Palabras clave
Suicidal ideation
Self-harm
Fearlessness about death
Mentalizing
Social cognition Letalidad del intento suicida
Ideación suicida
Autolesión
Temeridad ante la muerte
Mentalización
Cognición social
Cómo citar
Resumen
Antecedentes: La letalidad del intento suicida (IS) se asocia con deseo suicida incrementado y cognición social deficitaria. La temeridad ante la muerte (FAD) e hipomentalización podrían desempeñar un papel en IS y autolesiones.Aunque la investigación ha identificado una relación entre estos constructos, ésta es limitada. Este estudio examina el papel mediador de FAD y mentalización entre ideación suicida y letalidad del IS y autolesiones. Método: Participaron 1.371 pacientes tras un IS (70,1% mujeres; M= 40 años), de siete hospitales españoles. Empleamos la subescala Temeridad Ante la Muerte (ACSS-FAD), Cuestionario de Funcionamiento Reflexivo-8 (RFQ-8) y Escala de Gravedad del Suicidio Columbia (CSSRS). Analizamos mediación serial múltiple con ideación suicida como exposición; FAD y mentalización como mediadores; letalidad del IS y autolesiones como resultados. Resultados: Se obtuvieron efectos indirectos entre ideación suicida (B = 0,08; CI = 0,03-0,15), autolesiones y letalidad del IS, mediados por FAD (B = 0,02; CI = 0,001-0,04); entre ideación suicida y autolesiones, mediadas por mentalización (B = 0,10; CI = 0,04-0,17), y efectos indirectos totales entre ideación suicida y autolesiones mediante FAD y mentalización (B = 0,18; CI = 0,11-0,27). Conclusiones: Intervenciones en mentalización y FAD pueden disminuir la letalidad del IS y riesgo autolesivo.
Citas
Al-Halabí, S., & Fonseca-Pedrero, E. (2023). Manual de psicología de la conducta suicida. Pirámide.
Al-Halabí, S., & Fonseca-Pedrero, E. (2021). Suicidal behavior prevention: The time to act is now. Clinical and Health, 32(2), 89-92. https://doi.org/10.5093/clysa2021a17
Al-Halabí, S., Sáiz, P. A., Burón, P., Garrido, M., Benabarre, A., Jiménez, E., Cervilla, J., Navarrete, M. I., Díaz-Mesa, E. M., García-Álvarez, L., Muñiz, J., Posner, K., Oquendo, M. A., García-Portilla, M. P., & Bobes, J. (2016). Validation of a Spanish version of the Columbia-Suicide Severity Rating Scale (C-SSRS). Revista de Psiquiatría y Salud Mental, 9(3), 134-142. https://doi.org/10.1016/j.rpsm.2016.02.002
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Andreo-Jover, J., Curto Ramos, J., Bobes, J., Bravo-Ortiz, M., Cebria, A. I., Crespo-Facorro, B., De la Torre-Luque, A., Díaz-Marsa, M., Fernández- Rodrigues, V., Garrido-Torres, N., Grande, I., López Peña, M. P., Pemau, A., Roberto, N., Ruiz-Veguilla, M., Saiz, P., Rodríguez-Vega, B., Pérez- Sola, V., Palao-Tarrero, A., … Carrasco, J. L. (2024). The mediating role of reflective functioning in the association between childhood trauma and suicide attempt. Journal of Psychiatric Research, 171, 30-37. https://doi.org/10.1016/j.jpsychires.2024.01.005
Arensman, E., Larkin, C., McCarthy, J., Leitao, S., Corcoran, P., Williamson, E., McAuliffe, C., Perry, I. J., Griffin, E., Cassidy, E. M., Bradley, C., Kapur, N., Kinahan, J., Cleary, A., Foster, T., Gallagher, J., Malone, K., Ramos Costa, A. P., & Greiner, B. A. (2019). Psychosocial, psychiatric and work-related risk factors associated with suicide in Ireland: Optimised methodological approach of a case-control psychological autopsy study. BMC Psychiatry, 19(1), Article 275. https://doi.org/10.1186/s12888-019-2249-6
Badoud, D., Luyten, P., Fonseca-Pedrero, E., Eliez, S., Fonagy, P., & Debbané, M. (2015). The French version of the Reflective Functioning Questionnaire: Validity data for adolescents and adults and its association with non-suicidal self-injury. PLOS ONE, 10(12), Article e0145892. https://doi.org/10.1371/journal.pone.0145892
