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The relationship of self-reported executive functioning to suicidal ideation and suicide attempts Saffer, Boaz Y. 2015

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 THE RELATIONSHIP OF SELF-REPORTED EXECUTIVE FUNCTIONING TO SUICIDAL IDEATION AND SUICIDE ATTEMPTS by  Boaz Y. Saffer B.A., The University of British Columbia, 2010  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF  MASTER OF ARTS in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (Psychology)  THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver)  August 2015  © Boaz Y. Saffer, 2015   ii Abstract Introduction: Suicide has a devastating impact on individuals and communities worldwide yet few risk few factors reliably predict future suicide attempts. A growing body of research suggesting that that risk factors commonly associated with suicide (such as depression) are more predictive of suicidal thoughts, not suicidal acts – an important distinction since most people who think about suicide do not act on their thoughts. Executive functioning abilities mediate the relationship between thoughts and behaviours and therefore might be uniquely implicated in the progression from suicidal thoughts to suicidal acts. Our study examined whether two multidimensional measures of executive functioning differentiated those with a history of suicidal ideation from those with a history of suicide attempts using an online platform. Participants and Methods: Five-hundred and seventy seven participants (Mean age=34.6, SD=11.6) participated in study. Participants were divided into five groups based on lifetime, greater than past-12 month, and past-12 month histories of suicide ideation and suicide attempts: nonsuicidal (n=180), non-recent ideation (n=136), recent ideation (n=61), non-recent attempts (n=103), recent attempts (n=21). Executive functioning (EF) was measured using the Behavioural Rating Inventory of Executive Functions – Adult Version (BRIEF-A) and the Frontal Systems Behaviour Scale (FrSBe). Several covariates including impulsivity and other known suicide risk factors and potential confounds were also assessed. Results: Moderate to large differences (d range=.53-1.08) in executive functioning were obtained comparing recent attempters to recent ideators. Attempters and ideators differed most on the FrSBe disinhibition scale (d=1.08), BRIEF Behaviour Regulation Index (d=1.02), and BRIEF-A Global Executive Composite (d=1.01), with attempters reporting worse executive functioning. Interestingly, comparing lifetime attempters to ideators as well as non-recent iii attempters to ideators revealed only weak to small differences (d range=.11-.38 and .03 – .3, respectively). This pattern remained robust when controlling for covariates. Discussion: Lifetime attempters and ideators did not meaningfully differ on self-reported executive functioning. Executive functioning did, however, clearly differentiate recent attempters from recent ideators suggesting that impaired executive functioning might represent an important state risk factor for suicide attempts. However, findings may also represent a reporting bias, and it will be important for future studies to utilize prospective designs.    iv Preface This dissertation is an original intellectual product of the author, B. Y. Saffer.  Approval for this study was obtained from the UBC Behavioral Research Ethics Board. The Approval Certificate Number is H14-02018.                   v Table of Contents Abstract ........................................................................................................................................... ii Preface............................................................................................................................................ iv Table of Contents ............................................................................................................................ v List of Tables ............................................................................................................................... viii List of Figures ................................................................................................................................ xi List of Abbreviations .................................................................................................................... xii Acknowledgements ...................................................................................................................... xiii Chapter 1: Introduction ................................................................................................................... 1 Chapter 2: Literature Review - Measures of Executive Functioning and Risk of Suicide ............. 4 Iowa Gambling Task ........................................................................................................... 5 Stroop Test .......................................................................................................................... 7 Trail Making Test – Part B ................................................................................................. 9 Verbal Fluency .................................................................................................................. 11 Wisconsin Card Sorting Test ............................................................................................ 14 Chapter 3: Literature Review - Executive Functioning in Suicide Ideators and Suicide Attempters....................................................................................................................................................... 16 Chapter 4: Limitations in Understanding and Measuring Executive Functioning ....................... 21 Chapter 5: Summary of Literature Reviews ................................................................................. 25 Chapter 6: Summary of Research Project ..................................................................................... 27 Chapter 7: Methods ....................................................................................................................... 28 Procedure........................................................................................................................... 28 Participants ........................................................................................................................ 30 Demographic Measures ..................................................................................................... 32 Measures of Executive Functioning .................................................................................. 32 Behaviour Rating Inventory of Executive Function – Adult Version. ...................... 32 Frontal Systems Behaviour Scale. ............................................................................. 34 Covariate Measures ........................................................................................................... 35 Alabama Brief Screening for Probable Head Injury .................................................. 35 Drug Abuse Screening Test. ...................................................................................... 36 vi Generalized Self-Efficacy Scale. ............................................................................... 37 Measure of Impulsivity ..................................................................................................... 37 UPPS-P Impulsive Behaviour Scale. ......................................................................... 37 Measures of Other Clinical Variables ............................................................................... 39 Depression Anxiety Stress Scale. ............................................................................... 39 Difficulties in Emotion Regulation. ........................................................................... 40 Patient-Reported Outcome Measurement Information System. ................................ 40 Measures of Nonsuicidal Self-Injury, Suicidal Ideation, and Suicide Attempts............... 41 Beck Scale for Suicidal Ideation. ............................................................................... 41 Nonsuicidal Self-Injury. ............................................................................................. 42 Youth Risk Behaviour Survey (YRBS) Suicide Screening Questionnaire. ............... 43 Chapter 8: Results ......................................................................................................................... 44 Demographics ................................................................................................................... 44 Lifetime ...................................................................................................................... 44 Non-Recent ................................................................................................................ 45 Recent......................................................................................................................... 47 Descriptive and Inferential Statistics ................................................................................ 47 Covariates .......................................................................................................................... 48 Lifetime ...................................................................................................................... 48 Non-Recent ................................................................................................................ 48 Recent......................................................................................................................... 49 Non-Recent and Recent ............................................................................................. 49 Executive Functioning ...................................................................................................... 50 Lifetime ...................................................................................................................... 50 Nonsuicidal and Attempter Groups .......................................................... 50 Nonsuicidal and Ideator Groups ............................................................... 50 Ideator and Attempter Groups .................................................................. 51 Non-Recent ................................................................................................................ 51 Nonsuicidal and Attempter Groups .......................................................... 52 Nonsuicidal and Ideator Groups ............................................................... 52 Ideator and Attempter Groups .................................................................. 53 Recent......................................................................................................................... 53 Nonsuicidal and Attempter Groups .......................................................... 54 Nonsuicidal and Ideator Groups ............................................................... 54 Ideator and Attempter Groups .................................................................. 55 Non-Recent and Recent ............................................................................................. 55 Impulsivity ........................................................................................................................ 56 Lifetime ...................................................................................................................... 56 Nonsuicidal and Attempter Groups .......................................................... 56 Nonsuicidal and Ideator Groups ............................................................... 56 Ideator and Attempter Groups .................................................................. 57 vii Non-Recent ................................................................................................................ 58 Nonsuicidal and Attempter Groups .......................................................... 58 Nonsuicidal and Ideator Groups ............................................................... 58 Ideator and Attempter Groups .................................................................. 59 Recent......................................................................................................................... 59 Nonsuicidal and Attempter Groups .......................................................... 60 Nonsuicidal and Ideator Groups ............................................................... 60 Ideator and Attempter Groups .................................................................. 61 Recent and Non-Recent ............................................................................................. 61 Other Clinical Variables .................................................................................................... 62 Lifetime ...................................................................................................................... 62 Nonsuicidal and Attempter Groups .......................................................... 62 Nonsuicidal and Ideator Groups ............................................................... 63 Ideator and Attempter Groups .................................................................. 63 Non-Recent ................................................................................................................ 63 Nonsuicidal and Attempter Groups .......................................................... 64 Nonsuicidal and Ideator Groups ............................................................... 64 Ideator and Attempter Groups .................................................................. 65 Recent......................................................................................................................... 65 Nonsuicidal and Attempter Groups .......................................................... 66 Nonsuicidal and Ideator Groups ............................................................... 66 Ideator and Attempter Groups .................................................................. 67 Recent and Non-Recent ............................................................................................. 67 Suicidal ideation and Nonsuicidal Self-Injury .................................................................. 67 Lifetime ...................................................................................................................... 67 Nonsuicidal and Attempter Groups .......................................................... 68 Nonsuicidal and Ideator Groups ............................................................... 68 Ideator and Attempter Groups .................................................................. 69 Non-Recent ................................................................................................................ 69 Nonsuicidal and Attempter Groups .......................................................... 70 Nonsuicidal and Ideator Groups ............................................................... 70 Ideator and Attempter Groups .................................................................. 70 Recent......................................................................................................................... 71 Nonsuicidal and Attempter Groups .......................................................... 71 Nonsuicidal and Ideator Groups ............................................................... 72 Ideator and Attempter Groups .................................................................. 72 Recent and Non-Recent ............................................................................................. 72 Chapter 9: Discussion ................................................................................................................... 73 References ................................................................................................................................... 149 Appendix A. PEBL Demographics Questionnaire ..................................................................... 184 viii List of Tables Table 1. Studies Assessing the Performance of Individuals with a History of Suicide Attempt on the Iowa Gambling Task ............................................................................................................... 81 Table 2. Studies Assessing the Performance of Individuals with a History of Suicide Attempt on the Stroop Test .............................................................................................................................. 84 Table 3. Studies Assessing the Performance of Individuals with a History of Suicide Attempt on the Trail Making Test – Part B ..................................................................................................... 88 Table 4. Studies Assessing the Performance of Individuals with a History of Suicide Attempt on Measures of Verbal Fluency ......................................................................................................... 90 Table 5. Studies Assessing the Performance of Individuals with a History of Suicide Attempt on the Wisconsin Card Sorting Test .................................................................................................. 93 Table 6. Demographic Information for All Participants ............................................................... 96 Table 7. Demographic Information for Lifetime Nonsuicidal, Ideator, and Attempter Groups ... 98 Table 8. Demographic Information for Non-Recent (>12 month) Nonsuicidal, Ideator, and Attempter Groups........................................................................................................................ 101 Table 9. Demographic Information for Recent (<12 Month) Nonsuicidal, Ideator, and Attempter Groups ......................................................................................................................................... 104 Table 10. Descriptive Statistics for All Participants on Study Measures ................................... 107 Table 11. Descriptive and Inferential Statistics for Lifetime Nonsuicidal, Ideator, and Attempter Groups on Study Measures ......................................................................................................... 