Late-life suicide: machine learning predictors from a large European longitudinal cohort.

Background: People in late adulthood die by suicide at the highest rate worldwide. However, there are still no tools to help predict the risk of death from suicide in old age. Here, we leveraged the Survey of Health, Ageing, and Retirement in Europe (SHARE) prospective dataset to train and test a machine learning model to identify predictors for suicide in late life. Methods: Of more than 16,000 deaths recorded, 74 were suicides. We matched 73 individuals who died by suicide with people who died by accident, according to sex (28.8% female in the total sample), age at death (67 ± 16.4 years), suicidal ideation (measured with the EURO-D scale), and the number of chronic illnesses. A random forest algorithm was trained on demographic data, physical health, depression, and cognitive functioning to extract essential variables for predicting death from suicide and then tested on the test set. Results: The random forest algorithm had an accuracy of 79% (95% CI 0.60-0.92, p = 0.002), a sensitivity of.80, and a specificity of.78. Among the variables contributing to the model performance, the three most important factors were how long the participant was ill before death, the frequency of contact with the next of kin and the number of offspring still alive. Conclusions: Prospective clinical and social information can predict death from suicide with good accuracy in late adulthood. Most of the variables that surfaced as risk factors can be attributed to the construct of social connectedness, which has been shown to play a decisive role in suicide in late life.

Meaningful Associations Between Motivation for Treatment and Interpersonal Needs Within a Residential Sample of Women With Eating Disorders.

OBJECTIVE: Perceived burdensomeness (PB) and thwarted belongingness (TB), two proximal risk factors for suicide, may rise during residential eating disorder (ED) treatment when patients are separated from support and face exorbitant costs of care. In this setting, fostering motivation for treatment is challenging, and low motivation for treatment may exacerbate feelings of PB and TB. Simultaneously, PB and TB could reduce motivation for treatment, though no studies have explored this relationship longitudinally. Accordingly, this study examined associations between interpersonal needs (TB, PB) and motivation for treatment across the first 6 weeks of residential ED treatment. METHODS: Participants (n = 98) completed the Interpersonal Needs Questionnaire (INQ) and rated treatment motivation weekly. Pearson bivariate correlations examined the relationship between motivation and interpersonal needs at each timepoint. Two autoregressive cross-lagged panel models (AR-CLPMs) tested reciprocal relationships between these constructs longitudinally across the first 6 weeks of treatment. RESULTS: Motivation was significantly negatively correlated with PB and TB at all timepoints. In AR-CLPM 1, Week 2 Motivation predicted Weeks 3 PB, then Week 3 PB predicted Week 4 Motivation. In AR-CLPM 2, Week 2 TB predicted Week 3 Motivation, but Motivation did not predict TB at any timepoint. DISCUSSION: This study is the first to examine longitudinal relations between interpersonal needs and treatment motivation in residential ED care. PB and TB may influence one's motivation for treatment, although motivation and PB had a stronger reciprocal relationship than motivation and TB. Interpersonal needs should be addressed early in residential treatment to mitigate negative cycling.

Long-term impact of adverse childhood experiences and perceived social support on depression trajectories.

BACKGROUND: While the impact of adverse childhood experiences (ACEs) on depression is well-documented, how ACEs, physical violence victimization, social support, and school belongingness altogether shape depression from adolescence to young adulthood remains unclear. This study aims to clarify these relations by tracing the trajectory of depression across this critical developmental period. METHODS: We utilized a 14-year, four-wave dataset from the National Longitudinal Study of Adolescent to Adult Health (Add Health), including 5734 participants who were 7th to 12th graders at baseline (51.4 % females). Latent growth curve modeling (LGCM) was used to analyze the trajectory of depression from adolescence to young adulthood, assessing the impact of ACEs, physical violence victimization, social support, and school belongingness on this progression. RESULTS: Results from the LGCM indicated that childhood maltreatment and physical violence victimization were positively associated with an increase in depression from adolescence to young adulthood. Conversely, social support and school belongingness showed a negative association with depression, indicating their protective effects over time. Gender was found to moderate these longitudinal associations, with females showing increased vulnerability to the negative relations between early stressful environments (i.e., childhood maltreatment and physical violence victimization) and depression. Conversely, they seemed to benefit more from school belongingness and social support in mitigating depression. LIMITATIONS: The study variables were all self-reported and exhibited some issues with reliability. CONCLUSION: Practitioners should implement gender-specific programs for the prevention and intervention of depression from adolescence through young adulthood.

