A Social Exclusion Manipulation Interacts with Acquired Capability for Suicide to Predict Self-Aggressive Behaviors.

The interpersonal theory of suicide posits that individuals who simultaneously experience high levels of thwarted belongingness, perceived burdensomeness, and acquired capability for suicide are at high risk for a lethal or near-lethal suicide attempt. Although supported by self-report studies, no study has examined facets of the theory experimentally. The present study aimed to examine the belongingness and capability components of the theory by testing whether experimentally manipulated social exclusion interacts with self-reported acquired capability to predict higher self-administered shock levels on a self-aggression paradigm. A sample of 253 students completed self-report measures and were then randomly assigned to a social exclusion manipulation condition (future alone, future belonging, no feedback). Participants then participated in the self-aggression paradigm. The positive association between acquired capability and self-aggression was strongest among participants in the future alone social exclusion condition. In those assigned to the future belonging or no feedback conditions, the association between acquired capability and self-aggression was non-significant. These findings provide modest experimental support for the interpersonal theory of suicide and highlight a potential mechanism through which social exclusion may impact suicide risk. Limitations and future research directions are discussed.

Burdensomeness, Belongingness, and Capability: Assessing the Interpersonal-Psychological Theory of Suicide With MMPI-2-RF Scales.

Given the emerging body of literature demonstrating the validity of the interpersonal-psychological theory of suicide (IPTS), and the importance of increasing our understanding of the development of risk factors associated with suicidal behavior, it seems worthwhile both to expand IPTS research via Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) correlates and to expand the availability of methods by which to assess the constructs of the IPTS. The present study attempted to do so in a large adult outpatient mental health sample by (a) inspecting associations between the IPTS constructs and the substantive scales of the MMPI-2-RF and (b) exploring the utility of MMPI-2-RF scale-based algorithms of the IPTS constructs. Correlates between the IPTS constructs and the MMPI-2-RF scales scores largely followed a pattern consistent with theory-based predictions, and we provide preliminary evidence that the IPTS constructs can be reasonably approximated using theoretically based MMPI-2-RF substantive scales. Implications of these findings are discussed.

The role of stressful life events preceding death by suicide: Evidence from two samples of suicide decedents.

Stressful life events (SLEs) are associated with increased risk for suicidal behavior. Less is known regarding the intensity of SLEs and how this may vary as a function of suicide attempt history. As a large percentage of suicide decedents do not have a history of suicidal behavior, SLEs precipitating suicide may help characterize suicidality in this understudied population. This paper examines the intensity, number, and accumulation of SLEs preceding death by suicide among decedents with varying suicide attempt histories. Suicide attempts, SLEs, and suicide methods were examined in two samples: 62 prison-based and 117 community-based suicide decedents. Regression was used to compare the level of stressor precipitating death by suicide in decedents who died on a first attempt versus multiple previous attempts. A non-significant trend was observed in the prison population which was supported by significant findings in the community-based sample. Decedents who died on a first attempt experienced a stressor of a lower magnitude when compared to decedents with multiple previous suicide attempts. We discuss the implications of these findings in relation to the stress-diathesis model for suicide.

Investigating insomnia as a cross-sectional and longitudinal predictor of loneliness: Findings from six samples.

Loneliness has been repeatedly associated with sleep problems; however, there is a dearth of research examining the prospective relationship between insomnia and loneliness, as well as this association controlling for other psychiatric symptoms. This study evaluated the cross-sectional and prospective relationship between insomnia and loneliness using six samples: 666 undergraduates; 2785 Army recruiters; 208 adults with a history of suicidality and/or depression; 343 adult psychiatric outpatients; 326 young adults at elevated suicide risk; and 183 undergraduates. A meta-analysis also was conducted to examine the magnitude of the relationship between insomnia and loneliness across the six studies. More severe insomnia symptoms were significantly associated with greater feelings of loneliness while accounting for some (e.g., anxiety, nightmares) but not all (i.e., depression) psychiatric covariates. Findings underscore the strength of the association between insomnia and loneliness and suggest that depression may account for this relationship. Additional studies are needed to further establish the temporal relationship between these variables, delineate the role of depression in the association between insomnia and loneliness, and test whether insomnia may confer unique risk for subsequent loneliness.

Acute suicidal affective disturbance: Factorial structure and initial validation across psychiatric outpatient and inpatient samples.

