Clarifying the Relationship of Dissociative Experiences to Suicide Ideation and Attempts: A Multimethod Examination in Two Samples.

Fears of pain, injury, and death may represent key barriers to acting on suicidal thoughts. Dissociation, which involves a disconnection from one's body, may reduce fears and sensations of pain associated with harming the body, in turn facilitating suicide attempts. This study examined whether dissociation differentiated individuals with a history of suicide attempts from those with a history of suicide ideation, and investigated whether other relevant constructs explain this relationship. Sample 1 included 754 undergraduates (Mage = 21, 79% female) who completed a battery of self-report measures. Sample 2 included 247 undergraduates (Mage = 19, 74% female) who completed a self-report measure of dissociation, a clinical interview regarding suicide history, and four counterbalanced behavioral pain tolerance tasks. In both samples, dissociation was elevated in lifetime attempters compared to ideators (d = 0.28; d = 0.46; ps = 0.01) and slightly elevated in lifetime ideators compared to nonsuicidal individuals (d = 0.19, p = .02; d = 0.24, p = .47), though this effect was non-significant in the latter sample. In Sample 1, dissociation no longer differentiated attempters from ideators after controlling for clinical covariates. In Sample 2, dissociation was unrelated to behavioral pain tolerance tasks, and these tasks did not account for the association between dissociation and attempts. Overall, dissociation differentiated individuals with a history of suicide attempts from those with ideation alone in both samples. Pain tolerance did not explain this association; instead, it is possible that the relationship of dissociation to suicide attempts is due to "third variables" associated with both phenomena, such as symptoms of borderline personality disorder or posttraumatic stress disorder.

Ideation-to-action theories of suicide: a conceptual and empirical update.

This review provides a conceptual and empirical update regarding ideation-to-action theories of suicide. These theories-including the interpersonal theory (IPTS), integrated motivational-volitional model (IMV), three-step theory (3ST), and fluid vulnerability theory (FVT)-agree that, firstly, the development of suicidal ideation and secondly, the progression from suicide desire to attempts are distinct processes with distinct explanations. At the same time, these theories have some substantive differences. A literature review indicates that the IPTS has received extensive examination, whereas evidence has only begun to accumulate for the other theories. Based on current evidence, we offer three inferences. First, the capability for suicide meaningfully distinguishes those who have attempted suicide (attempters) from those with suicidal desire who have not attempted (ideators). This encouraging finding is broadly consistent with the IPTS, IMV, and 3ST. The nature and measurement of capability warrant further attention. Second, consistent with the 3ST, accumulating evidence suggests that pain and hopelessness motivate suicidal desire more than other factors. Third, the FVT, which is largely compatible with other theories, may be best equipped to explain the non-linear time-course of suicidal ideation and attempts. Longitudinal studies over various time-frames (minutes, hours, days, weeks, months) are necessary to further evaluate and elaborate ideation-to-action theories of suicide.

Recent advances in differentiating suicide attempters from suicide ideators.

PURPOSE OF REVIEW: This article summarizes findings from recent studies (published since 2015) examining differences between suicide attempters and suicide ideators. RECENT FINDINGS: Converging evidence suggests that the capability to attempt suicide (e.g., acquired capability, painful and provocative experiences, high tolerance for pain and distress) is higher in suicide attempters than suicide ideators. Other psychosocial and biological differences have also been identified but require replication. SUMMARY: Recent literature reviews find that traditional risk factors for suicide - such as depression, hopelessness, most psychiatric disorders, and even impulsivity - robustly predict suicide ideation but poorly predict suicide attempts among ideators. To address this knowledge gap, studies are increasingly employing an ideation-to-action framework. This framework views the development of suicide ideation and the progression from ideation to potentially lethal attempts as distinct processes with distinct explanations and predictors. Converging evidence suggests that factors associated with diminished fear of pain, injury, and death can increase one's capability to attempt suicide and facilitate the progression from suicidal thoughts to suicidal acts. Recent studies have also identified other variables that may differentiate attempters from ideators, but these require replication. Theories of suicide positioned within the ideation-to-action framework provide testable and promising hypotheses about the progression from ideation to attempts. These include the Interpersonal Theory, Integrated Motivational-Volitional Model, and Three-Step Theory.

The Relationship of Self-reported Executive Functioning to Suicide Ideation and Attempts: Findings from a Large U.S.-based Online Sample.

An increasing number of studies demonstrate that individuals with a history of suicidality exhibit impaired executive functioning abilities. The current study examines whether these differences are linked to suicidal thoughts or suicidal acts-a crucial distinction given that most people who think about suicide will not act on their thoughts. A large online sample of U.S. participants with a history of suicide ideation (n = 197), suicide attempts (n = 166), and no suicidality (n = 180) completed self-report measures assessing executive functioning, suicide ideation and attempts; in addition, depression, self-efficacy, and history of drug abuse and brain injury were assessed as potential covariates. Individuals with recent suicide attempts reported significantly worse executive functioning than ideators. This difference was not accounted for by depression, self-efficacy, history of drug abuse or brain injury. Self-reported executive functioning may represent an important short-term risk factor for suicide attempts.

The scarcity heuristic impacts reward processing within the medial-frontal cortex.

