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Suicide ideation is a prerequisite for suicide attempts. However, the majority of ideators will never act on their thoughts. It is therefore crucial to understand what differentiates those who consider suicide from those who attempt suicide. The aim of this study was to investigate the role of different aspects of capability for suicide (fearlessness about death, subjective pain tolerance, objective pain persistence) in differentiating suicide ideators from suicide attempters, single attempters from multiple attempters and recent attempters from distant attempters. A total of 308 psychiatric inpatients (53.6% female; age: M=36.92, SD=14.30) suffering from suicide ideation with or without lifetime suicide attempts were compared regarding fearlessness about death, subjective pain tolerance and objective pain persistence (assessed with a pressure algometer). No differences in fearlessness about death, subjective pain tolerance and objective pain persistence were found in suicide ideators vs. attempters, single vs. multiple attempters and recent vs. distant attempters. It might be presumed that fearlessness about death, subjective pain tolerance and objective pain persistence do not offer useful information for the differentiation between suicide ideators and attempters, however, there are several limitations to take into account. Further effort is needed to understand more clearly what differentiates suicide ideators from suicide attempters.

Background Positive mental health (PMH) has been shown to confer resilience against suicide ideation. However, it is unclear, whether PMH also buffers the relationship between suicide ideation and suicide attempts. The current study aimed to determine whether PMH moderates the association between lifetime suicide ideation and lifetime suicide attempts. Methods A total of 199 psychiatric inpatients with lifetime suicide attempts (female: n = 109; age: M = 37.56, SD = 14.38, range: 18–81) were interviewed on lifetime suicide ideation/behavior and completed a measure on PMH. Results PMH moderated the impact of lifetime suicide ideation on lifetime suicide attempts: For those individuals who reported high levels of PMH, the rate of lifetime suicide attempts was reduced even when experiencing frequent episodes of lifetime suicide ideation. Limitations Given the cross-sectional nature of the data, conclusions on causality should be handled carefully. Conclusion PMH seems to confer resilience and should be taken into account, when assessing individuals for suicide risk.

The Integrated Motivational-Volitional (IMV) Model of suicide posits that perceived burdensomeness and thwarted belongingness moderate the association between perceptions of entrapment and suicide ideation. However, the proposed moderation is yet to be tested. Possible moderator effects were investigated in an online sample (N = 480; 74% female; Mage = 28.5, SDage = 11.1). Entrapment and perceived burdensomeness predicted suicide ideation. However, neither perceived burdensomeness nor thwarted belongingness moderated the association between entrapment and suicide ideation. The present results do not support a key assumption of the IMV-Model. Nonetheless, they underscore the importance of perceived burdensomeness and entrapment in the prediction of suicide ideation.

Objective To evaluate the main prediction of the Interpersonal Theory of Suicide (IPTS): 3-way-interaction of perceived burdensomeness (PB), thwarted belongingness (TB), and acquired capability (AC) for the prediction of suicidal behavior in a representative population sample. Method A total of 2513 participants completed measures of suicidal behavior, TB, PB, acquired capability (AC-FAD), and symptoms of depression and anxiety. Results The two-way-interaction of TB and PB, and the three-way interaction of TB, PB and AC-FAD predict suicidality. Limitations Given the cross-sectional nature of the data, conclusions on causality should be handled carefully. Conclusion The main prediction of the IPTS has been proven in a general population sample.

The interpersonal theory of suicide (Joiner, T.E., 2005. Why People Die By Suicide. Harvard University Press, Cambridge) postulates that, for a serious or lethal suicide attempt one has to possess a desire to die and the capability to commit suicide. The capability is proposed to be acquired over time by repeated experiences with painful and provocative events such as self-injurious behavior and other experiences such as childhood abuse, combat exposure, physical fights, promiscuous sex, and playing contact sports. Up to now, experiences with painful and provocative events are measured with various versions of the Painful and Provocative Events Scale (PPES). However, a thorough validation of this assessment instrument is still lacking. Our study aimed at validating the German version of PPES, with two clinical (n=424) and one community sample (n=532). Results support a two-factor structure (eight items "active painful and provocative events", four items "passive painful and provocative events") that was invariant across the three subsamples. Nonetheless, low factor loadings, low indicator reliabilities, moderate construct reliability and mixed evidence for construct validity indicate that the PPES in its current form appears to be of limited use. The development of a new instrument to assess painful and provocative events seems appropriate.

