Torn between living or dying-analyses of influencing factors on suicide ambivalence and its longitudinally impact on suicidal ideation and behavior in a high-risk sample.

INTRODUCTION: Findings on the role of suicide ambivalence, an individual's wish to live (WL), and wish to die (WD) in the development of suicidality have been heterogenous. The main goal of this study was to examine associations of these constructs within the past week with sociodemographic factors and to longitudinally investigate their predictive power for suicidal ideation (SI) and suicide attempts (SA). METHODS: N = 308 patients (54% female; M = 36.92 years, SD = 14.30), admitted to a psychiatric ward due to suicidality, were assessed for all constructs after admission, after six, nine, and 12 months. Data were analyzed with univariate fixed-effect models and lagged mixed-effect regression models. RESULTS: Decreased, WL increased post-baseline. Gender showed no significant link to ambivalence, WD, and WL. Ambivalence and WD correlated negatively with age and positively with depressiveness. More participants in a relationship showed a WL compared with single/divorced/widowed participants. More single participants or those in a relationship showed ambivalence than divorced/widowed participants. More single participants showed a WD than participants in a relationship/divorced/widowed. Longitudinally, ambivalence and WD predicted SI and SA. CONCLUSION: The findings underscore the importance of taking suicide ambivalence and WD into account in risk assessment and treatment.

Suicidal ambivalence: A scoping review.

BACKGROUND: Suicidal ambivalence is considered a characteristic condition of suicidal individuals. At the same time, there is a lack of a uniform definition, conception and assessment of suicidal ambivalence. On this background, the current scoping review aims to explore the extent, range, and nature of research activity on suicidal ambivalence and to summarize research findings. METHODS: A systematic literature search was conducted in four different databases (PubMed, Psychinfo, Web of Science, and Google Scholar) using an array of search terms (e.g., ambivalence, internal suicide debate, reasons for living and reasons for dying, wish to live and wish to die). RESULTS: In total, 28 articles published between 1977 and 2023 were included in the scoping review. The study situation lacks a clear definition, conceptualization and operationalization of suicidal ambivalence. Nonetheless, suicidal ambivalence is a common experience in persons contemplating suicide and suicidal ambivalence seems to be present before, during and after a suicide attempt. Suicidal ambivalence is associated with diverse markers of negative/positive mental health as well as suicidal ideation and behavior. CONCLUSION: Results point to the relevance of suicidal ambivalence. At the same time, there are large gaps in knowledge about the development, impact and therapeutic responsiveness of suicidal ambivalence.

Better Safe Than Sorry. A Scoping Review of Monitoring for Negative Effects in Preregistrations of Psychological Interventions.

Although negative effects of psychological interventions are suspected to be common, they are rarely investigated. Experts and international guidelines agree that monitoring for negative effects in clinical studies is needed to make psychological interventions safer and to empower patients before they give their consent to participate. Therefore, monitoring should already be considered during planning and preregistration of a study. The aim of this scoping review was to find out how frequently studies on psychological interventions monitor their negative effects according to preregistrations and to investigate reasons why monitoring is not carried out. Preregistrations of psychological interventions on ClinicalTrials.gov were scrutinized for information on monitoring of negative effects and other study characteristics. In a survey, researchers of studies where no monitoring was reported were asked for reasons for not doing so. Overall, 2231 preregistrations of psychological interventions were found; of these, only 3.4% included explicit information on monitoring for negative effects. In the survey, more researchers reported having conducted monitoring, although the type of monitoring was often inadequate. The type of monitoring varied widely, and specific monitoring measurements were rarely used repeatedly. Monitoring for negative effects was more prevalent in studies investigating treatments versus low-threshold interventions, in studies conducted in Europe versus other continents and in more recent studies. Researchers reported lack of knowledge as the most frequent reason for not monitoring negative effects. Our results imply a lack of monitoring and inconsistent information on negative effects in preregistrations, with inconsistent use of the term monitoring and measurements, and a lack of knowledge among researchers. Improved knowledge and a standardized approach, starting with an adequate preregistration, would be helpful to routinely examine negative effects in psychological interventions to make them safer and better.

