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Abstract Introduction Nocturnal wakefulness is a unique risk factor for suicidal ideation in clinical as well as community samples. Preliminary data suggest that morning wakefulness may also be a protective factor against such thinking. However, these associations have not been explored in a nationally-representative dataset. Methods Data were collected from the 2015-2016 wave of the National Health and Nutrition Examination Survey. Participants reported typical bedtimes and waketimes. From these values, wakefulness during the night (00:00 to 05:59), morning (06:00 to 11:59), afternoon (12:00 to 17:59), and evening (18:00 to 23:59) was determined. Suicidal ideation was assessed by a question about “thoughts that you would be better off dead, or thoughts of hurting yourself in some way.” Ordinal logistic regression estimated the association between the number of hours awake at particular times of day and the frequency of suicidal ideation. Additional analyses adjusted for demographic factors and depressed mood. Results Out of 5133 respondents with available data, 125 reported suicidal ideation several days a week, 36 reported suicidal ideation more than half the days, and 29 reported suicidal ideation nearly every day. When controlling for demographics, morning wakefulness was associated with reduced frequency of suicidal ideation (OR: 0.69, 95% CI: [0.59,0.8]). Controlling for depressed mood attenuated, but did not eliminate, this association. Nocturnal wakefulness was not associated with suicidal ideation in this sample. Conclusion Using data from a nationally representative sample, morning wakefulness was associated with less frequent suicidal ideation. However, previous findings regarding nocturnal wakefulness were not replicated. The limited number of individuals in the sample endorsing both suicidal ideation and nighttime wakefulness may have insufficient power to detect an association. Support Dr. Grandner is supported by R01MD011600.

Child abuse (CA) is a well-established risk factor for suicidal ideation (SI) and suicidal behaviour (SB). However, only few studies have investigated the impact of CA on the persistence of SI over time. Those existing studies have used varying operationalizations to measure the persistence of SI, leading to inconsistent findings. The aim of this study is to examine the persistence of SI by integrating prospective ecological momentary assessments (EMAs) with retrospective structured interviews within one clinical sample. Patients admitted to psychiatric hospitals following an acute suicidal crisis (  = 75) or recent suicide attempt (  = 107) were assessed shortly after admission and then, after discharge, engaged in a 3-week EMA (EMA phase 1), followed by a 6-month EMA period (EMA phase 2). SI was measured using the Self-Injurious Thoughts and Behaviors Interview at baseline and via EMA prompts during both phases. Persistence was indicated by the number of episodes and repeated reports of SI. Multiple regression analyses were conducted to examine the influence of CA on the persistence of SI. Retrospective interview data showed that CA predicted the persistence of SI over the year before a suicidal crisis or suicide attempt (  = .22,  = 2.67,  = .008). Prospective EMA data indicated that CA was associated with greater persistence of passive SI during EMA phase 1 (  = .20,  = 2.19,  = .030) and with higher persistence of active SI in EMA phase 2 (  = .21,  = 1,99,  = .050). This study shows that CA is linked to greater persistence of SI across different methods and time points. It also highlights the importance of distinguishing between passive and active SI when examining persistence.

Introduction This prospective study explored associations among clinical insomnia, nocturnal cognitive hyperarousal, and nocturnal perinatal-focused rumination with suicidal ideation (SI) in perinatal women with mild-to-moderate depression. Methods From late pregnancy through early postpartum, 39 women with depression completed 17 weekly surveys assessing insomnia, depression, suicidal ideation, perceived stress, and three cognitive arousal indices. Results Women with nocturnal cognitive hyperarousal at baseline, relative to those with low nocturnal cognitive arousal, were at greater risk for developing new onset SI in late pregnancy or early postpartum (33% vs 1%). Moreover, nocturnal perinatal-focused rumination was independently associated with SI. SI-risk was highest when women reported clinical insomnia combined with nocturnal cognitive hyperarousal (OR=5.66, p=.037) or perinatal-focused rumination (OR=11.63, p=.018). Daytime perseverative thinking was not uniquely associated with SI. Conclusion Cognitive hyperarousal and perinatal-focused rumination at night are uniquely associated with SI among perinatal women with depression. Moreover, insomnia augments the suicidogenicity of nighttime cognitive activity. Future research should determine whether alleviating nocturnal cognitive arousal, pregnancy- and fetal/infant-related concerns, and insomnia with psychotherapy reduces SI for women with perinatal depression. Support (if any) This study was funded by the American Academy of Sleep Medicine (198-FP-18, PI: Kalmbach). Dr. Cheng’s effort was supported by the National Heart, Lung, and Blood Institute (K23-HL13866, PI: Cheng).