Belongingness in medical students: did it change during lockdown?

Belongingness has been proposed as a potential proxy for legitimate peripheral participation in medical education. Previous studies have shown good internal and external validity for tools designed to measure this variable, with potential use measuring the effectiveness of clinical teaching environments and as a marker of student wellbeing. This study examined changes in belongingness in medical students at the University of Exeter measured in spring 2019 and the equivalent period in 2021, during which COVID-19 related restrictions were in place in the United Kingdom. This study used a validated assessment tool that was self-administered via an online survey platform in 2021. Anonymised data was collected from undergraduate medical students from all years of training and results compared with previous data collected in 2019. The belongingness assessment tool described here had validity in undergraduate medical students studying at the University of Exeter and identified statistically significant changes in belongingness (as measured with this tool) between 2019 and the period during which COVID-19 restrictions were in place. These results suggest that belongingness - in undergraduate medical students fluctuates and varies under different conditions and that there was a statistically significant change during the period of lockdown restrictions. The ability to measure this key facet of educational development has the potential to monitor teaching environments to ensure optimal learning conditions for all students. Further work is required to assess whether the impacts of lockdown restrictions are transient or persist beyond the period of teaching restrictions and to determine any association with academic outcomes.

Beyond one-size-fits-all suicide prediction: Studying idiographic associations of risk factors for suicide in a psychiatric sample using ecological momentary assessment.

The Interpersonal Psychological Theory of Suicide (IPTS) states that thwarted belongingness (TB), perceived burdensomeness (PB), and hopelessness are risk factors for suicidal ideation. This ecological momentary assessment (EMA) study aimed to (1) demonstrate that there is substantial between-person variability in the association between IPTS predictors and suicidal ideation, (2) identify clusters of patients for which the predictors differently predict suicidal ideation, and (3) examine whether identified clusters are characterized by specific patient characteristics. EMA data were collected ten times per day for six days in 74 psychiatric inpatients and was analyzed with dynamic structural equation modelling. Idiographic associations were obtained and clustered using k-means clustering. We found substantial between-person variability in associations between IPTS predictors and suicidal ideation. Four distinct clusters were identified and different risk factors were relevant for different clusters. In the largest cluster (n = 36), none of the IPTS predictors predicted suicidal ideation. Clusters in which associations between IPTS variables and suicidal ideation were stronger showed higher suicidal ideation, depression, and lower positive affect. These findings suggest that a one-size-fits-all model may not adequately reflect idiosyncratic processes leading to suicidal ideation. A promising avenue might be to use idiographic approaches to personalize prediction and interventions.

Enabling and inhibiting doctors transitions: introducing the social identity resource and belonginess model (SIRB).

The transition into postgraduate medical training is complex, requiring an integration into the workplace, adjustment to new identities, and understanding of the social and organisational structure of healthcare. Studies suggest that social resources, including a sense of belonging, inclusivity from social groups, and having strong social identities can facilitate positive transitions. However, little is known about the role these resources play in junior doctors' transitions into the healthcare community. This study aimed to explore the implications of having access to social resources for junior doctors. This study undertook secondary analysis from a longitudinal qualitative study which followed 19 junior doctors (residents within two years of qualification) for nine months. Data were thematically analysed using an abductive approach, with the social identity resource and belongingness (SIRB) model as a conceptual lens to explore how social networks of support act as identity resources (IRs) for junior doctors as they experience transitions. The doctors narrated that having accessible IRs in the form of supportive workplace relationships enabled an integration and a sense of belonging into healthcare practice, supported the construction of new professional identities, and strengthened career intentions. Those with inaccessible IRs (i.e. poor workplace relationships) expressed a lack of belonging, and casted doubt on their identity as a doctor and their career intentions. Our study indicates that SIRB model would be beneficial for medical educators, supervisors, and managers to help them understand the importance and implications of having IRs within the workplace environment and the consequences of their accessibility for healthcare staff experiencing transitions.

Connected for life: How social connectedness can help prevent suicide in American Indian and Alaska Native communities.

Enhancing social support and connectedness can reduce suicide risk, yet few studies have examined this effect in American Indian and Alaska Native (AI/AN) adults. We assessed suicidal ideation and behavior, thwarted belongingness, social support, enculturation, historical trauma, and traumatic life events in 709 AI/AN adults at high risk of suicide from five AI/AN communities. Suicidal ideation was associated with thwarted belongingness and protected against by social support and engaging in AI/AN ceremonies. Among those who made lifetime suicide attempts, traumatic life events, symptoms of depression/anxiety due to historical trauma, and thwarted belongingness were linked to more attempts. More engagement in cultural practices was associated with fewer suicide attempts. Higher levels of social support were associated with more suicide attempts, an observation potentially attributable to the cross-sectional nature of the study. Interventions should focus on protective factors and context-specific interventions emphasizing community history, values, and strengths.