Positive mental health accounts for the relationship between insomnia symptoms and suicide-related outcomes.

Insomnia symptoms have been shown to be associated with suicide ideation/behavior. However, the underlying mechanism is unclear and studies on protective factors that might mitigate the association between sleep-related problems and suicide ideation/behavior are largely missing. On this background the aim of the current study was to investigate, whether positive mental health (PMH) accounts for the association between insomnia symptoms and suicidal ideation/behavior. A total of 913 participants (72.2% women; age: M(SD) = 25.91 (7.08)) completed measures on insomnia symptoms, PMH and suicide ideation/behavior via an online survey. The results reveal a significant association between insomnia symptoms and PMH. Both variables were significantly linked to lifetime suicide ideation/behavior and 12-month suicide ideation. Moreover, the association between insomnia symptoms and suicide-related outcomes was significantly mitigated by PMH. The current findings complement previous studies on the association between insomnia symptoms and suicide ideation/behavior. Furthermore, they demonstrate that PMH can mitigate the risk of suicide-related outcomes. Therapeutic intervention targeting insomnia symptoms and fostering PMH might be useful in the prevention of suicide ideation/behavior.

Suicide Crisis Syndrome: A systematic review.

BACKGROUND: The objective of this systematic review is to describe the scientific evidence for the Suicide Crisis Syndrome (SCS), a presuicidal cognitive and affective state consisting of five symptomatic dimensions: entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal. The aim of this article is to summarize the emerging literature on the SCS and to assess the extent to which a uniform syndrome can be assumed. METHODS: A systematic literature search was conducted in three different databases (PubMed, PsycInfo, and Google Scholar) using the search terms "Suicide Crisis Inventory," "Suicide Crisis Syndrome," "Narrative Crisis Model of Suicide," and "Suicide Trigger State." RESULTS: In total, 37 articles from 2010 to 2022 were identified by search criteria. Twenty-one articles published between 2017 and 2022 were included in the systematic review. All but three studies were conducted in the United States and examined clinical samples of adult high-risk psychiatric in- and outpatients. Sample sizes ranged from N = 170 to 4846. The findings confirm the unidimensional structure of the proposed disorder and support the predictive validity for short-term suicidal behavior above and beyond suicidal ideation. CONCLUSION: Despite the promising predictive validity of the SCS, a precise prediction of future suicidal behavior remains difficult.

Internet-based psychoeducation and support programme for relatives of young people with early psychosis: results of the first German-language intervention.

Background: International clinical guidelines recommend Family Interventions (FIs) especially for families of people at early stages of psychosis. The German S3 treatment guideline for schizophrenia gives FIs the highest level of clinical recommendation. However, some family relatives have limited access to these services due to health system constrains. Digital interventions have emerged as a solution to overcome this hindered access to evidence-based family interventions. Objective: The present pilot study evaluates the feasibility and potential efficacy of the first German moderated online psychoeducation and support programme (ePSP) for relatives of people with early psychosis, with the additional purpose to improve accessibility and reduce waiting times. Methods: A pre-post study was performed. A brief recruitment period was pre-established (10 weeks) to test potential improvement of regular therapy waiting times in Germany. A total of 25 relatives of people with early psychosis were recruited and received the 12-week moderated online intervention. Assessments were conducted at baseline and at post intervention. Acceptance of the intervention and the user's experience were also evaluated at post intervention. Results: Recruitment, retention rates and qualitative data support the feasibility and acceptability of the ePSP. Significant positive effects of the interventions were found on key therapeutic targets, including both primary outcomes (i.e., perceived stress and beliefs about the illness). Twenty-one participants also completed the open-ended questions of the user experience questionnaire, which yielded three main themes: most important modules, difficulties in using the programme and ways to improve ePSP. Discussion: These results provide preliminary efficacy estimates for a fully powered RCT to investigate superiority (or equipoise) effects of the ePSP in comparison to the routine face-to-face family therapy groups. This future RCT will also allow further exploration of ePSP to improve access to psychological therapy for relatives of young people with psychosis, also in relation to the new ground-breaking Digital Healthcare Act in Germany.