109 Table 12. Descriptive and Inferential Statistics for Non-Recent (>12 months) Nonsuicidal, Ideator, and Attempter Groups on Study Measures .................................................................... 112 Table 13. Descriptive and Inferential Statistics for Recent (<12 months) Nonsuicidal, Ideator, and Attempter Groups on Study Measures ................................................................................. 115 Table 14. Differences in Drug Abuse, Global Self-Efficacy, and Suspected Brain Injury between Lifetime Nonsuicidal, Ideator, and Attempter Groups ............................................................... 118 Table 15. Differences in Drug Abuse, Global Self-Efficacy, and Suspected Brain Injury between Non-Recent (> Past-12 Months) Nonsuicidal, Ideator, and Attempter Groups .......................... 118 Table 16. Differences in Drug Abuse, Global Self-Efficacy, and Suspected Brain Injury between Recent (< Past-12 Months) Nonsuicidal, Ideator, and Attempter Groups .................................. 119 Table 17. Differences in Drug Abuse, Global Self-Efficacy, and Suspected Brain Injury between Non-Recent (> Past-12 Months) and Recent (< Past-12 Months) Ideator and Attempter Groups..................................................................................................................................................... 119 Table 18. Differences in Executive Functioning between Lifetime Nonsuicidal, Ideators, and Attempter Groups........................................................................................................................ 120 Table 19. Predicting Lifetime Group Status Over and Above Covariates from Executive Functioning Scales ...................................................................................................................... 121 Table 20. Differences in Executive Functioning between Non-Recent (> Past-12 Months) Nonsuicidal, Ideator, and Attempter Groups .............................................................................. 122 Table 21. Predicting Non-Recent (> Past-12 Months) Group Status Over and Above Covariates from Executive Functioning Scales ............................................................................................ 123 Table 22. Differences in Executive Functioning between Recent (< Past-12 Months) Nonsuicidal, Ideator, and Attempter Groups .............................................................................. 124 ix Table 23. Predicting Recent (< Past-12 Months) Group Status Over and Above Covariates from Executive Functioning Scales ..................................................................................................... 125 Table 24. Differences in Executive Functioning between Non-Recent (> Past-12 Months) and Recent (< Past-12 Months) Ideator and Attempter Groups. ....................................................... 126 Table 25. Differences in Impulsivity between Lifetime Nonsuicidal, Ideators, and Attempter Groups ......................................................................................................................................... 127 Table 26. Predicting Lifetime Group Status Over and Above Covariates from Impulsivity Scales..................................................................................................................................................... 128 Table 27. Differences in Impulsivity between Non-Recent (>Past-12 Month) Nonsuicidal, Ideators, and Attempter Groups .................................................................................................. 129 Table 28. Predicting Non-Recent (> Past-12 Month) Group Status Over and Above Covariates from Impulsivity Scales .............................................................................................................. 130 Table 29. Differences in Impulsivity between Recent (< Past-12 Month) Nonsuicidal, Ideators, and Attempter Groups ................................................................................................................. 131 Table 30. Predicting Recent (< Past-12 Month) Group Status Over and Above Covariates from Impulsivity Scales ....................................................................................................................... 132 Table 31. Differences in Impulsivity between Non-Recent (> Past-12 Months) and Recent (< Past-12 Months) Ideator and Attempter Groups. ........................................................................ 133 Table 32. Differences in Clinical Variables between Lifetime Nonsuicidal, Ideator, and Attempter Groups........................................................................................................................ 134 Table 33. Predicting Lifetime Group Status Over and Above Covariates from Clinical Scales 135 Table 34. Differences in Clinical Variables between Non-Recent (> Past-12 Month) Nonsuicidal, Ideator, and Attempter Groups. .................................................................................................. 136 Table 35. Predicting Non-Recent (> Past-12 Month) Group Status Over and Above Covariates from Clinical Scales .................................................................................................................... 137 Table 36. Differences in Clinical Variables between Recent (< Past-12 Month) Nonsuicidal, Ideator, and Attempter Groups. .................................................................................................. 138 Table 37. Predicting Recent (< Past-12 Month) Group Status Over and Above Covariates from Clinical Scales ............................................................................................................................. 139 Table 38. Differences in Clinical Variables between Non-Recent (> Past-12 Months) and Recent (< Past-12 Months) Ideator and Attempter Groups. ................................................................... 140 Table 39. Differences in Suicidal ideation and Nonsuicidal Self-Injury between Lifetime Nonsuicidal, Ideators, and Attempter Groups............................................................................. 141 Table 40. Predicting Lifetime Group Status Over and Above Covariates from Suicidal ideation and Nonsuicidal Self-Injury ........................................................................................................ 142 Table 41. Differences in Suicidal Ideation and Nonsuicidal Self-Injury between Non-Recent (> Past-12 Month) Nonsuicidal, Ideators, and Attempter Groups................................................... 143 Table 42. Predicting Non-Recent (> Past-12 Month) Group Status Over and Above Covariates from Suicidal Ideation and Nonsuicidal Self-Injury ................................................................... 144 Table 43. Differences in Suicidal Ideation and Nonsuicidal Self-Injury between Recent (< Past-12 Month) Nonsuicidal, Ideators, and Attempter Groups........................................................... 145 Table 44. Predicting Recent (< Past-12 Month) Group Status Over and Above Covariates from Suicidal Ideation and Nonsuicidal Self-Injury ............................................................................ 146 x Table 45. Differences in Suicidal Ideation and Nonsuicidal Self-Injury between Non-Recent (> Past-12 Months) and Recent (< Past-12 Months) Ideator and Attempter Groups. ..................... 147  xi List of Figures  Figure 1. MTurk Participant Selection ........................................................................................ 148    xii List of Abbreviations  ABSPBI  – Alabama Brief Screening for Possible Brain Injury BRIEF-A  – Behaviour Rating Inventory of Executive Functions – Adult version BSI   – Beck Scale of Suicidal Ideation DASS   – Depression and Anxiety Stress Scale DAST   – Drug Abuse Screening Test DERS  - Difficulties in Emotion Regulation Scale FrSBe   – Frontal Systems Behaviour Scale GSES   – Global Self-Efficacy Scale IGT   – Iowa Gambling Task NSSI   – Non-Suicidal Self Injury PROMIS  – Patient-Reported Outcomes Measurement Information System TMT   – Trail Making Test TMTa   – Trail Making Test Part A TMTb   – Trail Making Test Part B UPPS-P  – UPPS-P Impulsivity Scale WCST  – Wisconsin Card Sorting Test YRBS   – Youth Risk Behaviour Survey          xiii Acknowledgements My deepest gratitude is to my supervisor, Dr. E. David Klonsky, for his inspiration, enthusiasm, and ability to explain things clearly and simply. Without his incredible patience, support, and supervision this thesis would not have been possible.  I am sincerely grateful to the members of my thesis committee, Dr. Luke Clark and Dr. Catherine Winstanley, for their insightful suggestions and prudent advice which have enhanced this research project and my research abilities in general.  I am indebted to the senior members of the Personality, Emotion, and Behaviour Lab – Ms. Alexis M. May, Ms. Sarah E. Victor, and Ms. Anita Hibbert – for their generous mentorship, guidance, thoughtful observations, and stimulating research conversations.  I would also like to thank the members of my clinical cohort in Kenny 1910 – Ms. Bri Glazier, Ms. Cara Dunkley, Ms. Jennifer Na, Ms. Jennifer Yip, and Ms. Joanne Park – for their unwavering friendship, comradery, and emotional support throughout the Master’s program.   I am deeply appreciative of the love, support, and encouragement provided by my family throughout my graduate education. To my parents-in-law, Mr. Vladimir Pogrebetsky and Mrs. Nataly Pogrebetsky, for continually questioning long-held conventions and providing alternative perspectives. To my mother, Ms. Myriam Morgenstern, who raised me to ask questions, nurtured curiosity, and inspired me to pursue higher education. To my father, Mr. Stuart P. Saffer, who fostered my independence, imparted sound advice, and provided unwavering support and calm reassurance when I needed it most.  Lastly, and most importantly, I am eternally grateful to my wife and best friend, Mrs. Yana Saffer, for her endless love, patience, and understanding which serve as the foundation xiv upon which this thesis and the past seven years of my life have been built. To her I dedicate this thesis.   1 Chapter 1: Introduction Suicide is a leading cause of global mortality and a significant public health problem. Reports by the World Health Organization (WHO) estimate that over 800,00 people die by suicide each year, more than in all armed conflicts worldwide (World Health Organization, 1999, 2014). Suicide and suicidal behaviour are devastating to families and communities and represent a substantial economic burden to societies. Specifically, across the United States and Canada alone, suicidal behaviour accounts for over $35 billion in lost productivity and medical costs each year (Centers for Disease Control and Prevention, 2012; SmartRisk, 2009). Furthermore, despite growing prevention efforts, suicide rates are projected to increase worldwide and significantly contribute to the global burden of disease (Mathers & Loncar, 2006). Improving understanding of suicide and suicide risk is therefore crucial in predicting and preventing suicide attempts.  Presence of a psychiatric disorder has strongly been associated with suicidality. Large scale epidemiological studies have repeatedly demonstrated that mood, anxiety, and substance disorders represent significant risk factors for suicidal thoughts and suicidal plans (Kessler, Berglund, Borges, Nock, & Wang, 2005). Researchers conducting psychological autopsies estimate that over 90% of those who die by suicide meet criteria for one or more psychiatric disorders at the time of their attempt (Arsenault-Lapierre, Kim, & Turecki, 2004; Bertolote & Fleischmann, 2002). However, even within psychiatric populations, only a minority of individuals who think about suicide will act on their thoughts (Angst, Angst, Gerber-Werder, & Gamma, 2005; Brown, Beck, Steer, & Grisham, 2000). Such findings suggest that the transition from suicidal thoughts to suicidal acts may involve different mechanisms than the development of suicidal ideation (Klonsky & May, 2014). Identifying risk factors that distinguish the subset of 2 ideators who progress to a suicide attempt could significantly improve prevention efforts. At present little is known about the differences between suicide ideators and suicide attempters (Klonsky & May, 2014). Neurocognitive abilities have been shown to strongly mediate the relationship between thoughts and behaviours, and therefore might be implicated in the transition from suicidal thoughts to suicidal acts. Early studies observed that suicidal individuals experience distorted cognitions (Shneidman, 1961), rigid and dichotomous thinking patterns (Neuringer, 1961, 1964), and impaired problem solving abilities (Levenson & Neuringer, 1971). Recent neuroimaging research has identified several cortical regions associated with distorted thinking patterns in those with history of suicide attempt (Jollant, Lawrence, Olié, Guillaume, & Courtet, 2011). Executive functioning is a neurocognitive domain closely associated with both ‘higher-order cognitions’ (Miller & Wallis, 2009; Zelazo, Carter, Reznick, & Frye, 1997) as well as neural activity within prefrontal cortical regions (Baddeley, 1992; Miller & Wallis, 2009) and therefore might be uniquely associated with suicidal behaviour. Increasing number of studies have examined executive functioning in suicidal populations, however, inconsistent definitions, methodologies, and findings limit the contribution of these studies to the existing literature.  In order to better understand the association between executive functioning and suicide, this thesis will (1) review studies using measures of executive functioning with general suicidal populations, (2) review studies that compared ideators to attempters on measures of executive functioning, and (3) outline the conceptual and operational limitations associated with the construct of executive functioning. Next, this thesis will use a large cross-sectional dataset to determine whether executive functioning distinguishes individuals with a history of suicidal ideation from individuals with a history of suicide attempts. Specifically, I intend to introduce 3 the research plan, recruitment procedure, and analyses, report the results of the statistical analyses, and discuss the research and clinical implications of the findings.    4 Chapter 2: Literature Review - Measures of Executive Functioning and Risk of Suicide The past decade has witnessed an increase in studies examining neurocognitive abilities in suicidal populations. Although several studies have examined whether neurocognitive abilities such as attention (Becker, Strohbach, & Rinck, 1999) and memory (Arie, Apter, Orbach, Yefet, & Zalsman, 2008; Williams & Broadbent, 1986) are impaired in those with history of suicide attempts, the majority of studies have focused almost exclusively on executive functioning abilities (Jollant et al., 2011). In these studies, executive functioning was measured using a variety of neurocognitive tests (Richard-Devantoy et al., 2012). Many of these tests require participants to complete one or more behavioural tasks. Participants’ performance on these tests is evaluated in several ways including calculating the number of correct answers or measuring the amount of time required to complete a particular task. Despite such similarities, however, tests of executive functioning differ from one another in their psychometric properties and the specific executive functioning ability they claim to be measuring. Such differences significantly limit cross-measure comparisons and therefore hinder the contribution of these studies to the existing literature. Findings from studies measuring executive functioning in suicidal populations will therefore be reviewed according to the specific neurocognitive test used. Specifically, this section will focus on five consistently-used measures of executive functioning – (1) Iowa Gambling Task, (2) Stroop test, (3) Trail Making Test - Part B, (4) Phonemic and Semantic measures of Verbal Fluency, and (5) the Wisconsin Card Sorting Test – and assess the extent to which these tests distinguish individuals with a history of suicidal ideation from individuals with a history of suicide attempts.  5 Iowa Gambling Task The Iowa Gambling Task (IGT) is a neuropsychological task designed to assess real-world high-risk decision making (Bechara, Damasio, Damasio, & Anderson, 1994). Typically, participants are loaned $2,000 of play money and are presented with four decks of cards. The participant has to select a card from one of the four decks. For each selection, a certain amount of money is awarded to the participant. However, when selecting cards from certain decks, a penalty will have to be paid after the initial sum of money has been awarded. Participants are told that the goal of the task is to maximize their profit on the $2,000 loan. Unbeknown to the participants, two of the four decks are considered ‘high risk’ because they involve larger payouts and incur substantial penalties. Continually selecting from these decks will result in the participant losing money in the long run. In contrast, the two remaining decks are considered ‘low risk’ because they involve smaller rewards but also incur smaller penalties. Selecting from these ‘low risk’ decks will result in financial gain over time. In order to succeed at the task, participants must forego decisions leading to short-term gain in favor of long-term profit. Although most healthy adults are able to correctly identify decks that lead to financial gain, patients with damage to the ventromedial prefrontal cortex (VMPFC) tend to select more cards from the ‘high risk’ decks, demonstrating poor decision making skills (Bechara, Tranel, Damasio, & Damasio, 1996).  A total of fourteen studies administered the IGT to individuals with a history of suicide attempts (Bridge et al., 2012; Gilbert et al., 2011; Gorlyn, Keilp, Oquendo, Burke, & Mann, 2013; Homaifar, Brenner, Forster, & Nagamoto, 2012; Jollant et al., 2005, 2007, 2010; Jollant, Guillaume, Jaussent, Bechara, & Courtet, 2013; Legris, Links, van Reekum, Tannock, & Toplak, 2012; Loyo, Martínez-Velázquez, & Ramos-Loyo, 2013; Malloy-Diniz, Neves, Abrantes, 6 Fuentes, & Corrêa, 2009; Martino, Strejilevich, Torralva, & Manes, 2011; Oldershaw et al., 2009; Westheide et al., 2008). These studies are outlined in Table 1.  