The present study aimed at investigating whether resting vagally mediated heart rate variability (HRV) as a trait-like biomarker of cognitive inhibitory control capacity is related to suicide ideation in a sample without suicide attempt history.Thirty-seven healthy students participated voluntarily (18 to 34 years, M=24.5, SD=4.1; 73.0% female). Time and frequency measures of HRV were derived from an electrocardiogram that was recorded using Einthoven's Triangle lead II. Participants filled in the Rasch-based Depression Screening and four questions concerning lifetime suicide ideation (SI). Bivariate Pearson's and partial (controlling for depression severity) correlation coefficients were calculated between SI and measures of vagally mediated HRV.A significant correlation between the ln10-transformed high-frequency band of resting vagally mediated HRV and SI was found (r=-.33, p.05). Correlations did not change substantially when controlling for depression. Mean heart rate as a time domain measure also significantly correlated with SI while controlling for depression (r=.36, p.05). A trend correlation between SI and Root Mean Square of Successive Differences between interbeat intervals emerged.SI was assessed with a composite score of four items measuring SI. Future studies should consider using more comprehensive assessment instruments.The relation between resting vagally mediated HRV and suicide ideation may be interpreted as indicating that reduced inhibitory cognitive control capacity may be a risk factor for suicidality. It may act already early in the suicidal process, before suicidal behavior develops and should be further investigated as potentially clinically important physiological predictor of suicidality.

Background The present study examined the hypothesis that patients' ratings would be less congruent and stable if they were asked to rate imprecise terms on frequency and intensity that were embedded in a behavioral or perceptual framework. Based on data acquired from the patients' ratings the presented terms were analyzed concerning their interindividual congruency, intraindividual stability across time and distinguishability of adjacent terms. Afterward, the results were compared to the results regarding the same analysis of unframed terms from an earlier investigation [16]. Methods In a longitudinal design, 44 patients (age M=39.1, SD=15.2, 68.2% female) with a depressive disorder filled out two established questionnaires (BDI or SCL-90) and questionnaires containing frequency and intensity terms framed in sentences concerning the subjective experience of sadness. Patients should rate the terms with regard to the percentage of time or intensity that is reflected by each term at two different measuring times within one week. Data analysis contained t-tests for paired samples and effect sizes d according to Cohen. Results The congruency of framed terms was influenced by an additional factor (vocabulary skills) in comparison to unframed terms. However, congruencies for both sets of terms were rather low. In contrast to unframed items, framed terms showed no intraindividual instability for frequency and intensity terms at all, but were influenced by all of the analyzed factors (age, gender, vocabulary skills, depression, and overall mental symptom burden). Patients could distinguish more adjacent framed terms than unframed terms. Conclusions The results give no clear suggestion if unframed or framed terms should be preferred as verbal anchors in self-report instruments. Unframed terms seem to have a slight advantage over framed terms as they are less influenced by the patient's background. However, patients are able to distinguish more adjacent terms if presented framed in a behavioral or perceptual context they are familiar with. Frequency terms showed a higher intraindividual stability of mental representations while both groups of terms exhibited low interindividual congruency. No more than four different verbal anchors could be used safely together in rating scales, as patients with a depressive disorder would not be able to reasonably differentiate more than these.

Highlights • EMA data were analyzed using network analysis (e.g., temporal networks). • Suicidal ideation at t was predicted by itself and perceived burdensomeness at t – 1. • Suicidal ideation at t − 1 predicted perceived burdensomeness, depression etc. at t. • At the same beep, suicidal ideation was related to all variables in the network. • Patients with higher average suicidal ideation had higher average hopelessness.