Pain tolerance and threshold in suicide attempters: A systematic review and meta-analysis.

It has been hypothesized that individuals less sensitive to pain could be at higher risk of suicide. However, data on pain sensitivity in suicide attempters (SA) obtained using experimental procedures are heterogeneous. The aim of this systematic review and meta-analysis was to investigate and compare pain tolerance and threshold in SA (patients with lifetime history of suicide attempt), non-attempters (psychiatric controls, PC), and healthy controls (HC). A random effects meta-analysis was used to estimate the standardized mean differences using data from 16 studies that compared physical pain tolerance and threshold in SA and PC or HC. Pain tolerance and threshold were not significantly different in SA and PC. However, pain tolerance, but not threshold, was higher in SA than HC. Our findings do not support the hypothesis of an altered pain perception related as a trait for suicidal vulnerability, but rather suggest altered pain perception related to psychiatric vulnerability.

[Utilization of Outpatient Psychotherapy and Outpatient Psychiatric Treatment by Men and Women after Inpatient Treatment due to Suicide Attempt or Acute Suicidal Crisis]. / Inanspruchnahme ambulanter Psychotherapie und ambulanter psychiatrischer Behandlung von Männern und Frauen nach stationärer Behandlung aufgrund eines Suizidversuchs oder akuter suizidaler Krise.

OBJECTIVE: The strongest predictor of suicide attempts is a previous suicide attempt. Individuals hospitalized for suicidal ideation and behavior face an increased risk of suicide following discharge. This study investigates the extent to which outpatient treatment services are utilized the first 6 months after discharge and whether men and women differ in this regard. METHOD: The study examines data of 124 individuals (with suicide attempts (lifetime), 59.7% female) on the use of outpatient treatment services in the 6 months after inpatient treatment. RESULTS: 37.9% (N=47) of individuals reported not having used any treatment services at all. Men were significantly less likely to make use of the services. CONCLUSION: Members of a group with an increased risk of suicide, to a large extent, fail to make use of outpatient treatment services. Discharge management should increasingly focus on (gender-specific) barriers and pave the way for treatment in outpatient.

Trust in higher guidance and suicidality in Afghan students under the Taliban regime

Background/Objective: After years of war, political instability and natural catastrophes high rates of PTSD and depression have been found in the Afghan population. On this background, it was investigated whether religious beliefs (trust in higher guidance; TIHG) moderated the association between PTSD symptoms and/or depression and suicidal ideation. Method: A total of 279 Afghan university students (61.6% women; aged 18 to 30 years) took part in this cross-sectional study between July and November 2022. Self-report measures of PTSD, depression, suicidal ideation, trust in higher guidance were used. Results: Severe PTSD symptoms were reported by 58.4%, clinically relevant depression symptoms were reported by 55.2% and current suicidal ideation was reported by 44.4% of the sample. TIHG moderated the impact of PTSD symptoms, on suicidal ideation. TIHG and depression were unrelated. Conclusion: PTSD symptoms, depression and suicidal ideation show an alarmingly high prevalence in this specific sample of Afghan students. TIHG seems to be a resilience factor of special importance. (AU)

Understanding suicidal ideation-a network analysis of the Interpersonal Needs Questionnaire.