Impaired performance on the IGT was associated with history of suicide attempt in eight studies (Bridge et al., 2012; Jollant et al., 2005, 2007, 2010, 2013; Loyo et al., 2013; Malloy-Diniz et al., 2009; Martino et al., 2011). Performance on the IGT differentiated between suicide attempters and patients controls in all of these studies (Bridge et al., 2012; Jollant et al., 2005, 2007, 2010, 2013; Loyo et al., 2013; Malloy-Diniz et al., 2009; Martino et al., 2011) with five studies reporting that performance on the IGT differentiated between suicide attempters and healthy controls (Jollant et al., 2005, 2010, 2013; Loyo et al., 2013; Malloy-Diniz et al., 2009). Reduced IGT performance was associated with a history of violent suicide attempts (Jollant et al., 2005) and suicidal ideation among those with a history of suicide attempt (Westheide et al., 2008). Five studies failed to find a relationship between suicide attempts and the IGT (Gilbert et al., 2011; Gorlyn et al., 2013; Homaifar et al., 2012; Legris et al., 2012; Oldershaw et al., 2009). Two of these studies included samples with affective disorders (Gilbert et al., 2011; Gorlyn et al., 2013), one study focused exclusively on populations with Traumatic Brain Injuries (TBIs; Homaifar et al., 2012), another study on individuals diagnosed with borderline personality disorder (BPD; Legris et al., 2012), and one study compared IGT performance across current and past groups of participants with a history of nonsuicidal self-injury and/or suicide attempt (Oldershaw et al., 2009).   A recent meta-analysis reviewing some of the aforementioned studies (Richard-Devantoy, Berlim, & Jollant, 2013) reported a moderate effect size, g = –.47, .95CI [–.65 to –7 .29], comparing IGT scores between suicide attempters and patients with mood disorders, and a large effect size, g = –.65, 95CI [–1.03 to –.27], comparing suicide attempters to healthy controls. A small effect size, g = –.24, .95CI [–.53 to .05], was found comparing affective patients to healthy controls. These findings are in-line with this review, suggesting that IGT performance is impaired in those with a history of suicide attempt to a greater degree than can be accounted for by neurocognitive impairment associated with mood-related psychopathology. Stroop Test The Stroop test is one of the earliest neuropsychological tests developed (Stroop, 1935) and is thought to measure an individual’s cognitive flexibility (Golden & Freshwater, 2002). To complete the test, participants are first instructed to identify a series of ink colours as fast as they can. Next, participants are presented with colour words (e.g. “Blue”, “Red”) printed in black ink and are told to read these words as quickly as possible. The last condition involves presenting participants with colour words that have been written in ink colours that do not match the printed colour word (e.g. the word “Blue” written in yellow ink). The participant is instructed to name the colour of the ink the words are printed in, and not read the word. The Stroop effect describes the finding that most people take significantly longer to name the ink-colour in the last condition than complete either previous conditions (identifying ink colours and reading colour words printed in black ink). Impaired performance on the Stroop has been repeatedly demonstrated to be impaired in those psychiatric disorders including depression (Epp, Dobson, Dozois, & Frewen, 2012), bipolar disorder (Bora, Yucel, & Pantelis, 2009), schizophrenia (Sitskoorn, Aleman, Ebisch, Appels, & Kahn, 2004), as well as attention-deficit/hyperactivity disorder (Lansbergen, Kenemans, & van Engeland, 2007). Neuroimaging studies have associated performance on the Stroop task with prefrontal cortical regions (Demakis, 2004; Nee, Wager, & 8 Jonides, 2007) including the dorsolateral prefrontal cortex (Milham, Banich, Claus, & Cohen, 2003). Fifteen studies examined Stroop performance in individuals with a history of suicide attempts (Barrett et al., 2011; Becker et al., 1999; Burton, Vella, Weller, & Twamley, 2011; Cha, Najmi, Park, Finn, & Nock, 2010; Gilbert et al., 2011; Harkavy-Friedman et al., 2006; Keilp et al., 2001, 2013; Keilp, Gorlyn, Oquendo, Burke, & Mann, 2008; Legris et al., 2012; Loyo et al., 2013; Malloy-Diniz et al., 2009; Raust et al., 2007; Richard-Devantoy et al., 2012; Richard-Devantoy, Szanto, Butters, Kalkus, & Dombrovski, 2014). These studies are outlined in Table 2.  Of the thirteen studies using the traditional Stroop test, five reported that the Stroop test significantly differentiated between suicide attempters and patient controls (Burton et al., 2011; Keilp et al., 2008, 2013; Legris et al., 2012; Richard-Devantoy et al., 2014). Seven studies reported that the Stroop test differentiated between suicide attempters and healthy controls (Keilp et al., 2001, 2008; Loyo et al., 2013; Malloy-Diniz et al., 2009; Raust et al., 2007; Richard-Devantoy et al., 2012, 2014). Two studies failed to find any difference between suicide attempters and either patient or healthy controls (Barrett et al., 2011; Gilbert et al., 2011). These findings suggest that the traditional Stroop test might be more sensitive to neurocognitive impairment associated with mood-related psychopathology than history of suicide attempt.  Three studies used a modified version of the Stroop test  (Becker et al., 1999; Cha et al., 2010; Loyo et al., 2013). Similarly to the traditional Stroop, participants completing the modified Stroop are required to name the colour of the ink certain words are printed in. However, in the modified version of the Stroop used by these studies, neutral words and suicide-related emotion words are used. A Stroop effect is said to occur when participants take longer to name the colour 9 of the ink for a suicide-related word than neutral words (e.g. “sad” vs. “car”). Two of the studies using the emotional Stroop reported that performance on the emotional Stroop was associated with history of suicide attempt (Becker et al., 1999; Cha et al., 2010), while one study did not observe a similar relationship (Loyo et al., 2013). These findings are encouraging but require further replication.  A large meta-analysis (Richard-Devantoy, Berlim, et al., 2013), including several of the aforementioned studies examined Stroop performance in those with a history of suicide attempt, patients with mood-disorders, and healthy controls. Combining performance on both the traditional and modified versions of the Stroop, the authors reported a small-moderate effect size g = .37 .95CI [.10 to .63] when comparing suicide attempters with mood-disordered patients. In contrast large effect sizes were noted between suicide attempters and healthy controls g = .91 .95CI [.41 to 1.42] as well as between patients with mood disorders and healthy controls g = .8, .95CI [.05 to 1.50]. These findings are consistent with the current review, indicating that impaired Stroop performance may be more closely associated with neurocognitive impairment due to mood-related disorders than history of suicide attempts.  Trail Making Test – Part B  The Trail Making Test (TMT) is a neuropsychological test assessing speed of processing, mental flexibility, set-shifting, and executive functioning (Tombaugh, 2004). Part A (TMTa) of the test presents the participant with a sheet of paper on which 25 circles with numbers from 1-25 have been printed. The circles have been scattered on the sheet and the participant is instructed to use a pencil and connect the circles in ascending order as quickly as possible. Part B (TMTb) also includes 25 circles, however only half the circles include numbers while the other half include letters. Completing the task requires the participant to connect the circles by drawing 10 a line from a number to a letter in ascending order – “1” to “A”, “A” to “2”, “2” to “B” and so on. Errors in connecting the circles are brought to the participant’s attention and the participant is asked to continue from the last correctly-connected circle. Both parts of the TMT are timed and the duration of each part is used to score the participant’s performance. TMTa is generally considered to measure visual scanning and psychomotor speed while Part B is associated with higher-order executive functioning skills (Bowie, Reichenberg, Patterson, Heaton, & Harvey, 2006). Some studies have associated performance on the TMTb with areas of the prefrontal cortex (Zakzanis, Mraz, & Graham, 2005) although further research is needed.   As outlined in Table 3, eleven studies administered the TMTb to individuals with a history of suicide attempts (Burton et al., 2011; Ellis, Berg, & Franzen, 1992; Harkavy-Friedman et al., 2006; Keilp et al., 2001, 2013; King et al., 2000; Martino et al., 2011; Nangle et al., 2006; Potkin, Anand, Alphs, & Fleming, 2003; Richard-Devantoy et al., 2012; Yen et al., 2008). Two studies reported that the TMTb differentiated between suicide attempters and patient controls (Ellis et al., 1992; Nangle et al., 2006) and one study reported that suicide attempters differed than healthy controls on the TMTb (Richard-Devantoy et al., 2012). Eight studies did not observe a relationship between lower TMTb scores, psychopathology, and suicidality (Burton et al., 2011; Harkavy-Friedman et al., 2006; Keilp et al., 2001, 2013; King et al., 2000; Martino et al., 2011; Nangle et al., 2006; Potkin et al., 2003; Richard-Devantoy et al., 2012; Yen et al., 2008).  A review of neuropsychological tests administered to mood-disordered populations suggests that performance on the TMTb is largely unrelated to history of suicide attempt (Richard-Devantoy, Berlim, et al., 2013). Specifically, a small effect size g = –.13, .95CI [–.46 to .18] was reported comparing suicide attempters and patient controls, indicating that those with a history of suicide attempt performed better than patients with mood disorders. In contrast, 11 moderate effect sizes were found when comparing suicide attempters to healthy controls g = .63, .95CI [.07, 1.19] and patient controls to healthy controls g = .73, .95C I [.22 to 1.23].  In line with this meta-analysis, our review suggests that that the TMTb is largely unrelated to history of suicide attempts. However, in contrast to the meta-analysis, this review found some evidence that performance on the TMTb does differentiate suicide attempters from patient and healthy controls. This discrepancy might be due to the greater number of studies included in this review, with several of these studies using clinical not diagnosed with mood disorders.  Verbal Fluency Verbal fluency tests measure a participant’s ability to generate words according to specific criteria. Phonemic tests of verbal fluency require an individual to produce as many words as possible that begin with a certain letter (typically either F, A, and S, or C, F, and L). In contrast, semantic tests of verbal fluency ask the participant to name as many exemplars of a particular category as possible. For example, a participant may be asked to name as many types of animals as they can. Participants are typically provided sixty seconds to produce as many words as possible. Because both phonemic and semantic tests of verbal fluency require effortful planning in organizing and producing stored information, they are generally considered to measure executive functioning abilities (Hunter & Sparrow, 2012). Lesion studies suggest that verbal fluency abilities are closely associated with frontal and temporal cortical regions (Baldo, Schwartz, Wilkins, & Dronkers, 2006; Henry & Crawford, 2004).   A total of fourteen studies administered a measure of verbal fluency to individuals with a history of suicide attempts (Audenaert et al., 2002; Barrett et al., 2011; Burton et al., 2011; 12 Harkavy-Friedman et al., 2006; Keilp et al., 2001, 2013; Kim, Jayathilake, & Meltzer, 2003; King et al., 2000; Martino et al., 2011; Nangle et al., 2006; Potkin et al., 2003; Richard-Devantoy, Guillaume, Olié, Courtet, & Jollant, 2013; Richard-Devantoy et al., 2012; Yen et al., 2008). These studies are outlined in Table 4.  Measures of semantic fluency were used in eight of the fourteen studies (Audenaert et al., 2002; Barrett et al., 2011; Burton et al., 2011; Keilp et al., 2001, 2013; Kim et al., 2003; Potkin et al., 2003; Richard-Devantoy, Guillaume, et al., 2013; Richard-Devantoy et al., 2012). High-lethality suicide attempters performed worse than patient controls in one study (Keilp et al., 2001) and suicide attempters performed worse than patient controls in another study (Richard-Devantoy, Guillaume, et al., 2013). One study reported that suicide attempters with schizophrenia performed better than schizophrenia patient controls (Kim et al., 2003) and four studies found that suicide attempters performed worse on semantic fluency measures than healthy controls (Audenaert et al., 2002; Keilp et al., 2013; Richard-Devantoy, Guillaume, et al., 2013; Richard-Devantoy et al., 2012). No differences between suicide attempters and ideators was reported by one study (Burton et al., 2011), and suicide attempters performed similarly to patient controls in two studies (Barrett et al., 2011; Potkin et al., 2003).  Measures of phonemic fluency were used in thirteen of the fourteen studies (Audenaert et al., 2002; Barrett et al., 2011; Burton et al., 2011; Harkavy-Friedman et al., 2006; Keilp et al., 2001, 2013; Kim et al., 2003; King et al., 2000; Martino et al., 2011; Nangle et al., 2006; Potkin et al., 2003; Richard-Devantoy, Guillaume, et al., 2013; Richard-Devantoy et al., 2012; Yen et al., 2008). Phonemic fluency measures differentiated violent suicide attempters from patient controls in one study (Keilp et al., 2001) and suicide attempters with schizophrenia performed better on measures of phonemic fluency than schizophrenia patient controls in another study 13 (Nangle et al., 2006). Five studies reported that performance on measures of phonemic fluency differentiated suicide attempters from healthy controls (Audenaert et al., 2002; Harkavy-Friedman et al., 2006; Keilp et al., 2013; Richard-Devantoy, Guillaume, et al., 2013; Richard-Devantoy et al., 2012). No performance differences on measures of phonemic fluency were reported between suicide attempters and suicide ideators in one study (Burton et al., 2011),  suicide attempters and patient controls in eight studies (Keilp et al., 2013; Kim et al., 2003; King et al., 2000; Martino et al., 2011; Potkin et al., 2003; Richard-Devantoy, Guillaume, et al., 2013; Richard-Devantoy et al., 2012; Yen et al., 2008), and suicide attempters and healthy controls in one study (King et al., 2000). Richard-Devantoy, Berlim, et al., (2013) reported that semantic measures of verbal fluency more strongly differentiated suicide attempters from patients with mood disorders g = –.32, .95CI [–.60 to –.04] than phonemic measures g = –.1, .95CI [–.29 to .08]. Larger effect sizes were reported when comparing suicide attempters to healthy controls on both semantic g = –.67, .95CI [–1.02 to –.33] and phonemic g = -.53, .95CI [–.82 to –.24] measures. Patient controls to performed more similarly to healthy controls on measures of semantic fluency g = –.30, .95CI [–.63 to .04] relative to phonemic fluency g = –.49 .95CI [–.67 to -.29].  Several of these findings are in-line with our review. First, semantic measures of verbal fluency seem to be more sensitive to history of suicide attempts than phonemic measures. Second, semantic and phonemic measures of verbal fluency more often differentiated suicide attempters form healthy controls than patient controls, suggesting that the same measures are more closely-related to psychopathology-related neurocognitive impairment. Since our review was not limited to mood-disordered populations, it is notable that both semantic and phonemic 14 measures of verbal fluency were sensitive to history of suicide attempts in schizophrenia populations with suicide attempters performing better than patient controls.  Wisconsin Card Sorting Test The Wisconsin Card Sorting Test (WCST) is one of the most frequently used measures of executive functioning (Butler, Retzlaff, & Vanderploeg, 1991) and a commonly administered neuropsychological test in general (Sullivan & Bowden, 1997). The test measures an individual’s cognitive flexibility and set-shifting abilities (D. A. Grant & Berg, 1948). The WCST requires that a participant match a card to one of four stimulus cards presented. Each stimulus card includes one or more coloured shape. Each card presented to the participant can be matched to the stimulus cards according to one of three possible categories – shape colour, shape type, or number of shapes. Feedback on each decision is provided to participants - “correct” vs. “wrong” - so as to guide future matching decisions. Healthy participants are typically able to uncover the matching rule being used. However, after a certain predetermined number of choices, the decision rule changes and the participants has to attempt different matching strategies to uncover the new matching rule. Patients with psychiatric disorders such as depression (Merriam, Thase, Haas, Keshavan, & Sweeney, 1999) and schizophrenia (Nieuwenstein, Aleman, & de Haan, 2001) typically experience greater difficulties in uncovering the matching rules and, as a result, have higher rates of matching errors in completing the task. Impaired performance on the WCST has been associated with reduced activation in the prefrontal cortex (Buchsbaum, Greer, Chang, & Berman, 2005; Demakis, 2003) including the dorsolateral and ventromedial prefrontal cortices as well as the basal ganglia (Monchi, Petrides, Petre, Worsley, & Dagher, 2001).  Fourteen studies administered the WCST to suicidal populations (Burton et al., 2011; Ellis et al., 1992; Gilbert et al., 2011; Homaifar et al., 2012; Keilp et al., 2001, 2013; Kim et al., 15 2003; King et al., 2000; Loyo et al., 2013; Malloy-Diniz et al., 2009; Martino et al., 2011; McGirr, Dombrovski, Butters, Clark, & Szanto, 2012; Miranda, Gallagher, Bauchner, Vaysman, & Marroquín, 2012; Yen et al., 2008). These studies are outlined in Table 5.   