Revised Attentional Fixation on Suicide Experiences Questionnaire and its relationship with suicidal ideation and behavior: A cross-sectional study

Lower- versus higher-order suicide-related attentional processing measures as predictors of adolescent suicide ideation and attempt

Cognitive theories suggest that biased suicide-related attentional processing confers risk for suicide ideation (SI) and attempts (SAs), but studies to date, which have been mixed, have not compared lower- and higher-order measures of attentional processes. The present study examined attention fixation, attention disengagement, and semantic interference as predictors of future SI and SA among adolescents, a high-risk age group for onset of SI and SAs. Adolescents (N = 135) (75 % female), ages 12-19 (M = 15.4, SD = 1.9), who presented to emergency or outpatient departments with SI (n = 84) or a SA (n = 51) completed an attention disengagement task (ADT), Suicide Stroop task, and the Attentional Fixation on Suicide Experiences Questionnaire (AFSEQ). A subsample of adolescents completed 3-month (n = 98) and 12-month follow-up assessments (n = 96) of SI severity and SA (n = 118) (based on adolescent or caregiver report). AFSEQ score predicted SI severity at 3- and 12-months, respectively, b = 0.47, p < .05; b = 0.44, p < .01, adjusting for ADT and relevant covariates, and also predicted SA at follow up, OR = 1.06, 95 % CI = 1.00-1.12, p < .05, adjusting for SA history, but not after adjusting for SI. Greater suicide-related attention disengagement difficulty predicted greater SI severity at 12 months, b = 0.03, p < .05, but not at 3 months. Self-reported, higher-order, attentional fixation may better predict future suicide-related risk among diverse adolescents than lower-order cognitive tasks assessing suicide-related attention disengagement or semantic interference.

Differences in suicide-specific attentional bias based on stimuli across the suicide Stroop and disengagement tasks

BACKGROUND

Evidence of suicide-specific attentional bias has been mixed, including the effect of specific suicide words (e.g., "suicide" versus "overdose"). The current study examined the psychometric properties and convergent validity of specific suicide words on the Stroop and disengagement tasks.

METHODS

Adults (79.8 % male, mean age = 42.19 ± 12.66) on a psychiatric inpatient unit completed both tasks, as well as clinical and demographic measures, following a recent suicide attempt (SA) (n = 55) or recent suicidal ideation (SI) with (n = 29) or without (n = 26) a SA history.

RESULTS

Mean reaction times (RTs) on both tasks demonstrated good internal consistency and were moderately correlated across tasks, while interference scores demonstrated poor reliability and were not correlated. Attentional bias to specific suicide words did not differentiate SA groups, except for a small, unexpected effect on the Stroop task showing greater interference to the word "funeral" among the recent SA group. Correlations with suicide risk factors differed for males and females.

LIMITATIONS

Participants all endorsed elevated SI, limiting generalizability beyond a recent suicidal crisis. Different suicide words were used on each task limiting direct comparisons. Groups based on SA history and gender were uneven, and correlations need to be replicated. Effects involving interference scores should be interpreted with caution given poor internal consistency.

CONCLUSION

The suicide Stroop and disengagement tasks partially capture distinct aspects of suicide-relevant attentional bias. Greater attention is needed regarding the particular stimuli and scoring methods as well as the role gender plays in suicide-relevant attentional bias.

Facets of Suicidal Ideation

According to SAMHSA (2023), approximately 16,600,000 American adults and teens reported having serious thoughts of suicide in 2022. While suicide prevention has primarily focused on suicide deaths and attempts, we contend that suicidal ideation (SI) deserves more in-depth investigation and should be an essential intervention target on its own. In support of this point, we provide three examples of ways to improve specificity in understanding of SI through the study of controllability of SI, the language used to assess SI, and measuring SI in real time. We also consider qualitative work on the content of SI, its treatment, and definitional considerations. We thus call for an increased general focus on SI within research, clinical care, and policy.

Ecological momentary assessments of cognitive dysfunction and passive suicidal ideation among college students

Cognitive dysfunction (CD), inclusive of specific cognitive content (e.g., hopelessness, unbearability) or impaired cognitive processes (e.g., attentional fixation on suicide, rumination), is a key risk factor for suicidal ideation (SI). This study aimed to evaluate multiple forms of CD using ecological momentary assessment (EMA) to determine the unique contributions of CD to concurrent and prospective SI. Fifty-five college students with a history of SI or non-suicidal self-injury completed EMA surveys measuring momentary CD and passive SI ("Wish to Die" [WTD], "Wish to Stay Alive" [WTL]) four times a day for 14 days (2149 total observations). Passive SI and CD variables showed notable within-person variability. Multiple CD variables were significant predictors of concurrent ideation when examined simultaneously in multilevel models with random intercepts and fixed slopes, and associations were stronger when participants were around others. Controlling for concurrent passive SI, between-person rumination was a significant predictor of prospective WTD, and both within-person unbearability and between-person hopelessness were each predictive of prospective WTL. These findings provide evidence for the roles of specific types of CD in conferring risk for passive SI and highlight potentially malleable factors that can be changed through targeted interventions.