INTRODUCTION: Identifying various interacting risk factors for suicidality is important to develop preventive measures. The Interpersonal-Psychological Theory of Suicidal Behavior (IPTS) postulates suicidal ideation resulting from the occurrence of Perceived Burdensomeness (PB) and Thwarted Belongingness (TB). Suicidal behavior ultimately occurs if people have a Capability for Suicide. In past studies, the validity of TB was often not empirically confirmed, questioning which of the aspects of TB are central and related to suicidal ideation and whether applied measurement methods adequately capture the construct. METHOD: Using a sample of 3,404 individuals from different clinical and nonclinical settings, 30% (1,023) of whom reported suicidal ideation, two network analyses were conducted on the Interpersonal Needs Questionnaire (INQ) and a variable mapping suicidal ideation. RESULTS: Analyses revealed that some items of the INQ were not related to suicidal ideation and the most central items did not have the strongest associations to suicidal ideation. CONCLUSION: Based on these results, a shortened version of the INQ with the four items that showed the strongest associations with suicidal ideation in the network analyses was suggested.

Validation of the Farsi version of the Suicide Ideation and Behavior Scale.

Objective: Suicide ideation and suicide attempts are prevalent in Farsi speaking populations. The present study aimed at validating the Farsi version of the Suicide Ideation and Behavior Scale (SIBS). Methods: Reliability and validity of the Farsi version of the SIBS were established in a highly burdened Afghan student sample (N = 279). Internal consistency, convergent and discriminant validity were investigated, and confirmatory factor analysis was conducted. Results: The Farsi version of the SIBS was shown to have a unidimensional structure with excellent internal consistency, as well as good convergent and divergent validity. Discussion: The results suggest that the SIBS is a brief, reliable, and valid measure of current suicidal ideation and behavior that can be used in Farsi speaking populations.

Multidimensional Assessment of Strengths and Their Association With Mental Health in Psychotherapy Patients at the Beginning of Treatment.

Background: Modern concepts assume that mental health is not just the absence of mental illness but is also characterized by positive well-being. Recent findings indicated a less pronounced distinction of positive and negative mental health dimensions in clinical samples. Self-perceived strengths were associated with markers of mental health in healthy individuals. However, analyses of strengths and their association with different mental health variables in clinical populations are scarce. Method: A cross-sectional design was conducted at a German outpatient training and research center. 274 patients before treatment (female: 66.4%, mean age = 42.53, SD = 13.34, range = 18-79) filled out the Witten Strengths and Resource Form (WIRF), a multidimensional self-report of strengths, as well as other instruments assessing positive and negative mental health variables. Data was analyzed with structural equation modeling and latent regression analyses. Results: Confirmatory factor analysis of the WIRF showed good model fit for the assumed three-subscale solution. Regarding mental health, a one-factor model with positive and negative variables as opposite poles showed acceptable fit. A correlated dual-factor model was not appropriate for the data. All WIRF subscales significantly predicted unique parts of variance of the latent mental illness factor (p = .035 - p < .001). Conclusion: The context-specific assessment of patients' strengths was confirmed and led to an information gain in the prediction of mental health. Results suggest that positive and negative facets of mental health are highly entwined in people with pronounced symptoms. The scientific and practical implications of these findings are discussed.

Remote blended treatment for individuals with suicidal ideation: A single-arm proof-of-concept trial.

INTRODUCTION: New digital treatment formats may reduce barriers to treatment for individuals with suicidal ideation. This study aimed to investigate the feasibility of a remote blended care programme for this population, defined as acceptability, demand, practicality, adaptation, indications of efficacy and safety. METHODS: We conducted a mixed-methods single-arm trial for proof-of-concept. Participants were eligible if they were at least 18 years old, had sufficient German proficiency, a Beck Scale for Suicidal Ideation score ≥2, internet access and lived near the outpatient clinic. The treatment consisted of 12 sessions of cognitive-behavioural videotherapy combined with online modules over 6 weeks. RESULTS: We included 10 participants. All patients were satisfied with the treatment; most patients (80%) reported unpleasant memories resurfacing. All patients completed all therapy sessions and a mean of 13.7 modules (SD = 5.7); three patients switched to face-to-face treatment, in one case due to safety concerns. All patients and most therapists (83.3%) found the treatment overall practicable. Most patients (66.7%) and therapists (66.7%) considered remote treatment equivalent to face-to-face therapy. There were no serious adverse events. CONCLUSION: While promising, the results suggest changes to the programme might be needed, particularly for patients' safety. A controlled feasibility trial should investigate temporary deteriorations.

