Objective-Adults with mood disorders are at elevated risk for suicide. Psychological features such as hopelessness increase their risk for suicide ideation. Few studies have examined psychological constructs posited to lower risk for suicide ideation. The authors tested the hypothesis that reasons for living (RFL) are inversely related to suicide ideation. Design-This report is a secondary analysis of cross-sectional data.Setting-Participants were recruited from the clinical services of three teaching hospitals in Rochester, NY.Participants-The sample consisted of 125 adults 50 years or older receiving treatment for a mood disorder.Measurements-A diagnostic interview and measures of suicide ideation, depression, hopelessness, and RFL were included in the assessment battery. Dependent variables were presence and severity of suicide ideation. Data were analyzed using multivariate logistic and linear regressions.Results-Patients who reported higher levels of fear of suicide were less likely to report suicide ideation. The relationships between hopelessness and both the presence and severity of suicide ideation were stronger among those who reported greater levels of responsibility to family.Conclusions-Clinicians working with at-risk older adults are encouraged to explore their patients' RFL. These cross-sectional findings point to the need for prospective research examining the associations among different RFL, hopelessness, and suicide ideation in depressed older adults. KeywordsAging; suicide ideation; reasons for living; hopelessness; depression More than 12,000 adults in the United States over the age of 50 die by suicide annually, 1 most of whom suffer from a mood disorder, typically major depression. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript however, never consider suicide, 4 suggesting the need to examine psychological processes that may confer or reduce risk for suicide ideation in this population.Hopelessness, defined as a system of negative beliefs and expectancies concerning oneself and one's future, 5 is an important risk factor for both suicide ideation and death by suicide in depressed adults over 50. It is associated with suicide ideation in diverse samples. [6][7][8][9][10] Prospective studies of patients seen in mental health treatment settings suggest that it also confers risk for death by suicide. 11,12 Reasons for living (RFL) are beliefs or expectancies thought to mitigate risk for suicide, and include survival and coping beliefs, responsibility to family, child-related concerns, fear of suicide, fear of social disapproval, and moral objections. 13 Few studies have examined these constituent components, [14][15][16][17][18] and most have focused on younger adults, 13,14,16 but older and younger adults may have different RFL. 19 RFL may also weaken the association between hopelessness and suicide ideation. Individuals who believe they have more RFL may be better prepared to buffer the negative effects of hopelessness. Just as optimism and attitudes to...

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Findings indicated that sleep disturbance was associated with time to suicide in this sample of veterans who died by suicide. The findings had implications for using the presence of sleep disturbance to detect near-term risk for suicide and suggested that sleep disturbance might provide an important intervention target for a subgroup of at-risk veterans.

The authors examined the proposition that recollections of childhood attachments, parental bonds, or romantic attachments are related to M. H. Davis's (1983) cognitive and emotional components of empathy. Participants were 178 undergraduates who completed self-report questionnaires. Recollections of parental bonds and romantic attachments made both independent and conjoint contributions to Davis's components. Parental overprotection and romantic anxiety predicted personal distress; parental care and romantic anxiety predicted empathic concern; and romantic avoidance predicted fantasy. The findings suggested that attachment may be more likely to influence empathy negatively than positively, that the relation between attachment and empathy may be more emotional than cognitive, and that romantic attachments may be more related to empathy than recollections of parental bonds.

These findings provide preliminary support for the validity and reliability of the RFL-OA. The findings also support the potential value of attending to reasons for living during clinical treatment with depressed older adults and others at risk for suicide.

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Cognitive Behavioral Therapy (CBT) has been found to be effective in preventing suicide-related behavior. However, it is often difficult to engage patients who are at-risk in treatment. Motivational Interviewing (MI) has been shown to increase treatment engagement and improve treatment outcomes when it is used to complement other treatments. As a general theory of human motivation that is consistent with MI, Self-Determination Theory (SDT) provides a framework for understanding how MI may be added to CBT to increase treatment engagement and effectiveness. In this paper, we use SDT to explain how MI may complement CBT to reduce suicide-related behavior, provide a case example of using MI with a suicidal patient before CBT-based treatment, and explore future directions for research.In the United States, over 300,000 people died by suicide between 1995 and 2005, making suicide a major public health concern (Centers for Disease Control and Prevention, 2008). Although an estimated 90% of individuals who die from suicide suffer from one or more mental disorders, up to 65% never receive psychological or psychiatric treatment (Cavanagh, Carson, Sharpe, & Lawrie, 2003). Psychosocial interventions such as Cognitive Behavioral Therapy are effective in reducing suicide-related behaviors (CBT; Tarrier, Taylor, & Gooding, 2008); thus, it is important to use theoretically and empirically supported methods to ensure that at-risk clients receive effective mental health treatment. Motivational Interviewing (MI;Miller & Rollnick, 2002) has been shown to increase treatment engagement and improve treatment outcomes when it is used to complement other treatments (Hettema, Steele, & Miller, 2005). However, MI is a clinical approach that currently lacks an underlying theory to explain the mechanisms by which it functions. As a general theory of human motivation that is consistent with the underlying principles of MI, Self-Determination Theory (SDT; Deci & Ryan, 2002) provides a framework for understanding the manner in which MI can be integrated with CBT to increase treatment Correspondence concerning this article should be addressed to Peter C. Britton, Ph.D., Center of Excellence, Department of Veteran Affairs Medical Center, 14424. peter.britton@va.gov. U.S. Department of Veterans AffairsPublic Access Author manuscript Cogn Behav Pract. Author manuscript; available in PMC 2016 October 19. Cognitive Behavioral Therapy (CBT) to Reduce Suicidal BehaviorIn a recent meta-analysis of 28 randomized controlled trials (RCTs), CBT was found to reduce suicide-related behavior (i.e., death by suicide, suicide attempts, suicide intent and/or plans, and ideation) in the 3 months following treatment (Tarrier et al., 2008). The primary cognitive behavioral interventions that were represented in the study included Dialectical Behavioral Therapy (DBT), problem-solving therapy, and Cognitive Therapy (CT). Although the findings were promising, a review of the major studies suggested that attrition was a common problem. For example, in Brown's ...

There are limited prospective data on suicide attempts (SA) during the months following treatment for substance use disorders (SUD), a period of high risk. In an analysis of the Drug Abuse Treatment Outcomes Study (DATOS), a longitudinal naturalistic multisite study of treated SUDs, variables associated with SA in the 12 months following SUD treatment were examined. Participants included 2,966 patients with one or more SUDs. By 12 months, 77 (2.6%) subjects had attempted suicide. Multivariate logistic regression analyses were used to identify variables associated with SA. Variables collected at baseline that were associated with SA included lifetime histories of SA, suicidal ideation (SI), and depression, cocaine as primary substance of use, outpatient methadone treatment, and short-term inpatient treatment. Male sex, older age, and minority race/ethnicity were associated with lower likelihood of SA. After controlling for baseline predictors, variables assessed at 12 months associated with SA included SI during follow-up and daily or more use of cocaine. The data contribute to a small but growing literature of prospective studies of SA among treated SUDs, and suggest that SUDs with cocaine use disorders in particular should be a focus of prevention efforts.