BACKGROUND: A new clinical entity, Acute Suicidal Affective Disturbance (ASAD), was recently proposed to characterize rapid-onset, acute suicidality including the cardinal symptom of behavioral intent. This study examines the proposed ASAD criteria factor-analytically and in relation to correlates of suicidal behavior and existing psychiatric disorders in samples of psychiatric outpatients and inpatients. METHODS: Two samples of psychiatric outpatients (N=343, aged 18-71 years, 60.6% female, 74.9% White) and inpatients (N=7,698, aged 15-99 years, 57.2% female, 87.8% White) completed measures of their ASAD symptoms and psychological functioning. RESULTS: Across both samples, results of a confirmatory factor analysis supported the unidimensional nature of the ASAD construct. Additionally, results provided evidence for the convergent and discriminant validity of ASAD, demonstrating its relation to, yet distinction from, other psychiatric disorders and correlates of suicide in expected ways. Importantly, ASAD symptoms differentiated multiple attempters, single attempters, and non-attempters, as well as attempters, ideators, and non-suicidal patients, and was an indicator of past suicide attempts above and beyond symptoms of depression and other psychiatric disorders. LIMITATIONS: This study utilized cross-sectional data and did not use a standardized measure of ASAD. CONCLUSIONS: ASAD criteria formed a unidimensional construct that was associated with suicide-related variables and other psychiatric disorders in expected ways. If supported by future research, ASAD may fill a gap in the current diagnostic classification system (DSM-5) by characterizing and predicting acute suicide risk.

The Interactive Effects of the Capability for Suicide and Major Depressive Episodes on Suicidal Behavior in a Military Sample.

Major depressive symptoms represent a significant risk for suicidal ideation and behavior. Given that suicide is fearsome, the interpersonal theory of suicide proposes that individuals who engage in suicidal behavior possess not only the desire to die, but also the acquired capability (AC) for suicide. This study examined whether major depressive episodes (MDEs) may be particularly relevant to suicidal behavior when considered in the context of AC. History of MDEs, AC, and suicide attempt history were examined in a large (n=3,377) sample of military members. Data were analyzed using hierarchical multiple regression. Results indicated that among individuals with high AC, the number of MDEs was significantly, positively associated with number of previous suicide attempts; MDEs were not significantly related to suicide attempt history among individuals with low AC. Findings held in the presence of robust covariates associated with suicidal behavior. Findings suggest that a history of MDEs alone may not indicate severe suicide risk - increased AC for suicide appears necessary for increased suicide risk. Implications for suicide treatment and prevention in military personnel are discussed.

Is Insomnia Lonely? Exploring Thwarted Belongingness as an Explanatory Link between Insomnia and Suicidal Ideation in a Sample of South Korean University Students.

STUDY OBJECTIVES: Suicide is a serious public health problem, and suicide rates are particularly high in South Korea. Insomnia has been identified as a risk factor for suicidal ideation; however, little is known about the mechanisms accounting for this relationship in this population. Based on the premise that insomnia can be lonely (e.g., being awake when everyone else is asleep), the purpose of this study was to examine whether greater insomnia severity would be associated with higher levels of thwarted belongingness and suicidal ideation, and whether thwarted belongingness would mediate the relationship between insomnia and suicidal ideation. METHODS: Predictions were tested in a sample of 552 South Korean young adults who completed self-report measures of insomnia severity, suicidal ideation, and thwarted belongingness. RESULTS: Greater insomnia symptom severity was significantly and positively associated with thwarted belongingness and suicidal ideation. Mediation analyses revealed that thwarted belongingness significantly accounted for the relationship between insomnia severity and suicidal ideation. CONCLUSIONS: These findings highlight the potential importance of monitoring and therapeutically impacting insomnia and thwarted belongingness to help reduce suicide risk.

Perceived burdensomeness and thwarted belongingness predict excessive reassurance seeking among clinical outpatients.

OBJECTIVE: The current study aimed to investigate whether perceived burdensomeness and thwarted belongingness (i.e., suicide risk factors) were associated with excessive reassurance seeking (a behavior linked to rejection). It was predicted that perceived burdensomeness and thwarted belongingness would predict higher levels of excessive reassurance seeking, controlling for depressive symptoms and global functioning. METHOD: A cross-sectional sample of 415 clinical outpatients (62% female; mean age = 28) was examined. RESULTS: Perceived burdensomeness and thwarted belongingness significantly predicted excessive reassurance seeking, controlling for depressive symptoms and global functioning. CONCLUSIONS: Perceived burdensomeness and thwarted belongingness predicted excessive reassurance seeking, suggesting that it would be beneficial for clinicians to assess for and target excessive reassurance seeking among individuals experiencing perceived burdensomeness and thwarted belongingness so that excessive reassurance seeking does not elicit interpersonal rejection.

