Novel Methods of Suicide Risk Identification: Towards a Better Understanding of Key Constructs

Friday, April 6: 10:30 AM  - 12:00 PM 
338R 
Symposium 
Mezzanine Level 
Room: McKinley 
Credits: 1.5 
Suicide is a major public health problem, claiming the lives of over 40,000 individuals in the U.S. annually. Regrettably, effective suicide risk prediction is elusive and, perhaps relatedly, suicide rates have remained stagnant. Given that identifying risk factors for suicidality is crucial for prevention and intervention measures, investigating non-traditional methods of understanding and predicting suicidal ideation and attempts is warranted. This symposium aims to spur research investigating markers of distinct pathways for suicidal ideation and behaviors by demonstrating the utility of Event-Related Potential (ERP) and personality assessments for predicting suicidal ideation, suicidal behaviors, and key constructs believed to contribute to these outcomes such as thwarted belongingness (a risk factor for suicidal ideation that reflects the extent to which an individual feels social inclusion), capability for suicide (a risk factor for suicidal behaviors consisting of both fearlessness about death and pain tolerance), and dimensional personality traits.
Towards this aim, Presenter 1 will discuss data demonstrating the utility of the Late Positive Potential (LPP), an ERP indexing emotional processing, for demonstrating distinct emotion regulation aberrations that mark suicidal ideation and past suicide attempters (relative to non-attempters). Presenter 2 will discuss the validation of a novel picture set aimed to elicit emotional reactivity specifically among those high in thwarted belongingness, a well-established risk factor for suicidal ideation. Presenter 3 will investigate neural correlates of fearlessness about death, a factor that contributes to individual differences in the capability for lethal self-harm, using the LPP while viewing threatening and mutilation images. Lastly, Presenter 4 will discuss recent findings using the Minnesota Multiphasic Personality Inventory (MMPI) as a non-traditional method of detecting suicide risk. Lastly, the Discussant will provide a commentary on the use of these methods for detecting suicide risk, the potential clinical applications of the mechanisms of suicidal ideation and behaviors uncovered by these projects, and how these findings contribute to the future of suicide risk research.

Learning Objectives

1. Demonstrate unique etiological pathways of suicidal ideation and suicidal behaviors.
2. Recognize risk factors for suicidal ideation and suicidal behaviors.
3. Utilize data from neurophysiological and personality inventory methods to better recognize suicide risk.  

Chair

Brian Albanese, MS, Florida State University

Discussant

Thomas Joiner, PhD, Florida State University

Audience Level

Intermediate/Advanced

Demographic

Adults

Diversity/Content

Diversity - No

Duration

90 minutes

Disorder

Suicide and Suicidal Ideation

Treatment Approach

CBT

Presentations

A Distinct Configuration of MMPI-2 Scales 2 and 9 Provides Incremental Information Regarding Suicide Attempt Risk Among Suicide Ideators in a Psychiatric Outpatient Sample

Suicide is a major public health problem, claiming the lives of over 40,000 individuals in the United States each year. Efforts are needed to (1) identify those at heightened risk for suicide utilizing objective assessment methods, and (2) determine factors that may be protective against engaging in suicidal behavior, even in the context of the desire to do so. Scales 2 (Depression) and 9 (Hypomania) of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) may be valuable in this regard. Whereas individuals high on both Scales 2 and 9 are dysphoric and prone to reckless action, individuals high on Scale 2 but low on Scale 9 are characterized by levels of high lethargy and physical unexcitability that may be protective against making a suicide attempt. The purpose of this study was to determine whether Scales 2 and 9 of the MMPI-2 interact to predict suicide attempts among suicide ideators. Participants were 189 psychiatric outpatients between the ages of 18 and 65 years (M=28.8, SD=11.8; 68.8% female, 74.5% non-Hispanic White) who reported nonzero levels of suicidal ideation on the Beck Scale for Suicide Ideation (BSS). Overall, 46.6% of patients reported a past suicide attempt. Consistent with hypotheses, we found an interaction between Scales 2 and 9 such that elevations on Scale 2 were positively associated with past suicide attempts at high levels of Scale 9 and negatively associated with suicide attempts at low levels of Scale 9. This study presents a novel MMPI-2 configuration that may enhance the assessment of suicide risk.  

Presenter

Brian Albanese, MS, Florida State University

Non-Presenting Co-Author

Ian Stanley, M.S., Florida State University

Emotion Regulation Neural Markers Differentially Predict Suicidal Ideation and Suicide Attempts: Evidence from the Late Positive Potential