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. 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. 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. 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.

Background Comorbidity between depressive and anxiety disorders is common. From network perspective, mental disorders arise from direct interactions between symptoms and comorbidity is due to direct interactions between depression and anxiety symptoms. The current study investigates the network structure of depression and anxiety symptoms in Chinese female nursing students and identifies the central and bridge symptoms as well as how other symptoms in present network are related to depression symptom “thoughts of death”. Methods To understand the full spectrum of depression and anxiety, we recruited 776 Chinese female nursing students with symptoms of depression and anxiety that span the full range of normal to abnormal. Depression symptoms were measured by Patient Health Questionnaire-9 while anxiety symptoms were measured by Generalized Anxiety Disorder 7-Item Questionnaire. Network analysis was used to construct networks. Specifically, we computed the predictability, expected influence and bridge expected influence for each symptom and showed a flow network of “thoughts of death”. Results Nine strongest edges existed in network were from the same disorder. Four were between depression symptoms, like “sleep difficulties” and “fatigue”, and “anhedonia” and “fatigue”. Five were between anxiety symptoms, like “nervousness or anxiety” and “worry too much”, and “restlessness” and “afraid something will happen”. The symptom “fatigue”, “feeling of worthlessness” and “irritable” had the highest expected influence centrality. Results also revealed two bridge symptoms: “depressed or sad mood” and “irritable”. As to “thoughts of death”, the direct relations between it and “psychomotor agitation/retardation” and “feeling of worthlessness” were the strongest direct relations. Conclusions The current study highlighted critical central symptoms “fatigue”, “feeling of worthlessness” and “irritable” and critical bridge symptoms “depressed or sad mood” and “irritable”. Particularly, “psychomotor agitation/retardation” and “feeling of worthlessness” were identified as key priorities due to their strongest associations with suicide ideation. Implications for clinical prevention and intervention based on these symptoms are discussed.

Abstract Subclinical risk markers for schizophrenia predict suicidality, but little is known about the nature of the relationship. Suicidal ideation is often considered homogenous, but distinguishing passive from active ideation (ie, thoughts of death vs thoughts of killing oneself) and different temporal patterns may further the understanding of risk factors. We tested whether schizotypy and psychotic experiences (PEs) in early adolescence predict subsequent growth trajectories of suicidal ideation and suicide attempt outcomes. Participants were 1037 members of the population-representative Dunedin Study cohort. PE was measured at 11 years and schizotypy at 13 and 15 years. Outcomes were passive and active suicidal ideation, and suicide attempt, measured at 18, 21, 26, 32, and 38 years. Passive ideation was best represented by 2 trajectories, including persistent and transient ideation classes. Schizotypy predicted membership in the smaller persistent class (odds ratio [OR] = 1.21, P = .041), whereas PE was not associated with class membership. The probability of suicide attempts was 13.8% in the persistent ideation class, compared with 1.8% in the transient class. Active ideation was best represented by a 1-class model, the intercept of which was predicted by schizotypy (OR = 1.23, P = .015). Suicide attempts were predicted by schizotypy (OR = 1.53, P = .040) and PE (OR = 3.42, P = .046), and this was partially mediated by indirect effects via the active ideation trajectory. Findings indicate that adolescent schizotypy and PE are related to subsequent suicidal ideation and attempts. Suicidal ideation is heterogeneous, and schizotypy is specifically related to a persistent passive ideation subgroup.

Background Suicidal ideation has been identified as one of the major predictors of attempted or actual suicide. Routinely screening individuals for endorsing suicidal thoughts could save lives and protect many from severe psychological consequences following the suicide of loved ones. The aim of this study was to validate the German version of the Beck Scale for Suicide Ideation (BSS) in a sample representative for the Federal Republic of Germany. Methods All 2450 participants completed the first part of the Scale, the BSS-Screen. A risk group of n  = 112 individuals (4.6%) with active or passive suicidal ideation was identified and subsequently completed the entire BSS. Results Satisfactory internal reliability (α = .97 for the BSS-Screen; α = .94 for the entire BSS) and excellent model fit indices for the one-dimensional factorial structure of the BSS-Screen (CFI = .998; TLI = .995; RMSEA = .045 [95%-CI: .030-.061]) were confirmed. Measurement invariance analyses supported strict invariance across gender, age, and depression status. We found correlations with related self-report measures in expected directions comparable to previous studies, indicating satisfactory construct validity. Limitations Our study involved cross sectional data, hence neither predictive validity nor retest-reliability were examined. As only the risk group of n  = 112 individuals completed the entire measure, confirmatory factor analyses could not be conducted for the full BSS. Conclusion The German translation of the BSS is a reliable and valid instrument for assessing suicidal ideation in the general population. Using it as a screening device in general and specialized medical care could substantially advance suicide prevention.

