Can Text Messages Identify Suicide Risk in Real Time? A Within-Subjects Pilot Examination of Temporally Sensitive Markers of Suicide Risk

Objective tools to assess suicide risk are needed to determine when someone is at imminent risk. In this pilot laboratory investigation, we used a within-subjects design to identify patterns in text messaging (short message service) unique to high-risk periods preceding suicide attempts. Individuals reporting a history of suicide attempt ( N = 33) retrospectively identified past attempts and periods of lower risk (e.g., suicide ideation). Language analysis software scored 189,478 text messages to capture three psychological constructs: self-focus, sentiment, and social engagement. Mixed-effects models tested whether these constructs differed in general (means) and over time (slopes) 2 weeks before a suicide attempt relative to lower-risk periods. Regarding mean differences, no language features uniquely differentiated suicide attempts from other episodes. However, when examining patterns over time, anger increased and positive emotion decreased to a greater extent as participants approached a suicide attempt. Results suggest private electronic communication has the potential to provide real-time digital markers of suicide risk.

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Can Text Messages Identify Suicide Risk in Real Time? A Within-Subjects Pilot Examination of Temporally-Sensitive Markers of Suicide Risk

10.31219/osf.io/6r2nq ◽

2019 ◽

Author(s):

Jeffrey J Glenn ◽

Alicia Nobles ◽

Laura Barnes ◽

Bethany Teachman

Keyword(s):

Suicide Attempt ◽

Real Time ◽

Text Messaging ◽

Lower Risk ◽

Suicide Risk ◽

Suicide Ideation ◽

Suicide Attempts ◽

Text Messages ◽

Within Subjects ◽

Over Time

Objective tools to assess suicide risk are needed to determine when someone is at imminent risk. This pilot laboratory investigation utilized a within-subjects design to identify patterns in text messaging (SMS) unique to high-risk periods preceding suicide attempts. Individuals reporting a history of suicide attempt (N=33) retrospectively identified past attempts and periods of lower risk (e.g., suicide ideation). Language analysis software scored 189,478 text messages to capture three psychological constructs: self-focus, sentiment, and social engagement. Mixed-effects models tested whether these constructs differed in general (means) and over time (slopes) two weeks before a suicide attempt, relative to lower-risk periods. Regarding mean differences, no language features uniquely differentiated suicide attempts from other episodes. However, when examining patterns over time, anger increased and positive emotion decreased to a greater extent as one approached a suicide attempt. Results suggest personal electronic communication has the potential to provide real-time markers of suicide risk.

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A Large Sample Survey of Suicide Risk among University Students in China

BMC Psychiatry ◽

10.1186/s12888-021-03480-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ran Wu ◽

Hong Zhu ◽

Zeng-Jian Wang ◽

Chun-Lei Jiang

Keyword(s):

Suicide Attempt ◽

University Students ◽

Predictive Factors ◽

Suicide Risk ◽

Suicide Ideation ◽

Suicide Attempts ◽

Weak Sense ◽

Anxiety Symptoms ◽

Large Sample ◽

Chinese University

Abstract Background This study aimed to examine suicide ideation, suicide attempts, and suicide risk by examining a large sample of Chinese university students and identify the predictive factors, including depressive and anxiety symptoms, for suicide attempt and suicide risk. Methods We recruited 6,836 students (aged 18–30) based on all students enrolled in 2016 from one university using cluster sampling. They completed four questionnaires: the Beck Scale for Suicide Ideation and the Suicidal Behaviors Questionnaire-Revised were used to measure suicide risk, and students’ depressive/anxiety symptoms were estimated using Patient Health Questionnaire and Generalized Anxiety Disorder Scale. Results Four major findings emerged. First, 18% of the students showed high suicide ideation, 14.5% showed suicide risk, 18.8% had suicide plans, and 1% had attempted suicide. Second, a weak sense of life’s value was common among university students, as 61.4% of students considered suicide as a way to end or evade problems. Third, the results of the binary logistic regression showed that education, suicide ideation, including the wish to die, attitude toward suicide, specificity/planning of suicide, and deception or concealment of contemplated suicide were predictive factors of suicide attempt and suicide risk. The variable “deterrents to active attempt” was also a predictive factor of suicide risk. Fourth, depressive and anxiety symptoms did not significantly predict suicide attempts or suicide risk. Only 10.8% and 5.6% of the students had self-reported scores above the clinical cut-off points for depression and anxiety, respectively. Conclusions This study highlighted the prevalence of suicide risk among Chinese university students. The high risk of suicide may not only be due to affective disorders, but also a weak sense of life’s value or other reasons. Suicide ideation that significantly predicts suicide risk can be used for suicide risk assessment. Universities should provide appropriate life education and suicide prevention and intervention such as teaching instructors gate-keeper skills.