Objective: Suicidal ideation (SI) and suicide attempts (SA) are theorized to arise from distinct etiological pathways. One mechanism that both SI and SA have been linked with is abnormal emotion regulation. However, no studies to date have tested if SI and SA exhibit distinct patterns of regulation to specific emotional contents. The current study was conducted to identify distinct, objective physiological markers of SI and SA by evaluating patterns of brain reactivity associated with dysfunctional emotional processing and regulation of SI and SA relevant stimuli. Method: A clinical sample (N = 246) with SI or SA risk factors completed electroencephalographic (EEG) recording while passively viewing or regulating their emotional processing of images depicting socially rewarding and threat/mutilation scenes. The Late Positive Potential (LPP), an event-related potential (ERP), was extracted to index individual differences in the ability to volitionally increase emotional processing of socially rewarding scenes and volitionally decrease emotional processing of threatening and mutilation images. All images were selected from the International Affective Picture System (IAPS). Results: Differential LPP responses were noted for SI and SA. Greater SI was marked by a smaller LPP while volitionally enhancing processing of socially rewarding material but was unrelated to the LPP while volitionally decreasing processing of threat/mutilation images. In contrast, a greater number of past SAs was marked by a smaller LPP while decreasing processing of threat/mutilation stimuli and was unrelated to the LPP while increasing processing of social reward images. Conclusions: This pattern of effects is consistent with theoretical frameworks positing that SI and SA have distinct risk profiles. Specifically, greater SI was related to a poor ability to increase processing of social reward images, and a more extensive SA history was related to a superior ability to decrease processing of threatening and mutilation images. These results further support the role of emotional regulation abnormalities in the etiology of SI and SA, and provides a novel perspective on a contributing factor to individual differences in the capability for suicide.  

Presenter

Brian Albanese, MS, Florida State University

Fearlessness About Death is Associated with Blunted Late-Positive Potential Amplitude When Viewing Threat/Mutilation Images

Despite concerted scientific efforts to predict suicide over the last 50 years, current predictive abilities remain no better than chance (Franklin et al., 2016). In part, this lack of predictive accuracy might be due to the heavy utilization of self-report measures in suicide research. Using more objective measures to assess risk could not only improve predictive accuracy, but also further our understanding about suicide. The Interpersonal Theory of Suicide (ITS; Joiner, 2005; Van Orden et al., 2010) and Three-Step Theory (3ST; Klonsky & May, 2015) posit that a person must not only possess the desire to die, but also the capability to die in order to enact a lethal/near lethal suicide attempt. According to these theories, individuals acquire some of this capability through experiencing painful and provocative events, ultimately increasing fearlessness about death (FAD) and pain tolerance. Currently, objective measurements for the capability for suicide are lacking. This study uses the late-positive potential (LPP), an event-related potential (ERP) component that reflects differences in emotional processing, to study how FAD may influence emotional processing of threat and mutilation images. We hypothesized that those with greater levels of self-reported FAD will show reduced LPP when viewing threat/mutilation images compared to those with lower self-reported FAD. Participants (N = 72) scoring 1.5 standard deviations above or below the mean on the Acquired Capability for Suicide Fearlessness about Death Scale (Ribeiro et al., 2014) were included in the analyses. Participants engaged in electroencephalographic (EEG) data collection while passively viewing images depicting neutral, positive, and negative images (i.e.., threat/mutilation scenes). Results indicated that the FAD was related to a significant difference in LPP when viewing negative as opposed to neutral images. Specifically, increased FAD was associated with blunted LPP when viewing threat/mutilation images. FAD was not associated with differences in LPP between positive versus neutral images. These effects are in line with existing theories of suicide, which propose that FAD reflects a numbed response to painful and provocative events. Those with greater levels of self-reported FAD showed reduced emotional processing when viewing threat/mutilation images compared to those with low FAD, implying empirical evidence for the capability of suicide using objective measurement. 

Presenter

Brian Bauer, MS, University of Southern Mississippi

Late Positive Potential (LPP) Differences as an Objective Marker of Suicide Risk

The main aim of the present study was to use an experimental paradigm combined with electroencephalography/event related potential (EEG/ERP) measures to test a potential neurophysiological assessment of thwarted belongingness (TB), a risk factor for suicide. A key limitation of previous research on the link between risk factors and suicidal behavior is this information has been almost exclusively self-reported. Measures of risk factors through objectives methods such as EEG/ERP could lead to more accurate risk assessment. The sample was composed of 280 individuals presenting for participation in a clinical trial. In the paradigm, participants observed 204 images total (60 neutral images and 144 emotional images. The ERP we were interested in this study was the Late Positive Potential (LPP). The LPP begins around 400–500 ms after the onset of a stimulus and lasts for a few hundred milliseconds. We conducted a hierarchical regression to examine the unique relations between SR-TB and the TB, unpleasant, and pleasant pictures. Unpleasant and pleasant LPPs were entered in the first step, followed by TB LPP in the second step, to test the incremental contribution provided by the TB LPP in explaining SR-TB. In this model, SR-TB was not significantly associated with unpleasant LPP (β = -.04, t = -.58, p = .57), was marginally significantly associated with pleasant LPP (β = -.13, t = -1.88, p = .06), and was significantly and positively associated with TB LPP (β = .14, t = 2.13, p = .035), indicating that SR-TB significantly predicted TB LPP relative to neutral LPP. Moreover, the inclusion of TB LPP to the model accounted for an additional 1.8% of variance in SR-TB [F(1,240) = 4.52, p = .035, R2 = .018, ΔR2 = .018]. This study represents a first step in creating objective, non-self report tests of suicide risk. A large percentage of individuals who deny suicide risk to medical personnel eventually die by suicide. Refinement and replication of a task such as the one developed for the current study could lead to more accurate assessment of these individuals. 

Presenter

Daniel Capron, PhD, University of Southern Mississippi