Thwarted Belongingness and Depressive Symptoms Among Older Adults: The Moderating Roles of Self-Warmth, Self-Coldness, and Place of Residence.

OBJECTIVES: This study investigated whether the relationship between thwarted belongingness and depressive symptoms was moderated by self-warmth and self-coldness and whether the moderating effects were conditional on place of residence (urban versus rural). METHODS: A sample of 236 Australian adults aged 65 to 97 years (M = 73.63, SD = 6.53) completed the Geriatric Depression Scale, Interpersonal Needs Questionnaire, and Self-Compassion Scale. RESULTS: The interaction between thwarted belongingness and self-warmth was significant for urban but not rural older adults. For urban older adults, the relationship between thwarted belongingness and depressive symptoms weakened as levels of self-warmth increased. The association between thwarted belongingness and depressive symptoms was significantly stronger for older adults living in rural areas than in urban areas. The relationship between thwarted belongingness and depressive symptoms strengthened as self-coldness levels increased. CONCLUSIONS: Self-warmth is a protective factor for older adults living in urban areas and experiencing thwarted belongingness. Self-coldness is an additional risk factor for older adults experiencing thwarted belongingness. CLINICAL IMPLICATIONS: Interventions focusing on increasing self-warmth among urban older adults and decreasing self-coldness among older adults might weaken the relationship between thwarted belongingness and depressive symptoms.

Relationship between clinical belonging, professional identity, and nursing information ability among nursing interns: Model construction.

BACKGROUND: Clinical belonging refers to the feeling that clinical medical staff feel recognized and accepted by others or groups. The level of clinical belonging of nursing interns affects students' learning motivation and confidence, which in turn affects their clinical practice behavior. AIM: To explore the effects of professional identity and nursing information ability on clinical belonging among nursing interns and establish a relationship model for these factors. METHODS: The researchers used the convenience sampling method to select 682 nursing interns from China. The survey was conducted using a general information questionnaire, clinical sense of belonging scale, nursing information ability self-assessment scale, and a nursing student professional identity questionnaire. The mediating effect of nursing information ability between their professional identity and clinical sense of belonging was analyzed using SPSS 21.0 and the path analysis in structural equation modeling. RESULTS: The total scores of clinical belonging, professional identity, and nursing information ability of nursing interns were (104.29 ± 13.11) points, (57.89 ± 7.16) points, and (70.29 ± 6.20) points, respectively. Nursing information ability had a direct effect on the clinical sense of belonging (effect value = 0.46, P < 0.05). Occupational identity had a direct effect (effect value = 0.52, P < 0.05) and an indirect effect (effect value = 0.21, P < 0.05) on clinical belonging. CONCLUSION: Nursing administrators in nursing colleges and hospitals should take effective measures to improve the professional identity and nursing information ability of nursing interns, as well as the clinical sense of belonging among nursing interns.

Perceived burdensomeness and thwarted belongingness as mediators of the relation between anxiety and suicidal ideation among adolescents.

INTRODUCTION: Anxiety and suicidal ideation have been shown to be positively related in adolescents. However, less is known about the strength of this association across different types of anxiety or the mechanisms through which this relation exists. Joiner's interpersonal theory of suicide suggests that thwarted belongingness (TB) and perceived burdensomeness (PB) lead to suicidal ideation; these constructs may explain a pathway through which anxiety and suicidal ideation are related. It was hypothesized that TB would mediate the relation between social anxiety disorder (SAD) symptoms and suicidal ideation, and PB would mediate the relation between generalized anxiety disorder (GAD) symptoms and suicidal ideation. METHODS: These longitudinal mediation models were assessed using data collected from 147 depressed adolescents, who were recently hospitalized for suicidal ideation or behavior, enrolled in a randomized controlled trial (RCT). RESULTS: Consistent with study hypotheses, PB mediated the relation between GAD symptoms and suicidal ideation severity. However, TB did not mediate the relation between SAD symptoms and suicidal ideation severity. CONCLUSION: These results suggest that screening for and addressing PB among youth with GAD may help reduce risk for suicidal behavior.