Perseveration on suicidal thoughts and images in daily life: An examination of the cognitive model of suicide through a dynamic systems lens

According to the cognitive model of suicide, interactions between hopelessness and attentional biases toward suicidal information create a narrowed attentional focus on suicide as a viable solution, particularly in the presence of life stress, leading to increased suicide risk. This study used a dynamic systems approach to examine the short-term temporal patterns between stress, hopelessness, suicide-specific rumination, and suicidal intent. Adults (N = 237; M = 27.12 years; 62% cisgender women; 87% White/European American) with elevated suicidal ideation completed ecological momentary assessments six times a day for 14 days. A multilevel model approach informed by dynamic systems theory was used to simultaneously assess stable and dynamic temporal processes underlying perceived stress, hopelessness, suicide-specific rumination, and suicidal intent. Each variable demonstrated temporal stability. In support of the cognitive model of suicide, we observed (1) a reciprocal relationship between stress and hopelessness such that stress and hopelessness amplified each other (early-stage processes), and (2) reinforcing loops such that hopelessness, suicide-specific rumination, and suicidal intent amplified each other (later-stage processes). A dynamic systems modeling approach underscored the negative impact of a perpetuating cycle of suicide-specific rumination, deepening hopelessness, and escalating suicidal intent on increasing suicide risk, which may be targets for intervention.

Uncontrollability of suicidal ideation adds incremental explanatory power in prediction of later suicidal ideation

OBJECTIVE

Suicidal ideation and suicidal behaviors are major public health concerns in the United States and are difficult to treat and predict. Risk factors that are incrementally informative are needed to improve prediction and inform prevention of suicidal thoughts and behaviors. Uncontrollability of suicidal ideation, one parameter of suicidal ideation, is one such candidate.

METHOD

In the current study, we assessed the predictive power of uncontrollability of suicidal ideation, over and above overall suicidal ideation, for future suicidal ideation in a large sample of active-duty service members. A total of 1044 suicidal military service members completed baseline assessments, of whom 664 (63.6%) completed 3-month follow-up assessments.

RESULTS

While baseline overall suicidal ideation itself was the strongest predictor of future suicidal ideation, uncontrollability of suicidal ideation added some incremental explanatory power.

CONCLUSION

Further study of uncontrollability of suicidal thought is needed to elucidate its impact on suicidal outcomes.

A test of invariance of the construct of suicidal ideation across three diverse samples

BACKGROUND

Suicide treatment research has placed major emphasis on preventing behavior, an observable phenomenon. Suicidal ideation (SI), however, is a distressing experience that annually impacts >15 million Americans; yet the construct validity of SI has not been well established, limiting empirical attention.

METHOD

We compared the coherence of three SI items (diminished wish to live, urge to die/controllability, suicide intent/expectations) and four related items across three adult samples (N = 314) that differed based on current SI severity and assessment time-scales (retrospective versus momentary).

RESULTS

A measurement model with scalar invariance had acceptable fit (CFI = 0.969, RMSEA = 0.076), indicating that the SI items consistently loaded onto one construct across samples. The structural model with metric invariance also had acceptable fit (CFI = 0.956, RMSEA = 0.063) and three of four related items (burdensome, hopelessness, and fatigue, but not agitation) were associated with SI across samples.

LIMITATIONS

Use of existing data limited the items considered.

CONCLUSIONS

Suicidal ideation is a coherent construct independent of the items used to assess it, the assessment's time-scale (retrospective versus momentary), or the severity of thoughts, and is worthy of greater empirical, clinical, and policy attention.

Metacognitions about suicidal thoughts

BACKGROUND

Rumination about suicide has recently been identified as a risk factor for suicidal behavior. According to the metacognitive model of emotional disorders, the activation and maintenance of rumination is dependent on specific metacognitive beliefs. On this background, the current study is concerned with the development of a questionnaire to assess suicide-specific positive and negative metacognitive beliefs.

METHODS

Factor structure, reliability and validity of the Scales for Suicide-related Metacognitions (SSM) were investigated in two samples comprised of participants suffering from lifetime suicide ideation. Participants of sample 1 (N = 214; 81.8% female; M_age = 24.9, SD_age = 4.0) took part in a single assessment using an online survey. Participants of sample 2 (N = 56; 71.4% female; M_age = 33.2, SD_age = 12.2) took part in two online assessments within a two week time-period. To establish convergent validity questionnaire-based assessments of suicidal ideation, general and suicide specific rumination and depression were used. Furthermore, it was analyzed whether suicide-related metacognitions predict suicide-specific rumination cross-sectionally and prospectively.

RESULTS

Factor analyses revealed a two-factor structure of the SSM. Results indicated good psychometric properties, and provided evidence for construct validity and stability of the subscales. Positive metacognitions predicted concurrent and prospective suicide-specific rumination beyond the effect of suicide ideation and depression and rumination predicted concurrent and prospective negative metacognitions.

CONCLUSION

Taken together the results provide initial evidence that the SSM is a valid and reliable measure of suicide-related metacognitions. Furthermore, findings are in line with a metacognitive conceptualization of suicidal crises and provide first indications of factors that might be relevant for the activation and maintenance of suicide-specific rumination.

Emotion-related impulsivity and suicidal ideation: Towards a more specific model

OBJECTIVES

Suicidal ideation is a pervasive and painful experience that varies considerably in its phenomenology. Here, we consider how one key risk variable might inform our understanding of variation in suicidal ideation: emotion-related impulsivity, the trait-like tendency towards unconstrained speech, behaviour, and cognition in the face of intense emotions. We hypothesized that emotion-related impulsivity would be tied to specific features, including severity, perceived lack of controllability, more rapidly fluctuating course, higher scores on a measure of acute suicidal affective disturbance, and more emotional and cognitive disturbance as antecedents.

METHODS

We recruited two samples of adults (Ns = 421, 221) through Amazon Mechanical Turk (MTurk), with oversampling of those with suicidal ideation. Both samples completed psychometrically sound self-report measures online to assess emotion- and non-emotion-related dimensions of impulsivity and characteristics of suicidal ideation.

RESULTS

One form of emotion-related impulsivity related to the severity, uncontrollability, dynamic course, and affective and cognitive precursors of ideation.

CONCLUSIONS

Despite limitations of the cross-sectional design and self-report measures, the current findings highlight the importance of specificity in considering key dimensions of impulsivity and suicidal ideation.