Examining aspects of psychological flexibility within the integrated motivational-volitional model of suicidal behavior: A prospective investigation.

BACKGROUND: According to the integrated motivational-volitional model of suicide, feelings of entrapment are related to the emergence of suicidal ideation (SI). However, this relation can be moderated by certain protective factors. METHODS: This study examined whether aspects of psychological flexibility (i.e., experiential avoidance, experiential acceptance, harnessing) moderated the relation between aspects of entrapment and SI severity in college students experiencing SI (N = 553) both cross-sectionally and when SI severity was measured 1 week later (N = 247). RESULTS: At baseline, experiential acceptance, but not experiential avoidance or harnessing, significantly moderated the relation between external entrapment and SI severity and internal entrapment and SI severity. No aspects of psychological flexibility prospectively moderated relations between entrapment and SI severity. CONCLUSIONS: Aspects of psychological flexibility may influence immediate vulnerability to SI severity among young adults experiencing feelings of entrapment. Implications for clinical interventions influencing changes in psychological flexibility are discussed.

The Virtual Hope Box mobile application: A systematic review of the literature.

INTRODUCTION: The Virtual Hope Box (VHB) mobile application is an adapted version of the conventional hope box intervention that is used in several evidence-based treatments for suicide behaviors. The VHB is an award-winning app developed by a collaboration between the Departments of Defense and Veterans Affairs. Multiple studies have assessed the utility and effectiveness of the VHB for use in suicide prevention, but no reviews of the literature have been conducted. METHODS: Authors performed a review of the literature using PsycINFO, EBSCOhost, and PubMed. 15 articles were ultimately included. RESULTS: Results were categorized into three areas: (1) efficacy and effectiveness, (2) feasibility, awareness, and usage in high-risk populations, and (3) implementation approaches to increase use among patients and providers. Existing evidence for the VHB supports its feasibility and acceptability, especially among military and veteran populations. Only one study investigated effectiveness in a randomized control trial. Although the VHB developers have disseminated the app nationally, low adoption rates among veteran patients and VA providers remain. Studies found that educational implementation strategies can improve utilization rates. CONCLUSIONS: Future research should examine suicide behaviors as outcomes, approaches to incorporating the VHB into treatment, and a range of populations.

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

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

Factor Structure and Measurement Invariance of the Suicide Status Form-IV.

The Suicide Status Form-IV (SSF-IV) is the measure used in the Collaborative Assessment and Management of Suicidality (CAMS). The SSF-IV Core Assessment measures various domains of suicide risk. Previous studies established a two-factor solution in small, homogeneous samples; no investigations have assessed measurement invariance. The current investigation sought to replicate previous factor analyses and used measurement invariance to identify differences in the Core Assessment by race and gender. Adults (N = 731) were referred for a CAMS consultation after exhibiting risk for suicide. Confirmatory factor analyses indicated good fit for both one- and two-factor solutions while the two-factor solution is potentially redundant. Configural, metric, and scalar invariance held across race and gender. Ordinal logistic regression models indicated that neither race nor gender significantly moderated the relationship between the Core Assessment total score and clinical outcomes. Findings support a measurement invariant, one-factor solution for the SSF-IV Core Assessment.

Negative Urgency, (Lack of) Premeditation, and Sensation Seeking: Indirect Relationships with Suicidal Ideation through Thwarted Interpersonal Needs.