The bidirectional longitudinal associations between fear of negative evaluation and suicidal ideation among Chinese adolescents: The mediating role of interpersonal needs factors.

Based on previous theories and studies, fear of negative evaluation (FNE) may be a key predictor of suicidal ideation in adolescents. However, few studies examined the longitudinal relationships between FNE and suicidal ideation. This study aimed to explore the bidirectional longitudinal relationships between FNE and suicidal ideation. Meanwhile, based on the Interpersonal Theory of Suicide, this study would examine the longitudinal mediating role of interpersonal needs factors (thwarted belongingness and perceived burdensomeness) on the relationship between FNE and suicidal ideation. A sample of 515 adolescents (Mage = 12.309, SD = 0.807; 49.3 % girls) completed questionnaires on 4 waves, 6 months apart. The Random Intercept Cross-Lagged Panel Models (RI-CLPMs) were utilized to estimate the associations among study variables. The results showed that: (1) there was a significant bidirectional longitudinal relationship between FNE and suicidal ideation; (2) thwarted belongingness and perceived burdensomeness independently and serially mediated the relationship between FNE and suicidal ideation. This study contributed to understanding the complex relationship between FNE and suicidal ideation, emphasizing the critical roles of thwarted belongingness and perceived burdensomeness. The findings underscore the bidirectional nature of these associations and provide insights into the potential pathways involved in the development of suicidal ideation among adolescents.

Do measures of social support and social distress share general factors associated with suicidal ideation and attempts?

INTRODUCTION: Aspects of social relationships have variably been associated with suicidal ideation (SI) and suicide attempts (SAs). This study assessed whether social support and social distress measures have general factors versus measure-specific factors that are associated with suicide risk. METHODS: Adults (N = 455, 60.0% female), admitted to psychiatric inpatient units following a recent suicide attempt or active SI, completed assessments of social support (emotional support, instrumental support, friendship, perceived support from significant others, friends, family) and social distress (loneliness, perceived rejection, perceived burdensomeness, thwarted belongingness). Bifactor modeling examined general and specific factors of social support and distress in relation to SI (week prior to hospitalization, via the Beck Scale for SI) and SAs (past 30 days, via the Columbia Suicide Severity Rating Scale). RESULTS: SI was significantly associated with the general social support (B = -1.51), the general social distress (B = 1.67), and the specific perceived burdensomeness (B = 1.57) factors. SAs were significantly associated with the specific Perceived Rejection (OR = 1.05) and Thwarted Belongingness (OR = 0.91) factors. CONCLUSION: General social support and social distress were associated with SI but not recent SAs. Specific social distress factors were also related to SI and SAs controlling for general social distress, suggesting areas for future interventions.

Belongingness, Well-Being and an Interview With Dr Pauline Dow.

The Supreme Court decision that race conscious admissions policies in universities are unconstitutional has created questions and concerns about the sustainability of diversity, equity and inclusion programs in many organizations and across sectors. This editorial provides hopeful examples of how belongingness is being embraced as a core value in many organizations. In an interview with education expert, Dr Pauline Dow, we discuss ways that the education sector creates trust and belongingness and explore best practices and leadership development methods that allow teachers to thrive. Lessons learned in the educator sector offer insights into how belongingness can be cultivated in other sectors, organizations and communities.

Thwarted belongingness and empathy's relation with organizational culture change.

Introduction: In response to several high-profile cases of senior leaders in the Canadian Armed Forces (CAF) being accused of various forms of sexual and professional misconduct, the organization has committed to culture change. Drawing on the group engagement model and empirical evidence, we propose that CAF members' experience of thwarted belongingness reduces their capacity to show empathy, which in turn affects their support for culture change. Method: Participants were 139 Naval and Officer Cadets from the Royal Military College of Canada who were predominantly male (61%), between 18 and 21 years old (80%), and not members of a visible minority group (68%). Data was collected via an online self-report survey assessing thwarted belongingness, empathy, and attitudes toward culture change. Results: Whether participants experienced thwarted belongingness was not directly related to their level of support for culture change. Individuals' thwarted belongingness was indirectly and negatively associated with support for culture change, through its impact on empathy. Discussion: Taken together, the results demonstrate that cadets' experience of belongingness contributed to their level of empathy, which together predicted their support for culture change initiatives. Efforts to change the culture of the CAF may need to consider improving members' levels of belongingness and, by extension, their levels of empathy. Implications for inclusion efforts are discussed.

Exploring the use of the Interpersonal Needs Questionnaire to examine suicidal thoughts and behaviors among Post-9/11 U.S. Combat Veterans: An integrative review.

