Life stress and suicide in adolescents

May combine two claims.

After controlling for demographic and clinical covariates, only Interpersonal Loss events distinguished attempters from psychiatric controls and from ideators; no events or difficulties differentiated ideators from controls.

“Controlling for demographic and clinical covariates, only Interpersonal Loss events distinguished attempters from psychiatric controls (OR = 2.27) and ideators (OR = 1.49); no events or difficulties differentiated ideators from controls.”

May combine two claims.

Although age and sex were correlated with some STRAIN variables, the observed effects were not moderated by demographic factors in any case.

“First, these analyses showed that, although age and sex were correlated with some of the STRAIN variables, the effects observed were not moderated by demographic factors in any case.”

May combine two claims.

All psychiatric symptom measures were moderately and significantly associated, and correlations between depression symptoms and the other four variables were particularly high, with rs from 0.54 to 0.65 and ps less than 0.001.

“All measures of psychiatric symptoms were moderately and significantly associated, and correlations between depression symptoms and the other four variables were particularly high (rs = 0.54–0.65, ps< 0.001).”

May combine two claims.

Groups differed in residualized suicide ideation severity, F(2, 194) = 17.20, p < 0.001, eta-squared partial = 0.15; PCs reported less severe suicide ideation than both SIs and SAs, but SIs and SAs did not significantly differ.

“As expected, the groups also differed in residualized suicide ideation severity, F(2, 194)= 17.20, p < 0.001, ηp2 = 0.15. PCs reported less severe suicide ideation than both SIs (p < 0.001, d = 1.21) and SAs (p < 0.001, d = 0.94), but the latter two groups did not significantly differ (p = 0.634, d = 0.20).”

The quote only partly states this claim.

Higher Interpersonal Loss counts were uniquely associated with being a SA relative to a PC in the single-lifetime-attempter sample, b = 1.10, SE = 0.37, chi-square[1, N = 175] = 9.07, p = 0.003, OR = 3.02, CI [1.47, 6.19].

“and higher life event counts were uniquely associated with being a SA relative to both a PC, b = 1.10, SE = 0.37, χ2[1, N = 175] = 9.07, p = 0.003, OR = 3.02, CI [1.47, 6.19],”

May combine two claims.

None of the other chronic difficulty variables were significant in the model, chi-squares[2, N = 197] less than 5.39, ps greater than 0.067.

“None of the other chronic difficulty variables were significant in the model, χ2s [2, N = 197] < 5.39, ps > 0.067.”

May combine two claims.

The effect of Interpersonal Loss stressors was specific to acute life events, and no category of chronic difficulty exposure was associated with STB group after adjusting for participants' psychiatric characteristics.

“Last, the effect of Interpersonal Loss stressors was specific to acute life events and no category of chronic difficulty exposure was associated with STB group after adjusting for participants’ psychiatric characteristics.”

May combine two claims.

There were group differences in rates of any mood disorder and any anxiety disorder; SI and SA adolescents had higher rates than PCs but did not significantly differ from one another.

“For diagnostic indices, there were group differences in rates of endorsing any mood disorder and any anxiety disorder; in both cases, SI and SA adolescents had higher rates of these diagnoses than PCs but did not significantly differ from one another.”

May combine two claims.

Rates of physical and sexual abuse differed across groups, and the SA group reported higher rates than both PC and SI adolescents.

“Rates of physical and sexual abuse differed across the groups, and the SA group reported higher rates than both PC and SI adolescents.”

May combine two claims.

Groups significantly differed in residualized hopelessness, F(2, 194) = 5.51, p = 0.005, eta-squared partial = 0.05, with SI adolescents reporting more severe hopelessness than PCs, and all other pairwise comparisons non-significant.

“In terms of the residualized symptom scores, groups significantly differed in residualized hopelessness, F(2, 194) = 5.51, p = 0.005, ηp2 = 0.05, such that SI adolescents reported more severe hopelessness than PCs (p = 0.003, d = 0.68), but all other pairwise comparisons were non-significant.”

The quote only partly states this claim.

The adjusted model with Interpersonal Loss events occurring 3-12 months prior to hospitalization remained significant, chi-square[16, N = 197] = 160.46, p < 0.001.

“The adjusted model remained significant, χ2[16, N = 197] = 160.46, p < 0.001.”

May combine two claims.

Chronic Interpersonal Loss separated both attempters and ideators from psychiatric controls, but it did not separate attempters from ideators.

