Understanding Suicide Risk Within the Research Domain Criteria (RDoC) Framework: Insights, Challenges, and Future Research Considerations

Suicide is a leading cause of death worldwide. Prior research has focused primarily on sociodemographic and psychiatric risk factors with little improvement in the prediction or prevention of suicidal behavior over time. The Research Domain Criteria (RDoC) may be an especially useful framework for advancing research in this area. This paper provides a brief and broad overview of research on suicidal behavior relating to each of the RDoC domains—highlighting the RDoC construct(s) where research has focused, construct(s) where research is lacking, and suggestions for future research directions. We also discuss major challenges for suicide research within the RDoC framework, including the intersection of RDoC domains, interaction of domains with the environment, incorporation of developmental stage, integration of distal and proximal processes, and inclusion of suicide-specific constructs. We conclude by underscoring important considerations for future research aimed at using the RDoC framework to study suicidal behavior and other forms of psychopathology.Psycholog

The detection of acute risk of self-injury project:Protocol for an ecological momentary assessment study among individuals seeking treatment

Background:Nonsuicidal self-injury (NSSI) is a major mental health concern. Despite increased research efforts on establishing the prevalence and correlates of the presence and severity of NSSI, we still lack basic knowledge of the course, predictors, and relationship of NSSI with other self-damaging behaviors in daily life. Such information will be helpful for better informing mental health professionals and allocating treatment resources. The DAILY (Detection of Acute rIsk of seLf-injurY) project will address these gaps among individuals seeking treatment.Objective: This protocol paper presents the DAILY project's aims, design, and materials used. The primary objectives are to advance understanding of (1) the short-term course and contexts of elevated risk for NSSI thoughts, urges, and behavior; (2) the transition from NSSI thoughts and urges to NSSI behavior; and (3) the association of NSSI with disordered eating, substance use, and suicidal thoughts and behaviors. A secondary aim is to evaluate the perspectives of individuals seeking treatment and mental health professionals regarding the feasibility, scope, and utility of digital self-monitoring and interventions that target NSSI in daily life.Methods: The DAILY project is funded by the Research Foundation Flanders (Belgium). Data collection involves 3 phases: a baseline assessment (phase 1), 28 days of ecological momentary assessment (EMA) followed by a clinical session and feedback survey (phase 2), and 2 follow-up surveys and an optional interview (phase 3). The EMA protocol consists of regular EMA surveys (6 times per day), additional burst EMA surveys spaced at a higher frequency when experiencing intense NSSI urges (3 surveys within 30 minutes), and event registrations of NSSI behavior. The primary outcomes are NSSI thoughts, NSSI urges, self-efficacy to resist NSSI, and NSSI behavior, with disordered eating (restrictive eating, binge eating, and purging), substance use (binge drinking and smoking cannabis), and suicidal thoughts and behaviors surveyed as secondary outcomes. The assessed predictors include emotions, cognitions, contextual information, and social appraisals.Results: We will recruit approximately 120 individuals seeking treatment aged 15 to 39 years from mental health services across the Flanders region of Belgium. Recruitment began in June 2021 and data collection is anticipated to conclude in August 2023.Conclusions: The findings of the DAILY project will provide a detailed characterization of the short-term course and patterns of risk for NSSI and advance understanding of how, why, and when NSSI and other self-damaging behaviors unfold among individuals seeking treatment. This will inform clinical practice and provide the scientific building blocks for novel intervention approaches outside of the therapy room that support people who self-injure in real time

Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies

Background A history of self-injurious thoughts and behaviors (SITBs) is consistently cited as one of the strongest predictors of future suicidal behavior. However, stark discrepancies in the literature raise questions about the true magnitude of these associations. The objective of this study is to examine the magnitude and clinical utility of the associations between SITBs and subsequent suicide ideation, attempts, and death. Method We searched PubMed, PsycInfo, and Google Scholar for papers published through December 2014. Inclusion required that studies include at least one longitudinal analysis predicting suicide ideation, attempts, or death using any SITB variable. We identified 2179 longitudinal studies; 172 met inclusion criteria. Results The most common outcome was suicide attempt (47.80%), followed by death (40.50%) and ideation (11.60%). Median follow-up was 52 months (mean = 82.52, s.d. = 102.29). Overall prediction was weak, with weighted mean odds ratios (ORs) of 2.07 [95% confidence interval (CI) 1.76–2.43] for ideation, 2.14 (95% CI 2.00–2.30) for attempts, and 1.54 (95% CI 1.39–1.71) for death. Adjusting for publication bias further reduced estimates. Diagnostic accuracy analyses indicated acceptable specificity (86–87%) and poor sensitivity (10–26%), with areas under the curve marginally above chance (0.60–0.62). Most risk factors generated OR estimates of <2.0 and no risk factor exceeded 4.5. Effects were consistent regardless of sample severity, sample age groups, or follow-up length. Conclusions Prior SITBs confer risk for later suicidal thoughts and behaviors. However, they only provide a marginal improvement in diagnostic accuracy above chance. Addressing gaps in study design, assessment, and underlying mechanisms may prove useful in improving prediction and prevention of suicidal thoughts and behaviors.Psycholog