This integrative review expands on the work of Kramer et al. (2020), by reviewing studies that utilized the Interpersonal Needs Questionnaire (INQ) to examine the interpersonal constructs (thwarted belongingness and perceived burdensomeness) of the Interpersonal Theory of Suicide (ITS) to understand suicidal thoughts and behaviors among service members and Veterans with combat experience. Very few studies (n = 9) in the literature were identified, however important relationships were revealed between combat exposure/experiences, thwarted belongingness, perceived burdensomeness, and suicidal thoughts and behaviors among military samples. Studies also reported risk factors for high levels of thwarted belongingness or perceived burdensomeness in military samples, such as moral injuries, betrayal, and aggression. This review highlights the utility of the INQ to measure ITS constructs among Post-9/11 U.S. Combat Veterans.

The moderating role of belongingness in the contribution of depression to suicide ideation following the October 7, 2023, terrorist attack in Israel: A nationwide prospective study.

INTRODUCTION: With >1300 civilians murdered, the terrorist attack of October 7 is one of the deadliest terrorist attacks in modern history. Previous research documented a sharp increase in depression in the aftermath of the attacks and the military conflict that followed. In this national prospective cohort study, we examined to what extent perceived belongingness (PB) moderates the association between depression and suicide ideation (SI) in the wake of the October 7th terrorist attack. METHODS: A representative sample of 710 Israeli adults (of them, 362 females, 51.1 %), Jews (557, 79.9 %), and Arabs (153, 20.1 %), aged 18-85 (M = 41.01, SD = 13.72) completed questionnaires assessing depression, current SI, and perceived belongingness at two timepoints: T1 (in August 2023) and T2 (in November 2023). RESULTS: Perceived belongingness at T1 predicted SI at T2 beyond demographic and trauma-related characteristics. Importantly, we found a significant interaction in which a PB at T1 moderated the link between depression and current SI at T2. Specifically, the level of depression at T2 contributed to current SI-T2 more strongly for individuals with low PB levels than for individuals with high PB levels. DISCUSSION: Our study highlights the impact of PB on SI following the October 7th terrorist attack. Clinicians treating individuals coping with depression should attend to their patients' sense of belongingness, as low PB comprises a significant risk factor for current SI. Moreover, community and national initiatives that could increase levels of PB among the citizens may help to diminish suicide risk in the aftermath of the attack.

Targeting belongingness among older people through engagement in senior centres: intervention development study in Denmark.

Adults often experience a loss of social relations and sense of belonging in later life, leading to the risk of social isolation. Municipal senior centres offer a potential site for intervention, as they provide social communities targeting older people. However, not all older people find it easy to access these social communities due to experiencing physical and/or psychosocial frailties and could therefore continue to experience a decline in social relations and sense of belonging, which potentiates poor physical and psychosocial health and well-being. To date, there are limited evidence-based interventions in Denmark. The present article describes the development of an intervention to increase belongingness and decrease social isolation among older people with frailties who attend Danish municipal senior centres. The development process was conducted with reference to the INDEX (IdentifyiNg and assessing different approaches to DEveloping compleX intervention) guidance. The development process resulted in a 6-month supportive intervention, consisting of four elements: skills development workshops for all staff members; a start conversation including frailty screening; allocation of a 'buddy' among existing service users; and monthly follow-up conversations with staff members. This theory-informed approach can progress to feasibility testing and outcome evaluation in order to generate an evidence base. Concurrently, the article reflects on current guidance for intervention development and how it may be used and optimized to strengthen developmental processes in the future.

Psychological mechanisms of the development of suicidal ideation: Longitudinal cohort study.

INTRODUCTION: This study aimed to investigate the mechanisms of the development of suicidal ideation and its moderating and protective factors. Drawing on the Interpersonal-psychological theory of suicide, we proposed that disruptions to belongingness, in conjunction with tolerance of health risk, may influence the development of suicidal ideation above and beyond psychosocial changes such as disruptions to finances and work. METHODS: The study involved a longitudinal investigation of an Australian representative sample reporting suicidal ideation fortnightly for 12 weeks between March and June 2020. RESULTS: The results indicated that participants who reported higher levels of belongingness, mastery, and intolerance of health risk were less likely to experience suicidal ideation and had lower severity of suicidal ideation. Mastery significantly strengthened the negative link between belongingness and the incidence of suicidal ideation, while agreeableness significantly strengthened the negative link between belongingness and the severity of suicidal ideation over time. CONCLUSION: The findings suggest that supporting effective social connectedness during times of isolation and promoting self-efficacy, mastery, and regulation of risk tolerance, may be crucial for suicide prevention and therapeutic intervention.

