The Columbia–Suicide Severity Rating Scale was initially designed to assess suicidal ideation and behavior in clinical trials. Psychometric analysis of data on adolescents indicated that a lifetime history of worst-point suicidal ideation including either suicidal intent or intent with a plan predicts a future risk of an actual attempt that is four times as great as the risk associated with a history of current suicidal ideation—including a desire to be dead—or increased general ratings of depression.

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The Columbia–Suicide Severity Rating Scale: Initial Validity and Internal Consistency Findings From Three Multisite Studies With Adolescents and Adults

Suicidal thoughts and behaviors (STBs) are major public health problems that have not declined appreciably in several decades. One of the first steps to improving the prevention and treatment of STBs is to establish risk factors (i.e., longitudinal predictors). To provide a summary of current knowledge about risk factors, we conducted a meta-analysis of studies that have attempted to longitudinally predict a specific STB-related outcome. This included 365 studies (3,428 total risk factor effect sizes) from the past 50 years. The present random-effects meta-analysis produced several unexpected findings: across odds ratio, hazard ratio, and diagnostic accuracy analyses, prediction was only slightly better than chance for all outcomes; no broad category or subcategory accurately predicted far above chance levels; predictive ability has not improved across 50 years of research; studies rarely examined the combined effect of multiple risk factors; risk factors have been homogenous over time, with 5 broad categories accounting for nearly 80% of all risk factor tests; and the average study was nearly 10 years long, but longer studies did not produce better prediction. The homogeneity of existing research means that the present meta-analysis could only speak to STB risk factor associations within very narrow methodological limits-limits that have not allowed for tests that approximate most STB theories. The present meta-analysis accordingly highlights several fundamental changes needed in future studies. In particular, these findings suggest the need for a shift in focus from risk factors to machine learning-based risk algorithms. (PsycINFO Database Record

Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research.

Why People Die by Suicide

Klonsky and May (2014) argued that an “ideation-to-action” framework should guide suicide theory, research, and prevention. From this perspective, (a) the development of suicide ideation and (b) the progression from ideation to suicide attempts are distinct processes with distinct explanations. The present article introduces a specific theory of suicide rooted in the ideation-to-action framework: the Three-Step Theory (3ST). First, the theory hypothesizes that suicide ideation results from the combination of pain (usually psychological pain) and hopelessness. Second, among those experiencing both pain and hopelessness, connectedness is a key protective factor against escalating ideation. Third, the theory views the progression from ideation to attempts as facilitated by dispositional, acquired, and practical contributors to the capacity to attempt suicide. To examine the theory, the authors administered self-report measures to 910 U.S. adults utilizing Amazon's Mechanical Turk (oversampling for ideation a...

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The Three-Step Theory (3ST): A New Theory of Suicide Rooted in the "Ideation-to-Action" Framework

Suicidal behavior is a leading cause of death and disability worldwide. Fortunately, recent developments in suicide theory and research promise to meaningfully advance knowledge and prevention. One key development is the ideation-to-action framework, which stipulates that (a) the development of suicidal ideation and (b) the progression from ideation to suicide attempts are distinct phenomena with distinct explanations and predictors. A second key development is a growing body of research distinguishing factors that predict ideation from those that predict suicide attempts. For example, it is becoming clear that depression, hopelessness, most mental disorders, and even impulsivity predict ideation, but these factors struggle to distinguish those who have attempted suicide from those who have only considered suicide. Means restriction is also emerging as a highly effective way to block progression from ideation to attempt. A third key development is the proliferation of theories of suicide that are positioned within the ideation-to-action framework. These include the interpersonal theory, the integrated motivational-volitional model, and the three-step theory. These perspectives can and should inform the next generation of suicide research and prevention.

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Suicide, Suicide Attempts, and Suicidal Ideation

Objective—This study examined gender differences in prevalence of eating disorder symptoms including body image concerns (body checking or avoidance), binge eating, and inappropriate compensatory behaviors. Method—A random sample of members (ages 18 to 35) of a health maintenance organization was recruited to complete a survey by mail or on-line. Items were drawn from the Patient Health Questionnaire and the Body Shape Questionnaire. Results—Among the 3,714 women and 1,808 men who responded, men were more likely to report overeating whereas women were more likely to endorse loss of control while eating. Although statistically significant gender differences were observe, with women significantly more likely than men to report body checking and avoidance, binge eating, fasting, and vomiting, effect sizes (“Number Needed to Treat”) were small to moderate. Conclusions—Few studies of eating disorders include men, yet our findings suggest that a substantial minority of men also report eating disorder symptoms.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/eat.20625

Gender difference in the prevalence of eating disorder symptoms.

Most individuals who consider suicide do not make suicide attempts. It is therefore critical to identify which suicide ideators are at greatest risk of acting on their thoughts. However, few seminal theories of suicide address which ideators go on to make attempts. In addition, perhaps surprisingly, most oft-cited risk factors for suicide-such as psychiatric disorders, depression, hopelessness, and even impulsivity-distinguish poorly between those who attempt suicide and those who only consider suicide. This special section of Suicide and Life-Threatening Behavior serves to highlight this knowledge gap and provide new data on differences (and similarities) between suicide attempters and suicide ideators.

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Differentiating suicide attempters from suicide ideators: a critical frontier for suicidology research.

Theoretical and empirical literature suggests that nonsuicidal self-injury (NSSI) may represent a particularly important risk factor for suicide. The present study examined the associations of NSSI and established suicide risk factors to attempted suicide in four samples: adolescent psychiatric patients (n = 139), adolescent high school students (n = 426), university undergraduates (n = 1,364), and a random-digit dialing sample of United States adults (n = 438). All samples were administered measures of NSSI, suicide ideation, and suicide attempts; the first three samples were also administered measures of depression, anxiety, impulsivity, and borderline personality disorder (BPD). In all four samples, NSSI exhibited a robust relationship to attempted suicide (median Phi = .36). Only suicide ideation exhibited a stronger relationship to attempted suicide (median Phi = .47), whereas associations were smaller for BPD (median rpb = .29), depression (median rpb = .24), anxiety (median rpb = .16), and impulsivity (median rpb = .11). When these known suicide risk factors and NSSI were simultaneously entered into logistic regression analyses, only NSSI and suicide ideation maintained significant associations with attempted suicide. Results suggest that NSSI is an especially important risk factor for suicide. Findings are interpreted in the context of Joiner's interpersonal-psychological theory of suicide; specifically, NSSI may be a uniquely important risk factor for suicide because its presence is associated with both increased desire and capability for suicide.

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Alexis M. May

Papers

The Three-Step Theory (3ST): A New Theory of Suicide Rooted in the "Ideation-to-Action" Framework

Suicide, Suicide Attempts, and Suicidal Ideation

Gender difference in the prevalence of eating disorder symptoms.

Differentiating suicide attempters from suicide ideators: a critical frontier for suicidology research.

The relationship between nonsuicidal self-injury and attempted suicide: converging evidence from four samples.