Blending Video Therapy and Digital Self-Help for Individuals With Suicidal Ideation: Intervention Design and a Qualitative Study Within the Development Process.

BACKGROUND: Digital formats have the potential to enhance accessibility to care for individuals with suicidal ideation. However, digital self-help interventions have faced limitations, including small effect sizes in reducing suicidal ideation, low adherence, and safety concerns. OBJECTIVE: Therefore, we aimed to develop a remote blended cognitive behavioral therapy intervention that specifically targets suicidal ideation by blending video therapy with web-based self-help modules. The objective of this paper is to describe the collaborative development process and the resulting intervention and treatment rationale. METHODS: First, we compiled intervention components from established treatment manuals designed for people with suicidal ideation or behavior, resulting in the development of 11 drafts of web-based modules. Second, we conducted a qualitative study, involving 5 licensed psychotherapists and 3 lay counselors specialized in individuals with suicidal ideation who reviewed these module drafts. Data were collected using the think-aloud method and semistructured interviews, and a qualitative content analysis was performed. The 4 a priori main categories of interest were blended care for individuals with suicidal ideation, contents of web-based modules, usability of modules, and layout. Subcategories emerged inductively from the interview transcripts. Finally, informed by previous treatment manuals and qualitative findings, we developed the remote blended treatment program. RESULTS: The participants suggested that therapists should thoroughly prepare the web-based therapy with patients to tailor the therapy to each individual's needs. Participants emphasized that the web-based modules should explain concepts in a simple manner, convey empathy and validation, and include reminders for the safety plan. In addition, participants highlighted the need for a simple navigation and layout. Taking these recommendations into account, we developed a fully remote blended cognitive behavioral therapy intervention comprising 12 video therapy sessions and up to 31 web-based modules. The treatment involves collaboratively developing a personalized treatment plan to address individual suicidal drivers. CONCLUSIONS: This remote treatment takes advantage of the high accessibility of digital formats while incorporating full sessions with a therapist. In a subsequent pilot trial, we will seek input from individuals with lived experience and therapists to test the feasibility of the treatment.

Self-burdensomeness, other-burdensomeness, and suicidal ideation.

Perceiving oneself as a burden to others (other-burdensomeness), as well as perceiving one's selfhood as a burden (self-burdensomeness), have been proposed as risk factors for suicidal ideation. Yet, it is unclear whether the altruistic motive of being a burden to others or the self-oriented motive of being a burden on oneself is more relevant to suicidal ideation. Given this background, two rival mediation models were tested. Data from N = 228 outpatients (64% female; age: M(SD) = 38.69 (12.27), range:17-65) undergoing psychotherapy were collected at two measurement time points over a three-month period (first measurement = T1, second measurement = T2). The significant positive association between other-burdensomeness (T1) and suicidal ideation (T2) was partially mediated by self-burdensomeness (T1). Furthermore, the significant positive association between self-burdensomeness (T1) and suicidal ideation (T2) was partially mediated by other-burdensomeness (T1). Results suggest that suicidal ideation can develop from both an altruistic, self-sacrificial perception of being a burden to others, as well as from a more self-oriented perception of being a burden to oneself. There is no indication that either self-burdensomeness or other-burdensomeness is a stronger indicator in the development of suicidal ideation.

Trust in higher guidance and suicidality in Afghan students under the Taliban regime{fr}(Confianza en la orientación superior y suicidalidad en estudiantes afganos bajo el régimen Talibán).