Objects that are rare are often perceived to be inherently more valuable than objects that are abundant - a bias brought about in part by the scarcity heuristic. In the present study, we sought to test whether perception of rarity impacted reward evaluation within the human medial-frontal cortex. Here, participants played a gambling game in which they flipped rare and abundant 'cards' on a computer screen to win financial rewards while electroencephalographic data were recorded. Unbeknownst to participants, reward outcome and frequency was random and equivalent for both rare and abundant cards; thus, only a perception of scarcity was true. Analysis of the electroencephalographic data indicated that the P300 component of the event-related brain potential differed in amplitude for wins and losses following the selection of rare cards, but not following the selection of abundant cards. Importantly, then, we found that the perception of card rarity impacted reward processing even though reward feedback was independent of and subsequent to card selection. Our data indicate a top-down influence of the scarcity heuristic on reward evaluation, and specifically the processing of reward magnitude, within the human medial-frontal cortex.

Suicide, Suicide Attempts, and Suicidal Ideation.

Suicidal behavior is a leading cause of death and disability worldwide. Fortunately, recent developments in suicide theory and research promise to meaningfully advance knowledge and prevention. One key development is the ideation-to-action framework, which stipulates that (a) the development of suicidal ideation and (b) the progression from ideation to suicide attempts are distinct phenomena with distinct explanations and predictors. A second key development is a growing body of research distinguishing factors that predict ideation from those that predict suicide attempts. For example, it is becoming clear that depression, hopelessness, most mental disorders, and even impulsivity predict ideation, but these factors struggle to distinguish those who have attempted suicide from those who have only considered suicide. Means restriction is also emerging as a highly effective way to block progression from ideation to attempt. A third key development is the proliferation of theories of suicide that are positioned within the ideation-to-action framework. These include the interpersonal theory, the integrated motivational-volitional model, and the three-step theory. These perspectives can and should inform the next generation of suicide research and prevention.

Factor Structure and Internal Validity of the Functional Movement Screen in Adults.

The factor structure and internal consistency of the Functional Movement Screen (FMS) have not been examined in a general healthcare population. Replicating the factor structure of the FMS is important because it illustrates the interdependence between each of the subtests, enabling the strength and conditioning professional to better interpret and act on an individual's FMS score. Anthropometric data and FMS scores were collected from 1,113 clients of a multidisciplinary healthcare clinic in Vancouver, BC The mean (SD) ages were 53.4 (11.1) for men (n = 656) and 49.3 (12.3) for women (n = 457). The mean FMS Summary Score was 13.7 (2.9) and was significantly negatively correlated with both age (r = -0.25; p < 0.001) and body mass index (r = -0.37; p < 0.001). The internal consistency of the FMS scale, which was assessed with both ordinal and Cronbach's alpha, was 0.73 and 0.64, respectively. Polychoric correlations between individual movements ranged from 0.03 to 0.59. Exploratory and confirmatory factor analyses (CFA) revealed that the FMS showed 2 main factors, a basic movement factor (shoulder mobility and active straight leg raise) and a complex movement factor (squat, hurdle step, inline lunge, and the trunk stability push-up). Rotary stability loaded onto both factors in the CFA, and its exclusion from the model had little effect. The findings of this study broadly replicated the intended factor structure of the FMS, as the individual movements aligned well with the intended factors.

Assessing cognitive impairment using PROMIS(®) applied cognition-abilities scales in a medical outpatient sample.

Having a brief, standardized, reliable, and valid self-rated test of perceived cognitive functioning could be beneficial in psychiatry clinical practice, research, and clinical trials. The PROMIS(®) Applied Cognition-Abilities scales were developed, evaluated, and distributed by the National Institutes of Health to measure perceived cognitive functioning. This study examines several aspects of the reliability and validity of the PROMIS(®) Applied Cognition-Abilities eight and four-item scales in a sample of adult and older adult medical outpatients (N = 148). Internal consistency reliability was high for both PROMIS(®) cognition scales. The brief four-item scale was highly correlated with the full eight-item scale (rs = 0.98). There was a moderate correlation between the PROMIS(®) Applied Cognition-Abilities scales and measures of depression (PHQ-9) and anxiety (GAD-7). Subgroups of participants screening positively for depression or anxiety reported significantly worse cognitive functioning than medical controls, with large effect sizes. The base rates of individual items endorsed by depressed, anxious, and control participants are reported. More than 42% of depressed and anxious participants reported problems with their memory and concentration compared with fewer than 8% of medical controls. The field would benefit from studies using the PROMIS(®) Applied Cognition-Abilities scales in more demographically diverse samples and with other established measures of cognition.

Clarifying the Relationship of Parental Bonding to Suicide Ideation and Attempts.

Suicide and suicidal behavior are major public health problems, especially among adolescents and young adults. Previous research has established links between parental bonding and suicidality; however, it remains unclear whether parental bonding is associated with suicide ideation, the progression from suicide ideation to suicide attempts, or both. This study examined the relation of parental bonding to suicide ideation and suicide attempts in adolescents from two settings: (1) acute psychiatric care (n = 172) and (2) high school (n = 426). All participants were administered validated measures of parental bonding, suicide ideation, and suicide attempts, as well as emotion dysregulation, loneliness, and self-worth. In the psychiatric sample, lower parental care significantly differentiated adolescents with a history of suicide attempts from those with suicide ideation only or without histories of suicidality. This pattern remained even after controlling for other known correlates of suicidality (i.e., emotional dysregulation, loneliness, and low self-worth). Similar effects were found in the community sample, although these findings failed to reach statistical significance. In both samples, parental overprotection was not associated with suicide ideation or suicide attempts. Results suggest that parental care may be an important risk factor for youth suicidal behavior and may help differentiate suicide attempters from suicide ideators.