The relationship between entrapment and suicidal behavior through the lens of the integrated motivational-volitional model of suicidal behavior

Suicide and suicidal behavior are major public health concerns. As a result, a number of psychological models have been developed to better understand the emergence of suicidal ideation and suicide attempts. One such model is the integrated motivational–volitional model, a tri-partite model of suicidal behavior, which posits that entrapment is central to the final common pathway to suicide. In this review, we summarize the extant research evidence for the relationship between entrapment and suicidal ideation and behavior. Although there is robust evidence for the relationship between entrapment and suicidal ideation and behavior, there are gaps in our knowledge. We discuss the clinical implications and suggest key directions for future research

Neuroeconomics of suicide.

Suicidal behavior is a leading cause of injury and death worldwide. Suicide has been associated with psychiatric illnesses such as depression and schizophrenia, as well as economic uncertainty, and social/cultural factors. This study proposes a neuroeconomic framework of suicide. Neuroeconomic parameters (e.g., risk-attitude, probability weighting, time discounting in intertemporal choice, and loss aversion) are predicted to be related to suicidal behavior. Neurobiological and neuroendocrinological substrates such as serotonin, dopamine, cortisol (HPA axis), nitric oxide, serum cholesterol, epinephrine, norepinephrine, gonadal hormones (e.g., estradiol and progesterone), dehydroepiandrosterone (DHEA) in brain regions such as the orbitofrontal/dorsolateral prefrontal cortex and limbic regions (e.g., the amygdala) may supposedly be related to the neuroeconomic parameters modulating the risk of suicide. The present framework puts foundations for ―molecular neuroeconomics‖ of decision-making processes underlying suicidal behavior

Predicting Suicidal Behavior: Are We Really that Far Along? Comment on “Discovery and Validation of Blood Biomarkers for Suicidality”

A recent publication focused on biomarkers of future suicidal behaviors identifies several genes expressed in high-risk states among four samples. We discuss the implications of this study as well as the current state of research regarding biomarkers of suicidal behavior

Is there a neuroanatomical basis of the vulnerability to suicidal behavior?: a coordinate-based meta-analysis of structural and functional MRI studies

Objective: We conducted meta-analyses of functional and structural neuroimaging studies comparing adolescent and adult individuals with a history of suicidal behavior and a psychiatric disorder to psychiatric controls in order to objectify changes in brain structure and function in association with a vulnerability to suicidal behavior. Methods: Magnetic resonance imaging studies published up to July 2013 investigating structural or functional brain correlates of suicidal behavior were identified through computerized and manual literature searches. Activation foci from 12 studies encompassing 475 individuals, i.e., 213 suicide attempters and 262 psychiatric controls were subjected to meta-analytical study using anatomic or activation likelihood estimation (ALE). Result: Activation likelihood estimation revealed structural deficits and functional changes in association with a history of suicidal behavior. Structural findings included reduced volumes of the rectal gyrus, superior temporal gyrus and caudate nucleus. Functional differences between study groups included an increased reactivity of the anterior and posterior cingulate cortices. Discussion: A history of suicidal behavior appears to be associated with (probably interrelated) structural deficits and functional overactivation in brain areas, which contribute to a decision-making network. The findings suggest that a vulnerability to suicidal behavior can be defined in terms of a reduced motivational control over the intentional behavioral reaction to salient negative stimuli

Nonsuicidal Self-Injury and Suicidal Behavior: A Latent Class Analysis among Young Adults

