The ethical imperative of self-directed tools in crisis helplines to prevent suicide at scale
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A network outcome analysis of psychological risk factors driving suicide risk in emergency department patients
Different theories of suicide propose somewhat different psychological factors that lead to suicidal thoughts and behaviors. For example, Beck’s theory highlights hopelessness, while the interpersonal–psychological theory of suicide emphasizes burdensomeness, lack of belonging and fearlessness about death. Surprisingly, few studies have tested which theoretically proposed psychological factors are most predictive of suicidal thoughts and behaviors. We used network outcome analysis to disentangle the effects of these constructs in predicting suicidal ideation, suicide plans and attempts. Participants were 1,412 patients presenting to an emergency department with psychiatric complaints, with follow-up assessments one month and six months (n = 938) later. Here we showed that different psychological factors predicted different parts of the continuum of suicidal thoughts and behaviors. Lack of belongingness was most predictive of suicidal ideation (partial correlation (pcor) = 0.14), acquired capability for death (that is, fearlessness of death) was most predictive of suicide planning (pcor = 0.08), and hopelessness was most predictive of suicide attempts (pcor = 0.12). Individuals’ explicit associations with death (that is, death = me) prospectively predicted all three outcomes (pcor = 0.13–0.23). The occurrence of suicidal thoughts and behaviors is best predicted using constructs from several different theories of suicide. Future theoretical and empirical work should integrate components of existing theories.
Childhood trauma cortisol and immune cell glucocorticoid transcript levels are associated with increased risk for suicidality in adolescence
Rising adolescent suicide rates present a growing unmet need. Childhood trauma (CT) has been associated with altered cortisol dynamics and immune cell glucocorticoid reactivity, yet their additive longer-term contributions to later suicide outcomes are less clear. The current study compared CT scores, resting salivary free cortisol and mononuclear cell gene expression levels of the nuclear receptor, subfamily 3, member 1 (NR3C1) coding the glucocorticoid receptor, and its co-chaperons FKBP prolyl isomerase 5 (FKBP5) and KIT Ligand (KITLG), between a cohort of adolescents presenting with a suicidal crisis requiring hospital treatment, and matched healthy controls. Childhood trauma scores and glucocorticoid measures were significantly altered among suicidal adolescents, and CT scores correlated with mononuclear cell glucocorticoid transcripts. Both CT scores and glucocorticoid measures explained substantial additive portions of the variance in adolescent suicidality. Long-term perturbations in cortisol dynamics and immune cell glucocorticoid response elements denote dysregulated immune stress reactivity, and may possess value in prediction and point to modifiable-risk factors in prevention of clinically significant suicidality during the brittle period of adolescence, years after childhood trauma exposure.
Urban inequality, the housing crisis and deteriorating water access in US cities
The housing unaffordability and cost-of-living crisis is affecting millions of people in US cities, yet the implications for urban dwellers’ well-being and social reproduction remain less clear. This Article presents a longitudinal analysis of household access to running water—a vital component of social infrastructure—in the 50 largest US cities since 1970. The results indicate that water access has worsened in an increasing number and typology of US cities since the 2008 global financial crash, disproportionately affecting households of color in 12 of the 15 largest cities. We provide evidence to suggest that a ‘reproductive squeeze’—systemic, compounding pressures on households’ capacity to reproduce themselves on a daily and societal basis—is forcing urban households into more precarious living arrangements, including housing without running water. We analyze the case study of Portland (Oregon) to illustrate the racialized nature of the reproductive squeeze under a housing crisis. Our insights reveal that plumbing poverty—a lack of household running water—is expanding in scope and severity to a broader array of US cities, raising doubts about equitable progress towards Sustainable Development Goals for clean water and sanitation for all (SDG 6) and sustainable cities (SDG 11) in an increasingly urbanized United States.
Systematic bone tool production at 1.5 million years ago
Recent evidence indicates that the emergence of stone tool technology occurred before the appearance of the genus Homo1 and may potentially be traced back deep into the primate evolutionary line2. Conversely, osseous technologies are apparently exclusive of later hominins from approximately 2 million years ago (Ma)3,4, whereas the earliest systematic production of bone tools is currently restricted to European Acheulean sites 400–250 thousand years ago5,6. Here we document an assemblage of bone tools shaped by knapping found within a single stratigraphic horizon at Olduvai Gorge dated to 1.5 Ma. Large mammal limb bone fragments, mostly from hippopotamus and elephant, were shaped to produce various tools, including massive elongated implements. Before our discovery, bone artefact production in pre-Middle Stone Age African contexts was widely considered as episodic, expedient and unrepresentative of early Homo toolkits. However, our results demonstrate that at the transition between the Oldowan and the early Acheulean, East African hominins developed an original cultural innovation that entailed a transfer and adaptation of knapping skills from stone to bone. By producing technologically and morphologically standardized bone tools, early Acheulean toolmakers unravelled technological repertoires that were previously thought to have appeared routinely more than 1 million years later.
COVID-19 death toll predictions show that triggering counterfactual thinking deteriorates judgmental performance
Effective communication during a health crisis is critical as it directly influences psychological and behavioral responses that will shape the further progression of the crisis. Past research has suggested that one type of cognitive mechanism that is likely to be affected by the framing of public health messages relates to counterfactual thinking.
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