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Attachment Organization in Suicide Prevention Research

Crisis ◽

10.1027/0227-5910/a000231 ◽

2014 ◽

Vol 35 (1) ◽

pp. 60-66 ◽

Cited By ~ 10

Author(s):

Amanda Venta ◽

Carla Sharp

Keyword(s):

Risk Factors ◽

Suicidal Ideation ◽

Suicide Attempt ◽

Interpersonal Relationships ◽

Suicide Ideation ◽

Suicide Attempts ◽

Critical Role ◽

Self Report ◽

Future Research ◽

Self Harm

Background: Identifying risk factors for suicide-related thoughts and behaviors (SRTB) is essential among adolescents in whom SRTB remain a leading cause of death. Although many risk factors have already been identified, influential theories now suggest that the domain of interpersonal relationships may play a critical role in the emergence of SRTB. Because attachment has long been seen as the foundation of interpersonal functioning, we suggest that attachment insecurity warrants attention as a risk factor for SRTB. Aims: This study sought to explore relations between attachment organization and suicidal ideation, suicide attempts, and self-harm in an inpatient adolescent sample, controlling for demographic and psychopathological covariates. Method: We recruited 194 adolescents from an inpatient unit and assigned them to one of four attachment groups (secure, preoccupied, dismissing, or disorganized attachment). Interview and self-report measures were used to create four variables reflecting the presence or absence of suicidal ideation in the last year, single lifetime suicide attempt, multiple lifetime suicide attempts, and lifetime self-harm. Results: Chi-square and regression analyses did not reveal significant relations between attachment organization and SRTB, although findings did confirm previously established relations between psychopathology and SRTB, such that internalizing disorder was associated with increased self-harm, suicide ideation, and suicide attempt and externalizing disorder was associated with increased self-harm. Conclusion: The severity of this sample and methodological differences from previous studies may explain the nonsignificant findings. Nonsignificant findings may indicate that the relation between attachment organization and SRTB is moderated by other factors that should be explored in future research.

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The Role of Past Suicidal Behavior on Current Suicidality: A Retrospective Study in the Israeli Military

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020649 ◽

2021 ◽

Vol 18 (2) ◽

pp. 649

Author(s):

Leah Shelef ◽

Jessica M Rabbany ◽

Peter M Gutierrez ◽

Ron Kedem ◽

Ariel Ben Yehuda ◽

...

Keyword(s):

Suicide Attempt ◽

Suicidal Behavior ◽

Military Service ◽

Suicide Ideation ◽

Rating Scale ◽

Suicide Attempts ◽

Significant Risk ◽

Significant Risk Factor ◽

Severity Rating ◽

Significant Difference

Past suicide attempts are a significant risk factor for future suicidality. Therefore, the present military-based study examined the past suicidal behavior of soldiers who recently made a severe suicide attempt. Our sample consisted of 65 active-duty soldiers (61.5% males), between the ages of 18 and 28 years old (M = 20.4, SD ± 1.3). The inclusion criterion was a recent severe suicide attempt, requiring at least a 24 h hospitalization. This sample was divided into two groups, according to previous suicidal behavior, namely whether their first suicide attempt was before or after enlistment (n = 25; 38.5% and n = 40; 61.5%, respectively). We then examined the lethality and intent of the recent event in regard to this division. Four measures were used to assess the subjects’ suicidal characteristics: the Columbia Suicide Severity Rating Scale, the Self-Harm Behavior Questionnaire, the Suicidal Behaviors Questionnaire-Revised, and the Beck Scale for Suicide Ideation. No significant difference in the severity of the suicide attempts (either actual or potential severity) were found between those who had suicide attempts before enlistment and those who had their first attempt in the service. As a matter of fact, most of the suicide attempts that occurred for the first time during military service had used a violent method (58.3%, n = 21). Finally, using multivariate analyses, we found that current thoughts and behavior, rather than past suicidality, was the strongest predictor for the lethality of suicide attempts.

