Understanding suicide risk for youth who are both Black and Native American: The role of intersectionality and multiple marginalization.

INTRODUCTION: Native American and multiracial youth experience elevated risk for suicide ideation (SI) and suicide attempts (SA); however, intersectional identities are often unexamined in suicide research. METHOD: We examined the prevalence of SI and SA, and the impact of intersectional identities (sex, sexual minority identity, and economic insecurity) on these rates, in 496 biracial Black-Native American, 2,804 Native American, 14,220 Black, 5,569 biracial Native American-White, 4,076 biracial Black-White, and 118,816 White youth who participated in the Minnesota Student Survey. RESULTS: Black-Native American youth reports of SI and SA resembled other Native American youth and were significantly higher than those reported by Black, White, and Black-White (SA only) youth. While sexual minority youth reported higher rates of SI and SA than heterosexual youth, this difference between sexual minority and heterosexual Black-Native American youth was smaller as compared to their peers. CONCLUSION: Though they largely resemble their mono/biracial Native American peers, Black-Native American youth show some distinct patterns of SA when accounting for their intersectional identities. Despite presumed similarities in systemic risk factors, Black and Black-Native American youth differ considerably in reported suicidality. The experiences of Black-Native American teens warrant further examination.

Suicide in African American Adolescents: Understanding Risk by Studying Resilience.

Historically, suicide rates for African American adolescents have been low, relative to rates for youth of other racial-ethnic backgrounds. Since 2001, however, suicide rates among African American adolescents have escalated: Suicide is now the third leading cause of death for African American adolescents. This disturbing trend warrants focused research on suicide etiology and manifestation in African American adolescents, along with culturally sensitive and effective prevention efforts. First, we revisit leading suicide theories and their relevance for African American adolescents. Next, we discuss health promotive and protective factors within the context of African American youth development. We also critique the current status of suicide risk assessment and prevention for African American adolescents. Then, we present a heuristic model of suicide risk and resilience for African American adolescents that considers their development within a hegemonic society. Finally, we recommend future directions for African American adolescent suicidology.

The Common Factors of Grit, Hope, and Optimism Differentially Influence Suicide Resilience.

No study to date has simultaneously examined the commonalities and unique aspects of positive psychological factors and whether these factors uniquely account for a reduction in suicide risk. Using a factor analytic approach, the current study examined the relationships between grit, hope, optimism, and their unique and overlapping relationships in predicting suicide ideation. Results of principle axis factor analysis demonstrated close relationships between these variables at both the construct and item level. Item-level analyses supported a five-factor solution (Stick-to-Itiveness, Poor Future, Consistency of Interest, Positive Future, and Poor Pathways). Four of the five factors (excluding Stick-to-Itiveness) were associated with suicide ideation. Additionally, results of a multiple regression analysis indicated that two of the five factors (Consistency of Interest and Positive Future) negatively predicted suicide ideation while Poor Future positively predicted suicide ideation. Implications regarding the interrelationships between grit, hope, and optimism with suicide ideation are discussed.

Alcohol use and the interpersonal theory of suicide in American Indian young adults.

Suicide is the second leading cause of death for American Indian (AI) young adults. Alcohol use is a well-established risk factor for suicide. On average, AIs ages 12 to 20 exhibit the second-highest rate of binge drinking compared to all other ethnic groups. The current study investigated the relation between alcohol use and suicide ideation in an AI sample and examined these relations in the context of the interpersonal theory of suicide (ITS). It was hypothesized that perceived burdensomeness and thwarted belongingness would each significantly moderate the relations between alcohol use and suicide ideation in an AI sample. College students who self-identified as American Indian (N = 84) completed measures of alcohol use and associated problems, perceived burdensomeness and thwarted belongingness, and suicidality. Results indicated that perceived burdensomeness significantly moderated the relation between alcohol use and suicide ideation, and this interaction was significant at high levels of perceived burdensomeness. However, thwarted belongingness was not a significant moderator of the relation between alcohol use and suicide ideation. Findings suggest that AI young adults who engage in increased alcohol use may be at increased risk for suicide, especially if they also experience stronger perceptions of being a burden on others. The current study provides support for continued examinations of the relationship between alcohol use and suicide to inform culturally appropriate interventions for AI young adults.

