics (i.e., baseline suicide risk history, inclusion criteria) were better indicators of a study's ability to capture suicidal ideation at the daily level. CONCLUSIONS: Findings highlights the impact of targeting participants with elevated suicide risk at study enrollment.

Suicide Attempts Among Racial and Ethnic Groups in a Nationally Representative Sample.

OBJECTIVE: Evaluate suicide attempt prevalence and potentially related sociodemographic and psychiatric factors among racial and ethnic groups. METHODS: Between 2012 and 2013, the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) conducted semi-structured interviews with 36,309 adults in the USA. We identified lifetime suicide attempt prevalence and significant predictors for each racial/ethnic group using stratified logistic regressions. Analyses were exploratory without a priori hypotheses. RESULTS: Asian/Native Hawaiian/other Pacific Islander and Black individuals had the lowest prevalence of suicide attempts while Alaska Native/American Indian and White individuals had the highest prevalence. Identifying as female and meeting criteria for psychiatric diagnoses featuring mood regulation difficulties (depression, borderline personality disorder, bipolar I disorder) were consistently related to a suicide attempt history across racial and ethnic groups, whereas substance abuse disorders and other sociodemographic factors differed between racial and ethnic groups in their associations with suicide attempt history. CONCLUSIONS: Although several factors were consistently related to suicide risk across racial and ethnic groups, the prevalence of suicide attempts and overall pattern of related factors were not uniform between racial and ethnic groups. POLICY IMPLICATIONS: Study findings highlight the importance of considering suicide risk within the context of race and ethnicity both regarding the overall prevalence of risk and in determining personal factors associated with elevated risk. A failure to appreciate experiences related to race and ethnicity may adversely impact suicide risk assessment and treatment, ultimately contributing to health disparities. Results suggest that additional research is warranted.

Development and Initial Validation of a Scale Assessing Suicide-Specific Rumination: The Suicide Rumination Scale.

Suicide-specific rumination, a repetitive mental fixation on one's suicidal thoughts and intentions, may influence the transition from suicidal thoughts to behaviors. Research on suicide-specific rumination has been hindered by the lack of an independent measurement tool. This article presents the development and validation of a self-report measure of suicide-specific rumination across several samples with lifetime suicidal ideation (Sample 1: N = 494 students; Sample 2: N = 219 community members; Sample 3: N = 128 adults at high risk for suicide). The Suicide Rumination Scale (SRS) item pool was reduced from a pool of 41 items to 8 items that are highly discriminant and of varying levels of difficulty. The SRS demonstrated measurement invariance, convergent validity, and nonredundancy with related measures. Importantly, the SRS differentiated suicide attempters from ideators, suggesting its potential clinical relevance. Overall, these findings suggest that the SRS is a valid and incrementally useful measure of suicide-specific rumination.

Testing Whether Suicide Capability Has a Dynamic Propensity: The Role of Affect and Arousal on Momentary Fluctuations in Suicide Capability.

To prevent suicidal behaviors, it is crucial to understand the mechanisms and processes that enable an individual to act on suicidal thoughts. Suicide capability, which involves an increased pain tolerance and fearlessness of death, is a critical factor that enables an individual to endure the physical pain necessary to make a lethal suicide attempt. Extant research has largely conceptualized suicide capability as developing linearly in response to painful and provocative experiences, but the emerging literature on the temporal dynamics of suicide has been challenging the notion of linearity in suicide risk. Few studies have directly measured and compared changes in suicide capability in response to rumination on different affective states. We sought to experimentally test if rumination in the context of low vs. high arousal emotions will prompt distinct changes in two core components of suicide capability: pain tolerance and fearlessness of death on two undergraduate student samples. In both studies, participants provided measures of subjective emotional state as well as pain threshold, tolerance, and persistence before and after completing experimental manipulations which included both emotion and rumination induction procedures. In the second study, measures of fearlessness about death and physiological arousal (heart rate) were added to the experimental procedures. We found significant decreases in pain threshold, tolerance, and persistence following the experimental manipulations but found no main effects of rumination or suicide risk. These findings suggest that suicide capability can fluctuate but these changes may occur through a different mechanism and/or differ between individuals at varying levels of suicide risk.