“In doing so, we found that chronic Interpersonal Loss (e.g., ongoing arguments with partner; long-term separation from a parent) differentiated attempters and ideators from psychiatric controls but not from one another.”

• AssumptionRests on an assumption: MINI-KID diagnoses are reliable enough for classifying participants into diagnostic groups.

May combine two claims.

Compared with excluded participants, the analyzed sample had more severe suicidal ideation and may be a particularly severe subset of the treatment program.

“Our sample reported more severe suicide ideation than excluded participants and may represent a subset of youth in the treatment program with particularly severe symptoms.”

May combine two claims.

The sample consisted of adolescents from an intensive residential program who had severe psychiatric symptoms, difficult peer, family, and/or academic circumstances, and very high rates of suicidal thoughts and behaviors.

“Last, adolescents in the present sample were recruited from an intensive residential treatment program. They had severe psychiatric symptoms, complex and often unsupportive peer, family, and/or academic environments, and very high rates of STBs (see also Stewart et al. 2017b, c; Vergara et al. 2019).”

• cites Stewart et al. 2017b, cNot checked yet

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• cites Vergara et al. 2019 sourceNot checked yet

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May combine two claims.

Interpersonal Loss events, a history of abuse, and depression were the factors that separated ideators from attempters.

“The factors that differentiated ideators and attempters—namely, Interpersonal Loss events, the presence of abuse, and depression”

• AssumptionRests on an assumption: MINI-KID diagnoses are reliable enough for classifying participants into diagnostic groups.

Classified as probably not a substantial claim. May combine two claims.

Contemporary ideation-to-action frameworks posit that stress exposure contributes to the development and worsening of suicide ideation and to the escalation from ideation to attempts.

“Contemporary ideation-to-action frameworks posit that stress exposure contributes to both the development and worsening of suicide ideation, as well as to the escalation from ideation to attempts (Klonsky et al. 2018).”

• cites Klonsky et al. 2018 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Life stress is central to virtually all major theories of suicide.

“Life stress is central to virtually all major theories of suicide (see O’Connor and Nock 2014).”

• cites O’Connor and Nock 2014Not checked yet

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May combine two claims.

Ideation-to-action theories make assumptions about which stressors are most implicated in suicidal thoughts and behaviors, but these stressors are rarely explicitly measured.

“First, although ideation-to-action theories of suicide make assumptions about the types of stressors most implicated in STBs (e.g., Klonsky et al. 2018), these forms of stress are rarely explicitly measured”

• cites Klonsky et al. 2018 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Integrated Motivational Volitional Theory of Suicide proposes that entrapment is essential to the development of suicide ideation and that for some people it is brought on by external circumstances.

“In contrast, the Integrated Motivational Volitional Theory of Suicide (IMV; O’Connor et al. 2016) proposes that entrapment (i.e., feelings of inescapable defeat) is essential to the development of suicide ideation, and for some, is brought on by external circumstances (e.g., caring for a chronically ill loved one).”

• cites O’Connor et al. 2016Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The Integrated Motivational Volitional Theory includes general stressful life events among volitional moderators that facilitate or impede the transition from ideation to attempts.

“General stressful life events are included among the IMV’s volitional moderators—a set of environmental (e.g., stressors), psychological (e.g., mental imagery), social (e.g., exposure to a loved one’s suicidal behavior), and physiological (e.g., pain tolerance) variables that facilitate or impede the transition from ideation to attempts.”

• cites O’Connor et al. 2016Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

All theories posit that for suicide ideation to progress to an attempt, one must have the capability to enact lethal self-harm.

“Finally, all theories posit that for suicide ideation to progress to an attempt, one must have the capability to enact lethal self-harm.”

May combine two claims.

The SITBI has demonstrated good reliability and convergent validity in prior studies.

“The SITBI has demonstrated good reliability and convergent validity in prior studies (Nock et al. 2007).”

• cites Nock et al. 2007 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Three-Step Theory implies that loss of interpersonal relationships may reduce connectedness and may be implicated in attempts among ideators.

“The loss of interpersonal relationships may reduce connectedness, and thus, the 3ST insinuates such losses may be implicated in attempts among ideators.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Integrated Motivational Volitional Theory proposes that any form of stress might facilitate the transition from ideation to attempts.

“while the IMV proposes that any form of stress might facilitate the transition from ideation to attempts.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Current understanding of the role stressors play in many psychiatric disorders is founded on cross-sectional studies employing rigorous stress assessments, well-characterized comparison groups, and clearly defined outcomes.