Potential Mechanisms Underlying Suicidality in Autistic People with Attention Deficit/Hyperactivity Disorder: Testing Hypotheses from the Interpersonal Theory of Suicide.

Background: Autistic people with co-occurring attention deficit/hyperactivity disorder (ADHD) appear to be at heightened risk of suicide. To understand why, we explored two explanatory mechanisms from the interpersonal theory of suicide: first, that co-occurring ADHD might be associated with greater risk through greater thwarted belongingness and perceived burdensomeness and, secondly, that hyperactive/impulsive features might incur additional risk through their association with painful and provocative events, which are suggested to create "capability" for suicide. Methods: Autistic adults (n = 314) completed an online survey including measures of thwarted belongingness, perceived burdensomeness, painful and provocative events, acquired capability for suicide, and ADHD features. Creating an overall index of likely ADHD, we examined associations between likely ADHD, suicide ideation, and lifetime suicide attempts through the parallel mediators of thwarted belongingness, perceived burdensomeness, anxiety, and depression. In several models, we then examined hyperactive, impulsive, and inattentive features as predictors of exposure to painful and provocative events and subsequent capability for suicide, and examined whether these two variables, sequentially or individually, mediated an association with lifetime suicide attempts. Results: Likely ADHD was associated with past-year suicide ideation through greater depression and perceived burdensomeness, which also mediated its association with more suicide attempts. Hyperactive and impulsive features were associated with exposure to painful and provocative events and through this acquired suicide capability. Both features were associated with more numerous suicide attempts through these two mediators sequentially, and through exposure to painful and provocative events alone. Conclusions: These data suggest that suicidality in autistic people with ADHD may be partially related to perceived burdensomeness and to acquired suicide capability after exposure to painful and provocative events. However, as we observed a pathway to suicidality associated with painful and provocative events alone, it is likely that there are also other explanatory mechanisms for the influence of traumatic events on suicide risk.

Why is this an important issue?: Suicide is a leading cause of premature death in autistic people, but we still know little about why autistic people are at greater risk and how we can help. Recent findings suggest that autistic people with co-occurring attention deficit/hyperactivity disorder (ADHD) are at even higher risk, but we do not yet understand why. What was the purpose of this study?: This research examined two potential explanations for higher risk of suicide in autistic people with co-occurring ADHD. First, we expected that because these individuals are often very isolated and struggle with independence and employment, they might be more vulnerable to two risk factors for suicide: "thwarted belongingness," the feeling of being alienated from other people, and "perceived burdensomeness," the feeling that one is a burden to others. We also expected that hyperactive/impulsive features associated with ADHD might make people more likely to experience painful and dangerous events. Exposure to events like this is suggested to make people less frightened of dying by suicide and more able to attempt to end their lives. This is called "acquiring capability" for suicide. What did the researchers do?: We asked 314 autistic adults to complete an online survey including measures of thwarted belongingness, perceived burdensomeness, exposure to painful and dangerous events, and acquired capability for suicide. They also completed a scale measuring ADHD features, and symptoms of depression and anxiety. We then looked at which of these factors, if any, explained suicide risk in autistic people with co-occurring ADHD. What were the results of the study?: Our data suggest that autistic people with co-occurring ADHD might be at greater risk of suicide ideation and attempts because they are more likely to experience depression and to feel like a burden to others. We also found that people with high degrees of hyperactive/impulsive features were more likely to experience painful and dangerous events, and, therefore, had greater capability for suicide­because of this, they were more likely to have attempted suicide more times in the past. Exposure to these kinds of traumatic events also increased the risk of suicide all by itself. What do these findings add to what was already known?: Very little is known about why autistic people with co-occurring ADHD might be at even higher risk of suicide than people with either ADHD or autism alone. No studies have examined explanations for suicide in this subgroup. What are potential weaknesses in the study?: Because this study looked at a snapshot of participants' current states, we cannot be sure of the direction of relationships between variables. For example, it might be that experiences of surviving suicide attempts actually make people feel more depressed and more like a burden afterward, rather than these feelings being the risk factors that contributed to suicide attempts. How will these findings help autistic adults now or in the future?: These findings indicate feelings and experiences that are relevant to suicide risk in autistic people with co-occurring ADHD, which might thus be important to target in interventions.