Understanding Indigenous Suicide Through a Theoretical Lens: A Review of General, Culturally-Based, and Indigenous Frameworks.

Many American Indian/Alaska Native (AI/AN) communities throughout North America continue to experience the devastating impact of suicide. Theoretical explanations of suicide from a psychological, sociological, cultural, and Indigenous perspective all differ in focus and applicability to AI/AN communities. These diverse theoretical frameworks and models are presented herein to examine the potential applicability, strengths, and limitations in understanding AI/AN suicide. In providing these perspectives, continued discussions and empirical examinations of AI/AN suicide can guide informative, culturally-informed suicide prevention and intervention efforts.

Implicit Association with Suicide as Measured by the Suicide Affect Misattribution Procedure (S-AMP) Predicts Suicide Ideation.

The identification of indirect markers of suicide that do not rely on explicit self-report of suicide ideation is vital, as research indicates that a significant number of individuals who die by suicide do not discuss or explicitly deny thoughts of suicide with a provider in their last health care interaction. The current study tests whether a new measure of implicit association with suicide, a modified version of the Affect Misattribution Procedure (AMP), predicts suicide ideation in participants oversampled for the experience of suicide ideation. Results indicated that implicit associations with suicide-related images were positively correlated with levels of suicide ideation and predicted suicide ideation when entered as a simultaneous predictor with symptoms of depression, thwarted belongingness, and perceived burdensomeness. Implicit associations with positive and negative images were unrelated to thoughts of suicide. The modified version of the AMP may be a particularly useful indirect measure of suicide ideation that can be easily included in suicide risk assessment paradigms in clinical practice and research studies.

The indirect effect of perceived burdensomeness on the relationship between indices of social support and suicide ideation in college students.

OBJECTIVE: Research has demonstrated that a lack of social support is related to suicide risk. This study examines perceived burdensomeness and thwarted belongingness, of the Interpersonal Theory of Suicide, as mechanisms of the social support-suicide relationship in college students. METHOD: The study consisted of 207 students from a Midwestern university. Data were collected from 2007 to 2008. Two multiple mediation analyses were conducted to examine whether perceived burdensomeness and thwarted belongingness mediated the relationship between indices of social support and suicide ideation. RESULTS: Perceived burdensomeness mediated the relationships between perceived social support and suicide ideation (95% confidence interval [CI] -.02 to -.00, effect size = -.01) and social connectedness and suicide ideation (95% CI -.03 to -.00, effect size = -.03). Thwarted belongingness did not mediate either relationship. CONCLUSIONS: Results suggest that a lack of social support could lead to perceptions of being a burden on others, which could lead to suicide ideation.

Empirical extension of the interpersonal theory of suicide: Investigating the role of interpersonal hopelessness.

The Interpersonal Theory of Suicide posits that hopelessness about thwarted belongingness and perceived burdensomeness is an important risk factor for the desire for suicide and suicide risk. Past research has indicated that general feelings of hopelessness interact with the constructs of thwarted belongingness and perceived burdensomeness to predict suicide ideation. However, no research has explicitly tested whether hopelessness specific to the interpersonal constructs of thwarted belongingness and perceived burdensomeness predicts suicide ideation and suicide risk. Participants in the current study (N = 173) were undergraduate students oversampled for history of suicide ideation, planning for suicide, and suicide attempt(s). Participants completed study measures online, including a new measure of hopelessness about thwarted belongingness and perceived burdensomeness. Results indicated that a three-way interaction of thwarted belongingness, perceived burdensomeness, and hopelessness about these interpersonal constructs, but not general hopelessness, predicted unique variance of suicide ideation and suicide risk. Results suggest that hopelessness about thwarted belongingness and perceived burdensomeness may be an important target for reducing suicidal desire.

Humor styles moderate borderline personality traits and suicide ideation.