Suicide attempters performed better on the WCST compared to suicide ideators in one study (Burton et al., 2011) and suicide attempters with schizophrenia also performed better on the WCST compared with schizophrenia patient controls (Kim et al., 2003). In contrast, high lethality attempters performed worse on the WCST than low-lethality attempters in two studies (Keilp et al., 2001; McGirr et al., 2012) and patient controls in one study (McGirr et al., 2012). Suicide attempters with TBI also performed worse than TBI patient controls in one study (Homaifar et al., 2012). Eight of the fourteen studies failed to find a difference between suicide attempters and patient controls (Ellis et al., 1992; Gilbert et al., 2011; Keilp et al., 2013; King et al., 2000; Loyo et al., 2013; Malloy-Diniz et al., 2009; Martino et al., 2011; Miranda et al., 2012; Yen et al., 2008) with four studies reporting no difference on the WCST between suicide attempters and healthy controls (Keilp et al., 2013; King et al., 2000; Loyo et al., 2013; Miranda et al., 2012). A recent meta-analysis of neuropsychological tests in affective samples (Richard-Devantoy, Berlim, et al., 2013) suggests that performance on the WCST does not differ between suicide attempters and mood-disordered patient controls g = .02, .95CI [–.21 to .24]. However, suicide attempters and mood-disordered patient controls differed from healthy controls g = .44, .95CI [.15 to .74] and g = .30, .95CI [–.05 to .66], respectively. Similarly, our review failed to find a relationship between the WCST and history of suicide attempt. These findings suggest that neurocognitive abilities assessed using the WCST are not be uniquely impaired in those with a history of suicide attempt. 16 Chapter 3: Literature Review - Executive Functioning in Suicide Ideators and Suicide Attempters The reviewed studies have advanced our understanding of the relationship between executive functioning and suicidality in general. Although some studies have demonstrated that certain neuropsychological tests can differentiate between psychiatric populations with and without a history of suicide attempt, the contribution of these findings is limited since the majority of these same studies failed to examine differences between patients with a history of suicide attempts and patients with a history suicidal ideation but no history of attempts. It remains unclear, therefore, whether the same neuropsychological tests are sensitive to suicidal thoughts or suicidal acts. This review identified only five studies that examined differences in executive functioning between suicide ideators and suicide attempters (Burton et al., 2011; Clark et al., 2011; Dombrovski et al., 2010, 2011; Richard-Devantoy et al., 2014). All five studies were conducted using mood-disordered samples with four of these focusing exclusively on older adults (Clark et al., 2011; Dombrovski et al., 2010, 2011; Richard-Devantoy et al., 2014). Burton et al. (2011) compared executive functioning abilities in thirty-seven recent suicide attempters and forty suicide ideators. Participants were recruited from a psychiatric inpatient unit. All participants were receiving treatment for a mood-related condition and the majority of participants had a comorbid substance- or alcohol-use disorder. The neuropsychological testing battery included the Trail Making Test – Part B (TMTb), FAS (phonemic) and Animals (semantic) tests of verbal fluency, the Stroop test, and the Wisconsin Card Sorting Test (WCST). Suicide attempters took longer to complete the TMTb, obtained lower performance scores on both measures of verbal fluency as well as the Stroop test, and committed more errors on the WCST. Of these differences, only the TMTb and WCST were found to be statistically significant.  17 Clark et al. (2011) compared decision making abilities in healthy and depressed older-adults populations. Twenty-five participants had a history of suicide attempt, thirteen participants had active suicidal ideation but no history of attempts, thirty-five participants presented with major depression and did not endorse either suicidal ideation or past suicide attempts, and twenty-two participants were included as healthy controls because they did not meet criteria for a psychiatric disorder and did not have a history of suicide attempt or ideation. Participants completed the Cambridge Gamble Task which presents participants with ten boxes coloured in either blue or red. The ratio of red to blue boxes is pseudo-random and can range from 1:9 to 9:1. Participants are told that the computer has hidden a token under either a red or blue box and that they are required to place a bet on whether the token is hiding under a red or blue box. The goal of the task is to increase one’s winnings while avoiding losing points. The task lasted for 72 trials. Quality of Decision-Making is calculated as the proportion of trials where the participant’s selection matches the more prominent colour. Moderate-large effect sizes were reported for differences in Quality of Decision-Making between the suicide attempter and patient groups d = 0.67, p = .02, and suicide attempters and healthy controls d = 0.79, p < .01. Suicide attempters performed worse than suicide ideators d = 0.66, although this difference was not statistically significant p = .081. This difference did became significant p = .002 after controlling for education and brain damage resulting from previous suicide attempts. Further controlling for substance use co-morbidity did not attenuate this relationship. The relationship of inhibition to suicidality was examined by Richard-Devantoy et al. (2014) using the Delis-Kaplan Executive Functioning System Colour-Word Interference Test (DKEFS-CWIT). The DKEFS-CWIT greatly resembles the traditional Stroop test previously described with the exception of an additional inhibition/switching condition. This condition 18 presents participants with colour words written, some of which are written in incongruently- coloured ink (i.e. the word “Blue” written in green ink). In addition, half of the words are surrounded by a box. For the words not enclosed in a box, the participant is instructed to identify the colour of the ink the word is written, and not read the word. For words enclosed in a box, however, the participant is instructed to read the word and not name the ink colour in which that word has been written in.  A total of one-hundred and two older adults participated in this study including thirty-one depressed older adults with a history of suicide attempts (seventeen with a history of a high-lethality suicide attempt and fourteen with a history of low-lethality suicide attempt), sixteen depressed older-adults with current suicidal ideation including a specific plan but no history of suicide attempts, thirty-eight depressed older adults with no lifetime history of suicide attempt or ideation, and seventeen healthy control participants with no history of suicide attempt or psychiatric disorder. Older adults with a history of suicide attempt took more time to complete the D-KEFS-CWIT inhibition condition than depressed and healthy controls. Examining group differences after dividing older adults with a history of suicide into high and low lethality groups revealed that older adults who attempted to suicide using a highly lethal method completed the D-KEFS-CWIT inhibition task slower than suicide ideators, depressed, and health participants. High-lethality suicide attempters also displayed poorer performance on the D-KEF-CWIT naming condition compared with healthy and patient controls. Low-lethality suicide attempters made more uncorrected errors (after controlling for age and education) on the D-KEFS-CWIT compared with depressed and healthy older adults. No significant differences between high and low-lethality older adults on any of the D-KEFS-CWIT variables. Furthermore, no significant differences were reported for three of the four D-KEFS-CWIT conditions including word-reading, colour-naming, and inhibition/switching.  19 Dombrovski et al. (2010) examined older adults’ executive functioning abilities using a probabilistic reversal learning task. Four groups were included in the study. The groups’ composition mirrors that of Clark et al. (2011), although their size slightly differs. Participants in this study had to select between two coloured rectangles on the screen. For the first forty trials, selecting stimulus 1 would be rewarded 80% of the time while selecting stimulus two would be punished 80% of the time. For the remaining 20% for each stimulus, incongruent feedback would be delivered such that selecting stimulus one would be punished and selecting stimulus two would be rewarded. Learning is said to occur when participants consecutively selected stimulus one eight times .After forty trials, the probabilities are reversed. All four groups demonstrated similar learning patterns for the first 40 trials. However, once the probabilities were reversed, suicide attempters were much less likely to achieve the learning criterion. Suicide ideators did not differ from nonsuicidal depressed patients and healthy controls. In other words, the inability to reverse probabilistic learning was uniquely associated with individuals who had previously attempted to suicide.  Impulsivity in suicide was examined by Dombrovski et al. (2011). Participants included five groups of older adults; fifteen suicide attempters with a history of high-lethality suicide attempt, fourteen low-lethality suicide attempters, twelve ideators, forty-two nonsuicidal depressed participants, and thirty-one healthy controls. Participants were administered the Kirby’s Monetary Choice Questionnaire (MCQ) which presents participants with 27 choices between smaller immediate rewards and large delayed rewards. High-lethality suicide attempters were found to be more likely to delay immediate rewards than both low-lethality suicide attempters and suicide ideators. Exploratory analysis between reward preference and real-life 20 behaviours revealed that preference for immediate rewards was associated uniquely with debt but not income, premorbid IQ, hopelessness, severity of depression or age at first attempt.   21 Chapter 4: Limitations in Understanding and Measuring Executive Functioning The association between suicidal behaviours and executive functioning abilities was reviewed by examining performance on five objective neuropsychological measures. Whether executive functioning abilities are impaired in suicidal populations was largely determined by participants’ performance on these tests. However, despite the ubiquity of these measures in the neuropsychological literature, executive functioning is a construct that is poorly understood and requires further clarification. For several decades, researchers have struggled to define what executive functioning is and which neurocognitive abilities are subsumed under this construct (Barkley, 2012; Kreutzer, DeLuca, & Caplan, 2011; Strauss, Sherman, & Spreen, 2006). Recent advances in neuroimaging technologies have allowed researchers to examine the cortical regions and neural pathways thought to underlie executive functioning abilities. Contrary to early assumptions, however, a growing body of literature is increasingly questioning whether executive functioning is, in fact, a unitary construct that corresponds to precise cortical regions (Alvarez & Emory, 2006; Jurado & Rosselli, 2007; Miyake et al., 2000). Furthermore, neuropsychologists in clinical practice have been critical of the generalizability of results obtained using neuropsychological measures of executive functioning, stating that the objectively-measured impairment often fail to capture subjectively-experienced real-world impairment (Barkley, 2012; Chaytor & Schmitter-Edgecombe, 2003; Manchester, Priestley, & Jackson, 2004). A brief review of the limitations of executive functioning and its assessment is therefore necessary in order to provide context to the patterns of cognitive impairment associated with suicidal behaviour.  There is a longstanding association between executive functions and the frontal lobes. Early neurologists conceptualized of executive functioning as ‘higher order’ neurocognitive 22 abilities involved in planning, decision making, and other intentional actions. These abilities were thought to correspond to neural pathways within frontal cortical regions in general and the prefrontal cortex (PFC) in particular (Luria, 1966, 1976). This association meant that functions associated with the PFC often became incorporated into the construct of executive functioning and that cognitive abilities subsumed under the umbrella of executive functioning were often assumed to reside within the PFC (Barkley, 2012). Such circulatory reasoning has led to different conceptualizations and definitions of executive functioning. Indeed, Lezak (2012) proposed that executive functioning is primarily involved in planning, volition, purposive action and effective performance while Baddeley (1992) viewed executive functioning to be a ‘central executive’ responsible for overseeing working memory tasks including the phonological loop and visuospatial sketchpad. More recently, Elliot (2003) defined executive functioning as the abilities required for solving novel problems, modifying behaviour in light of new information, generating strategies, and sequencing complex actions while Anderson (2001) associated attentional control, cognitive flexibility, and goal setting abilities with executive functioning. Clearly, a widely accepted definition of executive functioning abilities remains elusive. Researchers are increasingly examining whether executive functioning abilities can be explained by a single underlying factor. Miyake et al (2000) studied three longstanding executive functioning abilities (set-shifting, updating, and inhibition) using the Wisconsin Card Sorting Test (WCST), Tower of Hanoi (TOH), and random number generation (RNG). Confirmatory factor analysis suggested that these three neurocognitive abilities were moderately related but could easily be considered separable. Additional support for the fractioning of executive functioning was provided by Godefroy et al. (1999) who observed that patients with damage to the frontal lobes performed well on several executive functioning measures while patients with 23 damage to the parietal lobes exhibit impaired performance on tests assessing working memory. Several meta-analytic studies (Alvarez & Emory, 2006; Andrés, 2003; Nyhus & Barceló, 2009) examining clinical, lesion, and neuroimaging studies have found that many commonly used neuropsychological tests of executive functioning, including the WCST, Stroop test, and phonemic Verbal Fluency Tests, were sensitive but not specific markers of frontal lobe functioning. This growing literature suggests that executive functioning may not represent a unitary construct.  Clinicians assessing executive functioning abilities are not only concerned with whether objective-measures accurately assess their domain of interest but also whether tests results are representative and predictive of real-world functioning. Neuropsychological tests, however, assess neurocognitive abilities using abstract paradigms rarely encountered in real-world situations. A central question, therefore, is to what extent does performance on measures of executive functioning describe and predict functioning outside of controlled, typically lab-based, environments. Despite reported inconsistencies between patients’ performance on measures of executive functioning and self-reported information (Wilson, 1993), the ecological validity of neuropsychological tests has received relatively little attention in the empirical literature. Studies examining the relationship between objective and subjective measures of executive functioning have found small-moderate agreement, with Pearson correlations ranging from 0.1-0.5 (Chaytor, Schmitter-Edgecombe, & Burr, 2006; Odhuba, van den Broek, & Johns, 2005). Other studies have found no relationship between measures of executive functioning and self-reported information, although small-moderate correlations were reported between executive functioning tests and informant reports of participants’ daily functioning (Burgess, Alderman, Evans, Emslie, & Wilson, 1998; Chaytor & Schmitter-Edgecombe, 2003). More importantly, self-rated 24 executive functioning was found to predict real-world outcomes above and beyond neuropsychological measures in those with traumatic brain injuries (Bogod, Mateer, & MacDonald, 2003; Mangeot, Armstrong, Colvin, Yeates, & Taylor, 2002; Vriezen & Pigott, 2002; Wood & Liossi, 2006), attention-deficit/hyperactive-disorder (Barkley & Fischer, 2011; Barkley & Murphy, 2011; Stern, Pollak, Bonne, Malik, & Maeir, 2013), and autism-spectrum disorders (Zandt, Prior, & Kyrios, 2009). Barkley and Murphy (2011), reported that self-reported executive functioning was more closely associated with measures of deviant behaviour (antisocial acts, crime diversity, negative driving outcomes) and impairment in major life activities. Barkley and Murphy (2010) found that self-reported executive functioning predicted self- and employer-ratings of overall work performance across a variety of work contexts over and above objective measures of executive functioning. Similarly, Mangeot et al. (2002) found that self-reported executive functioning differentiated between TBI severity groups and was predictive of children’s adaptive functioning, behavioural adjustment, parent psychological distress, family burden, and general family functioning. In the same studies, objective measures of executive functioning were not predictive of any of the previous outcomes and were found to account for 2-8% of the variance associated with self-reported executive functioning impairment (Barkley & Fischer, 2011). These studies provide strong support to claims that objective-measures of executive functioning fail to capture real-world problems.    