Background: Identifying accurate methods of assessing suicidal ideation has important implications. The lack of a universal definition of suicidal ideation has complicated measurement efforts. This study details the development of a brief self-report measure of suicidal ideation which specifically focuses on thoughts of suicide. Method: The Questionnaire for Suicidal Ideation (QSI) was developed by collating items from three existing measures of suicidal ideation. Items explicitly describing acts or behaviours were removed and Posner et al.’s (2007) definition of suicidal ideation was applied to the remaining items. The final questionnaire consisted of 6 items. Participants were adults (n = 192) and adolescents (n = 152) attending community mental health services in the Irish public health service. Results: The QSI demonstrated excellent reliability in adult (α = .91) and adolescent (α = .90) samples. Exploratory factor analysis produced a one-factor solution explaining 70% and 66% of the variance in adult and adolescent samples respectively. Evidence of relation with other variables was demonstrated with strong correlations between the QSI and measures of depression, hopelessness and borderline symptoms (r = .48 - .68). Conclusions: The results suggest that the QSI may be a reliable and valid method of assessing suicidal ideation in clinical populations.

Suicide ideation expressed in social media has an impact on language usage. Many at-risk individuals use social forum platforms to discuss their problems or get access to information on similar tasks. The key objective of our study is to present ongoing work on automatic recognition of suicidal posts. We address the early detection of suicide ideation through deep learning and machine learning-based classification approaches applied to Reddit social media. For such purpose, we employ an LSTM-CNN combined model to evaluate and compare to other classification models. Our experiment shows the combined neural network architecture with word embedding techniques can achieve the best relevance classification results. Additionally, our results support the strength and ability of deep learning architectures to build an effective model for a suicide risk assessment in various text classification tasks.

Bullying is a risk factor for the physical and mental health of adolescents. The advent of new technologies has resulted in a brand-new type of bullying, cyberbullying (CB). The co-occurring effects of cyberbullying and traditional bullying(TB) forms of bullying on adolescent mental health are unclear. We performed a meta-analysis to explore the unique and combined effects of CB and TB on adverse psychological outcomes in victims by conducting a joint study of both types of bullying. By doing so, we provide the basis for a comprehensive community bullying prevention program. The database PubMed, PsyclNFO, and Web of Science were searched for studies from 2010 to 2021. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed for data abstraction, and the NIH tool was used to evaluate study-level risk of bias. 42 studies with 266,888 participants were identified. Random-Effect models were used for our study. The moderator analysis was used to explore the moderator of prevalence. Studies with three groups of victims (TB only, CB only, and Both) and two groups of victims (TB and CB) were compared in subgroup analysis. The mean victimization rate was 24.32% (95% CI 20.32–28.83%) for TB and 11.10% (95% CI 9.12–13.44%) for CB. Roughly one-third of TB victims were also victimized by CB. Conversely, only about one-third of CB victims were free from TB. The estimated ORs for depression, suicidal ideation, suicide attempts, and self-harm in the three-group (TB only, CB only and Both) analysis were: depression [TB only: 3.33 (2.22–5.00); CB only: 3.38 (2.57–4.46); Both: 5.30 (2.43–11.56)]; suicidal ideations [TB only: 3.08 (2.12–4.46); CB only: 3.52 (2.38–5.20); Both: 6.64 (4.14–10.64)]; self-harm [TB only: 2.70 (1.86–3.91); CB only: 3.57 (3.20–3.98); Both: 5.57 (2.11–16.00)]; and suicide attempts: [TB only: 2.61 (1.50–4.55); CB only: 3.52 (2.50–4.98); Both: 7.82 (3.83–15.93)]. TB and CB victimization among youth are a matter of public health concern. Victimization appears to be a marker of greater psychopathological severity, particularly suicide-related issues.