The way individuals use humor to interact interpersonally has been associated with general personality, depression, and suicidality. Certain humor styles may moderate the risk for suicide ideation (SI) in individuals who are high in specific risk factors (e.g., thwarted belongingness, perceived burdensomeness). Previous research suggests a relationship between humor styles and borderline personality disorder (BPD) and an increased risk of suicidality and suicide completion in individuals with BPD. Participants (n =176) completed measures of BPD traits, SI, and humor styles. It was hypothesized that BPD traits would be positively correlated with negative humor styles and negatively correlated with positive humor styles, and that humor styles would significantly moderate BPD traits and SI. Results showed that BPD traits were negatively correlated with self-enhancing humor styles and positively correlated with self-defeating humor styles, but that they were not significantly correlated with affiliative or aggressive humor styles. Bootstrapping analyses demonstrated that the affiliative, self-enhancing, and self-defeating humor styles significantly moderated BPD traits and SI, while the aggressive humor style did not.

Rumination's effect on suicide ideation through grit and gratitude: A path analysis study.

The current study documents the relationship between suicide ideation, grit and gratitude, and rumination subtypes of brooding and reflection. The relationship between rumination and suicide ideation has been well documented and previous research has demonstrated that grit and gratitude are protective factors against suicide. We hypothesized that both subtypes of rumination would have an indirect effect on suicide ideation through levels of grit and gratitude. Results of a conditional indirect effects path analysis indicated that brooding was indirectly related to suicide ideation through gratitude. Brooding interacted with grit such that it only predicted suicide ideation at low levels of grit. Reflection interacted with gratitude to predict levels of grit. Results suggest that brooding may impact suicide risk and resilience through its effect on gratitude, indicating important cognitive-behavioral targets for suicide prevention strategies. These results extend the literature about the relationship between well known risk factors for suicide and protective factors.

Experiencing racial microaggressions influences suicide ideation through perceived burdensomeness in African Americans.

Racial microaggressions are a contemporary form of subtle discrimination that occur in everyday exchanges, and are associated with a variety of negative mental health outcomes, including suicide ideation. Previous work (e.g., Torres-Harding, Andrade, & Romero Diaz, 2012) has identified 6 dimensions of racial microaggressions: invisibility, criminality, low-achieving/undesirable culture, sexualization, foreigner/not belonging, and environmental invalidations. The current study examined whether the 6 dimensions of racial microaggressions were associated with increased suicide ideation through perceived burdensomeness and thwarted belongingness among 135 African American young adults. Results indicated that perceived burdensomeness, but not thwarted belongingness, mediated the relationship between 3 racial microaggression dimensions (i.e., invisibility, low-achievement/undesirable culture, and environmental invalidations) and suicide ideation. These results imply that for African American college students, experiencing certain dimensions of racial microaggressions was associated with higher levels of perceived burdensomeness, which in turn was related to increased levels of suicide ideation. Clinical and societal implications are discussed. This study found that specific types of racial microaggressions were associated with higher levels of perceptions of being a burden on others, which in turn was associated with higher levels of suicide ideation in a sample of African Americans. These findings are important as they demonstrate 1 possible avenue through which racial microaggressions can negatively impact mental health. (PsycINFO Database Record

Maladaptive Five Factor Model personality traits associated with Borderline Personality Disorder indirectly affect susceptibility to suicide ideation through increased anxiety sensitivity cognitive concerns.

The current study investigated the relationship between maladaptive Five-Factor Model (FFM) personality traits, anxiety sensitivity cognitive concerns, and suicide ideation in a sample of 131 undergraduate students who were selected based on their scores on a screening questionnaire regarding Borderline Personality Disorder (BPD) symptoms. Those who endorsed elevated BPD symptoms in a pre-screen analyses completed at the beginning of each semester were oversampled in comparison to those with low or moderate symptoms. Indirect effect (mediation) results indicated that the maladaptive personality traits of anxious/uncertainty, dysregulated anger, self-disturbance, behavioral dysregulation, dissociative tendencies, distrust, manipulativeness, oppositional, and rashness had indirect effects on suicide ideation through anxiety sensitivity cognitive concerns. All of these personality traits correlated to suicide ideation as well. The maladaptive personality traits of despondence, affective dysregulation, and fragility were positive correlates of suicide ideation and predicted suicide ideation when all traits were entered in one linear regression model, but were not indirectly related through anxiety sensitivity cognitive concerns. The implication for targeting anxiety sensitivity cognitive concerns in evidence-based practices for reducing suicide risk in those with BPD is discussed.

