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Item The associations of childhood adversities and mental disorders with suicidal thoughts and behaviors - Results from the World Mental Health International College Student Initiative(Elsevier B V, 2025-08-01) Mortier P; Yang X; Altwaijri YA; Holdcraft JA; Lee S; Sampson NA; Albor Y; Alhadi AN; Alonso J; Al-Saud NK; Andersson C; Atwoli L; Auerbach RP; Muaka CA; Báez-Mansur PM; Ballester L; Bantjes J; Baumeister H; Bendtsen M; Benjet C; Berman AH; Bruffaerts R; Carrasco P; Chan SCN; Cohut I; Covarrubias Díaz Couder MA; Crockett MA; Cuijpers P; David OA; Dong D; Ebert DD; Gaete J; Felez-Nobrega M; García Forero C; Gili M; Gutiérrez-García RA; Haro JM; Hasking P; Hunt X; Husky MM; Jaguga F; Jansen L; Langer ÁI; Liu Y; Mac-Ginty S; Martínez V; Mason A; Mathai M; McLafferty M; Miranda-Mendizabal A; Murray EK; Musyoka CM; O'Neill SM; Papasteri CC; Piqueras JA; Popescu CA; Rapsey C; Robinson K; Rodriguez-Jimenez T; Scarf D; Siu O-L; Stein DJ; Struijs SY; Tomoiaga CT; Valdés-García KP; Vereecke S; Vigo DV; Wang AY; Wong SYS; Kessler RC; World Mental Health International College Student collaboratorsObjective: To investigate the associations of demographic variables, childhood adversities (CAs), and mental disorders (MDx) with onset, transition, and persistence of suicidal thoughts and behaviors (STB) among first-year university students. Method: Poisson regression models within a discrete-time survival framework were constructed using web-based self-report survey data from 72,288 incoming university students across 18 countries (response rate=20.9%; median age=19 years, 57.9% female, 1.4% transgender, 21.0% non-heterosexual). These models examined the associations of four demographic variables, five CAs, and eight MDx with STB outcomes. Results: Lifetime prevalence of suicidal ideation, plans, and attempts was 47.0%, 26.0%, and 9.6%, respectively; 12-month estimates were 30.6%, 14.0%, and 2.3%. In unadjusted analyses, associations were strongest between lifetime onset of suicidal ideation and CAs (RR range 4.4–7.0), particularly parental psychopathology (relative risk [RR]=7.0 [95% CI 6.5–7.7]), followed by MDx (RR range 1.3–3.0). Of the demographic subgroups, transgender students had highest risk of STB (lifetime ideation onset RR=2.4 [2.3–2.6]; ideation-to-attempt transition RR=1.5 [1.3–1.8]). In fully adjusted models, strongest predictors of lifetime ideation onset were emotional abuse (RR=2.1 [1.9–2.2]), major depressive disorder (RR=2.0 [1.9–2.1]), and bipolar disorder (RR=1.8 [1.6–2.0]). Ideation-to-attempt transition remained most strongly associated with panic disorder (RR=1.5 [1.3–1.7]), bipolar disorder (RR=1.4 [1.2–1.7]), and sexual abuse (RR=1.4 [1.2–1.7]). Most predictors were significantly but weakly associated with persistence of ideation and plan, while only physical abuse remained associated with repeated suicide attempts (RR=1.3 [1.0–1.8]). Conclusion: CAs and MDx are strong predictors of both onset of and transition within the STB spectrum, underscoring the importance of implementing early-life prevention interventions.Item A temporal network analysis of risk factors for suicide : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Manawatū, New Zealand(Massey University, 2024-03-19) Holman, MikaylaSuicide is a major public health concern in New Zealand, with the number of lives lost due to suicide increasing almost every year. The factors influencing a person’s decision to take their own life are numerous and often complex. Some of these factors are dynamic, fluctuating over short periods of time and ultimately altering a person’s risk for suicide. Network analysis is a novel statistical technique that can be used to explore complex causal associations in systems of variables, such as risk factors for suicide. The present study used temporal network analysis to explore the associations between dynamic risk factors for suicide over time. Data collection involved ecological momentary assessment, where a general community sample of 39 adult participants completed a brief survey five times per day for ten days, resulting in 1420 completed surveys. Each survey assessed participants’ momentary experience of suicidal ideation, depressed mood, hopelessness, social support, self-esteem, thwarted belongingness, perceived burdensomeness, anhedonia, worthlessness, alcohol intoxication, and fatigue. All variables fluctuated from measurement to measurement at least some of the time, highlighting the dynamic nature of suicide risk. Temporal, contemporaneous, and between-persons networks of the 11 measured variables were estimated using temporal network analysis. In the temporal network, hopelessness was the only variable that predicted an increase in suicidal ideation at the subsequent measurement. Multiple nodes were estimated to be positively associated with suicidal ideation in the contemporaneous network, including depressed mood, thwarted belongingness, perceived burdensomeness, and worthlessness, while self-esteem was negatively associated with suicidal ideation in this network. In the between-persons network, hopelessness was the only variable with a significant association with suicidal ideation. The results of this study highlight the importance of continuously assessing changes in suicide risk factors given their dynamic nature. Hopelessness may be an especially important risk factor to assess given its temporal association with increased suicidal ideation. Regarding future research opportunities, experimental N=1 network studies about the effectiveness of personalised interventions based on node centrality are an important next step in determining whether individualised networks have a place in personalised treatment for suicidality.Item Service user experiences and provider attitudes towards a caring contacts suicide prevention intervention : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand(Massey University, 2022) High, OliviaSuicide prevention is a global public health priority. Caring contacts (CC) is a suicide prevention intervention that has shown promise and increasing research interest. However, there has been a lack of clarity as to ideal intervention protocols, with service users having limited opportunities to meaningfully contribute to the design and development of the intervention. This study aimed to identify factors that could lead to improved implementation of CC delivered via text messaging in a New Zealand crisis mental health context. The primary study recruited 20 people who presented to the Wellington Emergency Department (ED) due to suicidal ideation or behaviour and agreed to receive 12 supportive one-way text messages over a period of 6 months. Of those recruited, 11 people completed follow-up interviews. Thematic analysis abstracted four themes related to participants’ experiences of receiving the messages: Caring Connection, Safety and Security, Reflections on Recovery, and Limitations. The secondary study explored service provider attitudes towards features of the intervention, suicide prevention and workplace culture towards research utilisation and implementation. Interviews with seven crisis mental health team members were conducted. Content analysis of interviews identified staff concerns about how service users may experience CC via text messaging, concerns about responsibility and possible flow-on effects. These concerns were underpinned by significant time constraints and resourcing pressures that also formed barriers to research engagement and service improvement efforts. This study has implications for understanding the mechanisms driving CC interventions and specific implementation considerations at the level of the innovation, provider, and organisation.