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.

No abstract

F or decades, knowledge about nonsuicidal self-injury (NSSI) was limited to only a small handful of empirical studies. However, the last 10 to 15 years have witnessed an explosion of research and significant advances in knowledge about NSSI. We now understand much about the classification, prevalence, correlates, forms, and functions of NSSI, and have dispelled many misconceptions. It is time for NSSI researchers to apply this basic knowledge to develop empirically grounded theoretical models and effective treatments. This In Review on NSSI was developed to help the field of mental health move forward in these 2 areas. First, this editorial briefly reviews what we now know about NSSI. Next, Margaret S Andover and Blair W Morris 1 describe an emotion regulation model for understanding and potentially treating NSSI and for explaining the emotion regulation function of NSSI in terms of basic emotion models. Finally, Brianna J Turner, Sara B Austin, and Alexander L Chapman 2 provide a systematic review of NSSI treatment outcome research, and note the need for new treatment approaches specifically tailored to target NSSI. We hope that this In Review not only provides state-of-the-art knowledge but also motivates and facilitates future efforts to better understand and treat NSSI.NSSI refers to the intentional destruction of one's own body tissue without suicidal intent and for purposes not socially sanctioned. 3,4 Common examples include cutting, burning, scratching, and banging or hitting, and most people who self-injure have used multiple methods. 3 Because NSSI is typically associated with emotional and psychiatric distress, 5,6 and because NSSI increases risk for suicide, 7,8 it is crucial to establish accurate conceptual and clinical models of this behaviour. In this introduction to the In Review on NSSI, we summarize what is now known about NSSI (much of which has been learned in just the past 10 to 15 years), dispel common myths, and describe the 2 review articles featured in this special section. What We Now KnowDespite some notable exceptions, [9][10][11] few researchers focused attention on NSSI until recently. One might identify the early 2000s as a turning point. Kim L Gratz 12 published an influential measure that facilitated research on NSSI, E David Klonsky and colleagues 5 found that NSSI is present and associated with psychiatric morbidity even in nonclinical populations, Matthew K Nock and Mitch J Prinstein 13 drew attention to the reasons why people engage in NSSI, and Jennifer J Muehlenkamp (see Muehlenkamp 14 and Muehlenkamp and Gutierrez 15 ) argued that NSSI should be

Recent literature reviews find that traditional risk factors for suicide - such as depression, hopelessness, most psychiatric disorders, and even impulsivity - robustly predict suicide ideation but poorly predict suicide attempts among ideators. To address this knowledge gap, studies are increasingly employing an ideation-to-action framework. This framework views the development of suicide ideation and the progression from ideation to potentially lethal attempts as distinct processes with distinct explanations and predictors. Converging evidence suggests that factors associated with diminished fear of pain, injury, and death can increase one's capability to attempt suicide and facilitate the progression from suicidal thoughts to suicidal acts. Recent studies have also identified other variables that may differentiate attempters from ideators, but these require replication. Theories of suicide positioned within the ideation-to-action framework provide testable and promising hypotheses about the progression from ideation to attempts. These include the Interpersonal Theory, Integrated Motivational-Volitional Model, and Three-Step Theory.

Recent findings suggest that neurocognitive deficits may hasten progression from suicidal thoughts to behavior. To test this proposition, we examined whether neurocognitive deficits distinguish individuals who have attempted suicide (attempters) from those who have considered suicide but never attempted (ideators).A comprehensive literature search yielded 14 studies comparing attempters to ideators on a range of neurocognitive abilities. In general, attempters and ideators scored comparably across neurocognitive abilities (median Hedges' g = À.18). An exception was a moderate difference for inhibition and decision making (median Hedges' g = À.50 and g = À.49, respectively). Results suggest that some neurocognitive abilities might help explain the transition from suicidal thoughts to suicide attempts. However, findings are regarded as suggestive, given the small number of studies, few cross-study examinations of neurocognitive domains, and variability in sample characteristics. Recommendations for future research are included. K E Y W O R D Sneurocognitive abilities, neurocognitive functioning, suicide, suicide prevention, suicide risk ---