OBJECTIVE: Differences in how impulsivity is conceptualized, along with a myopic focus on impulsivity's relationship with historical suicidal behaviors, have resulted in limited implications made from prior research regarding impulsivity and suicidal thoughts and behaviors. The current study investigated the indirect effect facets of impulsivity may have on suicidal ideation, specifically, through thwarted interpersonal needs. METHODS: Participants were N = 424 undergraduate students who completed a cross-sectional survey. Participants completed the Urgency, Premeditation, Perseverance, Sensation Seeking, Impulsive Behavior Scale (UPPS), the Adult Suicide Ideation Questionnaire (ASIQ), and the Interpersonal Needs Questionnaire (INQ). Parallel mediation models were run to examine the relation between facets of impulsivity, perceived burdensomeness, thwarted belongingness, and suicidal ideation. RESULTS: Thwarted belonginess and perceived burdensomeness significantly accounted for the variance in the relation between negative urgency and suicidal ideation. Neither thwarted belongingness nor perceived burdensomeness significantly explained variance in the relation between (lack of) premeditation and suicidal ideation. Conversely, perceived burdensomeness and thwarted belonginess significantly explained the inverse relation between sensation seeking and suicidal ideation (i.e., greater sensation seeking was related to lower perceived burdensomeness and thwarted belongingness and in turn lower suicidal ideation). CONCLUSION: Negative urgency, in particular, is related to suicidal ideation through thwarted interpersonal needs. Future research should continue to differentiate between various types of impulsivity and its relationship with both suicidal ideation and behaviors utilizing both cross-sectional and ambulatory assessments of these constructs.HIGHLIGHTSNegative urgency is related to suicidal ideation.Negative urgency is related to thwarted interpersonal needs.Thwarted interpersonal needs partially explain the relation between negative urgency and suicidal ideation.

Frequency and predictors of virtual hope box use in individuals experiencing suicidal ideation: An ecological momentary assessment investigation.

INTRODUCTION: The Virtual Hope Box (VHB) is a smartphone application designed to support emotion regulation when one is distressed, in a crisis, or experiencing suicidal ideation (SI). Initial proof of concept studies indicate that individuals are more likely to use the VHB than traditional hope boxes, and find it both easy to setup and helpful. To our knowledge, no studies have harnessed ambulatory assessment methodology to assess VHB use as it relates to incidence of suicidal thinking. METHODS: As such, we recruited N = 50 undergraduates who endorsed SI either the past year or past 2 weeks to complete a 10-day investigation. At baseline, participants were oriented to the VHB and instructed on how to use the application. Over the next 10 days, participants responded to prompts five times per day on their personal smartphones regarding their current experiences of SI and stress as well as VHB usage. RESULTS: Results found that most participants used the VHB at least once, rated its usefulness as high, and rated their perceived likelihood of future use as high. In addition, increases in state SI severity were related to subsequent VHB use. CONCLUSION: The VHB may be a useful tool for managing crises in undergraduates experiencing suicidal thoughts.

The Link between Deployment-Related Injuries and Suicidal Thinking in the Army National Guard: Examining the Role of Perceived Burdensomeness and Hopelessness.

OBJECTIVE: In 2020, Army National Guard members demonstrated greater risk of suicide than their military and civilian counterparts. Though literature on deployment-related experiences and suicidal ideation (SI) is mixed, investigations of specific deployment-related experiences (e.g., injuries) may further elucidate the relationship between deployment and suicide risk. Deployment-related injuries, including pain severity and functional impairment, have been linked to increased risk of SI, and correlates like perceived burdensomeness (PB) and hopelessness. The current study sought to examine the cross-sectional relationship between deployment-related injuries, including pain severity and functional impairment, and severity of SI through PB and hopelessness. METHOD: Immediately post-deployment, Army National Guard members (N = 2,261) completed validated self-report measures on past-week SI, PB, hopelessness, and single items regarding injury sustained during deployment and associated functional impairment and pain severity. RESULTS: Indirect effect analyses revealed that experience of deployment-related injury was related to SI through PB and hopelessness (R2 = .1993), functional impairment was related to SI through PB, and pain severity was related to SI through PB. Contrary to hypotheses, hopelessness was not associated with SI when PB was simultaneously considered. CONCLUSIONS: Army National Guard members who develop a sense of PB related to their injury and functional impairment of that injury may be at increased risk for suicidal ideation. Military suicide-prevention efforts may be potentiated through targeting distorted cognitions such as PB and hopelessness, especially in service members who have been injured.

