Life experiences and the acquired capability for suicide in incarcerated men

Examining the temporal stability of suicide capability among undergraduates: A latent growth analysis

BACKGROUND

Relatively few studies test the interpersonal psychological theory's monotonicity hypothesis. The monotonicity hypothesis proposes that suicide capability (i.e., fearlessness about death and pain tolerance) is stable or increases linearly with exposure to painful and provocative events. Research is conflicted, suggesting that suicide capability is static, decreases, or increases and returns to baseline. The current study thus tested this hypothesis in a sample of college students with histories of suicidal ideation. We hypothesized a stable and an increasing trajectory.

METHODS

Participants were 206 undergraduates; primarily women (73%), on average 19.05 years old, heterosexual (85%), and first-years (69%). Participants completed a baseline battery of questionnaires on suicide risk factors and daily diaries on suicide capability and suicidal ideation for 90 days (n = 7,342 surveys, 40% compliance rate). Group-based trajectory analyses were conducted with the SAS macro PROC TRAJ.

RESULTS

Modeling revealed a three group quadratic model.  Low (27.7%), Moderate (41.3%), and High (31.1%) suicide capability groups remained static over time. Baseline suicidal ideation, but not history of suicide attempts or family history of suicidal behavior, distinguished groups; participants with suicidal ideation at baseline were less likely to be in the low suicide capability group.

LIMITATIONS

Brief, dichotomized assessments, and a high attrition rate.

CONCLUSIONS

These data showed temporal stability of suicide capability and suggest that the "acquired" component of capability may be overemphasized. Clarifying the stability and modifiability of suicide capability will enable empirically-based applications of the theory to suicide prevention.

What Differentiates Prisoners Who Attempt Suicide from Those Who Experience Suicidal Ideation? A Nationally Representative Study

OBJECTIVE

Many people who think about suicide do not engage in suicidal behavior. Identifying risk factors implicated in the process of behavioral enaction is crucial for suicide prevention, particularly in high-risk groups such as prisoners.

METHOD

Cross-sectional data were drawn from a nationally representative sample of 17,891 prisoners (79% men) in the United States. We compared prisoners who attempted suicide (attempters; n = 2,496) with those who thought about suicide but never made an attempt (ideators; n = 1,716) on a range of established risk factors.

RESULTS

More than half (59%) of participants who experienced suicidal ideation had also attempted suicide. Violent offending, trauma, brain injury, alcohol abuse, and certain mental disorders distinguished attempters from ideators.

CONCLUSION

Our results fit within recent ideation-to-action theories that emphasize the role of a capability for suicide in the transition from thoughts to acts of suicide.

Mental disorders and risk of suicide attempt in prisoners

BACKGROUND

Mental disorders are overrepresented in prisoners, placing them at an increased risk of suicide. Advancing our understanding of how different mental disorders relate to distinct stages of the suicidal process-the transition from ideation to action-would provide valuable information for clinical risk assessment in this high-risk population.

METHODS

Data were drawn from a representative sample of 1212 adults (1093 men) incarcerated across 13 New Zealand prisons, accounting for 14% of the national prison population. Guided by an ideation-to-action framework, three mutually exclusive groups of participants were compared on the presence of mental disorders assessed by validated DSM-IV diagnostic criteria: prisoners without any suicidal history (controls; n = 778), prisoners who thought about suicide but never made a suicide attempt (ideators; n = 187), and prisoners who experienced suicidal ideation and acted on such thoughts (attempters; n = 247).

RESULTS

One-third (34.6%) of participants reported a lifetime history of suicidal ideation, of whom 55.6% attempted suicide at some point (19.2% of all prisoners). Suicidal outcomes in the absence of mental disorders were rare. Whilst each disorder increased the odds of suicidal ideation (OR range 1.73-4.13) and suicide attempt (OR range 1.82-4.05) in the total sample (n = 1212), only a select subset of disorders was associated with suicide attempt among those with suicidal ideation (n = 434). Drug dependence (OR 1.65, 95% CI 1.10-2.48), alcohol dependence (OR 1.89, 95% CI 1.26-2.85), and posttraumatic stress disorder (OR 2.09, 95% CI 1.37-3.17) distinguished attempters from ideators.

CONCLUSION

Consistent with many epidemiological studies in the general population, our data suggest that most mental disorders are best conceptualized as risk factors for suicidal ideation rather than for suicide attempt. Once prisoners consider suicide, other biopsychosocial factors beyond the mere presence of mental disorders may account for the progression from thoughts to acts of suicide.

