Rumination has been implicated as a risk factor for suicidal ideation and attempts, yet the literature to date has not been synthesized. We conducted a meta-analysis of the association between ...rumination and both suicidal ideation and attempts to consolidate the existing literature (k = 29). Results indicated that the relationships between global rumination (k = 13; Hedge's g = .74, p < .001, 95% CI .45, 1.04), brooding (k = 12; Hedge's g = .63, p < .001, 95% CI .35, .90), and reflection (k = 12; Hedge's g = .38, p = .002, 95% CI .10, .65) with suicidal ideation were significant. Associations between global rumination (k = 3; Hedge's g = .26, p < .001, 95% CI .08, .44) and brooding (k = 4; Hedge's g = .47, p = .004, 95% CI .02, .91) and suicide attempts were significant, but reflection (k = 4; Hedge's g = .09, p = .646, 95% CI −.54, .72) was unrelated. However, given the limited studies included in suicide attempt analyses-and the exclusive use of cross-sectional designs and heterogeneity with regard to samples and measures-these parameters should be taken with caution. Generally, age, gender, race/ethnicity, and year of publication were not moderators, and there was little evidence for publication bias across effects, with the exception of the effect of global rumination on suicidal ideation. Several future research directions are discussed.
Ecological momentary assessment (EMA) has increasingly been used to examine suicidality in naturalistic environments. Despite its potential to yield clinically relevant information, no EMA study has ...used an anonymous, fully online, design. This study reports on the feasibility and acceptability of real-time monitoring of suicide risk among 237 high-risk, anonymous, community-based adults (N = 237, 61.6% female, Mage = 27.12 years) who responded to six daily EMA prompts for 2 weeks. A subset (N = 69) completed a poststudy feedback survey to provide information on the acceptability of the study protocol. Response rates to EMA prompts (69.1%) demonstrated the feasibility of this design. Suicidal ideation was reported in 21.5% of prompts and by 86.1% of participants. Participants reported that their overall experience was positive, and that they would be willing to participate in a similar study again. Specific strengths and limitations of the study design were discussed in response to open-ended items. Finally, participants who created an alias email to ensure anonymity were less likely to report a suicide attempt (SA) history and more likely to complete the study. Overall, intensive EMA designs are feasible and acceptable when delivered online and to anonymous participants. Specific recommendations are provided for managing safety within these study designs, and for refinements in future work.
Public Significance Statement
This study provides evidence that conducting ecological momentary assessment studies of suicide in an entirely online format, with anonymous participation from community-based adults at high risk for suicide, are feasible and acceptable to participants.
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Objective
Here we argue for the necessity, validity, and clinical utility of a new diagnostic entity, acute suicidal affective disturbance (ASAD).
Method
We expand on the conceptual, clinical, and ...practical rationale for ASAD, propose its defining features, describe research results to date, and suggest avenues for future research.
Results
There is accruing evidence for the existence of a previously unclassified, rapid‐onset mood disturbance that geometrically escalates and regularly results in life‐threatening behavior.
Conclusions
ASAD research may not only improve the field's understanding of suicidal behavior but also enhance clinical effectiveness and save lives.
Over the past decade, the interpersonal theory of suicide has contributed to substantial advances in the scientific and clinical understanding of suicide and related conditions. The interpersonal ...theory of suicide posits that suicidal desire emerges when individuals experience intractable feelings of perceived burdensomeness and thwarted belongingness and near-lethal or lethal suicidal behavior occurs in the presence of suicidal desire and capability for suicide. A growing number of studies have tested these posited pathways in various samples; however, these findings have yet to be evaluated meta-analytically. This paper aimed to (a) conduct a systematic review of the unpublished and published, peer-reviewed literature examining the relationship between interpersonal theory constructs and suicidal thoughts and behaviors, (b) conduct meta-analyses testing the interpersonal theory hypotheses, and (c) evaluate the influence of various moderators on these relationships. Four electronic bibliographic databases were searched through the end of March, 2016: PubMed, Medline, PsycINFO, and Web of Science. Hypothesis-driven meta-analyses using random effects models were conducted using 122 distinct unpublished and published samples. Findings supported the interpersonal theory: the interaction between thwarted belongingness and perceived burdensomeness was significantly associated with suicidal ideation; and the interaction between thwarted belongingness, perceived burdensomeness, and capability for suicide was significantly related to a greater number of prior suicide attempts. However, effect sizes for these interactions were modest. Alternative configurations of theory variables were similarly useful for predicting suicide risk as theory-consistent pathways. We conclude with limitations and recommendations for the interpersonal theory as a framework for understanding the suicidal spectrum.