An Investigation of the Relationship Between Rumination Styles, Hope, and Suicide Ideation Through the Lens of the Integrated Motivational-Volitional Model of Suicidal Behavior.

To investigate the roles specific ruminative styles (brooding and reflection) and hope play in the Integrated Motivational-Volitional (IMV) model of suicidal behavior. Participants were students from a large U.S. state university who were selectively sampled for the experience of recent suicide ideation. Results of a bootstrapped moderated mediation model indicated that defeat had a direct effect on suicide ideation but not an indirect effect on suicide ideation through entrapment. Brooding, but not reflection, strengthened the relationship between defeat and entrapment. Hope weakened the relationship between entrapment and suicide ideation. Implications for the assessment and treatment of suicide risk and future research directions are discussed.

Historical loss thinking and symptoms of depression are influenced by ethnic experience in American Indian college students.

OBJECTIVE: Recent research has indicated that historical loss may play an important role in the experience of depression symptoms in American Indian/Alaska Native people. Increased frequency of historical loss thinking has been related to symptoms of depression and other pervasive psychological outcomes (i.e., substance abuse) in American Indian and Canadian First Nations communities. The current study investigated how aspects of ethnic minority experience relate to the incidence of historical loss thinking and symptoms of depression in American Indian adults. METHOD: Data are presented from 123 self-identified American Indian college students (ages 18-25, 67.50% female) who participated in the study in return for course credit and/or entrance into a raffle for gift cards. Participants completed the Adolescent Historical Loss Scale (AHLS), Scale of Ethnic Experiences (SEE), and the Center for Epidemiologic Studies-Depression Scale (CES-D). Indirect effects of ethnic experience on symptoms of depression through historical loss thinking were calculated with nonparametric bootstrapping procedures. RESULTS AND CONCLUSIONS: Results indicated that a strong ethnic identification, desire to predominantly socialize with other American Indians, and perceptions of discrimination were associated with increased historical loss thinking. Feelings of comfort and assimilation with the mainstream American culture were negatively related to historical loss thinking. Only perception of discrimination was directly related to symptoms of depression; however, ethnic identification and the preference to predominantly socialize with other American Indians were both indirectly related to elevated depressive symptoms through increased historical loss thinking. The clinical implications for these results are discussed. (PsycINFO Database Record

Construct validity of a proposed new diagnostic entity: Acute Suicidal Affective Disturbance (ASAD).

BACKGROUND: The current study presents initial support for the construct validity of Acute Suicidal Affective Disturbance (ASAD), a clinical entity consisting of acute suicide risk and several related features. METHODS: Participants (N=195) were university students who were recruited for a history of suicide attempt(s), history of suicidal ideation, or no history of suicide attempts or suicidal ideation. Participants completed study measures online. RESULTS: Factor analytic results indicated a one factor solution for a lifetime measure of ASAD symptoms. The measure demonstrated strong convergent and divergent validity with common correlates of suicide-related outcomes and incremental predictive validity, as lifetime occurrence of ASAD symptoms predicted number of past suicide attempts above and beyond a host of suicide risk factors. Lifetime ASAD symptoms differed between those with multiple suicide attempts, those with a single attempt, and participants without a history of attempts, as well as between participants with a history of both suicidal ideation and attempts and those with a history of suicidal ideation but not suicide attempts. LIMITATIONS: The cross-sectional research design limits the ability to infer causation between ASAD symptoms and suicidal behavior. Only past ASAD symptoms (not current symptoms) were measured. CONCLUSIONS: ASAD appears to be a unified clinical entity that characterizes acute suicide risk which may assist clinicians in determining a client's potential for death by suicide.

An Examination of Historical Loss Thinking Frequency and Rumination on Suicide Ideation in American Indian Young Adults.