Barker, J., Oakes-Rogers, S., & Leddy, A. (2022). What distinguishes high and low-lethality suicide attempts in older adults? A systematic review and meta-analysis. Journal of Psychiatric Research, 154, 91-101. https://doi.org/10.1016/j.jpsychires.2022.07.048
Bizzi, F., Riva, A., Borelli, J. L., Charpentier-Mora, S., Bomba, M., Cavanna, D., & Nacinovich, R. (2022). The Italian version of the Reflective Functioning Questionnaire: Validity within a sample of adolescents and associations with psychological problems and alexithymia. Journal of Clinical Psychology, 78(4), 503-516. https://doi.org/10.1002/jclp.23218
Brokke, S. S., Landrø, N. I., & Haaland, V. Ø. (2022). Impulsivity and aggression in suicide ideators and suicide attempters of high and low lethality. BMC Psychiatry, 22(1), Article 753. https://doi.org/10.1186/s12888-022-04398-w
Cayuela, L., Cerame, Á., Ortega-Calvo, M., & Cayuela, A. (2023). Incidence and prevalence of suicide attempts in primary care in Spain. International Journal of Mental Health and Addiction 1-11. https://doi.org/10.1007/ s11469-023-01165-0
Choo, C. C., Harris, K. M., & Ho, R. C. (2019). Prediction of lethality in suicide attempts: Gender matters. OMEGA - Journal of Death and Dying, 80(1), 87-103. https://doi.org/10.1177/0030222817725182
Chu, C., Buchman-Schmitt, J. M., Stanley, I. H., Hom, M. A., Tucker, R. P., Hagan, C. R., Rogers, M. L., Podlogar, M. C., Chiurliza, B., Ringer, F. B., Michaels, M. S., Patros, C. H. G., & Joiner, T. E. (2017). The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research. Psychological Bulletin, 143(12), 1313-1345. https://doi.org/10.1037/bul0000123
Clark, L. A., & Watson, D. (1995). Constructing validity: Basic issues in objective scale development. Psychological Assessment, 7(3), 309-319. Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155-159. Collier, J. E. (2020). Applied structural equation modeling using AMOS: Basic to Advanced Techniques (1st ed.). Routledge. https://doi.org/10.4324/9781003018414
Cwik, J. C., Forkmann, T., Glaesmer, H., Paashaus, L., Schönfelder, A., Rath, D., Prinz, S., Juckel, G., & Teismann, T. (2020). Validation of the German capability for suicide questionnaire (GCSQ) in a high-risk sample of suicidal inpatients. BMC Psychiatry, 20(1), Article 412. https://doi.org/10.1186/s12888-020-02812-9
De La Higuera-González, P., Galvez-Merlin, A., Rodríguez-Toscano, E., Andreo-Jover, J., & De La Torre-Luque, A. (2023). Theory of mind and psychopathology: A comprehensive assessment and an overview of impairments in neuropsychiatric disorders. In T. López-Soto, A. García- López, & F. J. Salguero-Lamillar (Eds.), The theory of mind under scrutiny. Logic, argumentation & reasoning (pp. 103-160). Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-46742-4_5
De la Torre-Luque, A., Borges, G., Benjet, C., Orozco, R., Medina-Mora, M. E., & Ayuso-Mateos, J. L. (2022). Diagnostic profiles in adolescence and emerging adulthood: Transition patterns and risk factors. Revista de Psiquiatría y Salud Mental, 16(1), 42–50. https://doi.org/10.1016/j.rpsm.2022.01.002
De la Torre-Luque, A., Pemau, A., Ayad-Ahmed, W., Borges, G., Fernandez- Sevillano, J., Garrido-Torres, N., Garrido-Sanchez, L., Garriga, M., Gonzalez-Ortega, I., & Gonzalez-Pinto, A. (2023). Risk of suicide attempt repetition after an index attempt: A systematic review and meta- analysis. General Hospital Psychiatry, 81, 51–56. https://doi.org/10.1016/j.genhosppsych.2023.01.007
