BackgroundThis study aims to develop the construct of a 'suicide trigger state' by exploring data gathered with a novel psychometric self-report instrument, the STS-2.MethodsThe STS-2, was administered to 141 adult psychiatric patients with suicidal ideation. Multiple statistical methods were used to explore construct validity and structure.ResultsCronbach's alpha (0.949) demonstrated excellent internal consistency. Factor analyses yielded two-component solutions with good agreement. The first component described near-psychotic somatization and ruminative flooding, while the second described frantic hopelessness. ROC analysis determined an optimal cut score for a history of suicide attempt, with significance of p < 0.03. Logistic regression analysis found items sensitive to history of suicide attempt described ruminative flooding, doom, hopelessness, entrapment and dread.ConclusionsThe STS-2 appears to measure a distinct and novel clinical entity, which we speculatively term the 'suicide trigger state.' High scores on the STS-2 associate with reported history of past suicide attempt.

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Biases are commonly seen in numerical cognition. The operational momentum (OM) effect shows that responses to addition and subtraction problems are biased in the whole-number direction of the operation. It is not known if this bias exists for other arithmetic operations. To determine whether OM exists in scalar operations, we measured response bias in adults performing symbolic (Arabic digits) and non-symbolic (dots) multiplication and division problems. After seeing two operands, with either a multiplication (×) or division (÷) sign, participants chose among five response choices. Both non-random performance profiles and the significant contribution of both operands in a multiple regression analysis predicting the chosen values, suggest that adults were able to use numerical information to approximate the outcomes in both notations, though they were more accurate on symbolic problems. Performance on non-symbolic problems was influenced by the size of the correct choice relative to alternatives. Reminiscent of the bias in addition and subtraction, we found a significant response bias for non-symbolic problems. Non-symbolic multiplication problems were overestimated and division problems were underestimated. These results indicate that operational momentum is present in non-symbolic multiplication and division. Given the influence of the size of the correct choice relative to alternatives, an interaction between heuristic bias and approximate calculation is possible.

Background and objectiveIncreasing mortality and decreasing life expectancy in the USA are largely attributable to accidental overdose, alcohol-related disease and suicide. These ‘deaths of despair’ often follow years of morbidity, yet little is known about trends in the clinical recognition of ‘diseases of despair’. The objective of this study is to characterise rates of clinically documented diseases of despair over the last decade and identify sociodemographic risk factors.DesignRetrospective study using a healthcare claims database with 10 years of follow-up.SettingParticipants resided nationwide but were concentrated in US states disproportionately affected by deaths of despair, including Pennsylvania, West Virginia and Delaware.ParticipantsCohort included 12 144 252 participants, with no restriction by age or gender.Outcome measuresDiseases of despair were defined as diagnoses related to alcohol misuse, substance misuse and suicide ideation/behaviours. A lookback period was used to identify incident diagnoses. Annual and all-time incidence/prevalence estimates were computed, along with risk for current diagnosis and patterns of comorbidity.Results515 830 participants received a disease of despair diagnosis (58.5% male, median 36 years). From 2009 to 2018, the prevalence of alcohol-related, substance-related and suicide-related diagnoses respectively increased by 37%, 94%, and 170%. Ages 55–74 had the largest increase in alcohol/substance-related diagnoses (59% and 172%). Ages <18 had the largest increase in suicide-related diagnoses (287%). Overall, odds for current-year diagnosis were higher among men (adjusted OR (AOR) 1.49, 95% CI 1.47 to 1.51), and among those with Affordable Care Act or Medicare coverage relative to commercial coverage (AOR 1.30, 1.24 to 1.37; AOR 1.51, 1.46 to 1.55).ConclusionsIncreasing clinical rates of disease of despair diagnoses largely mirror broader societal trends in mortality. While the opioid crisis remains a top public health priority, parallel rises in alcohol-related diagnoses and suicidality must be concurrently addressed. Findings suggest opportunities for healthcare systems and providers to deploy targeted prevention to mitigate the progression of morbidities towards mortality.

Panic attacks appear to be an independent risk factor for suicide attempt among depressed individuals with and without suicidal ideation. Further, panic attacks, particularly those characterized by prominent catastrophic cognitions, may mediate the transition from suicidal ideations to suicide attempts in subjects with depressive episodes. Assessment of these symptoms may improve prediction of suicide attempts in clinical settings.