“That said, current understanding of the role stressors play in many psychiatric disorders (e.g., depression; see Hammen 2018 for a review), is founded on cross-sectional studies employing rigorous stress assessments, well-characterized comparison groups, and clearly-defined outcomes (e.g., a major depressive episode).”

• cites Hammen 2018 sourceNot checked yet

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May combine two claims.

Suicide attempters may experience more stressful life events than ideators, especially interpersonal conflicts and potentially lethal physical danger.

“Overall, suicide attempters may experience more stressful life events than ideators, especially interpersonal conflicts and potentially lethal physical danger (e.g., violent trauma).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Excluded participants reported higher rates of physical abuse than included participants.

“Excluded participants reported higher rates of physical abuse than included participants, χ2[1, N=340] =4.77, p = 0.029, Φ = 0.12.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The SITBI and BSSI criteria have been used to classify suicidal thoughts and behaviors groups in several prior studies.

“The SITBI and BSSI criteria have been used to classify STB groups in several prior studies (e.g., Stewart et al. 2017b; Stewart et al. 2017c; Vergara et al. 2019).”

• cites Stewart et al. 2017bNot checked yet

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• cites Stewart et al. 2017cNot checked yet

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• cites Vergara et al. 2019 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Interviewers were research assistants or graduate students who received at least 25 hours of training and ongoing supervision.

“Interviewers were research assistants or graduate students who received minimum 25 h of training (e.g., didactics, mock-interviews) and ongoing supervision.”

May combine two claims.

The core social-psychological characteristics showed significant associations with psychiatric symptom severity, with varying magnitudes across categories, indicating that stressors with certain characteristics may be differentially linked to certain symptoms.

“Finally, the core social-psychological characteristics showed significant associations with psychiatric symptom severity (rs = 0.15–0.40, ps < 0.01), although the magnitude of these associations varied greatly across the different stressor categories, thus indicating that stressors with certain social-psychological characteristics may be differentially linked to certain symptoms (Slavich et al. 2”

• cites Slavich et al. 2019Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The Interpersonal Theory of Suicide suggests that life events involving interpersonal loss and/or humiliation are involved in developing the desire to die, a necessary precursor of an attempt.

“For instance, the ITS suggests that life events involving interpersonal loss and/or humiliation are involved in developing the desire to die, a necessary precursor of an attempt”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Three-Step Theory of Suicide proposes that general life stress contributes to proximal states of psychological pain and hopelessness that are necessary for developing ideation.

“The Three-Step Theory of Suicide (3ST; Klonsky and May 2015) proposes that general life stress contributes to proximal states (i.e., psychological pain and hopelessness) necessary for developing ideation.”

• cites Klonsky and May 2015 sourceNot checked yet

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Classified as probably not a substantial claim. May combine two claims.

Broadly defined interpersonal stressors appear in all theories, but each framework makes distinct predictions about which specific stressors facilitate developing suicide ideation and attempts among ideators.

“Broadly defined interpersonal stressors appear in all theories, but each framework also makes distinct predictions about the specific types of stressors that facilitate: (a) developing suicide ideation and (b) attempts among ideators.”

May combine two claims.

Using a BSSI cutoff of 4 or greater to indicate clinically significant suicide ideation is consistent with guidelines for adolescent psychiatric patients and prior research with adolescent psychiatric inpatients.

“In defining our PC and SI groups, we used a cutoff of 4 or greater on the BSSI to indicate clinically significant suicide ideation, which is consistent with guidelines for adolescent psychiatric patients (Holi et al. 2005) and prior research concucted with adolescent psychiatric inpatients (e.g., Stewart et al. 2017b, c).”

• cites Holi et al. 2005 sourceNot checked yet

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• cites Stewart et al. 2017b, cNot checked yet

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May combine two claims.

Stressor count was associated with psychiatric indices and physical health complaints, and these associations were robust while controlling for participant demographics.

“Stressor count was also associated with a variety of psychiatric indices (e.g., depression; anxiety; anhedonia; number of diagnoses) and physical health complaints (rs = 0.18–0.47), and these associations were robust while controlling for participant demographics (βs = 0.16–0.48, all ps < 0.006).”

• cites Slavich et al. 2019Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Among leading suicide theories, the Interpersonal Theory of Suicide has received the most empirical attention and support.