Introduction to the Special Issue: Recent Advances In Suicide Research: Mediators and Moderators of Risk and Resilience

The impact of suicide is undeniable. In the United States alone, over 40,000 people died by suicide in 2012 (Centers for Disease Control and Prevention [CDC], 2013). Moreover, it is estimated that 10 times as many people make medically serious suicide attempts every year, resulting in a cost to the medical system in excess of $150 million. A large body of research on suicide risk has been amassed with the implicit goal of reducing suicide’s impact. This goal has yet to be achieved. Since 1990, suicide rates have generally stayed the same (Kessler, Berglund, Borges, Nock, & Wang, 2005). The lack of progress in reducing suicide’s impact may be a result of limits to what we can learn from the majority of previous research, which has often relied upon bivariate and sometimes atheoretical models. Indeed, there has recently been a push to move beyond main effect models to more complex theoretically informed models of suicide risk that involve mediators and moderators (Glenn & Nock, 2014; O’Connor & Nock, 2014). Main effect models can only identify which factors are associated with suicide risk. Moderation and mediation models, however, help us understand the conditions under which suicide risk is enhanced or diminished as well as the mechanisms of how suicide risk is generated. The articles in this special issue of the International Journal of Cognitive Therapy address this need for a movement beyond main effects by answering three overarching questions: (1) What are the moderators that might increase or decrease risk for suicide?, (2) What are the mediators between suicide risk and suicide-related outcomes?, and (3) How can we better integrate theory into our empirical investigations?Psycholog

Do Theories of Suicide Play Well Together? Integrating Components of the Hopelessness and Interpersonal Psychological Theories of Suicide

Given that suicide is a leading cause of death worldwide, there has been considerable research on theories of suicide risk. Despite the volume of such research, each theory is largely investigated in isolation and there has been little attempt to integrate them. Thus, the goal of the present study is to integrate two theories of suicide risk, Alloy and Abramson’s hopelessness theory of suicide (HT) and Joiner’s interpersonal psychological theory of suicide (IPTS), into one mediational model where the effects of the risk associated with the HT variables (i.e., a negative cognitive style) on suicidal ideation are transmitted by the IPTS (i.e., perceived burdensomeness and thwarted belonging) variables. Participants were 245 young adults with elevated levels of depressive symptoms who completed self-report measures of suicide risk at baseline and a measure of suicidal ideation eight weeks later. The results of a mediated model supported our hypothesis. The effects of the HT variables on suicidal ideation were mediated by the IPTS variables. Furthermore, results did not support the reverse model, suggesting specificity of the direction of our hypotheses. These findings imply that there may be merit in attempting to integrate theories of suicide risk rather than studying them in isolation

Influence of anxiety, depression and looming cognitive style on auditory looming perception

Previous studies show that individuals with an anticipatory auditory looming bias over-estimate the closeness of a sound source that approaches them. Our present study bridges cognitive clinical and perception research, and provides evidence that anxiety symptoms and a particular putative cognitive style that creates vulnerability for anxiety (looming cognitive style, or LCS) are related to how people perceive this ecologically fundamental auditory warning signal. The effects of anxiety symptoms on the anticipatory auditory looming effect synergistically depend on the dimension of perceived personal danger assessed by the LCS (physical or social threat). Depression symptoms, in contrast to anxiety symptoms, predict a diminution of the auditory looming bias. Findings broaden our understanding of the links between cognitive-affective states and auditory perception processes and lend further support to past studies providing evidence that the looming cognitive style is related to bias in threat processing