No research has empirically investigated whether frequency of historical loss thinking is a potential risk factor for suicide ideation in American Indians. Results of this study demonstrated that the frequency of historical loss thinking was positively associated with brooding and reflection at a small magnitude, but was not directly related to suicide ideation. Bootstrapping analyses indicated small indirect effects of historical loss thinking frequency on suicide ideation through brooding and reflection individually, but only through brooding when analyzed in a parallel mediation model. These findings suggest that American Indians who more frequently engage in historical loss thinking may be susceptible to suicide ideation via an increase in ruminative tendencies, specifically brooding.

Seemingly Harmless Racial Communications Are Not So Harmless: Racial Microaggressions Lead to Suicidal Ideation by Way of Depression Symptoms.

Racial microaggressions, a contemporary form of subtle discrimination that occurs in everyday interactions, are associated with a variety of negative mental health outcomes. Research has not extended the connection between racial microaggressions and negative mental health to include suicide risk. Given the well-known association between negative mental health outcomes and suicide risk, the current study examined whether racial microaggressions predicted suicidal ideation through depression symptoms among 405 young adults of color. Depression symptoms mediated the relationship between racial microaggressions and suicidal ideation. This is the first study to associate racial microaggressions to suicide risk. Societal and clinical implications are discussed.

Five factor model traits as a predictor of suicide ideation and interpersonal suicide risk in a college sample.

Research has demonstrated an inconsistent relationship between suicide ideation and personality traits. This is the first study to empirically examine the relationship of the Five Factor Model of personality with current, past and no suicide ideation, and with the two interpersonal risk factors of suicide: thwarted belongingness and perceived burdensomeness (Joiner, T., 2005. Why people die by suicide. Cambridge, MA, US: Harvard University Press). Results indicate that high neuroticism was associated with both current ideation and a history of suicide ideation and extraversion was associated with current ideation. Neuroticism was positively related to thwarted belongingness and perceived burdensomeness, while extraversion was negatively related to these interpersonal predictors of suicide. Agreeableness was negatively related to thwarted belongingness but not perceived burdensomeness, indicating differentiated patterns of relationships between this personality domain and the two suicide constructs. Furthermore, these personality domains predicted 23.82% of variance for thwarted belongingness and 15.07% of the variance for perceived burdensomeness, above and beyond demographic variables associated with suicide ideation. This study, which was conducted with a college sample, demonstrates the potential benefit of identifying predispositional risk factors for suicide ideation and interpersonal predictors of suicide. This may have implications for the development of upstream preventative measures against suicide.

Does the experience of interpersonal predictors of suicidal desire predict positive attitudes toward Physician Assisted Suicide?

The current study examined the relationship between Physician Assisted Suicide (PAS) attitudes and interpersonal risk factors of suicidal desire as outlined by the interpersonal-psychological theory of suicidal behavior (Joiner, 2005). It was hypothesized that both thwarted belongingness and perceived burdensomeness would be positively related to PAS acceptance. Results indicated that thwarted belongingness and perceived burdensomeness predicted significance of favorable attitudes toward PAS in a college sample. Results suggest that attitudes toward PAS may be influenced by the experience of thwarted belongingness and perceived burdensomeness and provide a clear rationale for the study of these variables in populations more apt to consider hastened death. Future work regarding the application of the interpersonal-psychological theory of suicidal behavior in hastened death research is discussed.

Basic need satisfaction and suicidal ideation: a self-determination perspective on interpersonal suicide risk and suicidal thinking.

This study investigated the relationship between the basic psychological needs, as outlined by self-determination theory, and the interpersonal predictors of suicidal desire, as outlined by the interpersonal-psychological theory of suicidal behavior. It was hypothesized that basic need satisfaction (collective feeling of autonomy, relatedness, and competence) would be related to suicidal ideation through thwarted belongingness and perceived burdensomeness. Mediation analyses demonstrated that thwarted belongingness and perceived burdensomeness both individually mediated the relationship between basic need satisfaction and suicidal ideation. Relatedness also predicted variance of the interaction of thwarted belongingness by perceived burdensomeness while controlling for depression. The clinical utility of assessing need satisfaction as an indication of suicide risk is discussed. Future research to investigate the temporal relationship of the study variables is recommended.