Public Significance Statement
This meta-analysis generally found support for the interpersonal theory of suicide-thwarted belongingness and perceived burdensomeness were significant correlates of suicidal ideation severity, and thwarted belongingness, perceived burdensomeness, and capability for suicide were significantly associated with suicide attempt history. Effect sizes for these relationships were weak-to-moderate, suggesting potentially modest clinical significance. However, there was insufficient research on the theory's specific hypotheses, including its capacity for predicting death by suicide and the role of viewing thwarted belongingness and perceived burdensomeness as intractable in suicidal desire.
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In two nationally representative surveys of U.S. adolescents in grades 8 through 12 (N = 506,820) and national statistics on suicide deaths for those ages 13 to 18, adolescents’ depressive symptoms, ...suicide-related outcomes, and suicide rates increased between 2010 and 2015, especially among females. Adolescents who spent more time on new media (including social media and electronic devices such as smartphones) were more likely to report mental health issues, and adolescents who spent more time on nonscreen activities (in-person social interaction, sports/exercise, homework, print media, and attending religious services) were less likely. Since 2010, iGen adolescents have spent more time on new media screen activities and less time on nonscreen activities, which may account for the increases in depression and suicide. In contrast, cyclical economic factors such as unemployment and the Dow Jones Index were not linked to depressive symptoms or suicide rates when matched by year.
Sea-level rise can threaten the long-term sustainability of coastal communities and valuable ecosystems such as coral reefs, salt marshes and mangroves. Mangrove forests have the capacity to keep ...pace with sea-level rise and to avoid inundation through vertical accretion of sediments, which allows them to maintain wetland soil elevations suitable for plant growth. The Indo-Pacific region holds most of the world's mangrove forests, but sediment delivery in this region is declining, owing to anthropogenic activities such as damming of rivers. This decline is of particular concern because the Indo-Pacific region is expected to have variable, but high, rates of future sea-level rise. Here we analyse recent trends in mangrove surface elevation changes across the Indo-Pacific region using data from a network of surface elevation table instruments. We find that sediment availability can enable mangrove forests to maintain rates of soil-surface elevation gain that match or exceed that of sea-level rise, but for 69 per cent of our study sites the current rate of sea-level rise exceeded the soil surface elevation gain. We also present a model based on our field data, which suggests that mangrove forests at sites with low tidal range and low sediment supply could be submerged as early as 2070.
Introduction
Suicidal ideation (SI) has numerous limitations in predicting suicidal behavior. The Suicide Crisis Syndrome (SCS) is proposed as an alternative method of detecting risk. This study ...compares the relative utility of SI and SCS in statistically predicting SI and behaviors at one‐month follow‐up.
Methods
382 psychiatric patients (98 inpatients, 284 outpatients) completed baseline measures and provided information about suicide‐related outcomes one month later. Participants were grouped based on responses to measures assessing SCS and SI.
Results
Rates of follow‐up suicidal behavior were significantly higher among those reporting both SCS and SI (22.2%) than those reporting SI alone (6.0%) or neither SCS nor SI (0.9%). SCS alone (8.3%) had descriptively, but not statistically, higher rates of suicidal behavior than those with neither SCS nor SI, and did not differ from SI alone and the combination of SCS and SI. Those reporting SI—with and without SCS—had higher levels of follow‐up suicidal thoughts than those without SI.
Conclusion
The SCS was equivalent to SI, and incrementally informative alongside SI, in detecting individuals at risk of future suicidal behavior, whereas SI was more strongly related to future SI than SCS. The combination of SCS and SI may be clinically useful in detecting individuals who are at risk for suicide.