De Prisco, M., Oliva, V., Fico, G., Radua, J., Grande, I., Roberto, N., Anmella, G., Hidalgo-Mazzei, D., Fornaro, M., de Bartolomeis, A., Serretti, A., Vieta, E., & Murru, A. (2023). Emotion dysregulation in bipolar disorder compared to other mental illnesses: A systematic review and meta-analysis. Psychological Medicine, 53(16), 7484-7503. https://doi.org/10.1017/ S003329172300243X
Derks, S., van Wijngaarden, S., Wouda, M., Schuengel, C., & Sterkenburg, P. S. (2019). Effectiveness of the serious game «You & I» in changing mentalizing abilities of adults with mild to borderline intellectual disabilities: A parallel superiority randomized controlled trial. Trials, 20(1), Article 500. https://doi.org/10.1186/s13063-019-3608-9
Dickhoff, J., Opmeer, E. M., Heering, H. D., Bruggeman, R., van Amelsvoort, T., Bartels-Velthuis, A. A., Cahn, W., de Haan, L., Schirmbeck, F., Simons, C. J. P., van Os, J., Aleman, A., & van Tol, M.-J. (2021). Relationship between social cognition, general cognition, and risk for suicide in individuals with a psychotic disorder. Schizophrenia Research, 231, 227-236. https://doi.org/10.1016/j.schres.2021.02.024
Drabenstott, M. (2019). A matter of life and death: Integrating mattering into the interpersonal-psychological theory of suicide. Suicide & Life-Threatening Behavior, 49(4), 1006-1018. https://doi.org/10.1111/sltb.12504
Fonagy, P., Luyten, P., Moulton-Perkins, A., Lee, Y.-W., Warren, F., Howard, S., Ghinai, R., Fearon, P., & Lowyck, B. (2016). Development and validation of a self-report measure of mentalizing: The Reflective Functioning Questionnaire. PLOS ONE, 11(7), Article e0158678. https://doi.org/10.1371/journal.pone.0158678
Forkmann, T., Glaesmer, H., Paashaus, L., Rath, D., Schönfelder, A., Stengler, K., Juckel, G., Assion, H. J., & Teismann, T. (2020). Interpersonal theory of suicide: Prospective examination. BJPsych Open, 6(5), Article e113. https://doi.org/10.1192/bjo.2020.93
Fuggle, P., Fairbairn, J., & Fonagy, P. (2023). Outcomes for adaptive mentalization based integrative treatment informed care for adolescents using a deployment-based approach. Psychology and Psychotherapy. Advance online publication. https://doi.org/10.1111/papt.12496
Gervinskaitė-Paulaitienė, L., Ruggiero, M., Taubner, S., Volkert, J., & Barkauskienė, R. (2023). A follow-up study of the «Lighthouse» mentalization-based parenting program: Mentalization as a mediator of change. Clinical Child Psychology and Psychiatry. https://doi.org/10.1177/13591045231220965
Gillies, D., Christou, M. A., Dixon, A. C., Featherston, O. J., Rapti, I., García-Anguita, A., Villasis-Keever, M., Reebye, P., Christou, E., Al Kabir, N., & Christou, P. A. (2018). Prevalence and characteristics of self-harm in adolescents: Meta-analyses of community-based studies 1990–2015. Journal of the American Academy of Child & Adolescent Psychiatry, 57(10), 733-741. https://doi.org/10.1016/j. jaac.2018.06.018
González-Ortega, I., Díaz-Marsa, M., López-Peña, P., Fernández- Sevillano, J., Andreo-Jover, J., Bobes, J., Bravo-Ortiz, M. F., Cebria, A. I., Crespo-Facorro, B., De la Torre-Luque, A., Elices, M., Fernández- Rodrigues, V., Garrido-Torres, N., Grande, I., Palao-Tarrero, Á., Pemau, A., Roberto, N., Ruiz-Veguilla, M., Seijo-Zazo, E., … Zorrilla, I. (2023). Clinical predictors and psychosocial risk factors of suicide attempt severity. Spanish Journal of Psychiatry and Mental Health. https://doi.org/10.1016/j.sjpmh.2023.07.002
Greiner, C., Debbané, M., Besch, V., & Prada, P. (2022). TBM-Crise: Intervention hospitalière brève basée sur la mentalisation [Crisis-MBT: Mentalization-based brief hospitalization intervention]. Sante Mentale au Quebec, 47(2), 221-233.