25 Chapter 5: Summary of Literature Reviews The reviewed studies measured executive functioning abilities in suicidal populations. The association between executive functioning and suicide was assessed by examining participants’ performance on five neuropsychological measures of executive functioning. Across studies, suicide attempters exhibited worse performance on neuropsychological measures relative to healthy controls. However, scores obtained on four longstanding measures of executive functioning (Stroop test, Trail Making Test – Part B, Phonemic and Semantic Verbal Fluency, and the Wisconsin Card Sorting Test) did not greatly differ between suicide attempters and patient controls, suggesting that these tests were not sensitive to history of suicide attempts. In contrast, the Iowa Gambling Task was the only test that demonstrated impaired decision making abilities in suicidal populations above and beyond neurocognitive deficits associated with psychiatric conditions, however additional studies are required to determine the robustness of these findings. There are several limitations to these findings. First, the majority of studies used relatively small sample sizes and therefore may unreliably estimate the true associations between neurocognitive measures and suicide. Second, most studies examining neurocognitive abilities failed to compare ideators to attempters. Therefore, it remains unclear whether impairments in executive functioning represent risk factors for suicidal thoughts, suicidal acts, or both. Third, because a growing literature suggests that executive functioning is not a unitary construct, it is unclear which neurocognitive abilities are assessed by longstanding measures of executive functioning. Lastly, despite evidence that self-reported executive functioning is more predictive of real-world outcomes than the behavioural measures utilized in the studies reviewed, few 26 studies have examined whether those with a history of suicide attempts self-report impaired executive functioning abilities. 27 Chapter 6: Summary of Research Project This study contributes to the research literature by examining self-reported executive functioning, impulsivity, and clinical variables generally associated with suicidality in a large online sample. To examine which variables differentiate ideators from attempters, participants are divided into three groups according to 1) lifetime history of suicide attempts (attempters), 2) lifetime history of suicidal ideation but no history of suicide attempts (ideators), and 3) no lifetime history of either suicide attempt or suicidal ideation (nonsuicidal).  Furthermore, the same sorting criteria was used to create non-recent and recent groups based on the presence of suicidal ideation and suicide attempts occurring either 1) during one’s lifetime but not recently (i.e., prior to the past 12-months) or 2) recently (i.e., during the past-12 months).  Using these groups, several analyses were performed. First, demographic differences between nonsuicidal, ideators, and attempters within lifetime, non-recent, and recent groups are explored. Second, group differences on covariate variables including history of drug abuse, suspected brain injury, and perceived self-efficacy are examined. Third, between-group differences within lifetime, non-recent, and recent groups are examined in four sections according to domain of functioning – (1) executive functioning, (2) impulsivity, (3) clinical variables, (4) nonsuicidal self-injury and suicidal ideation. Fourth, the degree to which individual scales predict nonsuicidal, ideator, and attempter status, over and above the covariate variables, is explored to provide a more nuanced understanding of the specific domains of functioning that most differentiate between these three groups.  28 Chapter 7: Methods Procedure Participants were recruited from Amazon’s Mechanical Turk (MTurk). Participation in the study was limited to U.S. residents (based on ownership of having a U.S. bank account) who had at least 90% approval in completing 100 or more Human Intelligence Tasks (HITs). Participants were told the study would take between 1 to 3 minutes to complete and that they would be paid $0.15 for their participation. Eligible participants were provided with a link to a screening questionnaire hosted by Qualtrics, an online questionnaire software company. In order to avoid multiple survey completions by the same MTurk participant, Qualtrics restrictions allowing one response per IP address and one response per MTurk ID (as outlined by Peer, Paolacci, Chandler, & Mueller, 2012) were enabled. Furthermore, participants had to complete a “captcha” or “reverse Turing test” to verify that human participants were completing the questionnaires as opposed to programs (bots) designed to automatically complete MTurk HITs.  Upon providing informed consent, participants completed a brief online survey which included the Youth Risk Behaviour Survey – Suicide Screening Questionnaire (YRBS; Grunbaum et al., 2002; Kolbe, Kann, & Collins, 1993) assessing lifetime and past 12-month history of suicidal ideation and suicide attempts as well as the Patient-Reported Outcome Measurement Information System (PROMIS®; Cella et al., 2007, 2010; Fries, Bruce, & Cella, 2005) Anxiety short-form 4a and Depression short-form 4a instruments assessing anxiety- and depression-related symptoms occurring during the previous seven days. Participants’ responses to the YRBS suicide items determined their membership into one of three groups; participants that endorsed no lifetime history of suicidal ideation or suicide attempts were classified as nonsuicidal, participants with a lifetime history of suicidal ideation but no history of suicide 29 attempts were classified as ideators, and participants with a history of suicidal ideation and suicide attempts were categorized as attempters. Participants that reported no history of suicidal ideation but a history of suicide attempts were excluded from further participation in the study since suicidal ideation must, even briefly, precede any suicide attempt.  Participants that successfully completed the screening questionnaire were invited to complete a longer one-hour survey for an additional payment of $2.00. Recruitment was limited to two-hundred and fifteen nonsuicidal participants, two-hundred and fifteen ideators, and two-hundred and fifteen attempters. Once the quota for a particular group was met, further recruitment of similar participants was blocked. Participants who refused to complete the longer survey were presented with a unique code to enter into MTurk indicating that they had completed the screening survey.  Participants who agreed to participate in the longer survey were required to provide informed consent to prior to participating in the longer study. Upon providing consent, participants first completed a demographics questionnaire alongside several clinical measures. Specifically, participants completed the following clinical measures sequentially: (1) the Behavioural Rating Inventory of Executive Functions – Adult version (BRIEF-A; Roth et al., 2005), (2) the Frontal Systems Behaviour Scale (FrSBe; Grace & Malloy, 2001), (3) UPPS-P Impulse Behaviour Scale (Cyders et al., 2007), (4) the Generalized Self-Efficacy Scale (GSES; Schwarzer & Jerusalem, 1995) scale, (5) the Alabama Brief Screening for Possible Brain Injury (ABSPBI), (6) the Drug Abuse Screening Test (DAST-10; Skinner, 1982), (7) the Depression, Anxiety, and Stress Scale (DASS-42; Lovibond & Lovibond, 1995), (8) a gateway question assessing lifetime history of nonsuicidal self-injury (Briere & Gil, 1998) followed by items from the Self-Injurious Thoughts and Behaviours Interview (SITBI; Nock, Holmberg, Photos, & 30 Michel, 2007), and (9) the Beck Scale for Suicidal Ideation (BSI; Beck, Kovacs, & Weissman, 1979; Beck, Steer, & Ranieri, 1988). Participants classified as nonsuicidal were not administered the BSI. Attention checking questions requesting that participants either select a particular answer (“Please select Sometimes”) or respond to a question with only one possible correct answer (“Have you won more than two Noble prizes?”) were used to ensure that participants were paying attention to the questions being asked.  Before completing the study, were asked to select positive strategies used when feeling stressed or upset as well as rank five strengths or values that are important to them. These questions were completed to induce positive mood and elicit positive coping strategies to buffer the effect of the more sensitive questions. Participants were also provided with an extensive list of mental health resource before being provided with their unique study completion code. Throughout both surveys participants were provided with a link to a crisis line number and chat service. Ethical approval for this study was obtained from the Behavioural Research Ethics Board of the University of British Columbia (UBC BREB Number: H14-02018).  Due to a technical error measures assessing emotion dysregulation (DERS; Gratz & Roemer, 2004) and age were not administered to participants in the initial battery. However, we obtained BREB approval for an immediate follow-up and obtained data on emotion dysregulation and age from 79.4% and 82.3% of the sample, respectively. Participants  As outlined in Figure 1, 2905 attempts were made to access the screening survey. Of these, 450 attempts were identified as duplicate attempts and subsequently blocked, 19 participants did not complete the verification captcha, 10 participants did not complete the 31 screening questionnaire, and 19 participants completed the questionnaire twice of which only their first response set was kept, leaving a total of 2406 unique participants who completed the screening questionnaire only once. Of the 2406 participants who completed the screening questionnaires, 808 participants were invited to complete the longer questionnaire. 134 participants declined the offer, 17 participants accepted the offer but did not provide consent, 1 participant did not complete the captcha, 29 participants did not complete the entire survey, and 50 participants failed one or more attention-checking questions, leaving 577 participants that completed the longer survey. Lastly, of the 577 participants, 43 flagged one or more of the validity scales embedded in the BRIEF-A measure. These validity scales are designed to measure overly negative, infrequent, and inconsistent reporting.  Removing participants who flagged one or more of the BRIEF-A validity scales left a total of 534 participants; 180 lifetime nonsuicidal participants, 197 lifetime ideators, and 166 lifetime attempters. Participants were then further subdivided into non-recent and recent groups based on whether they experienced suicide ideation or suicide attempts prior to the past 12-months or within the past-12 months, respectively. 136 participants reported a non-recent history of suicidal ideation and no past-12 month history of either suicidal ideation or suicide attempts. 103 participants reported a non-recent history of suicide attempts and no past-12 month history of either suicidal ideation or suicide attempts. 61 and 21 participants reported a recent history of suicidal ideation and suicide attempts, respectively. 42 participants reported a non-recent history of suicide attempts and a recent history of suicidal ideation. These participants were not included in either the non-recent attempter or recent ideator groups since they would differ from the participants already in these groups who had no current suicidal ideation and no past-history of attempts, respectively, and therefore would complicate the conclusions obtained comparing these 32 groups to those without current ideation or a non-recent history of attempts. Consequently, these 42 participants were removed from analyses.  Demographic information for all participants is outlined in Table 6. Participants reported an average 34.6 years of age (SD = 11.5). Over half of participants were female (55.2%, N=300) and single (53.8%, N=292), while 31.3% (N=170) of participants reported being married. Most participants reported Caucasian ethnicity (77.7%, N=422), heterosexual sexual orientation (79.2%, N=430), and obtaining at least some college or university education (90.8%, N=493). Yearly reported household income varied with 17.1% (N=93) participants reporting earning between 20,000-$29,000 annually.  Demographic Measures Demographic information was obtained using a lab-based questionnaire (See Appendix A. PEBL Demographics Questionnaire). The questionnaire includes 12 questions asking participants to report their date of birth, gender, race/ethnicity, sexual orientation, and current marital status. The questionnaire also assesses highest level of education, yearly household income, occupation, weekly working hours, and number of people residing in the household.  Measures of Executive Functioning Behaviour Rating Inventory of Executive Function – Adult Version. The Behaviour Rating Inventory of Executive Function – Adult Version (BRIEF-A; Roth, Isquith, & Gioia, 2005) is a 75-item self-report inventory used to assess perceived executive functioning. For each item, participants indicate on a scale from 1 (Never) to 3 (Often) the frequency they have experienced the described behaviour. Higher scores indicate greater executive functioning impairment. The BRIEF includes one composite score and two indices 33 comprised of nine individual clinical subscales The Behavioural Regulation Index (BRI) is created by combining four subscales including (1) Inhibit, (2) Shift, (3) Emotional Control, and (4) Self-Monitor. The Metacognition Index (MI) is composed of five subscales including (1) Initiate, (2) Working Memory, (3) Plan/Organize, (4) Task Monitor, and (5) Organization of Materials. The BRI and MI are combined to create the Global Executive Composite (GEC). The BRIEF-A includes three validity scales intended to measure infrequent (Infrequency Scale), inconsistent (Inconsistency Scale), and unusually negative (Negativity Scale) reporting.  Internal consistency for the BRIEF-A clinical scales is good to excellent (Ciszewski, Francis, Mendella, Bissada, & Tasca, 2014; Reid, Karim, McCrory, & Carpenter, 2010; Roth et al., 2005). Test-retest reliability ranged for the clinical subscales over a four week period (Roth et al., 2005). The BRIEF-A has been shown to strongly correlate with other measures of executive functioning including the Frontal Systems Behaviour Scale (FrSBe; Grace & Malloy, 2002), Dysexecutive Questionnaire (DEX; Wilson, Alderman, Burgess, Emslie, & Evans, 1996), and the Cognitive Failures Questionnaire (CFQ; Broadbent, Cooper, FitzGerald, & Parkes, 1982), demonstrating good convergent validity.  The BRIEF-A was shown to be sensitive to differences in executive functioning in an older-adult sample with mild cognitive and cognitive complaints (Rabin et al., 2006). The BRIEF-A has also been used in adult samples with attention-deficit/hyperactivity disorder (ADHD; Stern et al., 2013) eating-disorders (Ciszewski et al., 2014), sexual disorders (Reid et al., 2010) and traumatic brain injury (TBI; Waid-Ebbs, Wen, Heaton, Donovan, & Velozo, 2012).   34 The internal consistency reliability (Cronbach’s alpha) was .97 for the Global Executive Composite, .94 for the Behaviour Regulation Index (BRI), and .96 for the Metacognitive Index (MI) in this sample. Cronbach’s alpha for the individual subscales ranged from .76 to .94 with .76 for Inhibit, .82 for Shift, .94 for Emotional Control, .82 for Self-Monitor, .86 for Initiate, .88 for Working Memory, .89 for Plan/Organize, .81 for Task Monitor, and .91 for Organization of Materials.  Frontal Systems Behaviour Scale. The Frontal Systems Behaviour Scale (FrSBe; Grace & Malloy, 2001) is a 46-item self-reported rating scale designed to assess behaviour associated with damage to the frontal lobes. According to the manual, the FrSBe was designed to be (a) brief, reliable, and valid; (b) to assess adult behaviour before and after frontal systems damage occurs; and (c) to permit multiple observers to provide behaviour ratings (Grace & Malloy, 2001). For each of the 46 items, participants use a Likert-type scale to indicate their responses. Higher scores on the FrSBe reflect greater perceived impairment. The FrSBe yields a total score and three subscale corresponding to the apathy, disinhibition, and executive functioning factor-analytically derived subscales (Niemeier, Perrin, Holcomb, Nersessova, & Rolston, 2013; Stout, Ready, Grace, Malloy, & Paulsen, 2003). The FrSBe includes normative information on men and women aged 18 to 95 with education ranging from 10 years to doctoral level (Grace, 2011).  The FrSBe total score as well as the individual subscales have demonstrated good-excellent internal reliability, with Cronbach’s alpha ranging from 0.78 to 0.94 (Grace & Malloy, 2001; Grace, 2011; Velligan, Ritch, Sui, DiCocco, & Huntzinger, 2002), and good test-retest reliability (Velligan et al., 2002) with correlation values ranging from 0.65 to 0.78. Scores on the FrSBe have been shown to be significantly correlated to other measures of executive functioning 35 including the BRIEF-A (Roth et al., 2005) and the Neuropsychiatric Inventory (NPI; , Cummings et al., 1994; Norton, Malloy, & Salloway, 2001). The FrSBe has shown to predict instrumental activities of daily living (IADLs; Karzmark, Llanes, Tan, Deutsch, & Zeifert, 2012) and community integration (Reid-Arndt, Nehl, & Hinkebein, 2007) over and above neuropsychological tests of intelligence and executive functioning. The internal consistency reliability of the FrSBe scales in this sample were .87 for Apathy, .85 for Disinhibition, .87 for Executive Dysfunction, and .94 for the combined subscales total score. Covariate Measures Alabama Brief Screening for Probable Head Injury  The Alabama Brief Screening for Probable Head Injury (ABSPBI; Alabama Department of Rehabilitation Services, 2006) is a brief screening instrument designed to determine if an individual has experienced a brain injury during the course of a domestic violence incident, or at any other time. Part one includes eight questions assessing a history of brain injury and acts as a gateway section. Participants respond to these questions by selecting either “Yes” or “No”. Responding positively to any of the eight gateway questions in part one will result in participants completing part two of the ABSPBI which is includes a checklist of eleven common symptoms associated with head brain injury.  The ABSPBI was developed by the U.S. Department of Health and Human Services (U.S. Department of Health and Human Services, 2006) in collaboration with Dr. Mary Hibbert (Alabama Department of Rehabilitation Services, 2006b). Information regarding the psychometric properties of ABSPBI have yet to be published in peer-reviewed journals. For this 36 study, a history of brain injury was determined if individuals endorsed one or more of the first seven items in part one, question eight part one (“Did you lose consciousness or feel dazed or confused after experiencing any of the event(s) listed above), and one or more symptoms in part two.   