“Among leading suicide theories, the ITS has received the most empirical attention (and, by extension, support; see Chu et al. 2017)”

• cites Chu et al. 2017 sourceNot checked yet

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May combine two claims.

Stone and colleagues found an association between dependent life events and subsequent attempts among females, but this effect was not robust when controlling for suicide attempt history.

“However, Stone and colleagues found an association between dependent life events and subsequent attempts among females, though this effect was not robust when controlling for participants’ suicide attempt history.”

• cites Stone et al. 2014 sourceNot checked yet

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May combine two claims.

Exposure to war and sexual victimization, and being the victim of violence or threats, have been associated with greater odds of subsequent attempts among ideators in adult and adolescent samples.

“Exposure to war and sexual victimization (Stein et al. 2010) and being the victim of violence or threats (Borges et al. 2008) have also been associated with greater odds of subsequent attempts among ideators, in adult and adolescent samples, respectively.”

• cites Stein et al. 2010 sourceNot checked yet

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• cites Borges et al. 2008 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

All theories suggest that life events characterized by pain, danger, and/or fear may contribute to acquiring suicide capability.

“Suicide capability is multi-determined, but all theories suggest that life events characterized by pain, danger, and/or fear (e.g., being in a physical fight) may contribute to acquiring suicide capability.”

May combine two claims.

The non-specific approach precludes determining whether certain stressors are more strongly related to suicidal thoughts and behaviors, while the specific approach limits comparative analyses and reduces statistical power because base rates for particular stressors are lower.

“The former approach precludes determining whether certain types of stressors are more strongly related to STBs than others and the latter limits the ability to conduct comparative analyses and reduces statistical power, since base rates for experiencing particular stressors are lower for more narrowly defined stress categories (see Liu and Miller 2014).”

• cites Liu and Miller 2014 sourceNot checked yet

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May combine two claims.

Lifetime stressor count was associated with significant additional explained variance in outcomes while controlling for other stress measures, indicating incremental predictive validity of the Adolescent STRAIN.

“Furthermore, lifetime stressor count was associated with significant additional explained variance in these outcomes while controlling for other stress measures (ΔR2s = 0.013–0.060), thus highlighting the incremental predictive validity of the Adolescent STRAIN above and beyond other commonly used instruments for assessing life stress.”

• cites Slavich et al. 2019Not checked yet

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May combine two claims.

Pettit and colleagues found that greater chronic stress exposure predicted suicide ideation but not attempts among adolescent inpatients.

“Similarly, Pettit and colleagues (Pettit et al. 2011) focused on chronic difficulties and found that greater chronic stress exposure predicted suicide ideation but not attempts among adolescent inpatients.”

• cites Pettit et al. 2011 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Most psychiatric controls reported no current suicide ideation.

“Most (n = 34, 89.47%) of the PCs reported no current suicide ideation (BSSI = 0).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The MINI-KID has high concordance with gold-standard diagnostic interviews and is a reliable assessment of psychiatric disorders in adolescent outpatients.

“The MINI-KID has high concordance with gold-standard diagnostic interviews and is a reliable assessment of psychiatric disorders in adolescent outpatients (Sheehan et al. 2010).”

• cites Sheehan et al. 2010 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Included participants had higher BSSI scores than excluded participants.

“Included participants had higher BSSI scores as compared to excluded participants, t(338) = 2.25, p = 0.025, d = 0.25.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The STRAIN classification system was created during initial development and validation and was informed by a review of the life stress literature, gold-standard stress assessment instruments, and expert consultation.

“The classification system that designates which stressor falls into which category was created during the initial development and validation of the STRAIN and was informed by an exhaustive review of the life stress literature, the structure of gold-standard stress assessment instruments, and consultations with stress assessment experts (see Slavich and Shields 2018).”

• cites Slavich and Shields 2018 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Higher Adult STRAIN scores have been associated with worse mental and physical health and poorer cognitive, biological, and clinical functioning across several studies and health contexts.

“Higher Adult STRAIN scores have also been associated with worse mental and physical health, as well as poorer cognitive, biological, clinical functioning across several different studies and distinct health contexts (e.g., Bower et al. 2014; Cuneo et al. 2017; Dooley et al. 2017; Goldfarb et al. 2017; Lam et al. 2019; Shields et al. 2017a, b; Slavich and Shields 2018; Toussaint et al. 2016).”