Transmission of parental neuroticism to offspring's depression: the mediating role of rumination.

Rumination is a cognitive process that involves repetitively focusing on the causes, situational factors and consequences of one's negative emotion, and it is a potent risk factor for depression. Parental depression and neuroticism may exert an influence on offspring's development of rumination, which may increase offspring's risk for depression. The current study included 375 biological parent-offspring dyads. Parents were assessed for depressive symptoms and neuroticism; adult offspring were assessed for depressive symptoms and rumination. Structural equation modelling was used to examine the effects of parental depressive symptoms and parental neuroticism on adult offspring's depression, and to determine whether offspring's rumination mediated this relationship. Results provided evidence that offspring's rumination fully mediated the relationship between parental neuroticism and offspring's depressive symptoms. Parental depressive symptoms and neuroticism may contribute a genetic predisposition for depressive symptoms in offspring, but it also may promote an environment in which maladaptive cognitive processes, such as rumination, are learned. Given the role that rumination plays in mediating the association between neuroticism and depressive symptoms-targeting rumination in the treatment of high risk individuals would be important in reducing onset of depressive disorders.

An examination of the relationship between anger and suicide risk through the lens of the interpersonal theory of suicide.

Research has implicated a relationship between anger and suicidality, though underlying mechanisms remain unclear. The current study examined this relationship through the lens of the interpersonal theory of suicide (ITS). According to the ITS, individuals who experience thwarted belongingness, perceived burdensomeness, and elevated acquired capability for suicide are at increased risk for death by suicide. The relationships between anger and these variables were examined and these variables were examined as potential mediators between anger and suicidal ideation and behavior. Additionally, exposure to painful and provocative events was examined as a potential mediator between anger and acquired capability. As part of intake at a community mental health clinic, 215 outpatients completed questionnaires assessing depression, suicidal ideation, anger, perceived burdensomeness, thwarted belongingness, and acquired capability. Regression analyses revealed unique relationships between anger and both thwarted belongingness and perceived burdensomeness, covarying for depression. The association between anger and acquired capability trended toward significance. The links between anger and suicidal ideation and behavior were fully mediated by thwarted belongingness and perceived burdensomeness, but this effect was driven by perceived burdensomeness. Additionally, the link between anger and acquired capability was fully mediated by experience with painful and provocative events. In conclusion, results suggest that anger is uniquely associated with perceived burdensomeness and thwarted belongingness. Anger is associated with suicidal ideation and behavior via perceived burdensomeness and with greater acquired capability for suicide via experiences with painful and provocative events. Treatment for problematic anger may be beneficial to decrease risk for suicide.

Differences between suicide attempters and nonattempters in depressed older patients: depression severity, white-matter lesions, and cognitive functioning.

OBJECTIVES: The population of older adults with major depressive disorder (MDD) has the highest rate of suicide. White-matter brain lesions (WML) are a potential biologic marker for suicidality in young and middle-aged adults and are correlated with cognitive impairment in older adults. In this study of older patients with MDD, we examined 1) if a history of suicide attempts was associated with a more severe course of MDD; 2) if WML are a biologic marker for suicide; and 3) if suicide attempt history is associated with cognitive impairment mediated by WML. SETTING: Data from the Neurocognitive Outcomes of Depression in the Elderly study. PARTICIPANTS: Depressed patients (60+) who had ever attempted suicide (n = 23) were compared with depressed patients (60+) who had not attempted suicide (n = 223). MEASUREMENTS: Baseline and follow-up assessments were obtained for depressive symptoms (every 3 months) and cognitive functioning (every 6 months) over 2 years. Three magnetic resonance imaging scans were conducted. RESULTS: At baseline, suicide attempters reported more severe past and present symptoms (e.g., depressive symptoms, current suicidal thoughts, psychotic symptoms, earlier age of onset, and more lifetime episodes) than nonattempters. Suicide attempters had more left WML at baseline, and suicide attempt history predicted a greater growth in both left and right WML. WML predicted cognitive decline; nonetheless, a history of suicide attempt was unrelated to cognitive functioning. CONCLUSIONS: Severity of depressive symptoms and WML are associated with suicide attempts in geriatric depressed patients. Suicide attempts predicted neurologic changes, which may contribute to poorer long-term outcomes in elder attempters.

The interpersonal effects of Facebook reassurance seeking.