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Nearly Lethal Resuscitated Suicide Attempters Have No Low Serum Levels of Cholesterol and Triglycerides

Psychological Reports ◽

10.2466/pr0.106.3.785-790 ◽

2010 ◽

Vol 106 (3) ◽

pp. 785-790 ◽

Cited By ~ 17

Author(s):

Maurizio Pompili ◽

David Lester ◽

Marco Innamorati ◽

Paolo Girardi ◽

Roberto Tatarelli

Keyword(s):

Suicide Attempt ◽

Mood Disorders ◽

Serum Cholesterol ◽

Suicide Risk ◽

Suicide Attempts ◽

Serum Levels ◽

Small Sample ◽

Major Depressive ◽

Lower Serum ◽

Lower Serum Cholesterol

To verify the hypothesis that suicide attempts are associated with lower serum cholesterol and triglyceride levels of patients with mood disorders, 26 patients with mood disorders (bipolar disorder and major depressive disorder) were admitted after a medically serious suicide attempt to the emergency department and then hospitalized in the psychiatric unit of the Sant'Andrea Hospital (Rome, Italy). Controls were 87 patients who had not made a recent suicide attempt. Attempters and nonattempters did not differ in the levels of serum cholesterol or triglycerides. Indeed, attempters had nonsignificantly higher serum levels of cholesterol and lower serum levels of triglycerides. The use of biologic indicators such as levels of serum cholesterol and triglycerides in the prediction of suicide risk in mood disorders was not fully supported from this small sample.

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Suicide attempts preceding completed suicide

The British Journal of Psychiatry ◽

10.1192/bjp.173.6.531 ◽

1998 ◽

Vol 173 (6) ◽

pp. 531-535 ◽

Cited By ~ 167

Author(s):

Erkki T. Isometsä ◽

Jouko K. Lönnqvist

Keyword(s):

Suicide Attempt ◽

Suicide Prevention ◽

Suicide Risk ◽

Suicide Attempts ◽

Early Recognition ◽

Preventive Measure ◽

Time Interval ◽

Psychological Autopsy ◽

Autopsy Study ◽

History Of

BackgroundThis study investigated three questions with major implications for suicide prevention: the sensitivity of the history of previous suicide attempt(s) as an indicator of suicide risk, the time interval from a preceding suicide attempt to the fatal one, and switching of suicide methods by those eventually completing suicide.MethodThe lifetime history of suicide attempts and the methods the victims (n=1397) used were examined in a nationwide psychological autopsy study comprising all suicides in Finland within a 12-month research period in 1987–1988.ResultsOverall, 56% of suicide victims were found to have died at their first suicide attempt, more males (62%) than females (38%). In 19% of males and 39% of females the victim had made a non-fatal attempt during the final year. Of the victims with previous attempts, 82% had used at least two different methods in their suicide attempts (the fatal included).ConclusionsMost male and a substantial proportion of female suicides die in their first suicide attempt, a fact that necessitates early recognition of suicide risk, particularly among males. Recognition of periods of high suicide risk on the grounds of recent non-fatal suicide attempts is likely to be important for suicide prevention among females. Subjects completing suicide commonly switch from one suicide method to another, a finding that weakens but does not negate the credibility of restrictions on the availability of lethal methods as a preventive measure.