Drug Abuse Screening Test. A modified, 10-item version of the Drug Abuse Screening Test (Skinner, 1982) was used in this study. The DAST-10 is a self-report measure designed to assess drug-use severity in the previous 12-months. For each questions, participants indicate whether they have engaged in the specific behaviour by selecting either “Yes” or “No”. A total score is calculated by counting the number of positive responses on nine of the ten questions and one reverse-scored question. Higher scores indicate greater drug abuse. Recommended cut-scores reflecting severity of drug abuse have been developed with scores between 1-2 indicating low-level abuse, 3-5 moderate abuse, 6-8 substantial abuse, and 9-10 severe abuse. A cut score of 3 has been found to have .70-.84 sensitivity and .76-.80 specificity in diagnosing drug abuse disorders using the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 2000; Cocco & Carey, 1998; Maisto, Carey, Carey, Gordon, & Gleason, 2000).  The DAST-10 has been found to have strong psychometric properties including good - excellent internal consistency (Carey, Carey, & Chandra, 2003; Cocco & Carey, 1998; McCabe & Teter, 2007) and good test-retest reliability (Cocco & Carey, 1998). Support for the unidimensional structure of the DAST-10 was found in one study (Carey et al., 2003) although an earlier study found a three-factor  structure (Cocco & Carey, 1998). The DAST-10 has been used with samples of unselected undergraduate students (McCabe & Teter, 2007), psychiatric outpatients (Cocco & Carey, 1998), and adults with severe mental illness (Maisto et al., 2000).  37 The internal consistency reliability (Cronbach’s Alpha) of the DAST-10 total score in this sample was .81.  Generalized Self-Efficacy Scale. The Generalized Self-Efficacy Scale (GSES; Schwarzer & Jerusalem, 1998) is a brief 10-item measure designed to assess perceived self-efficacy in coping with a variety of stressors. For each statement, participants select an answer ranging from 1 (Not at all true) to 4 (Exactly true). A single total score for the GSES is derived by combining the numeric value of each answer. A high score indicates greater perceived self-efficacy.  The GSES demonstrates good-excellent internal consistency reliability (Luszczynska, Scholz, & Schwarzer, 2005; Schwarzer, Mueller, & Greenglass, 1999), adequate-good test-retest reliability (Schwarzer et al., 1999), and a unidimensional construct (Schwarzer et al., 1999). The GSES has been translated to several languages (Schwarzer, Babler, & Kwiatek, 1997) and has been widely used in large samples in Europe, Asia, the Middle-East, North-America  (Luszczynska, Gutiérrez‐Doña, & Schwarzer, 2005; Luszczynska, Scholz, et al., 2005), with online participants (Schwarzer et al., 1999), individuals with medical conditions (Luszczynska, Scholz, et al., 2005), as well as individuals with symptoms of anxiety and depression (Muris, 2002). The internal consistency (Cronbach’s alpha) of the GSES scale in this sample was .93.   Measure of Impulsivity UPPS-P Impulsive Behaviour Scale. The UPPS-P Impulsive Behaviour Scale (Cyders et al., 2007) is an expanded 59-item version of the factor-analytically derived UPPS 45-item self-report scale (UPPS-P; Whiteside, 38 Lynam, Miller, & Reynolds, 2005; Whiteside & Lynam, 2001). The UPPS-P retains the four-factor model of the UPPS and adds a fifth dimension (Positive urgency) of theoretical importance (Cyders et al., 2007). The UPPS-P therefore measures five facets of impulsivity including (1) Urgency: behaviours exhibited in the presence of negative affect, (2) Perseverance (lack of): the ability to persist in completing a task, (3) Premeditation (lack of): the ability to plan ahead and consider the potential consequences of various behaviours, (4) Sensation seeking: the tendency to seek excitement, stimulation, and adventure, and (5) Positive urgency: behaviours exhibited in response to very positive affective states. For each statement, participants select an answer using a 4-point scale ranging from 1 (Agree strongly) to 4 (Disagree strongly). Higher scores indicate more of the domain being measured. The five dimensions can be combined to create a total score reflecting a participant’s general predisposition to act impulsively.  The UPPS-P retains the strong psychometric properties of the UPPS (Whiteside et al., 2005; Whiteside & Lynam, 2001) demonstrating good-excellent internal consistency reliability (Cyders, 2011) and a five-factor structure that is robust to sex differences (Cyders, 2011). The UPPS has been validated for use in both non-clinical (Cyders, 2011; Cyders et al., 2007) and clinical samples including pathological gamblers (Michalczuk, Bowden-Jones, Verdejo-Garcia, & Clark, 2011), individuals with psychopathic traits (Derefinko, Dewall, Metze, Walsh, & Lynam, 2011), alcohol abuse (Coskunpinar, Dir, & Cyders, 2013; Cyders et al., 2007) and externalizing behaviours (Carlson, Pritchard, & Dominelli, 2013).  The internal consistency reliability (Cronbach’s alpha) of the UPPS-P scales in this sample were .92 for Urgency, .89 for Premeditation (lack of), .89 for Perseverance (lack of), .90 for Sensation seeking, .96 for Positive urgency, and .95 for the combined subscales total score.  39 Measures of Other Clinical Variables Depression Anxiety Stress Scale. The Depression Anxiety Stress Scale (DASS; Lovibond & Lovibond, 1995) is a 42-item measure used to assess symptoms of anxiety, depression, and stress during the last seven days. For each question, participant indicate the degree to which each symptom applied to them on a scale from 0 (did not apply to me at all) to 3 (Applied to me very much, or most of the time). Fourteen questions per scale are combined to create scale total scores. Higher scores indicate more of the domain being measured. Cut-scores representing normal, mild, moderate, severe, and extremely severe symptomatology have been created for each scale using a large adult sample (Lovibond & Lovibond, 1995). The DASS scales have excellent internal consistency reliability in both non-clinical  (Antony, Bieling, Cox, Enns, & Swinson, 1998; Brown, Chorpita, Korotitsch, & Barlow, 1997; Lovibond & Lovibond, 1995) and clinical samples (Antony et al., 1998; Brown et al., 1997; Page, Hooke, & Morrison, 2007), as well as good test-retest reliability (Brown et al., 1997). Studies using non-psychiatric and psychiatric samples have replicated the three-factor structure of the DASS scales (Antony et al., 1998; Brown et al., 1997; Crawford & Henry, 2003; Lovibond & Lovibond, 1995; Page et al., 2007) and found that the DASS scales correlates highly with legacy measures of depression, anxiety, and stress (Antony et al., 1998; Brown et al., 1997; Crawford & Henry, 2003; Lovibond & Lovibond, 1995; Page et al., 2007), demonstrating good-excellent convergence validity.  The internal consistency reliability (Cronbach’s alpha) in this sample was .97 for the Depression scale, .92 for the Anxiety scale, .95 for the Stress scale, and .98 for the combined subscales total score.  40 Difficulties in Emotion Regulation. The Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) is a 36-item scale used to assess difficulties regulating emotion across six subscales including (1) Nonacceptance, (2) Goal-Directed Behaviour, (3) Impulse Control Difficulties, (4) Lack of Emotional Awareness, (5) Limited Access to Emotion Regulation Strategies, (6) and Lack of Emotional Clarity. For each question, participants indicate on a Likert scale ranging from 1 (almost never) to 5 (almost always) how often each item applies to them. Higher scores indicate greater emotion dysregulation.  The DERS has been validated in both adult (Gratz & Roemer, 2004) and adolescent samples (Weinberg & Klonsky, 2009) demonstrating good internal consistency and test-retest reliability (Tull & Roemer, 2007).  The internal consistency reliability (Cronbach’s alpha) of the DERS scales in this sample was .94 for Nonacceptance, .93 for Goal-Directed Behaviour, .92 for Impulse Control Difficulties, .85 for Lack of Emotional Awareness, .92 for Limited Access to Emotion Regulation Strategies, .86 for Lack of Emotional Clarity, .96 for the combined subscales total score.  Patient-Reported Outcome Measurement Information System. The Patient-Reported Outcome Measurement Information System (PROMIS®; Cella et al., 2007, 2010; Fries et al., 2005) are a set of instruments designed to measure Patient-Reported Outcomes (PROs) across several domains of functioning including anxiety, depression, fatigue, pain interference (and pain intensity), satisfaction with social roles, and sleep disturbance. In this study, only the PROMIS® Anxiety 4a and PROMIS® Depression 4a short forms were used to 41 assess anxiety- and depression-related symptoms occurring in the previous seven days. Each form is composed of four questions. For each question, participants rate the frequency of the symptom specified on a scale ranging from 1 (Never) to 5 (Always). Total scores for each scale are created by combining the numeric value of the four answers. Total items for each scale are converted to a T-score metric with the mean of the US population equal to 50, and a standard deviation fixed at 10. Higher scores indicate more of the domain being measured. The PROMIS® instruments have been found to have excellent psychometric properties including internal consistency (Bjorner et al., 2014a; Cella et al., 2010), as well as strong convergent and divergent validity (Pilkonis et al., 2011; Revicki et al., 2009). Further research has provided support for the validity of the PROMIS® scales in several samples including those with spinal cord injury, muscular dystrophy, post-polio syndrome, and multiple sclerosis (Cook, Bamer, Amtmann, Molton, & Jensen, 2012; Cook, Molton, & Jensen, 2011; Salem, Bamer, Alschuler, Johnson, & Amtmann, 2014). Recent research has found few differences in PROMIS® short form scores obtained using different modes of administration such as paper-based questionnaires, personal computers, personal digital assistants, touch-screen tablets, and interactive voice recording (Bjorner et al., 2014a, 2014b; Stukenborg et al., 2014). Measures of Nonsuicidal Self-Injury, Suicidal Ideation, and Suicide Attempts Beck Scale for Suicidal Ideation. Originally administered as a semi-structured clinical interview, The Beck Scale for Suicidal Ideation (BSI; Beck, Kovacs, & Weissman, 1979) has been adapted to accommodate self-reported suicidal ideation (Beck et al., 1988). The BSI measures suicidal ideation using nineteen items. For each item, participants are presented with three statement responses organized in increasing severity. For example, a participant completing the BSI must select from 42 the following response options on a three-point scale; (0) “I have no desire to kill myself”, (1) “I have a weak desire to kill myself” or (2) “I have a moderate to strong desire to kill myself”. A total score is calculated by combining the values of each question and therefore ranges from 0 to 48. Greater scores indicate greater suicidal ideation.  The self-report version of the BSI demonstrates excellent internal consistency reliability (Beck et al., 1988; Steer, Rissmiller, Ranieri, & Beck, 1993; Witte et al., 2006), as well as good to excellent concurrent, convergent, and discriminant validity (Beck et al., 1988). A cut-off score of 24 has been found to have 1.0 sensitivity and .90 specificity for identifying psychiatric emergency patients with suicidal ideation. The BSI has been used with adolescents (R. A. Steer, Kumar, & Beck, 1993), mixed psychiatric inpatients (Pinninti, Steer, Rissmiller, Nelson, & Beck, 2002; R. a Steer et al., 1993), as well as healthy (Heisel, Flett, & Besser, 2002) and inpatient geriatric samples (Witte et al., 2006).  The internal consistency reliability (Cronbach’s alpha) in this sample was .88. Nonsuicidal Self-Injury. A gateway question similar to the item used by Briere & Gil (1998) was used to assess lifetime history of nonsuicidal self-injury (NSSI). Specifically, the following question was used: “In your lifetime, how often have you intentionally hurt yourself – for example, by scratching, cutting, or burning – even though you were not trying to commit suicide?” Participants answered this question by selecting one of the following options: (1) 0 times, (2) between one and four times, (3) between five and nine times, (4) between ten and fifty times, and (5) more than fifty times. Unlike the question used by Briere & Gil (1998), the question used in the survey asked about lifetime NSSI frequency, rather than past-6 month NSSI frequency. Participants that 43 endorsed a history of one or more episodes of NSSI were presented with items assessing age of onset, most recent NSSI, time between urge to engage in NSSI and performing an act of NSSI, whether medical treatment is required after NSSI, and six functions of NSSI. These items were taken directly from the Self-Injurious Thoughts and Behaviours Interview (SITBI; Nock et al., 2007), a structured interview designed to assess NSSI and suicidal ideation, plans, gestures, and attempts.  The SITBI has demonstrated excellent inter-rater and test-retest reliability over 6 months (Nock et al., 2007). The SITBI overlaps with other measures assessing NSSI, suicidal ideation, and suicide attempts (Nock et al., 2007) and has been used in samples of children (Barrocas, Hankin, Young, & Abela, 2012), adolescents (Dour, Cha, & Nock, 2011; Glassman, Weierich, Hooley, Deliberto, & Nock, 2007), and adult patients presenting to a psychiatric emergency department (Cha et al., 2010; Nock et al., 2010).  Youth Risk Behaviour Survey (YRBS) Suicide Screening Questionnaire. The Youth Risk Behaviour Survey (YRBS; Grunbaum et al., 2002; Kolbe, Kann, & Collins, 1993) is a large-scale survey administered in the United States by the Centre for Disease Control. The survey is administered semi-annually to a nationally representative sample and assess health risk behaviours including lifetime and 12-month suicidal ideation and history of suicide attempt. A history of suicide attempt is assessed by the item: “Have you ever tried to kill yourself”. Suicidal ideation is determined to be present if participants answered “yes” to the item: “Have you ever seriously thought about killing yourself?” The YRBS suicide questions have demonstrated good reliability (Brener et al., 2002; May & Klonsky, 2011).  44 Chapter 8: Results  Results are first examined across lifetime nonsuicidal, ideators, and attempter groups. Lifetime groups were created according to reported 1) lifetime history of suicide attempt (attempters), 2) history of suicidal ideation but no history of attempts (ideators) and 3) no history of either ideation or attempts (nonsuicidal). To examine whether scores on self-report measures differed between the three groups due to recency of ideation and attempts, participants were further divided into non-recent and recent groups based on past-12 month history of suicidal ideation and suicide attempts. Specifically, participants who reported no history of suicidal ideation or suicide attempts in the past 12-months but did reported either a lifetime history of suicide attempt or lifetime history of suicidal ideation but no history of attempt were categorized as non-recent attempters and non-recent ideators, respectively. In contrast, participants reporting a history of suicide attempts or suicidal ideation and no history of attempt occurring in the past 12-months were categorized as recent attempters and recent ideators, respectively. A lifetime nonsuicidal group was used to compare both non-recent and recent ideators and attempter groups. To ensure that groups differ only in the presence of either non-recent or recent suicidal ideation or suicide attempts, participants with a lifetime history of suicide attempts but recent ideation were removed from analyses.  Demographics Lifetime Demographic information for lifetime nonsuicidal, ideators, and attempters is reported in Table 7. Significant age differences between the three groups were obtained, Welch’s F(2, 289.96) = 5.97, p<.005, ω2 = .03. Post hoc tests using Bonferroni correction revealed that nonsuicidal participants were significantly older than both ideators (p<.01) and attempters 45 (p<.005) with no significant age differences obtained between ideators and attempters (p>.9). Chi-square tests found significant differences in sex, χ2(2, N=543) = 22.45, p< 001, Φ = .20, sexual orientation, χ2(8, N=543) = 40.23, p<.001, Φ =.27, marital status, χ2(8, N=543) = 23.27 , p<.005, Φ = .21, highest level of education, χ2(12, N=543) = 26.87, p<.01 , Φ = .22, and yearly household income, χ2(20, N=543) = 33.40, p<.05, Φ = .25. No Race/Ethnicity differences were observed between the three groups χ2(14, N=543) = 16.65, p>.25, Φ = .18. The attempter group had a greater proportion of female participants (68.7%) than ideators (54.7%) and nonsuicidal groups (43.3%). All three groups differed significantly from one another on sexual orientation. Specifically, nonsuicidal participants had the highest proportion of heterosexual participants and the lowest proportion of bisexual participants (92.2% and 3.9%, respectively) compared to ideators (78.7% and 12.7%, respectively) and attempters (65.7% and 24.1%, respectively). Ideators had proportionally less married participants (24.9%) than nonsuicidal participants (39.4) and attempters had a greater proportion of divorced/separated participants (16.9%) than nonsuicidal participants (7.2%). Attempters had a greater proportion of participants with some college or university (51.8%) and a lesser proportion of college or university graduates (21.1%) than ideators (39.1% and 37.1%, respectively) and nonsuicidal participants (34.4% and 37.8%, respectively). Proportional differences in yearly household income were observed for participants earning between $5000 and $9999, with more attempters endorsing this income (6.0%) than nonsuicidal participants (1.1%). Non-Recent Demographic information for non-recent nonsuicidal, ideators, and attempters is reported in Table 8. A one-way analysis of variance (ANOVA) revealed small but significant age differences between the three groups, Welch’s F(2, 214.25) = 4.59, p<.05, ω2 = .02, however, 46 these differences were no longer significant once post-hoc tests using Bonferroni correction were used. Chi-square tests also revealed no significant differences in Race/Ethnicity, χ2(14, N=419) = 13.99, p>.45, Φ = .18, and yearly household income χ2(20, N=419) = 26.22, p>.25, Φ = .25. In contrast, significant proportional differences between the three groups were obtained using chi-square tests on sex χ2(2, N=419) = 17.65, p<.001, Φ = .21, sexual orientation, χ2(8, N=419) = 31.78, p<.001, Φ = .28, marital status, χ2(8, N=419) = 20.46, p<.01, Φ = .22, and highest level of education χ2(12, N=419) = 24.84 p<.05, Φ = .24. Specifically, the attempter group had a greater proportion of females (68.9%) compared with the nonsuicidal group (43.3%) with neither group differing significantly from the ideator group (55.9%). A greater proportion of the ideator and attempter groups reported bisexual orientation (14.7% and 24.3%, respectively) compared with the nonsuicidal group (3.9%) with no significant proportional differences observed comparing the ideator and attempter group. Similarly, the ideator and attempter groups did not significantly differ from one another on the proportion of heterosexual participants (77.2% and 67.0%, respectively) but did significantly differ with the nonsuicidal group (92.2%). Regarding marital status, the ideator group had the largest proportion of single participants (61.8%) which significantly differed from the attempter group (44.7%) but not the nonsuicidal group (51.7%). The ideator group also had the smallest proportion of married participants (26.5%), which significantly differed from the nonsuicidal group (39.4%) but not the attempter group (35.9). The attempter group had a significantly larger proportion of participants reporting some college or university education (54.4%) and a smaller proportion of participants reporting being a college or university graduate (20.4%) than the nonsuicidal group (34.4% and 37.8%, respectively), with neither groups differing from the nonsuicidal group (42.6% and 33.8%, respectively).  