BACKGROUND: Social networking sites like Facebook represent a potentially valuable means for individuals with low self-esteem or interpersonal difficulties to connect with others; however, recent research indicates that individuals who are most in need of social benefits from Facebook may be ineffective in their communication strategies, and thereby sabotage their potential to benefit interpersonally. The current study tested whether reassurance seeking via Facebook negatively influenced self-esteem, and whether this change in self-esteem mediated the relationship between Facebook reassurance seeking and greater thwarted belongingness and perceived burdensomeness. METHOD: Participants completed measures online at two time-points approximately 24 days apart. RESULTS: Results provided evidence that Facebook reassurance seeking predicted lower levels of self-esteem, which in turn predicted increased feelings that one does not belong and that one is a burden. LIMITATIONS: Key limitations to this study include our use of a predominantly young, female, Caucasian sample, a novel reassurance seeking measure, and only evaluating two time points. CONCLUSIONS: These results suggest that Facebook usage has the potential for negative and far-reaching influences on one's interpersonal functioning.

Status update: maladaptive Facebook usage predicts increases in body dissatisfaction and bulimic symptoms.

BACKGROUND: The current study examined the effects of online social evaluations and comparisons on body dissatisfaction and bulimic symptoms. METHODS: We tested the effects of maladaptive Facebook usage (defined as the tendency to seek negative social evaluations and/or engage in social comparisons via Facebook) on body dissatisfaction and bulimic symptoms in a sample of 232 college females followed for approximately 4 weeks. RESULTS: Results provided evidence that maladaptive Facebook usage significantly predicted increases in bulimic symptoms and episodes of over-eating approximately four weeks later. Body dissatisfaction was found to fully mediate the relationship between maladaptive Facebook usage and increases in over-eating episodes, whereas body dissatisfaction partially mediated the relationship between maladaptive Facebook usage and increases in bulimic symptoms more broadly. LIMITATIONS: Limitations include the use of a novel measure of maladaptive Facebook usage due to the absence of an existing measure and a non-clinical sample. CONCLUSIONS: The results of this study suggest that reducing maladaptive Facebook usage may be a fruitful target for interventions aimed at reducing body dissatisfaction and symptoms of eating pathology.

Interpersonal processes in depression.

Humans have an intrinsic need for social connection; thus, it is crucial to understand depression in an interpersonal context. Interpersonal theories of depression posit that depressed individuals tend to interact with others in a way that elicits rejection, which increases their risk for future depression. In this review, we summarize the interpersonal characteristics, risk factors, and consequences of depression in the context of the relevant theories that address the role of interpersonal processes in the onset, maintenance, and chronicity of depression. Topics reviewed include social skills, behavioral features, communication behaviors, interpersonal feedback seeking, and interpersonal styles as they relate to depression. Treatment implications are discussed in light of the current research on interpersonal processes in depression, and the following future directions are discussed: developing integrative models of depression, improving measurement of interpersonal constructs, examining the association between interpersonal processes in depression and suicide, and tailoring interventions to target interpersonal processes in depression.

A longitudinal study of differences in late- and early-onset geriatric depression: depressive symptoms and psychosocial, cognitive, and neurological functioning.

OBJECTIVES: Studies suggest early-onset depression (EOD) is associated with a more severe course of the depressive disorder, while late-onset depression (LOD) is associated with more cognitive and neuroimaging changes. This study examined if older adults with EOD, compared with those with LOD, would exhibit more severe symptoms of depression and, consistent with the glucocorticoid cascade hypothesis, have more hippocampal volume loss. A second goal was to determine if LOD, compared with EOD, would demonstrate more cognitive and neuroimaging changes. METHOD: At regular intervals over a four-year period non-demented, older, depressed adults were assessed on the Mini-Mental Status Examination and the Montgomery-Asberg Depression Rating Scale. They were also assessed on magnetic resonance imaging. RESULTS: Compared with LOD, EOD had more depressive symptoms, more suicidal thoughts, and less social support. Growth curve analyses indicated that EOD demonstrated higher levels of residual depressive symptoms over time. The LOD group exhibited a greater decrement in cognitive scores. Contrary to the glucocorticoid cascade hypothesis, participants with EOD lost right hippocampal volume at a slower rate than did participants with LOD. Right cerebrum gray matter was initially smaller among participants with LOD. CONCLUSIONS: EOD is associated with greater severity of depressive illness. LOD is associated with more severe cognitive and neurological changes. These differences are relevant to understanding cognitive impairment in geriatric depression.