• cites Bower et al. 2014 sourceNot checked yet

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• cites Cuneo et al. 2017 sourceNot checked yet

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• cites Slavich and Shields 2018 sourceNot checked yet

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May combine two claims.

Community research is not well suited to determine whether stress exposure differentiates ideators from attempters because attempters often report higher psychopathology and because low base rates of suicidal thoughts and behaviors limit clinical significance.

“However, community research is not well suited to determine whether stress exposure differentiates ideators from attempters because: (a) suicide attempters often report higher rates of psychopathology”

• Also stated in: § Life Stress: Suicide Ideators Versus Suicide Attempters · plain

  “and (b) there are low base rates of STBs, which limits the clinical significance of results with respect to informing prevention and interventions.”

• AssumptionRests on an assumption: Suicide attempters often report higher rates of psychopathology.
• AssumptionRests on an assumption: There are low base rates of suicidal thoughts and behaviors.

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

The findings may improve identification of ideators most likely to make an attempt and enable targeted early interventions.

“Ultimately, this may improve the identification of ideators most likely to make an attempt, enabling the deployment of targeted early interventions.”

May combine two claims.

Miller and colleagues found that higher than usual chronic strain predicted suicide ideation and was prospectively associated with suicidal behavior among female adolescents, but only among those reporting prior abuse.

“Finally, Miller and colleagues (Miller et al. 2017) also found that higher than usual chronic strain predicted suicide ideation and was prospectively associated with suicidal behavior among female adolescents. However, the latter effect only occurred among those reporting prior abuse.”

• cites Miller et al. 2017 sourceNot checked yet

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May combine two claims.

The present results show that exposure to acute Interpersonal Loss is specifically related to attempts and that this association is unlikely due to more severe ideation.

“First, they show that exposure to acute Interpersonal Loss is specifically related to attempts, and that this association is unlikely due to more severe ideation.”

May combine two claims.

Interpersonal relationships are paramount in adolescence, and threats to these social bonds may be uniquely potent precipitants of adolescent suicide.

“Interpersonal relationships are paramount in adolescence and threats to these social bonds may be uniquely potent precipitants of adolescent suicide (Whitlock et al. 2014).”

• cites Whitlock et al. 2014 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The reliability of BHS items was excellent, with alpha = 0.91.

“The reliability of BHS items was excellent, α = 0.91.”

Classified as probably not a substantial claim.

Residualizing anxiety, anhedonia, hopelessness, and suicide ideation on depression symptoms was done to reduce the likelihood of overfitting primary models by including many moderately correlated predictors.

“This approach was used to reduce the likelihood of overfitting primary models by including many moderately correlated predictors.”

Probably not a substantial claim: may not pass S3 (load-bearing).

MASC items demonstrated excellent reliability, with alpha = 0.92.

“MASC items demonstrated excellent reliability, α = 0.92.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The internal consistency of the SHAPS was good, with alpha = 0.88.

“The internal consistency of the SHAPS was good, α = 0.88.”

Classified as probably not a substantial claim.

Ideation-to-action theories of suicide stipulate that a variety of stressful experiences contribute to the development of suicide ideation.

“Ideation-to-action theories of suicide stipulate that a variety of stressful experiences contribute to the development of suicide ideation (Joiner 2005; O’Connor et al. 2016).”

• cites Joiner 2005Not checked yet

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• cites O’Connor et al. 2016Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Two sensitivity analyses were conducted to limit the confounding effect of temporal overlap between life stress and suicide attempts.

“Last, we conducted two sensitivity analyses aimed at limiting the confounding effect of temporal overlap between life stress and suicide attempts.”

May combine two claims.

The reliability of the CTQ-SF physical and sexual abuse subscale items was good for physical abuse (alpha = 0.84) and excellent for sexual abuse (alpha = 0.94).

“The reliability of items in the physical and sexual abuse subscales was good, α = 0.84, and excellent, α = 0.94, respectively.”

Probably not a substantial claim: may not pass S3 (load-bearing).

CES-D items had excellent internal consistency, with alpha = 0.94.

“The CES-D items had excellent internal consistency, α = 0.94.”

May combine two claims.

Depression is among the strongest correlates of suicide ideation, and in adolescents, the presence of a unipolar mood disorder increases odds of subsequent suicide ideation by more than 4-fold.

“Depression is among the strongest correlates of suicide ideation, and in adolescents, the presence of a unipolar mood disorder increases odds of subsequent suicide ideation by more than 4-fold (Nock et al. 2013).”