Examination of real-time variation in interpersonal hopelessness and suicidal desire in a college student sample reporting past-2-week suicidal ideation.

INTRODUCTION: Interpersonal hopelessness (IH), as outlined in the Interpersonal Theory of Suicide, is theorized to include two correlated, distinct constructs: hopelessness about one's thwarted belongingness (IH-TB) and about perceived burdensomeness on others (IH-PB). Few studies have explored IH, and none have explored its temporal stability or prospective prediction of suicidal desire. METHODS: Undergraduates (N = 43) selectively recruited for past-2-week suicidal ideation completed five ecological momentary assessment surveys per day for 10-days. Intraclass correlations, root mean square of successive differences, and multilevel models were used to examine the data and test relationships among predictor variables. RESULTS: IH-TB and IH-PB demonstrated greater temporal stability than general hopelessness. IH-TB, IH-PB, and their interaction were significant predictors of suicidal desire concurrently and prospectively. IH-PB was no longer significantly predictive of suicidal desire when adjusting for general hopelessness. Post-hoc models showed that suicidal desire was not predictive of IH-TB, IH-PB, or their interaction suggesting the relationship is not recursive. CONCLUSION: Results showed that interventions aimed at decreasing one's hopelessness specific to TB and PB may be beneficial for decreasing suicidal desire. Future research should seek to replicate these results in larger and more diverse samples and consider the use of shorter ambulatory assessment intervals.

Perceived stress and suicidal ideation: The role of dispositional mindfulness.

OBJECTIVES: Extant literature suggests that dispositional mindfulness may reduce the impact perceived stress has on the severity of suicidal ideation (SI). Only one study has analyzed this question but did so with a cross-sectional design in a sample of undergraduate women. METHODS: This study analyzed the potential moderating role of dispositional mindfulness on the relation between perceived stress and SI cross-sectionally and at one-week follow-up in a sample of US adults (N = 598) with a history of SI. RESULTS: Results indicated that dispositional mindfulness and its facets were inversely related to perceived stress, SI severity at baseline, and SI severity one week later. At baseline, regression results indicated that only the nonreacting component of dispositional mindfulness interacted with perceived stress to concurrently predict SI severity. This relation was not significant when SI severity was measured one week later. LIMITATIONS: Study results are limited by the high attrition rate from baseline to follow-up and the relatively homogeneous sample. CONCLUSION: Study results indicate that dispositional mindfulness, particularly components related to nonreacting, is inversely related to SI severity concurrently but not prospectively. Interventions focused on mindfulness skills, particularly skills around nonreaction to inner experience, may be beneficial for those considering suicide.

Veteran suicide rates mirror, but do not account for, elevated suicide rates among the general population in US cultures of honor.

INTRODUCTION: Veteran total and firearm suicide rates are higher compared to the general population. Among the general population, total and firearm suicide rates are higher in US states deemed cultures of honor compared to non-honor states, likely because honor states have higher firearm ownership rates and fewer firearm laws. Considering that veterans tend to live in states with fewer firearm laws and that veteran population rates predict both statewide total and firearm suicide rates, it is possible that the elevated suicide rates seen in honor states in part due to those states having a greater presence of veterans compared to non-honor states. METHOD: Publicly available databases were used to obtain total and firearm suicide rates (per 100 k) for veterans and non-veterans, as well as our covariates (e.g., rurality). RESULTS: Veteran population proportions were higher in honor states than non-honor states. Veteran and non-veteran total and firearm suicide rates were higher in honor states compared to non-honor states. Statewide differences in all four suicide rates were indirectly explained by honor states having higher firearm ownership than non-honor states. CONCLUSIONS: These findings add to a growing body of literature showing that enacting firearm regulations may be a viable public health approach for preventing suicide.

The Temporal Dynamics of Wish to Live, Wish to Die, and Their Short-Term Prospective Relationships With Suicidal Desire.