The relationship of religious involvement indicators and social support to current and past suicidality among depressed older adults.

Elderly people, particularly those with major depression, are at the highest risk for suicide than any other age group. Religious involvement is associated with a range of health outcomes including lower odds of death by suicide. However, not much is known about the effects of religious involvement on suicidal ideation in the elderly or which aspects of religiosity are beneficial. This study examined the relative influence of various conceptualizations of religious involvement, above and beyond the protective effects of social support, on current and past suicidality among depressed older adults. Participants were 248 depressed patients, 59 years and older, enrolled in the Neurocognitive Outcomes of Depression in the Elderly study. A psychiatrist assessed current suicidal ideation using the suicidal thoughts item from the Montgomery-Asberg Depression Rating Scale. Past history of suicide attempts, four religious involvement indicators, social support indicators, and control variables were assessed via self-report. Church attendance, above and beyond importance of religion, private religious practices, and social support, was associated with less suicidal ideation; perceived social support partially mediated this relationship. Current religious practices were not predictive of retrospective reports of past suicide attempts. Church attendance, rather than other religious involvement indicators, has the strongest relationship to current suicidal ideation. Clinicians should consider public religious activity patterns and perceived social support when assessing for other known risk and protective factors for suicide and in developing treatment plans.

Does the stress generation hypothesis apply to eating disorders?: an examination of stress generation in eating, depressive, and anxiety symptoms.

BACKGROUND: The stress generation hypothesis posits that individuals actively contribute to stress in their lives. Although stress generation has been studied frequently in the context of depression, few studies have examined whether this stress generation process is unique to depression or whether it occurs in other disorders. Although evidence suggests that stress contributes to the development of eating disorders, it is unclear whether eating disorders contribute to subsequent stress. METHODS: A prospective design was used to examine the influence of eating disorder symptoms on negative life stressors. Two hundred and ninety female undergraduates completed questionnaires at two time points that examined eating disorder, depressive and anxiety symptoms and the presence of negative life events. RESULTS: Regression analyses found that while eating disorder symptoms (i.e. bulimic symptoms and drive for thinness) were independent, significant predictors of negative life events, they did not predict negative life events above and beyond symptoms of depression. LIMITATIONS: Limitations include the use of self-report measures and a college-based sample, which may limit generalizability of the results. CONCLUSIONS: Findings suggest that if stress generation is present in individuals with symptoms of eating disorders, it is likely attributable to symptoms of depression. Thus, it may be important for clinicians to target depressive symptoms in order to reduce the frequency of negative life stressors among individuals with eating disorders.

An urge to jump affirms the urge to live: an empirical examination of the high place phenomenon.

BACKGROUND: The experience of a sudden urge to jump when in a high place has been speculated to be associated with suicidal ideation; however, scant data has informed this speculation. We termed this experience the high place phenomenon (HPP) and proposed that it stems from a misinterpreted safety signal (i.e., survival instinct). The present study aimed to assess the prevalence of the HPP, to provide evidence that the phenomenon is not exclusive to suicide ideators, and to explore the role of anxiety sensitivity in the phenomenon. METHODS: 431 undergraduate college students completed online measures of lifetime frequency of experiencing the HPP, suicidal ideation, anxiety sensitivity, depressive symptoms, and history of mood episodes. RESULTS: The HPP was commonly reported in the general population, even among participants with no history of suicidal ideation. There was a significant correlation between anxiety sensitivity and the HPP, and this relationship was moderated by level of current suicidal ideation. Particularly, the relationship between anxiety sensitivity and the HPP was potentiated among participants with low levels of suicidal ideation. LIMITATIONS: The cross-sectional design of the study limits the strength of the conclusions that can be drawn. CONCLUSIONS: The HPP is commonly experienced among suicide ideators and non-ideators alike. Thus, individuals who report experiencing the phenomenon are not necessarily suicidal; rather, the experience of HPP may reflect their sensitivity to internal cues and actually affirm their will to live.

Development and validation of a brief self-report measure of agitation: the Brief Agitation Measure.

Emerging evidence indicates that agitation is an ominous precursor to imminent death by suicide, yet measures of it are few, and to our knowledge, no self-report measure of agitation exists. To fill this gap, we have developed the Brief Agitation Measure (BAM), which is designed as a brief measure to assess agitation. In this article, we provide preliminary evidence from 2 studies examining the reliability and validity of the BAM in an undergraduate sample as well as a clinical sample. We close with a discussion of the limitations of the studies and implications of our findings.