• cites Nock et al. 2013 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Retrospective recall of stressors raises the possibility that some stressors were missed or reported inaccurately, i.e., recall bias.

“As participants retrospectively recalled stressors, there are potential concerns that stressors were missed or inaccurately reported (i.e., recall bias).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The Adolescent STRAIN gives no guidance on interpreting items, so variability may increase because participants understand stressors differently.

“Third, notwithstanding its considerable strengths (e.g., scalability, behaviorally-anchored probe questions, branching logic), the Adolescent STRAIN does not guide participants on how to interpret items, which could increase variability attributable to their idiosyncratic understanding of what constitutes a stressor (see Harkness and Monroe 2016).”

• cites Harkness and Monroe 2016 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

It is conceivable that Interpersonal Loss is more strongly linked to STBs in adolescence.

“As interpersonal relationships are salient in adolescence (Steinberg and Morris 2001) and youth may be more sensitive to negative social experiences (Platt et al. 2013), it is conceivable that Interpersonal Loss is more strongly linked to STBs in adolescence.”

• cites Steinberg and Morris 2001 sourceNot checked yet

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• cites Platt et al. 2013 sourceNot checked yet

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May combine two claims.

Because the data were cross-sectional, causal direction cannot be assumed even though steps were taken to strengthen confidence in it.

“First, data were cross-sectional, and despite taking steps to enhance confidence in the direction of the effects, causality cannot be assumed.”

May combine two claims.

Like many stress measures, the Adolescent STRAIN records whether stressors occurred in a period but lacks an independent rater panel to produce objective, context-based severity ratings.

“Like many other stress measures, it provides data on whether certain stressors have occurred during a given time frame, but does not employ an independent panel of raters who generate objective, contextually based ratings of stressor severity.”

May combine two claims.

Chronic stressors, particularly Interpersonal Loss, might relate to adolescent suicide ideation both directly and indirectly through psychiatric symptoms.

“Chronic stressors, particularly those involving Interpersonal Loss, may be associated with adolescent suicide ideation directly and/or indirectly via their relations with psychiatric symptoms.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Adolescent attempters may experience a higher rate of dependent stressful life events, which might produce differences between attempters and non-attempters both prior to and following index attempts.

“Furthermore, adolescent attempters may experience a higher rate of dependent stressful life events—that is, events partly influenced by their own characteristics—which might produce differences between attempters and non-attempters both prior to and following index attempts.”

May combine two claims.

Two factors reduce the recall bias concern: the STRAIN asks about major stressors from the past year, which can be recalled accurately, and the analyses controlled for psychiatric symptoms that might bias recall.

“These concerns are tempered by (a) the STRAIN’s focus on major stressors over the past year, which studies show can be recalled accurately (Johnson 2005; Paykel 1997) and (b) controlling for psychiatric symptoms (e.g., depression) that may bias recall.”

• cites Johnson 2005 sourceNot checked yet

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• cites Paykel 1997 sourceNot checked yet

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Classified as probably not a substantial claim.

The model variables covered different time windows: stressors over the past year, attempts in the past month, and symptoms in the past week.

“Fourth, the variables used in our models were measured using different time frames (e.g., stressors over the past year, past month attempts, symptoms in the past week).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Interpersonal stress strongly and reliably predicts major depressive episodes.

“Notably, interpersonal stress is a potent and reliable predictor of major depressive episodes (Hammen 2018; Harkness et al. 2010)”

• cites Hammen 2018 sourceNot checked yet

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• cites Harkness et al. 2010 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Financial- and employment-related stress may be most relevant for predicting suicide in middle adulthood, while health-related events and difficulties may play a more central role in suicide for older adults.

“In contrast, financial- and employment-related stress may be most relevant for predicting suicide in middle adulthood (DeJong et al. 2010; Innamorati et al. 2008), while health-related events and difficulties may play a more central role in suicide for older adults, particularly through their effects on cognitive-affective states like perceived burdensomeness (e.g., Cukrowicz et al. 2011).”

• cites DeJong et al. 2010 sourceNot checked yet

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• cites Innamorati et al. 2008 sourceNot checked yet

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• cites Cukrowicz et al. 2011 sourceNot checked yet

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May combine two claims.

IPT-A targets specific interpersonal problems and teaches communication and problem-solving skills to improve coping.

“and focuses on particular interpersonal problems by equipping adolescents with communication and problem solving skills to bolster coping.”