The internal debate hypothesis (Kovacs & Beck, 1977) suggests that those at risk for suicidal thoughts and behaviors may experience fluctuations in both the wish to live (WTL) and wish to die (WTD). Previous research has investigated this hypothesis using various cross-sectional (Goods et al., 2019 [cf. Page & Stritzke, 2020]) and longitudinal methodologies (e.g., Bryan et al., 2016). No investigations have determined the within-day temporal dynamics of WTL and WTD using ecological moment assessment (EMA), however. N = 49 undergraduate university students recruited from a research participant pool from a large southeastern university in the United States with a lifetime history of suicide ideation completed the current 10-day EMA investigation. Results demonstrated that WTL, WTD, and resulting suicidal ambivalence (i.e., relatively equal WTL/WTD ratings) demonstrated similar within-person person variability; however, WTD scores appeared to demonstrate higher average variability compared to WTL and ambivalence scores. Although state WTL and WTD were concurrently related to state suicidal desire, only WTD prospectively predicted suicidal desire when controlling for the influence of the outcome variable at the previous timepoint. Ambivalence scores also prospectively predicted suicidal desire when controlling for suicidal desire at the previous timepoint. Results support the clinical and theoretical utility of separate WTL and WTD assessment. WTD was relatively stable within this sample but may be closely related to risk for future suicidal thinking. Changes in WTL may reduce state risk for suicidal desire but could be more trait-like in nature compared to WTD. Future research that investigates these hypotheses should consider the study limitations outlined.

Suicide Cognitions Scale: Psychometric Support in a Community Sample Using Bifactor Modeling and Altered Item Content.

The Suicide Cognitions Scale (SCS) measures suicide-related beliefs proposed by the Fluid Vulnerability Theory. A recent investigation of a revised version of the SCS (i.e., SCS-R) which omits items explicitly referencing suicide has indicated that the measure is highly influenced by a general factor and may be useful for distinguishing severity levels of suicidal thoughts and behaviors; however, limited concurrent validity studies with a range of suicide-related experiences have been conducted. As such, this study replicated and extended previous psychometric research on the SCS-R in an online survey study with a community sample of N = 10,625 U.S. adults. Results confirmed the unidimensional structure of the SCS-R. Logistic regression analyses indicated that the total score of the SCS-R is useful in distinguishing varying levels of suicidal thoughts and behaviors such as past-month planning for suicide without attempt versus past-month suicide attempt. Implications and limitations are discussed.

Substance Misuse among a Diverse Psychiatric Inpatient Sample: Suicidal Thoughts and Behaviors and Motivation to Change.

Suicidal thoughts and behaviors (STBs) are among the most common reasons for admission to psychiatric inpatient units and a large percentage of these patients also engage in substance misuse. Yet, no known studies have examined whether patients with STBs admitted to inpatient psychiatry units are motivated to change their substance misuse and, if so, whether they benefit from MET-CBT for substance misuse while on the inpatient unit. This study assesses the relationship between STB and motivation to improve substance misuse among 321 (61.1% male, Mage = 35.3 years, 59.8% non-Hispanic/Latin White) patients admitted to an inpatient psychiatric unit with a substance use disorder (SUD) or substance misuse who attended at least one group MET-CBT session, 50.2% of whom were admitted to an inpatient unit for STBs. Patients admitted for STBs reported greater motivation to reduce substance misuse than patients admitted without documented STB, and they did not differ from patients without documented STBs on the number of MET-CBT sessions attended, or ratings of session helpfulness (which were high). Patients admitted for STBs reported significantly increased motivation to change substance misuse after attending MET-CBT for SUD. These findings indicate that psychiatric inpatients with STBs report motivation to change substance misuse as well as willingness to attend MET-CBT for their SUD.

Vehicle Firearm Storage: Prevalence and Correlates in a Sample of Male Firearm Owners.