47 Recent Demographic information for recent nonsuicidal, ideators, and attempters is reported in. Table 9  Significant age differences between the three groups were obtained, Welch’s F(2, 48.00) = 10.99, p<.01, ω2 = .04. Post hoc tests using Bonferroni correction revealed that nonscuicidal participants were significantly older than attempters (p<.01) with no significant age differences between nonsuicidal participants and ideators (p>.40) as well as between ideators and attempters (p>.15). Chi-square tests revealed no significant differences in sex, χ2(2, N=262) = 1.89, p>.35, Φ = .09, Race/Ethnicity , χ2(12, N=262) = 14.26 , p>.25, Φ = .23, highest level of education, χ2(12, N=262) = 15.19, p>.20 , Φ = .24, and yearly household income, χ2(20, N=262) = 27.46, p>.10 , Φ = .32. In contrast, significant proportional differences were obtained using chi-square tests in sexual orientation, χ2(8, N=262) = 15.98, p<.05, Φ = .25 and marital status, χ2(8, N=262) = 23.02, p<.01, Φ = .30. Specifically, the nonsuicidal group had the largest proportion of participants reporting heterosexual sexual orientation (92.2%) and the smallest proportion of participants reporting their sexual orientation as “other” (0.6%) which significantly differed from the attempter group (71.4% and 9.5%, respectively), with neither group significantly differing from the ideator group (82.0% and 3.3%, respectively). Regarding marital status, the nonsuicidal group had the largest proportion of married participants (39.4%) and the smallest proportion of participants reporting their marital status as “other” (0.6%) which significantly differed from the ideator group (21.3% and 6.6%, respectively), with neither group differing from the attempter group (14.3% and 0.0%, respectively).  Descriptive and Inferential Statistics Table 10 outlines the descriptive statistical information obtained by the entire sample on the study measures. Descriptive and inferential statistics divided according to lifetime history of 48 suicidal ideation and suicide attempts are outlined in Table 11, according to non-recent ideation and attempts (> past 12 months) in Table 12,Table 11 and according to recent ideation and attempts (< past 12 months) in Table 13. Significant differences between lifetime groups as well as non-recent groups were obtained on all but two of the scales administered; DERS – Emotional Awareness and UPPS-P – Sensation Seeking. Similarly, significant differences between recent groups were obtained for all but two scales; BSI – Total Score and DERS – Emotional Awareness.  Covariates Past-year drug abuse, global self-efficacy, and suspected brain injury were classified as covariates due to their potential to impact perceived cognitive functioning. These variables are examined separately both in the following section and in later analyses.  Lifetime As outlined in Table 14, weak to moderate effect size differences in past year drug abuse (d range = .21 – .51) and global self-efficacy (d range = .24 – .59) as well as weak to small (Φ range = .06 - 20) effect sizes differences in suspected brain injury were observed. Across all measures, small to moderate differences were found comparing nonsuicidal and attempter groups (d range = .51 – 59, Φ = .20), small differences comparing nonsuicidal and ideator groups (d range = .31 – 35, Φ = .14), and weak ideator and attempter groups (d range = .21 – 24, Φ = .06).  Non-Recent  As outlined in Table 15, weak to moderate effect size differences in past year drug abuse (d range = .16 – .40) and global self-efficacy (d range = .10 – .32) as well as weak to small (Φ range = .09 - 20) effect sizes differences in suspected brain injury were observed. Across all 49 measures, small differences were found comparing nonsuicidal and attempter groups (d range = .32 – 40, Φ = .20), small differences comparing nonsuicidal and ideator groups (d range = .22 – 24, Φ = .12), and weak differences between ideator and attempter groups (d range = .10 – 19, Φ = .09).  Recent  As outlined in Table 16, small to large effect size differences in past year drug abuse (d range = .38 – .97), moderate to large effect size differences in global self-efficacy (d range = .68 – 1.47), and weak to small (Φ range = .14 - 22) effect sizes differences in suspected brain injury were observed. Small to large differences were found comparing nonsuicidal and attempter groups (d range = .97 – 1.47 Φ = .22), weak to moderate differences comparing nonsuicidal and ideator groups (d range = .38 – 68, Φ = .16), and weak to large differences between ideator and attempter groups (d range = .73 – 80, Φ = .14).  Non-Recent and Recent   As outlined in Table 17, comparing non-recent and recent ideators revealed small effect size differences in both past year drug abuse (d = .21) and global self-efficacy (d = .46) and weak effect size differences in suspected brain injury status (Φ = .05). In contrast, comparing non-recent and recent attempters revealed large effect size differences in past year drug abuse (d = .78) and global self-efficacy (d = 1.25) as well as weak effect size differences in suspected brain injury (Φ = .10).  50 Executive Functioning Lifetime  Effect size differences between lifetime groups on measures of executive functioning are outlined in Table 18. Across all BRIEF-A and FrSBE scales, moderate to large effect size differences (d range = .53 – 1.04) were obtained comparing nonsuicidal and attempter groups, small to moderate effect size differences (d range = .36 – .77) were observed comparing nonsuicidal and ideator groups, and weak to small effect size differences (d range = .11 – .38) were obtained comparing ideator and attempter groups. Nonsuicidal and Attempter Groups To determine which executive functioning scales differentiated between lifetime nonsuicidal and attempter group status, all BRIEF-A and FrSBe scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that all BRIEF-A and FrSBe scales accounted for significant and unique variance over and above the covariates.  A forward method (LR) logistic regression model was then used to determine which of the BRIEF-A and FrSBe scales that significantly contributed to the model would account for the majority of the variance in differentiating nonsuicidal and attempter groups. As outlined in Table 19, the BRIEF-A Emotional Control and FrSBe Apathy scales accounted for the majority of that variance in group status, together explaining a total 23 – 31% of the variance.  Nonsuicidal and Ideator Groups To determine which executive functioning scales differentiated between lifetime nonsuicidal and ideator group status, all BRIEF-A and FrSBe scales were first individually 51 entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that eight of the nine BRIEF-A scales and all of the FrSBe scales accounted for unique and significant variance in explaining group status, over and above the covariates. The BRIEF-A Self-Monitor scale was the only scale that did significantly contribute to the model.  A forward method (LR) logistic regression model was then used to determine which of the BRIEF-A and FrSBe scales that significantly contributed to the model would account for the majority of the variance in differentiating nonsuicidal and ideator groups. As outlined in Table 19, the BRIEF-A Emotional Control and BRIEF-A Initiate scales accounted for the majority of the variance in group status, together explaining a total 13 – 17% of the variance.  Ideator and Attempter Groups To determine which executive functioning scales differentiated between lifetime ideator and attempter group status, all BRIEF-A and FrSBe scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed the BRIEF-A Emotional Control scale was the only scale that accounted for significant and unique variance over and above the covariates. As outlined in Table 19, entering the BRIEF-A Emotional Control scale into a forward method (LR) logistic regression model revealed that the BRIEF-A Emotional Control scale accounted for 3 – 5% of the variance in ideator vs. attempter group status.  Non-Recent Effect size differences between non-recent groups on measures of executive functioning are outlined in Table 20. Across all BRIEF-A and FrSBE scales, small to large effect size 52 differences (d range = .31 –.81) were obtained comparing nonsuicidal and attempter groups, small to moderate effect size differences (d range = .30 – .62) were observed comparing nonsuicidal and ideator groups, and weak to small effect size differences (d range = .03 – .31) were obtained comparing ideator and attempter groups. Nonsuicidal and Attempter Groups To determine which executive functioning scales differentiated between non-recent nonsuicidal and non-recent attempter group status, all BRIEF-A and FrSBe scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that seven of the nine BRIEF-A scales and two of three FrSBe scales accounted for unique and significant variance in explaining group status, over and above the covariates. Specifically, he BRIEF-A Self-Monitor, BRIEF-A Task Monitor, and FrSBe Executive Dysfunction scales did significantly contribute to the model.  A forward method (LR) logistic regression model was then used to determine which of the BRIEF-A and FrSBe scales that significantly contributed to the model would account for the majority of the variance in differentiating nonsuicidal and attempter groups. As outlined in Table 21, the BRIEF-A Emotional Control scale accounted for the majority of the variance in group status, accounting for 13 – 19% of the variance.  Nonsuicidal and Ideator Groups To determine which executive functioning scales differentiated between non-recent nonsuicidal and non-recent ideator groups, all BRIEF-A and FrSBe scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that eight of the nine BRIEF-A scales and all 53 three FrSBe scales accounted for unique and significant variance in explaining group status, over and above the covariates. Specifically, the BRIEF-A Self-Monitor scale was the only scale that did significantly contribute to the model.  A forward method (LR) logistic regression model was then used to determine which of the BRIEF-A and FrSBe scales that significantly contributed to the model would account for the majority of the variance in differentiating nonsuicidal and ideator groups. As outlined in Table 21, the BRIEF-A Inhibit and BRIEF-A Initiate scales significantly accounted for the majority of the variance in group status, together explaining a total 9 – 14% of the variance.  Ideator and Attempter Groups To determine which executive functioning scales differentiated between non-recent ideator and non-recent attempter groups, all BRIEF-A and FrSBe scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that none of the BRIEF-A or FrSBE scales accounted for unique and significant variance in explaining group status, over and above the covariates.  Recent Effect size differences between recent groups on measures of executive functioning are outlined in Table 22. Across all BRIEF-A and FrSBE scales, large effect size differences (d range = 1.25 – 2.06) were obtained comparing recent nonsuicidal and recent attempter groups, moderate to effect size differences (d range = .49 – 1.14) were observed comparing recent nonsuicidal and recent ideator groups, as well as recent ideator and recent attempter groups (d range = .53 – 1.08). 54 Nonsuicidal and Attempter Groups To determine which executive functioning scales differentiated between recent nonsuicidal and recent attempter groups, all BRIEF-A and FrSBe scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that four of the nine BRIEF-A scales and two of the three FrSBe scales accounted for unique and significant variance in explaining group status, over and above the covariates. Specifically, the BRIEF-A Inhibit, BRIEF-A Shift, BRIEF-A Self-Monitor, BRIEF-A Working Memory, BRIEF-A Task Monitor and the FrSBe Executive Dysfunction scales did significantly contribute to the model.  A forward method (LR) logistic regression model was then used to determine which of the BRIEF-A and FrSBe scales that did significantly contribute to the model would account for the majority of the variance in differentiating nonsuicidal and attempter groups. As outlined in Table 23, the BRIEF-A Initiate and FrSBe Disinhibition scales significantly accounted for the majority of the variance in group status, together explaining a total 27 – 86% of the variance.  Nonsuicidal and Ideator Groups To determine which executive functioning scales differentiated between recent nonsuicidal and recent ideator groups, all BRIEF-A and FrSBe scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that eight of the nine BRIEF-A scales and all three FrSBe scales accounted for unique and significant variance in explaining group status, over and above the covariates. Specifically, the BRIEF-A Task Monitor scale was the only scale not did significantly contribute to the model.  55 A forward method (LR) logistic regression model was then used to determine which of the BRIEF-A and FrSBe scales that did significantly contribute to the model would account for the majority of the variance in differentiating nonsuicidal and ideator groups. As outlined in Table 23, the BRIEF-A Emotional Control and FrSBe Apathy scales significantly accounted for the majority of the variance in group status, together explaining a total 23 – 33% of the variance.  Ideator and Attempter Groups To determine which executive functioning scales differentiated between recent ideator and recent attempter groups, all BRIEF-A and FrSBe scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that only the FrSBe Disinhibition scale accounted for unique and significant variance in explaining group status, over and above the covariates. As outlined in Table 23, entering the FrSBe Disinhibition scale into a forward method (LR) logistic regression model revealed that the FrSBe Disinhibition scale accounted for 17 – 26% of the variance in ideator vs. attempter group status.  Non-Recent and Recent  As outlined in Table 24, weak to moderate effect size differences (d range = .09 – .61) were obtained comparing non-recent ideators to recent ideators on measures of executive functioning. In contrast, large effect size differences (d range = .83 – 1.26) were obtained comparing non-recent attempters to recent attempters on measures of executive functioning.  56 Impulsivity Lifetime Effect size differences between lifetime groups on measures of impulsivity are outlined in Table 25. Weak to large effect size differences (d range = .14 – .88) were obtained comparing nonsuicidal and attempter groups, weak to moderate effect size differences (d range = .03 – .58) were observed comparing nonsuicidal and ideator groups, and weak to small effect size differences (d range = .11 – .48) were obtained comparing ideator and attempter groups.  Nonsuicidal and Attempter Groups  To determine which UPPS-P scales differentiated between lifetime nonsuicidal and lifetime attempter groups, all UPPS-P scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that only two of the UPPS-P scales - Negative Urgency and (Lack of) Perseverance - accounted for unique and significant variance in explaining group status, over and above the covariates.  A forward method (LR) logistic regression model was then used to determine which of the UPPS-P scales that significantly contributed to the model would account for the majority of the variance in differentiating nonsuicidal and attempter groups. As outlined in Table 26, the UPPS-P Negative Urgency significantly accounted for the majority of the variance in group status, explaining 15 – 22% of the variance. Nonsuicidal and Ideator Groups To determine which UPPS-P scales differentiated between lifetime nonsuicidal and lifetime ideator groups, all UPPS-P scales were first individually entered into a logistic 57 regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that three of the five UPPS-P scales - Negative Urgency, (Lack of) Premeditation, and (Lack of) Perseverance - accounted for unique and significant variance in explaining group status, over and above the covariates.  