The Relationship Between Painful/Provocative Training Experiences and Capability for Suicide Among Medical Students

The primary aim of this study was to examine the relationship between capability for suicide and painful and provocative experiences related to practicing within the medical profession (mPPEs) among students enrolled in a College of Osteopathic Medicine (n = 114). It was posited that frequency of engagement in mPPEs would predict scores on measures of capability for suicide above and beyond the effects of gender and painful and provocative experiences unrelated to practicing within the medical profession (PPEs). It was also posited that frequency of both witnessing and performing an mPPE would moderate the impact of curriculum component on capability for suicide, such that students enrolled in the clinical component of the medical school curriculum (i.e. students within the third and fourth years of training) would exhibit the highest mean levels of capability, particularly when such individuals have witnessed and performed an elevated number of provocative medical experiences. Results indicated that frequency of mPPEs significantly predicted scores on measures of capability for suicide, suggesting that students frequently engaging in mPPEs exhibit higher capability for suicide. Moreover, this finding suggests that medical training contributes to the development of capability for suicide through exposure to mPPEs. Results also indicated that neither frequency of witnessing or performing mPPEs significantly moderated the impact of curriculum component on capability. Findings from the current study may serve to inform suicide prevention efforts among medical students by highlighting the relationship between mPPEs and capability for suicide, among a population known to exhibit elevated suicidal ideation

Examining the Association Between Psychotropic Medication and Suicidal Desire and Risk

The primary aim of this study was to examine the relationship between components of suicidal desire and psychotropic medication. Specifically, the usage of psychotropic medication, the usage of specific classes of psychotropic medications and the amount of psychotropic medication utilized and differences in feelings of perceived burdensomeness, thwarted belongingness and overall suicide risk were examined. The present study utilized pre-collected data consisting of 225 patients with substance use disorder undergoing residential treatment for substance dependence. It was posited that individuals utilizing psychotropic medications would exhibit higher mean levels of thwarted belongingness, perceived burdensomeness, and suicide risk relative to individuals not utilizing psychotropics and that individuals utilizing multiple psychotropic medications would exhibit higher suicidal desire and risk than individuals utilizing zero or one psychotropic medication. Additionally, it was posited that individuals utilizing antipsychotics would exhibit higher suicidal desire and risk than individuals utilizing any other type of psychotropic medication. For all hypotheses it was posited that such effects would occur above and beyond severity of psychopathology and substance use. Results indicated a significant difference in suicide risk between individuals utilizing a psychotropic and individuals not utilizing a psychotropic. Additional exploratory analyses indicated a significant difference in levels of perceived burdensomeness between individuals utilizing an antidepressant and individuals utilizing any other type of psychotropic besides an antidepressant. Overall, results suggest that the use of psychotropic medication may increase the risk for suicide. These findings highlight the need for routine suicide risk assessments for patients utilizing psychotropic medications

The Relationship Between Non-Suicidal Self-Injury and Both Perceived Burdensomeness and Thwarted Belongingness

Prior research has established a connection between non-suicidal self-injury (NSSI) and suicidal behavior. The interpersonal-psychological theory of suicidal behavior (IPTS) posits that an individual must possess both a desire and capability for suicide in order to engage in a lethal suicide attempt. The IPTS conceptualizes the role of NSSI in suicidal behavior as contributing to an individual’s acquired capability. The primary aim of this study was to investigate the relationship between frequency of engagement in NSSI and suicidal desire (thwarted belongingness and perceived burdensomeness). In this study, undergraduate students (n = 999) completed various questionnaires online. Results revealed a significant, positive association between NSSI frequency and thwarted belongingness and a non-significant association between NSSI frequency and perceived burdensomeness. Additionally, results indicated a significant indirect effect of NSSI frequency on burdensomeness and belongingness through depression and borderline personality disorder symptoms. The direct effect of NSSI frequency on belongingness remained significant; however, the direct effect of NSSI frequency on burdensomeness did not. These findings suggest that the relationship between NSSI and suicide is not strictly limited to acquired capability, but rather includes a component of suicidal desire

Military Personnel Compared to Multiple Suicide Attempters: Interpersonal Theory of Suicide Constructs

The current study aimed to address the discrepancy between suicide rates in the military and general population by comparing facets of the interpersonal theory of suicide between civilians with multiple suicide attempts and U.S. military personnel. Military personnel exhibited higher levels of capability for suicide but lower levels of perceived burdensomeness and thwarted belongingness than civilian multiple attempters. When comparing only personnel endorsing ideation and civilian multiple attempters, the significant difference for capability remained, but the differences for perceived burdensomeness and thwarted belongingness became nonsignificant. Results suggest the emergence of ideation places personnel at a greater risk for suicide than many civilian multiple attempters