This study conducted a simulation study for computer-adaptive testing based on the Aachen Depression Item Bank (ADIB), which was developed for the assessment of depression in persons with somatic diseases. Prior to computer-adaptive test simulation, the ADIB was newly calibrated.Recalibration was performed in a sample of 161 patients treated for a depressive syndrome, 103 patients from cardiology, and 103 patients from otorhinolaryngology (mean age 44.1, SD=14.0; 44.7% female) and was cross-validated in a sample of 117 patients undergoing rehabilitation for cardiac diseases (mean age 58.4, SD=10.5; 24.8% women). Unidimensionality of the itembank was checked and a Rasch analysis was performed that evaluated local dependency (LD), differential item functioning (DIF), item fit and reliability. CAT-simulation was conducted with the total sample and additional simulated data.Recalibration resulted in a strictly unidimensional item bank with 36 items, showing good Rasch model fit (item fit residuals|2.5|) and no DIF or LD. CAT simulation revealed that 13 items on average were necessary to estimate depression in the range of -2 and +2 logits when terminating at SE≤0.32 and 4 items if using SE≤0.50. Receiver Operating Characteristics analysis showed that θ estimates based on the CAT algorithm have good criterion validity with regard to depression diagnoses (Area Under the Curve≥.78 for all cut-off criteria).The recalibration of the ADIB succeeded and the simulation studies conducted suggest that it has good screening performance in the samples investigated and that it may reasonably add to the improvement of depression assessment.

Background The depression module of the Patient Health questionnaire (PHQ-9) is a wide-spread self-report instrument for the assessment of depression with compelling psychometric characteristics when relying on classical test theory assumptions. This study aimed at evaluating whether the PHQ-9 may be interpreted as a dimensional scale measuring depression severity in the elderly general population using Rasch analysis with special emphasis on its unidimensional structure and differential item functioning (DIF) due to gender, age, and the presence of somatic multimorbidity. Methods A representative sample of the elderly German general population (N=1631; age 60–85 years, 53.5% female) filled in the PHQ-9, a questionnaire about chronic medical conditions and a demographic data sheet. Unidimensionality and psychometric properties of the PHQ-9 were ascertained applying confirmatory factor analysis (CFA) and Rasch analysis. Results Results revealed substantial violations of the unidimensionality of the scale: item 8 (retardation or agitation) had to be eliminated and multiple residual correlations were added. Gender-related DIF emerged for two items, and three items showed insufficient Rasch model fit. Limitations The large sample leads to high statistical power that might technically increase the probability of detecting model misfit or DIF. The sampling procedure leads to a possible underestimation of morbidity due to the exclusion of those elderly patients living in nursing homes. Conclusions Results suggest that – when applied in the elderly general population – the PHQ-9 should be interpreted in terms of a diagnostic algorithm for classificatory decisions about a DSM-IV based probable diagnosis of depression rather than as a dimensional scale.

Objective The second exteroceptive suppression (ES2) is assumed to be an indicator of central antinociceptive processing, although some conflicting data have been produced. We examined the impact of experimentally induced psychophysiological conditions on the latency and duration of the ES2. Also, the association to the subjective evaluation of the painful electrical stimulation by which the ES2 is elicited was studied. Methods ES2 was assessed in 46 healthy volunteers running through four experimentally induced psychophysiological conditions: stress, relaxation, depressed mood, and heterotopic pressure pain. Conditions were presented in a repeated measure design in permuted sequences. Ten stimulation-recording sequences per condition were averaged. ES2 parameters were compared to a baseline condition and correlated to subjective pain perception. Results ES2 duration was found to be prolonged and ES2 latency to be shortened under the impact of relaxation and depressed mood. The subjective perception of the painful electrical stimulation was affected by the experimental conditions. Conclusion Data lend support to the hypothesis that the repeatedly observed limited stability of ES2 parameters might be caused by the variability of individual psychophysiological states. Against expectation, subjective pain perception is not systematically correlated with ES2 parameters. Thus it can be questioned whether the ES2 is directly associated with pain processing at all.