Griffiths, H., Duffy, F., Duffy, L., Brown, S., Hockaday, H., Eliasson, E., Graham, J., Smith, J., Thomson, A., & Schwannauer, M. (2019). Efficacy of mentalization-based group therapy for adolescents: The results of a pilot randomised controlled trial. BMC Psychiatry, 19(1), Article 167. https://doi.org/10.1186/s12888-019-2158-8
Harris, L. M., & Ribeiro, J. D. (2021). Does fearlessness about death mediate the association between NSSI and suicide attempts? A longitudinal study of over 1,000 high-risk individuals. Journal of Consulting and Clinical Psychology, 89(3), 176-187. https://doi.org/10.1037/ccp0000626
Hatkevich, C., Venta, A., & Sharp, C. (2019). Theory of mind and suicide ideation and attempt in adolescent inpatients. Journal of Affective Disorders, 256, 17-25. https://doi.org/10.1016/j.jad.2019.05.051
Ilic, M., & Ilic, I. (2022). Worldwide suicide mortality trends (2000-2019): A joinpoint regression analysis. World Journal of Psychiatry, 12(8), 1044- 1060. https://doi.org/10.5498/wjp.v12.i8.1044
Instituto Nacional de Estadística [National Institute of Statistics] (June, 5, 2024). INEbase / Sociedad / Salud /Estadística de defunciones según la causa de muerte / Últimos datos [INEbase / Society / Health / Death statistics by cause of death / Latest data]. Retrieved June 5, 2024, from https://www.ine.es/jaxiT3/Datos.htm?t=7947
Joiner, T. (2005). Why people die by suicide. Harvard University Press. Kennedy-Turner, J., Sawrikar, V., Clark, L., & Griffiths, H. (2023).
Do attachment-related differences in reflective functioning explain associations between expressed emotion and youth self-harm? Current Psychology, 42(29), 25520–25534. https://doi.org/10.1007/s12144- 022-03614-w
Kim, B., Kim, Y., Park, C. H. K., Rhee, S. J., Kim, Y. S., Leventhal, B. L., Ahn, Y. M., & Paik, H. (2020). Identifying the medical lethality of suicide attempts using network analysis and deep learning: Nationwide study. JMIR Medical Informatics, 8(7), Article e14500. https://doi.org/10.2196/14500
Kim, E. S., & Willson, V. L. (2014). Testing measurement invariance across groups in longitudinal data: Multigroup second-order latent growth model. Structural Equation Modeling: A Multidisciplinary Journal, 21(4), 566- 576. https://doi.org/10.1080/10705511.2014.919821
Krantz, S. M., Heerschap, J., Balzen, K. M., Sachs, R., Kennard, B. D., Emslie, G. J., & Stewart, S. M. (2022). Fearlessness about death and suicide planning predict lethality of adolescent suicide attempts during and following treatment. Journal of Clinical Psychology, 78(7), 1540-1553. https://doi.org/10.1002/jclp.23324
Laghi, F., Terrinoni, A., Cerutti, R., Fantini, F., Galosi, S., Ferrara, M., & Bosco, F. M. (2016). Theory of mind in Non-Suicidal Self-Injury (NSSI) adolescents. Consciousness and Cognition, 43, 38-47. https://doi.org/10.1016/j.concog.2016.05.004
Levi-Belz, Y., Gvion, Y., & Apter, A. (2022). The serious suicide attempts approach for understanding suicide: Review of the psychological evidence. OMEGA - Journal of Death and Dying, 86(2), 591-608. https://doi.org/10.1177/0030222820981235
Li, C. Q., Zhang, J. S., Ma, S., Lv, R. R., Duan, J. L., Luo, D. M., Yan, X. J., Ma, N., & Song, Y. (2020). Gender differences in self-harm and drinking behaviors among high school students in Beijing, China. BMC Public Health, 20(1), Article 1892.