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The effect of sexual abuse and dissociation on suicide attempt

BMC Psychiatry ◽

10.1186/s12888-021-03662-9 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Silje Støle Brokke ◽

Thomas Bjerregaard Bertelsen ◽

Nils Inge Landrø ◽

Vegard Øksendal Haaland

Keyword(s):

Sexual Abuse ◽

Risk Factor ◽

Suicide Attempt ◽

Indirect Effects ◽

Suicide Ideation ◽

Suicide Attempts ◽

Suicidal Thoughts ◽

Dissociative Experiences ◽

Self Harm

Abstract Background Suicide attempt is the most predictive risk factor of suicide. Trauma – especially sexual abuse – is a risk factor for suicide attempt and suicide. A common reaction to sexual abuse is dissociation. Higher levels of dissociation are linked to self-harm, suicide ideation, and suicide attempt, but the role of dissociation in suicidal behavior is unclear. Methods In this naturalistic study, ninety-seven acute psychiatric patients with suicidal ideation, of whom 32 had experienced sexual abuse, were included. Suicidal behaviour was assessed with The Columbia suicide history form (CSHF). The Brief trauma questionnaire (BTQ) was used to identify sexual abuse. Dissociative symptoms were assessed with Dissociative experiences scale (DES). Results Patients who had experienced sexual abuse reported higher levels of dissociation and were younger at onset of suicidal thoughts, more likely to self-harm, and more likely to have attempted suicide; and they had made more suicide attempts. Mediation analysis found dissociative experiences to significantly mediate a substantive proportion of the relationship between sexual abuse and number of suicide attempts (indirect effects = 0.17, 95% CI = 0.05, 0.28, proportion mediated = 68%). Dissociative experiences significantly mediated the role of sexual abuse as a predictor of being in the patient group with more than four suicide attempts (indirect effects = 0.11, 95% CI = 0.02, 0.19, proportion mediated = 34%). Conclusion The results illustrate the importance of assessment and treatment of sexual abuse and trauma-related symptoms such as dissociation in suicide prevention. Dissociation can be a contributing factor to why some people act on their suicidal thoughts.

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Examining Time Perspective Orientation in Suicide Ideation and Suicide Attempts

Journal of Social and Clinical Psychology ◽

10.1521/jscp.2019.38.7.627 ◽

2019 ◽

Vol 38 (8) ◽

pp. 627-646

Author(s):

Arezoo Shahnaz ◽

Boaz Y. Saffer ◽

E. David Klonsky

Keyword(s):

Psychological Functioning ◽

Suicide Risk ◽

Time Perspective ◽

Suicide Ideation ◽

Suicide Attempts ◽

Time Perspectives ◽

The Past ◽

History Of ◽

Negative Orientation ◽

Two Measures

Introduction: Time perspective orientation (TPO) refers to the way an individual psychologically and behaviorally connects to temporal concepts of past, present, and future. Previous studies have hypothesized that certain types of time perspectives, such as a negative orientation towards the past, predict negative psychological functioning and outcomes, including suicide risk. The current study examines whether differences in TPOs are linked to suicidal thoughts or suicidal acts using two measures of time perspective. Methods: We recruited a large online U.S.-based sample comprised of three groups: participants with (a) a history of suicide attempts (attempters; n = 107), (b) a history of suicide ideation but no history of attempts (ideators; n = 164), and (c) no history of ideation or attempts (nonsuicidal; n = 194). Results: A Positive Past (d = 0.71) and Negative Past (d = 0.89) orientation yielded large differences between individuals with a history of suicide ideation and nonsuicidal participants, where Positive Past was elevated among nonsuicidal participants and Negative Past among ideators. These differences were not accounted for by depression or anxiety. However, TPO differences between individuals with a history of suicide ideation and individuals with a history of attempts ranged from negligible to small (d range = 0.03—0.33). Discussion: The findings suggest that time perspective may be robustly associated with the development of suicide ideation, but only minimally related to suicide attempts among ideators.

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Risk of suicide attempt associated with isotretinoin: a nationwide cohort and nested case-time-control study

International Journal of Epidemiology ◽

10.1093/ije/dyz093 ◽

2019 ◽

Vol 48 (5) ◽

pp. 1623-1635 ◽

Cited By ~ 7

Author(s):

Catherine Droitcourt ◽

Emmanuel Nowak ◽

Caroline Rault ◽

André Happe ◽

Béranger Le Nautout ◽

...