Previous research has linked unsafe firearm storage practices and other ownership-related characteristics to key factors that facilitate the transition from suicidal thoughts to suicidal behaviors (i.e., acquired capability for suicide). This research has not investigated the extent to which firearm owners store firearms in their vehicles, a factor that increases ready access to the most lethal means of suicide. OBJECTIVE: This cross-sectional study investigated the prevalence of occasional and permanent vehicle firearm storage as well as demographic and psychological correlates of this practice in a sample of N = 408 adult male firearm owners oversampled for historical thoughts of suicide. METHODS: Participants completed an online survey for monetary compensation. RESULTS: Over 40% of participants indicated at least occasionally storing firearms in their vehicles with over 15% indicating storage of firearms unlocked and loaded. Elevated scores on measures of negative affect, worry, intolerance of uncertainty, and historical suicidal thoughts and behaviors were seen in those who endorsed vehicle firearm storage compared to those who did not. CONCLUSION: Individual and public health firearm safety strategies would benefit from an explicit focus on the transition of firearms to and from one's vehicle.HIGHLIGHTSOver 40% of male firearm owners at least occasionally store a firearm in a vehicle.15% of those who store a firearm in a vehicle do so unlocked and loaded.Suicidal thought severity was related to storing a firearm in a vehicle.Historical suicidal behaviors were related to storing a firearm in a vehicle.

Perfectionism and Suicidal Ideation.

Background: The integrated motivational-volitional (IMV) model of suicidal behavior posits that defeat leads to suicidal ideation through increased vulnerability for feelings of entrapment. One potentially important vulnerability factor for the development of feelings of defeat is socially prescribed perfectionism. Aims: The current study investigated these relationships in a sample of 313 US adults. Method: Mediation and parallel mediation analyses were conducted to determine the relationships between defeat, entrapment, social prescribed perfectionism, negative social comparison, and rejection sensitivity. Results: Findings indicated that socially prescribed perfectionism was significantly related to defeat through both negative social comparison and rejection sensitivity even when controlling for depression symptoms. Negative social comparison and rejection sensitivity were related to entrapment through feelings of defeat. This relationship was strongest when analyzing externalized (vs. internalized) entrapment. Limitations: The findings were limited by the cross-sectional study design as well as the relatively homogeneous sample. Implications and future directions are discussed.

Examining the Interrelationships Among Suicide Cognitions, Suicidal Ideation, and Theoretically Derived Protective Factors.

INTRODUCTION: Several protective factors for mitigating suicidal ideation (SI) such as positive affect, reasons for living, purpose in life, meaning in life, gratitude, grit, optimism, social support, and hope have been identified and received empirical support. However, few studies have examined the interrelationships of these protective factors and the identification of protective factors most closely linked to lower levels of SI may be useful for both theory-building initiatives and improvement of suicide-specific interventions. Network analysis offers an approach for testing the relation among these constructs, SI, and suicide risk factors. METHODS: A sample N = 557 undergraduate students oversampled for lifetime SI completed a cross-sectional, online survey. The data was used to estimate an undirected, cross-sectional network of the aforementioned protective factors. RESULTS: The resulting inferred network implicates strong negative influence of suicide cognitions, but not recent SI, and the strong positive influence of presence of meaning in life, trait hope, and low negative affect. CONCLUSIONS: Implications for dimensionality of SI versus suicide cognitions, targeting presence of meaning in life, trait hope, and negative affect in treatment, and cross-cultural variations in reasons for living are discussed. The study is limited by the cross-sectional and convenience sampling methodology.HighlightsProtective factors may have less direct influence on suicidal ideationSuicide cognitions and the suicidal mode may be of phenomenological importancePresence of meaning and trait hope may be primary targets for suicide interventions.

Defeat, Entrapment, and Hopelessness: Clarifying Interrelationships between Suicidogenic Constructs.