Validation of a Chinese Version of the Acquired Capability for Suicide Scale

This study aimed to revise and validate a Chinese Version of the Acquired Capability for Suicide Scale (ACSS-CV). In study 1 of 395 Chinese college students, a two-factor model comprising fearlessness about death and pain tolerance achieved satisfactory model fit. In study 2 of 491 different students, the ACSS-CV had good internal consistency, test-retest reliability, convergent validity, and discriminant validity. The ACSS-CV may be considered a useful instrument for measuring the acquired capability for suicide in Chinese college students.

Establishing the psychometric properties and construct validity of the Painful and Provocative Events Scale-Revised

BACKGROUND

Engagement in painful and provocative events is central to hypotheses for how capability for suicide develops. However, the existing measure of painful and provocative events is not psychometrically sound. We developed a measure with improved psychometric properties: the Painful and Provocative Events Scale (PPES)-Revised.

METHOD

In study 1, 447 adults (53.5% women, mean age = 35.4 years) answered 77 items describing painful and/or provocative experiences. Exploratory factor analysis (EFA) was performed. In study 2, 403 adults (55.1% women, mean age = 38.1 years) answered the retained items and confirmatory factor analysis (CFA) was performed. The scale's factorial invariance across gender was examined. Estimates of convergent and discriminant validity were obtained.

RESULTS

EFA yielded a two-factor structure, which was confirmed with CFA. The factor structure was invariant across men and women. Estimates of convergent and discriminant validity were promising.

LIMITATIONS

Limitations include non-weighted items, additional need for CFA among high-risk groups, lack of assessment of person-specific painful and provocative events, and need for prospective research to establish the scale's predictive validity.

CONCLUSIONS

By assessing painful and provocative events more uniformly and reliably than the existing measure, the PPES-Revised has the potential to advance the understanding of capability for suicide.

An Exploratory Analysis of Violent Offending and the Acquired Capability for Suicide in Male Prisoners

Recently, the Interpersonal Theory of Suicide has offered some understanding as to why inmates are at a disproportionately high risk to die by suicide. The present study was designed to investigate how one aspect of the theory, the acquired capability for suicide, may differ between prison inmates with violent offenses versus those without. Data from 343 male prisoners within the Mississippi Department of Corrections were used to examine potential differences between these two groups on scales of the Acquired Capability for Suicide Scale. Contrary to the hypothesis that violent offenders would evidence higher levels of acquired capability, only the Spectator Enjoyment of Violence subscale was significantly different between the two groups, with nonviolent offenders producing higher scores. Potential explanations for these findings and implications for correctional mental health care providers are discussed.

Correlates of suicide ideation and behaviors among transgender people: A systematic review guided by ideation-to-action theory

Transgender people are at high risk for suicide ideation, attempts, and deaths compared to the general population. Several correlates of suicide ideation and attempts have been identified empirically to understand this increased risk. However, few attempts have been made to systematically review this literature. Further, a theory to understand and identify targetable factors for intervention has rarely been applied to this population. In the first systematic review guided by ideation-to-action frameworks of suicide, we systematically reviewed the literature from January 1991 to July 2017 regarding correlates of suicide ideation, attempts, and deaths among transgender people. To be included in the review, articles must have been reported in English, reported on empirical data, included a sample or subsample of transgender people, and reported separately on correlates of suicide ideation, attempts, or deaths. Two independent reviewers searched three major databases, references of included articles, and unpublished literature, which produced 45 articles for review. The review suggested that ideation-to-action frameworks would be worth investigating within this population, with attention to sources of psychological pain, social connectedness, and capacity/capability for suicide unique to this population. Additionally, other aspects of cultural identity were often studied (e.g., race, religion), suggesting the need to understand intersectionality of identities among transgender people and their effects on suicide risk. Finally, the review highlighted important limitations of the literature, namely measurement of suicide ideation and attempts and sampling method, which future work should seek to improve.

A test of the interpersonal-psychological theory of suicide among arrested domestic violence offenders

Little is known about risk factors for suicide ideation and attempts among domestic violence offenders. Guided by the interpersonal-psychological theory of suicide, this cross-sectional study examined risk factors for suicide ideation and attempts among 312 men and 84 women arrested for domestic violence and mandated to attend batterer intervention programs. Men reported greater capability for suicide, but no gender differences were found in perceived burdensomeness and thwarted belongingness. After controlling for correlates of suicide ideation, perceived burdensomeness-but not thwarted belongingness or its interaction with perceived burdensomeness-associated with suicide ideation. Suicide attempters exhibited greater perceived burdensomeness, drug use and problems, borderline personality disorder symptoms, depressive symptoms, and suicide ideation, but not capability for suicide, than nonattempters. Gender did not moderate the associations of the IPTS constructs with suicide ideation and attempts. These findings parallel tests of the interpersonal-psychological theory in other samples. Additional work is needed to identify factors that distinguish risk for suicide ideation from risk for suicide attempts among domestic violence offenders.