Treating the Capability for Suicide: A Vital and Understudied Frontier in Suicide Prevention

Current efforts at suicide prevention center largely on reducing suicidal desire among individuals hospitalized for suicidality or being treated for related psychopathology. Such efforts have yielded evidence-based treatments, and yet the national suicide rate has continued to climb. We propose that this disconnect is heavily influenced by an unmet need to consider population-level interventions aimed at reducing the capability for suicide. Drawing on lessons learned from other public health phenomena that have seen drastic declines in frequency in recent decades (HIV, lung cancer, motor vehicle accidents), we propose that current suicidality treatment efforts trail current suicidality theories in their lack of focus on the extent to which individuals thinking about suicide are capable of transitioning from ideation to attempt. We summarize extant evidence for specific capability-centered approaches (e.g., means safety) and propose other options for improving our ability to address this largely overlooked variable. We also note that population-level approaches in this regard would represent an important opportunity to decrease risk in individuals who either lack access to evidence-based care or underreport suicidal ideation, as a reduced capability for suicide would theoretically diminish the potency of suicidal desire and, in this sense, lower the odds of a transition from ideation to attempt

The Relationship Between Post-Battle Experiences and Thwarted Belongingness and Perceived Burdensomeness In Three United States Military Samples

Suicide rates within the military are elevated relative to the general population; however, research suggests that many of the suicide risk factors for military personnel are similar to the suicide risk factors for civilians. Given that many military specific experiences (e.g., number of deployments) are not considered robust predictors of either suicidal ideation or behavior, it has been posited that deployment specific experiences (e.g., post-battle experiences) may be better able to explain the increased rates of suicide among military personnel. Therefore, the current study aimed to examine the relationship between post-battle experiences and perceived burdensomeness (PB), thwarted belongingness (TB), and suicidal ideation within 3 different military samples: a non-clinical sample of Army National Guard personnel, a non-clinical sample of active duty U.S. Air Force Security Forces personnel, and a clinical sample of U.S. Army personnel receiving outpatient treatment. Post-battle experiences were found to be significantly associated with TB in both non-clinical samples; however, the association between post-battle experiences and TB was non-significant within the clinical sample. Furthermore, results indicated that post-battle experiences were not significantly associated with either PB or suicidal ideation in any of the samples. These findings suggest that in non-clinical samples, post-battle experiences impact a soldier’s ability to feel connected to others. Within clinical samples, results indicate that post-battle experiences may not be a direct contributor to either PB or TB. These results indicate a need for universal intervention promoting interpersonal support of military personnel and their families prior to development of further need for psychological interventions. This upstream approach may decrease further development of TB and potentially prevent suicidal desire

The Relationship between Post-Battle Experiences and Thwarted Belongingness and Perceived Burdensomeness in Three United States Military Samples

Suicide rates within the military are elevated relative to the general population; however, research suggests that many of the suicide risk factors for military personnel are similar to the suicide risk factors for civilians. Given that many military specific experiences (e.g., number of deployments) are not considered robust predictors of either suicidal ideation or behavior, it has been posited that deployment specific experiences (e.g., post-battle experiences) may be better able to explain the increased rates of suicide among military personnel. Therefore, the current study aimed to examine the relationship between post-battle experiences and perceived burdensomeness (PB), thwarted belongingness (TB), and suicidal ideation within 3 different military samples: a non-clinical sample of Army National Guard personnel, a non-clinical sample of active duty U.S. Air Force Security Forces personnel, and a clinical sample of U.S. Army personnel receiving outpatient treatment. Post-battle experiences were found to be significantly associated with TB in both non-clinical samples; however, the association between post-battle experiences and TB was non-significant within the clinical sample. Furthermore, results indicated that post-battle experiences were not significantly associated with either PB or suicidal ideation in any of the samples. These findings suggest that in non-clinical samples, post-battle experiences impact a soldier’s ability to feel connected to others. Within clinical samples, results indicate that post-battle experiences may not be a direct contributor to either PB or TB. These results indicate a need for universal intervention promoting interpersonal support of military personnel and their families prior to development of further need for psychological interventions. This upstream approach may decrease further development of TB and potentially prevent suicidal desire