Keyword(s):

General Population ◽

Suicide Attempt ◽

Lower Risk ◽

Suicide Attempts ◽

Case Definition ◽

Control Analysis ◽

Health Insurance Data ◽

Time Control ◽

And Control ◽

Control Study

Abstract Background Isotretinoin is the only effective treatment for severe acne. An isotretinoin-related suicide risk is still debated and under scrutiny by regulatory agencies. Our objectives were: to assess the risk of suicide attempt before, during and after isotretinoin treatment; to detect any potential triggering effect of isotretinoin initiation on suicide attempt. Methods We implemented a cohort and nested case-time-control study of subjects treated with oral isotretinoin (course or initiation) aged 10–50 years, using the Nationwide French Health Insurance data (2009–2016). The main outcome was hospitalized suicide attempt. Standardized incidence ratios for hospitalized suicide attempts were calculated before, during and after isotretinoin treatment. The number of isotretinoin initiations was compared in risk and control periods of 2 months using a case-time-control analysis. Results In all, 443 814 patients (median age 20.0 years; interquartile range 17.0–27.0 years) were exposed to isotretinoin, amounting to 244 154 person-years, with a marked seasonality for treatment initiation. Compared with the French general population, the occurrence of suicide attempts under isotretinoin treatment was markedly lower, with a standardized incidence ratio of 0.6 [95% confidence interval (CI) = 0.53–0.67]; the same applied, to a lesser extent, before and after isotretinoin treatment. In the case-time-control analysis, among cases of suicide attempt, 108 and 127 isotretinoin initiations were observed in the risk and control periods respectively (i.e. 0–2 months and 2–4 months before the date of suicide attempt). The comparison with the 1199 and 1253 initiations observed among matched controls in the same two periods yielded a case-time-control odds ratio of 0.89 (95% CI = 0.68–1.16). A sensitivity analysis using three-month periods and a complementary analysis adding completed suicides for case definition showed consistent results. Conclusion Compared with the general population, a lower risk of suicide attempt was observed among patients exposed to isotretinoin and there was no evidence for a triggering effect of isotretinoin initiation on suicide attempt. A selection of patients at lower risk for suicidal behaviour and appropriate treatment management could explain these findings. Risk management plans should therefore be maintained.

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Repetitive negative thinking about suicide: Associations with lifetime suicide attempts

Clinical Psychology in Europe ◽

10.32872/cpe.5579 ◽

2021 ◽

Vol 3 (3) ◽

Author(s):

Tobias Teismann ◽

Thomas Forkmann ◽

Johannes Michalak ◽

Julia Brailovskaia

Keyword(s):

Suicide Attempt ◽

Suicidal Behavior ◽

Suicide Ideation ◽

Suicide Attempts ◽

Clinical Sample ◽

Cross Sectional Study ◽

Repetitive Negative Thinking ◽

Cross Sectional ◽

Suicide Attempters ◽

Negative Thinking

Background Repetitive negative thinking has been identified as an important predictor of suicide ideation and suicidal behavior. Yet, only few studies have investigated the effect of suicide-specific rumination, i.e., repetitive thinking about death and/or suicide on suicide attempt history. On this background, the present study investigated, whether suicide-specific rumination differentiates between suicide attempters and suicide ideators, is predictive of suicide attempt history and mediates the association between suicide ideation and suicide attempts. Method A total of 257 participants with a history of suicide ideation (55.6% female; Age M = 30.56, Age SD = 11.23, range: 18–73 years) completed online measures on suicidality, general and suicide-specific rumination. Results Suicide-specific rumination differentiated suicide attempters from suicide ideators, predicted suicide attempt status (above age, gender, suicide ideation, general rumination) and fully mediated the association between suicide ideation and lifetime suicide attempts. Conclusion Overall, though limited by the use of a non-clinical sample and a cross-sectional study design, the present results suggest that suicide-specific rumination might be a factor of central relevance in understanding transitions to suicidal behavior.

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