Background/Objective: After years of war, political instability and natural catastrophes high rates of PTSD and depression have been found in the Afghan population. On this background, it was investigated whether religious beliefs (trust in higher guidance; TIHG) moderated the association between PTSD symptoms and/or depression and suicidal ideation. Method: A total of 279 Afghan university students (61.6% women; aged 18 to 30 years) took part in this cross-sectional study between July and November 2022. Self-report measures of PTSD, depression, suicidal ideation, trust in higher guidance were used. Results: Severe PTSD symptoms were reported by 58.4%, clinically relevant depression symptoms were reported by 55.2% and current suicidal ideation was reported by 44.4% of the sample. TIHG moderated the impact of PTSD symptoms, on suicidal ideation. TIHG and depression were unrelated. Conclusion: PTSD symptoms, depression and suicidal ideation show an alarmingly high prevalence in this specific sample of Afghan students. TIHG seems to be a resilience factor of special importance.

Effects of digital cognitive behavioral therapy for depression on suicidal thoughts and behavior: Protocol for a systematic review and meta-analysis of individual participant data.

INTRODUCTION: Digital cognitive behavioral therapy (i-CBT) interventions for the treatment of depression have been extensively studied and shown to be effective in the reduction of depressive symptoms. However, little is known about their effects on suicidal thoughts and behaviors (STB). Information on the impact of digital interventions on STB are essential for patients' safety because most digital interventions are self-help interventions without direct support options in case of a suicidal crisis. Therefore, we aim to conduct a meta-analysis of individual participant data (IPDMA) to investigate the effects of i-CBT interventions for depression on STB and to explore potential effect moderators. METHODS: Data will be retrieved from an established and annually updated IPD database of randomized controlled trials investigating the effectiveness of i-CBT interventions for depression in adults and adolescents. We will conduct a one-stage and a two-stage IPDMA on the effects of these interventions on STB. All types of control conditions are eligible. STB can be measured using specific scales (e.g., Beck scale suicide, BSS) or single items from depression scales (e.g., item 9 of the PHQ-9) or standardized clinical interviews. Multilevel linear regression will be used for specific scales, and multilevel logistic regression will be used for treatment response or deterioration, operationalized as a change in score by at least one quartile from baseline. Exploratory moderator analyses will be conducted at participant, study, and intervention level. Two independent reviewers will assess the risk of bias using the Cochrane Risk of Bias Tool 2. CONCLUSION: This IPDMA will harness the available data to assess the effects (response and deterioration) of i-CBT interventions for depression interventions on STB. Information about changes in STB is essential to estimate patients' safety when engaging in digital treatment formats. TRIAL REGISTRATION: We will pre-register this study with the open science framework after article acceptance to ensure consistency between online registration and the published trial protocol.

Eating disorder treatment in routine clinical care: A descriptive study examining treatment characteristics and short-term treatment outcomes among patients with anorexia nervosa and bulimia nervosa in Germany and Switzerland.

This descriptive study examined patient characteristics, treatment characteristics, and short-term outcomes among patients with Anorexia Nervosa (AN) and Bulimia Nervosa (BN) in routine clinical care. Results for patients receiving full-time treatment were contrasted with results for patients receiving ambulatory treatment. Data of a clinical trial including 116 female patients (18-35 years) diagnosed with AN or BN were subjected to secondary analyses. Patients were voluntarily admitted to one of nine treatment facilities in Germany and Switzerland. Patients received cognitive-behavioral interventions in accordance with the national clinical practice guidelines for the treatment of EDs under routine clinical care conditions, either as full-time treatment or ambulatory treatment. Assessments were conducted after admission and three months later. Assessments included a clinician-administered diagnostic interview (DIPS), body-mass-index (BMI), ED pathology (EDE-Q), depressive symptoms (BDI-II), symptoms of anxiety (BAI), and somatic symptoms (SOMS). Findings showed that treatment intensity differed largely by setting and site, partly due to national health insurance policies. Patients with AN in full-time treatment received on average 65 psychotherapeutic sessions and patients with BN in full-time treatment received on average 38 sessions within three months. In comparison, patients with AN or BN in ambulatory treatment received 8-9 sessions within the same time. Full-time treatment was associated with substantial improvements on all measured variables for both women with AN (d = .48-.83) and BN (d = .48-.81). Despite the relatively small amount of psychotherapeutic sessions, ambulatory treatment was associated with small increases in BMI (d = .37) among women with AN and small improvements on all measured variables among women with BN (d = .27-.43). For women with AN, reduction in ED pathology were positively related to the number of psychotherapeutic sessions received. Regardless of diagnosis and treatment setting, full recovery of symptoms was rarely achieved within three months (recovery rates ranged between 0 and 4.4%). The present study shows that a considerable amount of patients with EDs improved after CBT-based ED treatment in routine clinical care within three months after admission. Intensive full-time treatment may be particularly effective in quickly improving ED-related pathology, although full remission of symptoms is typically not achieved. A small amount of ambulatory sessions may already produce considerable improvements in BN pathology and weight gain among women with AN. As patient characteristics and treatment intensity differed largely between settings, results should not be interpreted as superiority of one treatment setting over another. Furthermore, this study shows that treatment intensity is quite heterogeneous, indicating the possibility for increasing effectiveness in the treatment of EDs in routine clinical care.