Psychological theories of suicide posit conceptually similar constructs related to the development of suicidal thinking. These constructs often evince high-magnitude interrelationships across studies. Within these theories, defeat, entrapment and hopelessness standout as conceptually and quantitatively similar. Theoretical improvements may be facilitated through clarifying the subscale and item-level similarities among these constructs. Factor analytic and phenomenological work has demonstrated equivocal evidence for a distinction between defeat and entrapment; hopelessness is not typically analyzed together with defeat and entrapment despite evidence of large-magnitude interrelationships. This study explored the interrelationships among the foregoing constructs within a sample of undergraduate students (N = 344) from two universities within the Southeastern United States. Participants, oversampled for lifetime history of suicidal ideation and attempts, completed an online cross-sectional survey assessing defeat, entrapment, hopelessness and SI. Exploratory factor and parallel analyses demonstrated support for a one factor solution when analyzed at subscale level of the three measures as well as when all items of the three measures were analyzed together. Ad hoc exploratory structural equation modeling (ESEM) bifactor results evinced support for the existence of a single, general factor at the item level. Item level communalities and bifactor fit indices suggest that hopelessness may be somewhat distinct from defeat and entrapment. Clinical and theoretical implications are discussed in the context of study limitations.

Development and initial psychometric properties of the Cannabidiol Outcome Expectancies Questionnaire (CBD-OEQ).

Cannabidiol (CBD), a nonpsychoactive cannabinoid, is used by many individuals to treat medical and mental health conditions, despite limited support for the efficacy of CBD for these conditions. Identification of CBD-related outcome expectancies (i.e., beliefs concerning the anticipated effects of CBD) could be useful in understanding the etiology and maintenance of CBD use and/or be useful in administration or clinical trial research. Although there are several measures of cannabis outcome expectancies, cannabis comprises several active compounds (e.g., tetrahydrocannabinol [THC], CBD). Thus, cannabis outcome expectancies may not reflect CBD-specific outcome expectancies. Yet, no known CBD-specific outcome expectancy measure exists. The present study used a three-phase, mixed-methods approach to develop and test the psychometric properties of the Cannabidiol Outcome Expectancy Questionnaire (CBD-OEQ). The CBD-OEQ assessed endorsement (i.e., how much an individual agrees/disagrees with an expected outcome) and desirability ratings (i.e., how desirable an expected outcome is). The initial item pool was administered to 600 adults who endorsed having heard of or using CBD products. Factor analyses supported a 60-item, six-factor structure. There was an initial support for internal consistency and convergent, discriminant, and incremental validity of the CBD-OEQ subscale scores in the present sample. Desirability ratings explained minimal additional variance in CBD variables for most subscales, but moderated the relationship between endorsement ratings and use behaviors for Global Negative Effects and No Effect subscales. The newly developed CBD-OEQ could be used as both a research and a clinical tool. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Experiences of hospitalization for suicide ideation and suicide attempt in gender diverse adults.

INTRODUCTION: This study sought to investigate general perceptions of suicide-related hospital-based care that Transgender/Gender Diverse (TGD) adults have experienced as well as correlates of their perceived usefulness of this care. METHODS: Data were collected via a cross-sectional online survey of N = 3718 self-identified TGD individuals. Single-item self-report measures of all constructs of interest were used. RESULTS: A total of n = 1056 participants indicated hospitalization for either a past suicide attempt (SA) or suicidal ideation (SI). Irrespective of being hospitalized for SI or SA, perceived usefulness of hospital-based care was low with 50% or more of participants rating their care as some degree of unhelpful. Older age, general trust in mental healthcare providers, and voluntary admission were related to higher perceived helpfulness of care for both SI and SA admissions. Higher pride in TGD identity was positively related to perceived helpfulness of care but only for admissions related to SAs. CONCLUSION: Improving perceived usefulness of hospital-based care may be important for improving subsequent suicide-related help-seeking. Increasing training and provision of care that improves trust with mental healthcare providers and potentially reduces need for involuntary admission may help improve hospital-based, suicide-related care in TGD adults.