https://doi.org/10.1186/s12889- 020-09979-6
Liotta, M., Mento, C., & Settineri, S. (2015). Seriousness and lethality of attempted suicide: A systematic review. Aggression and Violent Behavior, 21, 97-109. https://doi.org/10.1016/j.avb.2014.12.013
Makara-Studzińska, M., Somasundaram, S. G., Halicka, J., Madej, A., Leszek, J., Rehan, M., Ashraf, G. M., Gavryushova, L. V., Nikolenko, V. N., Mikhaleva, L. M., Muresanu, C., Kirkland, C. E., Avila-Rodriguez, M., & Aliev, G. (2021). Suicide and suicide attempts in elderly patients: An epidemiological analysis of risk factors and prevention. Current Pharmaceutical Design, 27(19), 2231-2236. https://doi.org/10.2174/1381612826999201126202008
Marie, L., Poindexter, E. K., Fadoir, N. A., & Smith, P. N. (2020). Understanding the transition from suicidal desire to planning and preparation: Correlates of suicide risk within a psychiatric inpatient sample of ideators and attempters. Journal of Affective Disorders, 274, 159-166. https://doi.org/10.1016/j. jad.2020.05.037
Müller, S., Wendt, L. P., Spitzer, C., Masuhr, O., Back, S. N., & Zimmermann, J. (2022). A critical evaluation of the Reflective Functioning Questionnaire (RFQ). Journal of Personality Assessment, 104(5), 613-627. https://doi.org/10.1080/00223891.2021.1981346
Nestor, B. A., & Sutherland, S. (2022). Theory of mind and suicidality: A meta- analysis. Archives of Suicide Research: Official Journal of the International Academy for Suicide Research, 26(4), 1666-1687. https://doi.org/10.1080/1 3811118.2021.1939209
O’Connor, R. C., & Nock, M. K. (2014). The psychology of suicidal behaviour.
The Lancet Psychiatry, 1(1), 73-85. https://doi.org/10.1016/S2215-0366(14)70222-6
Øien-Ødegaard, C., Hauge, L. J., & Reneflot, A. (2021). Marital status, educational attainment, and suicide risk: A Norwegian register-based population study. Population Health Metrics, 19(1), Article 33. https://doi.org/10.1186/s12963-021-00263-2
Pérez Rodríguez, S., Marco Salvador, J. H., & García-Alandete, J. (2017). The role of hopelessness and meaning in life in a clinical sample with non-suicidal self-injury and suicide attempts. Psicothema, 29(3), 323-328. https://doi.org/10.7334/psicothema2016.284
Pérez, V., Elices, M., Toll, A., Bobes, J., López-Solà, C., Díaz-Marsá, M., Grande, I., López-Peña, P., Rodríguez-Vega, B., Ruiz-Veguilla, M., de la Torre-Luque, A., & SURVIVE Group. (2020). The Suicide Prevention and Intervention Study (SURVIVE): Study protocol for a multisite cohort study with nested randomized-controlled trials. Revista de Psiquiatría y Salud Mental, 16(1), 16–23. https://doi.org/10.1016/j.rpsm.2020.11.004
Poindexter, E. K., Mitchell, S. M., Brown, S. L., & Cukrowicz, K. C. (2022). Interpersonal trauma and suicide ideation: The indirect effects of depressive symptoms, thwarted belongingness, and perceived burden. Journal of Interpersonal Violence, 37(1-2), 551-570. https://doi.org/10.1177/0886260520917513
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., & Mann, J. J. (2011). The Columbia–Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266-1277. https://doi.org/10.1176/appi.ajp.2011.10111704
Rasmussen, S., Hawton, K., Philpott-Morgan, S., & O’Connor, R. C. (2016). Why do adolescents self-harm? Crisis, 37(3), 176-183. https://doi.org/10.1027/0227-5910/a000369
Ribeiro, J. D., Silva, C., & Joiner, T. E. (2014). Overarousal interacts with a sense of fearlessness about death to predict suicide risk in a sample of clinical outpatients. Psychiatry Research, 218(1-2), 106-112. https://doi.org/10.1016/j.psychres.2014.03.036