Although there is a general consensus among researchers that engagement in nonsuicidal self-injury (NSSI) is associated with increased risk for suicidal behavior, little attention has been given to whether suicidal risk varies among individuals engaging in NSSI. To identify individuals with a history of NSSI who are most at risk for suicidal behavior, we examined individual variability in both NSSI and suicidal behavior among a sample of young adults with a history of NSSI (N = 439, Mage = 19.1). Participants completed self-report measures assessing NSSI, suicidal behavior, and psychosocial adjustment (e.g., depressive symptoms, daily hassles). We conducted a latent class analysis using several characteristics of NSSI and suicidal behaviors as class indicators. Three subgroups of individuals were identified: 1) an infrequent NSSI/not high risk for suicidal behavior group, 2) a frequent NSSI/not high risk for suicidal behavior group, and 3) a frequent NSSI/high risk for suicidal behavior group. Follow-up analyses indicated that individuals in the ‘frequent NSSI/high risk for suicidal behavior’ group met the clinical-cut off score for high suicidal risk and reported significantly greater levels of suicidal ideation, attempts, and risk for future suicidal behavior as compared to the other two classes. Thus, this study is the first to identity variability in suicidal risk among individuals engaging in frequent and multiple methods of NSSI. Class 3 was also differentiated by higher levels of psychosocial impairment relative to the other two classes, as well as a comparison group of non-injuring young adults. Results underscore the importance of assessing individual differences in NSSI characteristics, as well as psychosocial impairment, when assessing risk for suicidal behavior

Suicidal Behavior and the Labor Market Productivity of Young Adults

This paper provides a comprehensive analysis of the link between suicidal behaviors and human capital formation of young adults in the United States. Using data from the National Longitudinal Study of Adolescent Health, we estimate the effects of suicide thoughts and attempts on the probability of engaging in work or school. The richness of the data set allows us to implement several strategies to control for unobserved heterogeneity and the potential reverse causality. These include using a large set of control variables that are likely to be correlated with both suicidal behavior and the outcome measures, an instrumental variables method, and a fixed effects analysis from the subsample of twin pairs contained in the data. The longitudinal nature of the data set also allows us to control for past suicidal thoughts and suicide attempts of the individuals from their high school years as well as the suicidal behavior of their family members. Results from the different identification strategies consistently indicate that both suicide thoughts and suicide attempts decrease the likelihood a young adult individual engages in work or schooling.

A History of Trauma is Associated with Aggression, Depression, Non-Suicidal Self-Injury Behavior, and Suicide Ideation in First-Episode Psychosis.

The association between trauma and psychosis outcomes is well-established, and yet the impact of trauma on comorbid clinical symptoms-such as aggression, non-suicidal self-injury behavior (NSSIB), suicide ideation, and suicide behavior-for those with psychosis is unclear. To effectively treat those with first-episode psychosis (FEP) and a history of trauma, we need to understand the impact of trauma on their whole presentation. FEP participants were recruited from an Early Psychosis Program (N = 187, ages 12-35, 72.2% male). Clinicians gathered history of trauma, aggression, and suicide data, and rated current symptom severity and functioning. Data was coded using clinician rated measures, self-report measures, and retrospective clinical chart review. Regression analyses examined whether trauma was associated with a history of aggression, suicidal ideation, suicide behavior, NSSIB, symptoms, and functioning. Trauma was associated with aggression, aggression severity and type of aggression (aggression towards others). Trauma was also associated with depression severity, suicide ideation, most severe suicide ideation, and NSSIB. Trauma was not associated with suicide behavior, severity of suicide behavior or psychosocial functioning. Integrating trauma treatment into FEP care could reduce rates of depression, aggression, suicide ideation, and NSSIB for those with a history of trauma. To reduce suicide attempt occurrence and improve functioning, more research is needed

Cognition and Suicide: Effectiveness of Cognitive Behaviour Therapy

The aim of this review paper is to show an overview of the empirical evidence of effectiveness of cognitive behavioral therapy (CBT) in reducing suicidal cognitions and suicidal behavior. The topic of suicidal cognition and suicidal behavior is of special importance to clinicians and practitioners. Analyses of empirical findings from the oldest, first systematic review and meta-analysis and the newest one shown that there not enough evidence from clinical trials to suggest that CBT focusing on mental illness reduces suicidal cognitions and behaviors. But, from the other hand, CBT focusing on suicidal cognitions and suicidal behaviors was found to be effective. Taking into consideration the effectiveness of this psychotherapy, we can conclude that it is preferable for clinicians to be trained in working with CBT techniques focused on suicidal cognition and behavior that are independent of treatment of mental disorders. In addition, it is necessary to initiate new research that will make it possible to create preventive and interventional programs dedicated to reducing the risk of suicide. Keywords: cognition, suicide, cognitive behavior, psychotherapy, effectiveness