Optimizing the scientific study of suicide with open and transparent research practices.

Suicide research is vitally important, yet-like psychology research more broadly-faces methodological challenges. In recent years, researchers have raised concerns about standard practices in psychological research, concerns that apply to suicide research and raise questions about its robustness and validity. In the present paper, we review these concerns and the corresponding solutions put forth by the "open science" community. These include using open science platforms, pre-registering studies, ensuring reproducible analyses, using high-powered studies, ensuring open access to research materials and products, and conducting replication studies. We build upon existing guides, address specific obstacles faced by suicide researchers, and offer a clear set of recommended practices for suicide researchers. In particular, we consider challenges that suicide researchers may face in seeking to adopt "open science" practices (e.g., prioritizing large samples) and suggest possible strategies that the field may use in order to ensure robust and transparent research, despite these challenges.

Editorial overview: Analytic and methodological innovations for suicide-focused research.

This editorial overview provides an introduction to the Suicide and Life-Threatening Behaviors Special Issue: "Analytic and Methodological Innovations for Suicide-Focused Research." We outline several challenges faced by modern suicidologists, such as the need to integrate different analytical and methodological techniques from other fields with the unique data problems in suicide research. Therefore, the overall aim of this issue was to provide up-to-date methodological and analytical guidelines, recommendations, and considerations when conducting suicide-focused research. The articles herein present this information in an accessible way for researchers/clinicians and do not require a comprehensive background in quantitative methods. We introduce the topics covered in this special issue, which include how to conduct power analyses using simulations, work with large data sets, use experimental therapeutics, and choose covariates, as well as open science considerations, decision-making models, ordinal regression, machine learning, network analysis, and measurement considerations. Many of the topics covered in this issue provide step-by-step walkthroughs using worked examples with the accompanied code in free statistical programs (i.e., R). It is our hope that these articles provide suicidologists with valuable information and strategies that can help overcome some of the past limitations of suicide research, and improve the methodological rigor of our field.

Rumination in the Context of Anger and Sadness: Differential Effects on State Agitation.

BACKGROUND: Agitation is an important transdiagnostic factor for several mental health disorders and a significant risk factor for dangerous or maladaptive coping behaviors. How an individual responds to experiences of agitation itself may also play a crucial role in conferring risk towards maladaptive behaviors. Specifically, ruminating on high arousal emotions, such as anger, will also be more likely to initiate and maintain agitation, thereby increasing risk for impulsive and maladaptive behaviors. METHODS: Undergraduate students (N=117) were randomly assigned to an emotion induction condition (i.e., control, sadness only, anger only, sadness and anger) followed by either a control condition or a rumination induction. They completed measures on subjective emotional state and agitation at baseline, after emotion induction, after rumination induction, and at the end of session. RESULTS: Agitation was influenced by negative affect broadly with each experimental condition leading to agitation. Anger influenced momentary change in agitation and sustained agitation when combined with rumination. LIMITATIONS: The majority of participants in the current study were young, white females and the findings may not generalize to individuals of diverse genders and cultures who may have experience and cope with agitation differently. CONCLUSIONS: Recognizing and mitigating rumination during moments of anger may help decrease a clients' use of problematic coping behaviors.

Emotion regulation difficulties and borderline personality disorder: The moderating role of race.

Borderline personality disorder (BPD) is a disorder characterized by emotion regulation (ER) difficulties. Although research indicates that patterns of ER differ across racial groups, few studies have examined the role of race in the ER-BPD association. This study sought to address this gap. Participants in this study identified as either East Asian, White, or Black, and were recruited from sites in Western Canada and the Southern United States. Two samples were included in this study: (a) 194 university students who self-reported BPD features and (b) 88 adults from the community who underwent diagnostic interviews and had a BPD diagnosis. All participants self-reported ER difficulties. Results revealed that race moderated the link between some aspects of ER difficulties and BPD. For instance, relations between (a) nonacceptance of emotions and BPD affect instability, (b) limited access to ER strategies and BPD identity disturbance, and (c) low emotional awareness and BPD diagnosis were stronger among White (vs. Black or East Asian) participants. Implications of these findings for the diagnosis and treatment of BPD across racial groups are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

An examination of PTSD symptoms and their effects on suicidal ideation and behavior in non-treatment seeking veterans.