Ribeiro, J. D., Witte, T. K., Van Orden, K.A., Selby, E.A., Gordon, K. H., Bender, T. W., & Joiner, T. E. (2014). Fearlessness about Death: The psychometric properties and construct validity of the revision to the Acquired Capability for Suicide Scale. Psychological Assessment, 26(1), 115-126. https://doi.org/10.1037/a0034858
Rogers, M. L., Gai, A. R., & Joiner, T. E. (2022). Fluctuations in and associations between physical and psychological distance to suicide methods, fearlessness about death, and suicidal intent. Journal of Psychopathology and Clinical Science, 131(8), 868-880. https://doi.org/10.1037/abn0000783
Ruiz-Parra, E., Manzano-García, G., Mediavilla, R., Rodríguez-Vega, B., Lahera, G., Moreno-Pérez, A. I., Torres-Cantero, A. M., Rodado-Martínez, J., Bilbao, A., & González-Torres, M. Á. (2023). The Spanish version of the Reflective Functioning Questionnaire: Validity data in the general population and individuals with personality disorders. PLOS ONE, 18(4), Article e0274378. https://doi.org/10.1371/journal.pone.0274378
Sáiz, P. A., de la Fuente-Tomas, L., García-Álvarez, L., Bobes-Bascarán, M. T., Moya-Lacasa, C., García-Portilla, M. P., & Bobes, J. (2020). Prevalence of passive suicidal ideation in the early stage of the coronavirus disease 2019 (COVID-19) pandemic and lockdown in a large Spanish sample. The Journal of Clinical Psychiatry, 81(6), Article 13899. https://doi.org/10.4088/JCP.20l13421
Salagre, E., Grande, I., Jiménez, E., Mezquida, G., Cuesta, M. J., Llorente, C., Amoretti, S., Lobo, A., González‐Pinto, A., Carballo, J. J., Corripio, I., Verdolini, N., Castro‐Fornieles, J., Legido, T., Carvalho, A. F., Vieta, E., Bernardo, M., & PEPs Group. (2021). Trajectories of suicidal ideation after first‐episode psychosis: A growth mixture modeling approach. Acta Psychiatrica Scandinavica, 143(5), 418-433. https://doi.org/10.1111/acps.13279
Schmeckenbecher, J., Philipp, A. C., Emilian, C. A., Zimmermann, C., & Kapusta, N. D. (2023). The fearlessness about death scale’s efficacy for differentiating suicide attempts from non-suicidal self-injury, a meta-analysis. Death Studies, 48(8), 801-809. https://doi.org/10.1080/07481187.2023.2277818
Seo, C., Di Carlo, C., Dong, S. X., Fournier, K., & Haykal, K.-A. (2021). Risk factors for suicidal ideation and suicide attempt among medical students: A meta-analysis. PLOS ONE, 16(12), Article e0261785. https://doi.org/10.1371/journal.pone.0261785
Spitzer, C., Zimmermann, J., Brähler, E., Euler, S., Wendt, L., & Müller, S. (2021). Die deutsche Version des Reflective Functioning Questionnaire (RFQ): Eine teststatistische Überprüfung in der Allgemeinbevölkerung [The German Version of the Reflective Functioning Questionnaire (RFQ): A Psychometric Evaluation in the General Population]. Psychotherapie, Psychosomatik, Medizinische Psychologie, 71(3-4), 124-131. https://doi.org/10.1055/a-1234-6317
Stagaki, M., Nolte, T., Feigenbaum, J., King-Casas, B., Lohrenz, T., Fonagy, P., Personality and Mood Disorder Research Consortium, & Montague, P. R. (2022). The mediating role of attachment and mentalising in the relationship between childhood maltreatment, self- harm and suicidality. Child Abuse & Neglect, 128, Article 105576. https://doi.org/10.1016/j.chiabu.2022.105576
Streiner, D. L., Norman, G. R., & Cairney, J. (2015). Health measurement scales: A practical guide to their development and use. Oxford University Press.
Turecki, G., Brent, D. A., Gunnell, D., O’Connor, R. C., Oquendo, M. A., Pirkis, J., & Stanley, B. H. (2019). Suicide and suicide risk. Nature Reviews Disease Primers, 5(1), Article 1. https://doi.org/10.1038/ s41572-019-0121-0
Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T. E. (2008). Suicidal desire and the capability for suicide: Tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76(1), 72-83. https://doi.org/10.1037/0022-006X.76.1.72