Psychometric evaluation and Rasch analyses of the German Overall Anxiety Severity and Impairment Scale (OASIS-D).

The Overall Anxiety Severity and Impairment Scale (OASIS) is a 5-item self-report measure that captures symptoms of anxiety and associated functional impairments. This study evaluates a German version (OASIS-D) that was administered to a convenience sample of 1398 primary care patients of whom 419 were diagnosed with panic disorder with/without agoraphobia. Psychometric properties were analyzed using classical test theory as well as probabilistic test theory. Factor analyses suggested a unitary (latent) factor structure. The internal consistency was good to excellent. Convergent as well as discriminant validity with other self-report measures was found. A sum score (range 0-20) of ≥ 8 emerged as optimal cut-score for screening purposes. A difference score of ≥ 5 was indicative of reliable individual change. A Rasch analysis of local item independence suggested response dependency between the first two items. Rasch analyses of measurement invariance detected noninvariant subgroups associated with age and gender. Analyses of validity and optimal cut-off score were solely based on self-report measures, which may have introduced method effects. In sum, the findings support the transcultural validity of the OASIS and indicate its applicability to naturalistic primary care settings. Caution is warranted when using the scale to compare groups that differ in age or gender.

Metacognitions about suicidal thoughts.

BACKGROUND: Rumination about suicide has recently been identified as a risk factor for suicidal behavior. According to the metacognitive model of emotional disorders, the activation and maintenance of rumination is dependent on specific metacognitive beliefs. On this background, the current study is concerned with the development of a questionnaire to assess suicide-specific positive and negative metacognitive beliefs. METHODS: Factor structure, reliability and validity of the Scales for Suicide-related Metacognitions (SSM) were investigated in two samples comprised of participants suffering from lifetime suicide ideation. Participants of sample 1 (N = 214; 81.8% female; Mage = 24.9, SDage = 4.0) took part in a single assessment using an online survey. Participants of sample 2 (N = 56; 71.4% female; Mage = 33.2, SDage = 12.2) took part in two online assessments within a two week time-period. To establish convergent validity questionnaire-based assessments of suicidal ideation, general and suicide specific rumination and depression were used. Furthermore, it was analyzed whether suicide-related metacognitions predict suicide-specific rumination cross-sectionally and prospectively. RESULTS: Factor analyses revealed a two-factor structure of the SSM. Results indicated good psychometric properties, and provided evidence for construct validity and stability of the subscales. Positive metacognitions predicted concurrent and prospective suicide-specific rumination beyond the effect of suicide ideation and depression and rumination predicted concurrent and prospective negative metacognitions. CONCLUSION: Taken together the results provide initial evidence that the SSM is a valid and reliable measure of suicide-related metacognitions. Furthermore, findings are in line with a metacognitive conceptualization of suicidal crises and provide first indications of factors that might be relevant for the activation and maintenance of suicide-specific rumination.