• cites Mufson et al. 2004 sourceNot checked yet

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May combine two claims.

The interpersonal theory of suicide, integrated motivational-volitional model, and three-step theory all propose that pain, danger, and fear experiences can build suicide capability and thus separate attempters from non-attempters.

“The ITS, IMV, and 3ST all suggest that experiences involving pain, danger, and/or fear may contribute to suicide capability, and consequently, differentiate suicide attempters from non-attempters.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Depression tends to be more strongly linked to suicidal ideation than to suicide attempts.

“Although depression is generally more strongly associated with suicide ideation than attempts (Nock et al. 2013)”

• cites Nock et al. 2013 sourceNot checked yet

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Classified as probably not a substantial claim. May combine two claims.

The number and type of stressful life events preceding major depressive episodes vary across the lifespan, but similar research has not been conducted in the context of STBs.

“The number and type of stressful life events preceding major depressive episodes vary across the lifespan (Harkness et al. 2010), but similar research has not been conducted in the context of STBs.”

• cites Harkness et al. 2010 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

People with depression create interpersonal stressors that partly stem from their own behaviors or traits.

“depressed individuals generate interpersonal stressors that are at least partly related to their behaviors or characteristics (Hammen 2018; Harkness and Stewart 2009).”

• cites Hammen 2018 sourceNot checked yet

  Not checked in the free run.

• cites Harkness and Stewart 2009 sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The study did not collect exact onset dates for MINI-KID diagnoses and did not assess their inter-rater reliability, since consent to record diagnostic interviews was lacking.

“Although MINI-KID diagnoses likely preceded attempts (and, in many cases, life stressors), precise dates of onset were not collected and furthermore, as we did not have consent to record diagnostic interviews, the inter-rated reliability of MINI-KID diagnoses was not examined.”

May combine two claims.

This study did not assess access to lethal methods, suicidal intent, or other key determinants of suicide attempts.

“However, it is important to note that the present study did not measure access to lethal means, suicidal intent, or other critical determinants of suicide attempts.”

May combine two claims.

The findings might not extend to youth in outpatient or community care or to those with milder psychiatric symptoms.

“Therefore, these results may not necessarily generalize to other youth in outpatient or community treatment settings, or to those exhibiting less severe psychiatric symptoms.”

Probably not a substantial claim: may not pass S2 (checkable).

The factors that distinguished ideators from attempters might suggest interventions that are especially helpful for lowering suicide risk in adolescents.

“The factors that differentiated ideators and attempters—namely, Interpersonal Loss events, the presence of abuse, and depression—may also point toward interventions that may be most helpful in reducing suicide risk in youth.”

• AssumptionRests on an assumption: MINI-KID diagnoses are reliable enough for classifying participants into diagnostic groups.

Classified as probably not a substantial claim.

The authors deliberately selected current psychiatric symptoms to control for state effects when participants reported life stress.

“Current psychiatric symptoms were explicitly chosen to control for state effects on reporting life stress.”

May combine two claims.

For repeated stressors, the Adolescent STRAIN collects severity and timing only for the worst occurrence, which may have led to underestimated effects among youth who experienced the same stressor repeatedly.

“Also, to enhance efficiency, the Adolescent STRAIN only obtains severity and stress exposure timing data for the most severe occurrence for stressors experienced multiple times; consequently, we may have underestimated effects for youth who experienced the same stressor multiple times.”

Probably not a substantial claim: may not pass S2 (checkable).

Because DBT addresses intense negative emotions, skills like distress tolerance might help manage acute suicide risk in youth with trauma histories and recent Interpersonal Loss.

“Given DBT’s focus on managing intense negative affect, particular skills (e.g., distress tolerance) may be useful for managing acute suicide risk among youth with trauma histories and recent Interpersonal Loss events.”

• AssumptionRests on an assumption: MINI-KID diagnoses preceded suicide attempts and life stressors in most cases.
• AssumptionRests on an assumption: MINI-KID diagnoses are reliable enough for classifying participants into diagnostic groups.

May combine two claims.

In youth, tests of the interpersonal theory of suicide have generally shown small links between acquired capability and suicide attempts, though some studies have not.

“Studies testing the ITS in youth have found modest relations between acquired capability and suicide attempts and a minority of studies have failed to find this association (see Stewart et al. 2017a).”

• cites Stewart et al. 2017aNot checked yet

  Not checked in the free run.