Objective: The interpersonal theory of suicide has contributed to advances in the understanding and prevention of suicidal behavior, with over a decade of empirical examination. Few studies, however, ...have used a longitudinal design with repeated short-term follow-ups to examine the temporal trajectories of perceived burdensomeness, thwarted belongingness, and suicidal ideation, nor have any studies to our knowledge investigated the propositions of the interpersonal theory of suicide using a dynamic systems theory approach. The present study examined the temporal dynamics of perceived burdensomeness, thwarted belongingness, and suicidal ideation, as moderated by capability for suicide, using dynamic systems modeling analyses in a sample of 91 adults at high risk for suicide (Mage = 27.03 years, SD = 8.64; 53.8% female, 44.0% male, 1.1% nonbinary, 1.1% transgender female). Method: Participants completed brief online self-report measures at 6 time-points, each 3 days apart. Results: Results were generally in support of the interpersonal theory of suicide: perceived burdensomeness, thwarted belongingness, and suicidal ideation exhibited patterns of temporal stability that were accentuated at high levels of capability for suicide; perceived burdensomeness and thwarted belongingness exhibited a reciprocal temporal pattern, as did perceived burdensomeness and suicidal ideation. However, thwarted belongingness did not have an incremental influence on suicidal ideation. Conclusions: Overall, these findings provide additional information about the nature of suicidal ideation and interpersonal risk factors over time and point to nonlinear dynamic systems modeling as an analytic technique that may prove useful in understanding trajectories of suicidal thoughts and behaviors.
What is the public health significance of this article?
This study provided support for some propositions of the interpersonal theory of suicide using a short-term, repeated-measures design and dynamic systems modeling in a sample at high risk for suicide. Specifically, perceived burdensomeness, thwarted belongingness, and suicidal ideation were relatively stable over time; perceived burdensomeness influenced suicidal ideation over time; and perceived burdensomeness exhibited a reciprocal pattern with thwarted belongingness and suicidal ideation. Effects were stronger at higher levels of capability for suicide, consistent with the interpersonal theory of suicide.
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Objective: Affective states and rumination have each been linked to suicidal ideation; however, to our knowledge, no studies have examined their interactive effect in predicting suicidal ideation in ...the short term. The present study examined the concurrent and short-term prospective relationships between affective states, rumination, and suicidal ideation using ecological momentary assessment (EMA). Method: A sample of 237 community-based adults at high risk for suicide (Mage = 27.12 years, 61.6% cisgender women) responded to six EMA prompts each day for 2 weeks that assessed their momentary affective states (depression, anxiety, happiness, hopelessness, agitation, irritability), rumination, and suicidal ideation. Results: Rumination moderated the relationship between concurrent affective states and suicidal ideation, at both the within-person and between-person levels. Specifically, the relations between affective states and suicidal ideation were stronger at higher levels of rumination. These interaction effects were not found when examining short-term prospective associations. Conclusions: Affective states and rumination may each confer risk for suicidal ideation in the short term, and rumination may serve as a catalyst of the link between affective states and suicidal ideation when examined concurrently. Clinical implications, limitations, and future research directions are discussed.
What is the public health significance of this article?
This study highlights rumination as an important moderating feature influencing of the relationship between emotions and suicidal ideation. Individuals who ruminate more, both in general and from moment to moment, have a stronger relationship between these affective states and suicidal ideation.
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Suicide-specific rumination, defined as a mental fixation on one's suicidal thoughts, intentions, and plans, may be an important predictor of suicidal behavior. To date, suicide-specific rumination ...has demonstrated convergence with, yet distinction from, a variety of suicide risk factors, and differentiated suicide attempters from ideators. However, no research has examined whether suicide-specific rumination is associated with lifetime suicide attempts above and beyond the presence of a host of other relevant suicide risk factors. The present study tested this hypothesis in samples of students (N = 300) and community members recruited via Amazon's MTurk (N = 209) who reported a lifetime history of suicidal ideation. Results indicated that suicide-specific rumination was associated with the presence of a lifetime suicide attempt, above and beyond a variety of other commonly-cited risk factors for suicidal thoughts and behaviors in both samples, including suicidal ideation, general rumination, interpersonal theory variables, emotion-relevant factors (dysregulation, experiential avoidance, distress tolerance, negative affect), symptoms of depression and anxiety, and overarousal. Overall, though limited by the use of non-clinical samples and a cross-sectional study design, that suicide-specific rumination outperformed all other suicide risk factors in predicting the presence of a lifetime suicide attempt suggests the potential potency of this relatively understudied risk factor in understanding transitions to suicidal behavior.
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