Associations of suicidal ideation with opioid/prescription drug use, violence, food insecurity, and community factors among New Hampshire high school students

Purpose: Suicide is the second leading cause of death for New Hampshire (NH) youth. Evidence-based public health emphasizes the use of data for translating research into practice/policy. We utilized data from the Youth Risk Behavior Survey (YRBS) to support community-academic partnerships and inform suicide prevention interventions. Methods: Data from the 2011 NH YRBS, a cross-sectional survey of 9th-12th grade students, were analyzed. Gender-stratified, adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using logistic regression models (SAS 9.4, ProcSuveylogistic) to evaluate associations between suicidal ideation (seriously considering attempting suicide within the past 12 months), violence (e.g., physical bullying, cyber-bullying, forced sexual activity), opioid/prescription drug use, food insecurity, and perceptions of being valued by one’s community. Results: Overall, the prevalence of suicidal ideation was 14.3% (females 16.8%; males 12.2%). For both genders, higher prevalence of suicidal ideation was observed among students in grades 9 (15.6%) and 10 (17.8%) compared to grades 11 (11.6%) and 12 (11.3%). In adjusted models, among girls, suicidal ideation was positively associated with the use of opioid/prescription drugs (aOR: 1.38; CI: 1.13-1.67)), violence (being forced to have sex (aOR 2.32 (CI 1.12-4.81)); being bullied on school property (aOR 2.28 (CI 1.31-3.97)), and food insecurity ((aOR 1.36 (CI 1.02-1.81)). Among boys, suicidal ideation was positively associated with opioid/drug use (aOR 1.25 (CI 1.04-1.49)), cyberbullying (aOR 2.69(CI 1.17-6.18)), and food insecurity ((aOR 1.44 (CI 1.14-1.83). Youth who perceived that they did not matter to their community were more likely to report suicidal ideation (Girls: aOR: 1.62; CI: 1.27-2.08; Boys: aOR: 1.37; (CI: 1.10-1.71)), compared to those who felt that they mattered to their community. Conclusions: Drug use, violence, and food insecurity emerged as significant risk factors for suicidal ideation among NH youth. Interventions that make youth feel that they matter to their communities may protect against suicidal ideation

SUICIDALITY AND SIDE EFFECTS OF ANTIDEPRESSANTS AND ANTIPSYCHOTICS

Antidepressants and antipsychotics can cause side effects in various organs and organic systems, and some (and) in the central nervous system, which can also be clinically manifested by suicidal behavior as well. Tricyclic antidepressants particularly of imipramine and clomipramine can have pro-suicidal effect, which is believed to be the consequence of their own hypothetic asynchronous cognitive-psychomotor pharmacodynamic action. Antidepressants from the group of selective serotonin reuptake inhibitors can at the beginning of administration as monotherapy also have pro-suicidal effects in patients with hints of suicidality or suicidal behavior, by increasing the intensity of already present suicidal predictors, such as dysphoria, anxiety, impulsiveness, agitation etc. Antipsychotics can act stimulatingly upon predictors of suicidal behavior, that is, pro-suicidal in an indirect way through side effects they cause indirect pro-suicidal neurological and consecutive psychological impact, as it is called. It is particularly valid for classic antipsychotics causing primarily neurological, i.e. extrapyramidal side effects, along which consecutive psychological side effects can occur as well. However, new antipsychotics in comparison to classic ones, have less pronounced neurological, extrapyramidal symptoms and signs but more somatic-metabolic side effects, and thereby their action can be mostly manifested as indirect pro-suicidal neurological and somatic-metabolic as well as consecutive psychological activity