This study sought to examine the effect of general PTSD symptoms as well as specific PTSD symptom clusters on suicidal ideation and suicidal attempts. We first compared a correlated factors solution consistent with the DSM-5 symptom clusters for PTSD with a bifactor solution comprising a General PTSD factor and orthogonal specific factors. Using the best fitting model (i.e., bifactor solution), we then investigated the effect of specific PTSD symptom clusters on severity of suicidal ideation and suicide attempts above and beyond the effect of general PTSD symptoms. A sample of 773 veterans who have never sought professional mental health treatment were screened for suicidal ideation within the past two weeks. One month after the baseline measurement, the participants completed a follow-up assessment, again by telephone. A bi-factor solution was used to account for a general PTSD factor as well as the specific DSM-5 PTSD symptom clusters. After controlling for baseline suicidal ideation and behavior, it appeared that the Anxious Arousal factor was predictive of changes in the magnitude of severity of suicidal ideation and the General PTSD factor was predictive of the onset of new suicidal behavior at the one-month follow-up. Additionally, the Re-experiencing factor of PTSD also significantly predicted new suicidal behavior at the one-month follow-up. These results suggest that it may beneficial for clinicians, who are assessing individuals with PTSD for suicidality, to be aware of the frequency, duration, and content of their clients' repetitive, intrusive thoughts as these thoughts may increase their capability to inflict non-lethal or lethal forms of self-injury.

The intensity of suicidal ideation at the worst point and its association with suicide attempts.

This study seeks to determine if the severity of suicidal ideation at the worst point can differentiate individuals who think about suicide (ideators) from those who make a suicide attempt (attempters). Subsequently, the indirect effect of worst point ideation on differentiating ideators from attempters through various pathways such as an increased capability for suicide, painful and provocative experiences, non-suicidal self-injury (NSSI), and planning for suicide was examined. The sample included 229 adults with a lifetime history of suicidal ideation who were recruited through Amazon's Mechanical Turk program and asked to complete a battery of self-report questionnaires. Furthermore, the sample was oversampled on the basis of prior suicide attempts. Our results suggest that there is a strong relationship between worst point ideation and suicide attempts such that there is a greater likelihood of endorsing past suicide attempts when individuals reported high intensity at the worst point of their suicidal ideation. An elevated level of painful and provocative events partially accounted for the aforementioned relationship while a heightened capability for suicide. The results from the present study suggest utility in managing intensity of suicidal ideation and the importance of addressing painful and provocative behaviors to prevent potentially lethal suicide attempts in the future.

Repetitive negative thinking and suicide: a burgeoning literature with need for further exploration.

Extant research has found a significant overlap between various repetitive negative thinking (RNT) patterns, such as rumination and worry, across different affective disorders implicating that the process of repetitive negative thinking is likely trans-diagnostic. Furthermore, RNT patterns at the core of psychiatric disorders associated with suicide (e.g., rumination and worry) have been found to be associated with suicide even after accounting for the disorder. A synthesis of existing literature on repetitive negative thoughts suggest that following negative emotional experiences, RNTs may lead to a sense of entrapment and hopelessness that may contribute to the onset of suicidal ideation and then facilitate the transition from thinking about suicide to making a suicide attempt by increasing an individual's capability for suicide through repetitive exposure to violent thoughts and imagery associated with suicide.

Overarousal as a mechanism of the relation between rumination and suicidality.

Rumination, particularly brooding, is associated with suicidal ideation and attempts; however, mechanisms of these associations have not been identified. The present study examined manifestations of overarousal-agitation, insomnia, and nightmares-that have been linked to both rumination and suicide as indirect indicators of the link between brooding and suicidal ideation/attempts. A sample of 492 psychiatric outpatients (64.2% female), aged 17-65 years (M = 26.75, SD = 10.32), completed self-report measures before their intake appointments with a therapist. Results indicated that agitation and nightmares, but not insomnia, each significantly explained the association between brooding and suicidal ideation and between brooding and the presence of a past suicide attempt. Overall, these findings provide evidence that certain types of overarousal may serve as a mechanism of the association between brooding and suicidal ideation and attempts. Clinical implications, limitations, and future research directions are discussed.