A forward method (LR) logistic regression model was then used to determine which of the UPPS-P scales that significantly contributed to the model would account for the majority of the variance in differentiating nonsuicidal and ideator groups. As outlined in Table 26, all three of the UPPS-P scales entered into the model accounted for significant and unique variance, together explaining a total 12 – 18% of the variance. Ideator and Attempter Groups  To determine which UPPS-P scales differentiated between lifetime ideator and lifetime attempter groups, all UPPS-P scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that only two of the five UPPS-P scales - Negative Urgency and (Lack of) Premeditation - accounted for unique and significant variance in explaining group status, over and above the covariates.  A forward method (LR) logistic regression model was then used to determine which of the UPPS-P scales that significantly contributed to the model would account for the majority of the variance in differentiating nonsuicidal and ideator groups. As outlined in Table 26, the UPPS-P (Lack of) Premedication scale accounted for the majority of the variance, explaining 4 – 7% of the variance. 58 Non-Recent Effect size differences between non-recent groups on measures of impulsivity are outlined in Table 27. Weak to moderate effect size differences (d range = .14 – .72) were obtained comparing nonsuicidal and attempter groups, weak to small effect size differences (d range = .07 – .36) were observed comparing nonsuicidal and ideator groups, and weak to small effect size differences (d range = .03 – .35) were obtained comparing ideator and attempter groups.  Nonsuicidal and Attempter Groups  To determine which UPPS-P scales differentiated between non-recent nonsuicidal and non-recent attempter groups, all UPPS-P scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that only two of the five UPPS-P scales - Negative Urgency and (Lack of) Perseverance - accounted for unique and significant variance in explaining group status, over and above the covariates.  A forward method (LR) logistic regression model was then used to determine which of the UPPS-P scales that significantly contributed to the model would account for the majority of the variance in differentiating nonsuicidal and ideator groups. As outlined in Table 28, the UPPS-P Negative Urgency scale accounted for the majority of the variance, explaining 9 – 14% of the variance. Nonsuicidal and Ideator Groups To determine which UPPS-P scales differentiated between non-recent nonsuicidal and non-recent ideator groups, all UPPS-P scales were first individually entered into a logistic 59 regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that only two of the five UPPS-P scales - Negative Urgency and (Lack of) Perseverance - accounted for unique and significant variance in explaining group status, over and above the covariates.  A forward method (LR) logistic regression model was then used to determine which of the UPPS-P scales that significantly contributed to the model would account for the majority of the variance in differentiating nonsuicidal and ideator groups. As outlined in Table 28, the UPPS-P Negative Urgency scale accounted for the majority of the variance, explaining 4 – 7% of the variance. Ideator and Attempter Groups To determine which UPPS-P scales differentiated between non-recent ideator and non-recent attempter groups, all UPPS-P scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that only UPPS-P (Lack of) Premeditation scale accounted for unique and significant variance in explaining group status, over and above the covariates. As outlined in Table 28, entering this scale into a forward method (LR) logistic regression model revealed that the UPPS-P (Lack of) Premeditation scale explained 2 – 4% of the variance. Recent Effect size differences between recent groups on measures of impulsivity are outlined in Table 29. Small to large effect size differences (d range = .39 – 1.74) were obtained comparing nonsuicidal and attempter groups, weak to moderate effect size differences (d range = .02 – .78) 60 were observed comparing nonsuicidal and ideator groups, and moderate to large effect size differences (d range = .67 – 1.37) were obtained comparing ideator and attempter groups.  Nonsuicidal and Attempter Groups  To determine which UPPS-P scales differentiated between recent nonsuicidal and recent attempter groups, all UPPS-P scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that three of the five UPPS-P scales - Negative Urgency, (Lack of) Perseverance, and Positive Urgency - accounted for unique and significant variance in explaining group status, over and above the covariates.  A forward method (LR) logistic regression model was then used to determine which of the UPPS-P scales that significantly contributed to the model would account for the majority of the variance in differentiating nonsuicidal and ideator groups. As outlined in Table 30, both the UPPS-P Negative Urgency and (Lack of) Perseverance scales accounted for significant and unique variance, together explaining a total 25 – 77% of the variance. Nonsuicidal and Ideator Groups To determine which UPPS-P scales differentiated between recent nonsuicidal and recent ideator groups, all UPPS-P scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that only two of the five UPPS-P scales - Negative Urgency and (Lack of) Premeditation - accounted for unique and significant variance in explaining group status, over and above the covariates.  61 A forward method (LR) logistic regression model was then used to determine which of the UPPS-P scales that significantly contributed to the model would account for the majority of the variance in differentiating nonsuicidal and ideator groups. As outlined in Table 30, both the UPPS-P Negative Urgency and (Lack of) Premeditation scales accounted for significant and unique variance, together explaining a total 25 – 77% of the variance. Ideator and Attempter Groups To determine which UPPS-P scales differentiated between recent ideator and recent attempter groups, all UPPS-P scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that four of the five UPPS-P scales accounted for unique and significant variance in explaining group status, over and above the covariates. The UPPS-P (Lack of) Perseverance was the only scale that did not significantly contribute to the model.  A forward method (LR) logistic regression model was then used to determine which of the UPPS-P scales that significantly contributed to the model would account for the majority of the variance in differentiating nonsuicidal and ideator groups. As outlined in Table 30, both the UPPS-P Negative Urgency and (Lack of) Premeditation scales accounted for significant and unique variance, together explaining a total 25 – 37% of the variance. Recent and Non-Recent As outlined in Table 31, weak to small effect size differences (d range = .01 – .46) were obtained comparing non-recent ideators to recent ideators on measures of impulsivity. In contrast, small to large effect size differences (d range = .25 – 1.09) were obtained comparing non-recent attempters to recent attempters on measures of impulsivity.  62 Other Clinical Variables Lifetime Effect size differences between lifetime groups on clinical measures assessing depression, anxiety, stress, and emotion dysregulation are outlined in Table 32. Small to large effect size differences (d range = .22 – .92) were obtained comparing nonsuicidal and attempter groups, small to moderate effect size differences (d range = .21 – .75) were observed comparing nonsuicidal and ideator groups, and weak to small effect size differences (d range = .01 – .34) were obtained comparing ideator and attempter groups.  Nonsuicidal and Attempter Groups  To determine which clinical variables differentiated between lifetime nonsuicidal and lifetime attempter groups, all DASS and DERS scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that all of the DASS scales and three of the six DERS scales accounted for unique and significant variance in explaining group status, over and above the covariates. Specifically, the DERS Goal-Directed, Emotional Awareness, and Emotional Clarity scales did not account for significant variance.  A forward method (LR) logistic regression model was then used to determine which of the DASS and DERS scales that significantly contributed to the model would account for the majority of the variance in differentiating nonsuicidal and attempter groups. As outlined in Table 33, the DASS Anxiety, DASS Stress, and DERS Impulse Control scales each significantly accounted for unique variance in group status, together explaining a total 25 – 32% of the variance. 63 Nonsuicidal and Ideator Groups To determine which clinical variables differentiated between lifetime nonsuicidal and lifetime ideator groups, all DASS and DERS scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that all of the DASS scales and four of the six DERS scales accounted for unique and significant variance in explaining group status, over and above the covariates. Specifically, the DERS Emotional Awareness and Emotional Clarity scales did not account for significant variance.  A forward method (LR) logistic regression model was then used to determine which of the DASS and DERS scales that significantly contributed to the model would account for the majority of the variance in differentiating nonsuicidal and attempter groups. As outlined in Table 33, the DASS Depression DERS Non-Acceptance scales each significantly accounted for unique variance in group status, together explaining a total 16 – 23% of the variance. Ideator and Attempter Groups To determine which clinical variables differentiated between lifetime ideator and lifetime attempter groups, all DASS and DERS scales were individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that none of the DASS or DERS scales accounted for unique and significant variance in explaining group status, over and above the covariates.  Non-Recent Effect size differences between non-recent groups on clinical measures assessing depression, anxiety, stress, and emotion dysregulation are outlined in Table 34Table 32. Small to 64 moderate effect size differences (d range = .19 – .72) were obtained comparing nonsuicidal and attempter groups and nonsuicidal and ideator groups (d range = .19 – .54). Weak to small effect size differences (d range = .00 – .24) were obtained comparing ideator and attempter groups.  Nonsuicidal and Attempter Groups  To determine which clinical variables differentiated between non-recent nonsuicidal and non-recent attempter groups, all DASS and DERS scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that all of the DASS scales and three of the six DERS scales accounted for unique and significant variance in explaining group status, over and above the covariates. Specifically, the DERS Goal-Directed, Emotional Awareness, and Emotional Clarity scales did not account for significant variance.  A forward method (LR) logistic regression model was then used to determine which of the DASS and DERS scales that significantly contributed to the model would account for the majority of the variance in differentiating nonsuicidal and attempter groups. As outlined in Table 35, the DERS Non-Acceptance scale alone accounted for the majority of the unique variance in group status, together explaining a total 11 – 16% of the variance.  Nonsuicidal and Ideator Groups To determine which clinical variables differentiated between non-recent nonsuicidal and non-recent ideator groups, all DASS and DERS scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that all of the DASS scales and four of the six DERS scales accounted for unique and significant variance in explaining group status, over and above the 65 covariates. Specifically, the DERS Emotional Awareness, and Emotional Clarity scales did not account for significant variance.  A forward method (LR) logistic regression model was then used to determine which of the DASS and DERS scales that significantly contributed to the model would account for the majority of the variance in differentiating nonsuicidal and attempter groups. As outlined in Table 35, the DASS Depression and DERS Non-Acceptance scales significantly accounted for the majority of the unique variance in group status, together explaining a total 08 – 13% of the variance.  Ideator and Attempter Groups To determine which clinical variables differentiated between non-recent ideator and non-recent attempter groups, all DASS and DERS scales were individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that none of the DASS or DERS scales accounted for unique and significant variance in explaining group status, over and above the covariates.  Recent Effect size differences between recent groups on clinical measures assessing depression, anxiety, stress, and emotion dysregulation are outlined in Table 36Table 32. Small to large effect size differences (d range = .41 – 1.74) were obtained comparing nonsuicidal and attempter groups and nonsuicidal and ideator groups (d range = .25 – 1.47). Weak to large effect size differences (d range = .15 – .83) were obtained comparing ideator and attempter groups.  66 Nonsuicidal and Attempter Groups  To determine which clinical variables differentiated between recent nonsuicidal and recent attempter groups, all DASS and DERS scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed two of the three DASS scales and three of the six DERS scales accounted for unique and significant variance in explaining group status, over and above the covariates. Specifically, the DASS Stress, DERS Goal-Directed, DERS Emotional Awareness, and DERS Emotional Clarity scales did not account for significant variance.  A forward method (LR) logistic regression model was then used to determine which of the DASS and DERS scales that significantly contributed to the model would account for the majority of the variance in differentiating nonsuicidal and attempter groups. As outlined in Table 37, the DASS Anxiety and DERS Impulse Control scales each accounted for significant and unique variance in group status, together explaining a total 21 – 61% of the variance.  Nonsuicidal and Ideator Groups To determine which clinical variables differentiated between recent nonsuicidal and recent ideator groups, all DASS and DERS scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed all of the DASS scales and four of the six DERS scales accounted for unique and significant variance in explaining group status, over and above the covariates. Specifically, DERS Emotional Awareness and Emotional Clarity scales did not account for significant variance.  67 A forward method (LR) logistic regression model was then used to determine which of the DASS and DERS scales that significantly contributed to the model would account for the majority of the variance in differentiating nonsuicidal and ideator groups. As outlined in Table 37, the DASS Depression and DERS Non-Acceptance scales each accounted for significant and unique variance in group status, together explaining a total 33 – 54% of the variance.  Ideator and Attempter Groups To determine which clinical variables differentiated between recent ideator and recent attempter groups, all DASS and DERS scales were first individually entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed none of the DASS or DERS scales accounted for unique and significant variance in explaining group status, over and above the covariates.  Recent and Non-Recent As outlined in Table 38, weak to large effect size differences (d range = .06 – 1.02) were obtained comparing non-recent ideators to recent ideators on measures of depression, anxiety, stress, and emotion dysregulation. Similarly, small to large effect size differences (d range = .21 – 1.20) were obtained comparing non-recent attempters to recent attempters on measures of depression, anxiety, stress, and emotion dysregulation.  Suicidal ideation and Nonsuicidal Self-Injury Lifetime Effect size differences between lifetime groups on measures assessing suicidal ideation and nonsuicidal self-injury are outlined in Table 39. Since suicidal ideation was not measured in nonsuicidal participants, between-group comparisons using nonsuicidal groups were removed 68 from analyses. A small effect size difference (d = .43) in suicidal ideation was obtained between ideator and attempter groups. Large (d = 1.18), moderate (d = .65), and moderate (d = .63) effect size differences in history of nonsuicidal self-injury were obtained comparing nonsuicidal and attempter, nonsuicidal and ideator, and ideator and attempter groups, respectively.  Nonsuicidal and Attempter Groups To determine whether nonsuicidal self-injury differentiated between lifetime nonsuicidal and lifetime attempter groups, this variable was first entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). This analysis revealed that lifetime history of nonsuicidal self-injury accounted for unique and significant variance in explaining group status, over and above the covariates. As outlined in Table 40, entering this variable into a forward method (LR) model revealed that lifetime nonsuicidal self-injury accounted for 26 – 35% of the variance in group status.  Nonsuicidal and Ideator Groups  To determine whether nonsuicidal self-injury differentiated between lifetime nonsuicidal and lifetime ideator groups, this variable was first entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). This analysis revealed that lifetime history of nonsuicidal self-injury accounted for unique and significant variance in explaining group status, over and above the covariates. As outlined in Table 40, entering this variable into a forward method (LR) model revealed that lifetime nonsuicidal self-injury accounted for 08 – 13% of the variance in group status.  69 Ideator and Attempter Groups To determine whether suicidal ideation and nonsuicidal self-injury differentiated between lifetime nonsuicidal and lifetime ideator groups, these variables were first entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that both suicidal ideation as well as lifetime history of nonsuicidal self-injury accounted for unique and significant variance in explaining group status, over and above the covariates.  A forward method (LR) logistic regression model was then used to determine whether suicidal ideation or nonsuicidal self-injury, or both would account for significant and unique variance in differentiating ideator and attempter groups. As outlined in Table 40, both suicidal ideation and nonsuicidal self-injury each accounted for significant and unique variance in group status, together explaining a total 10 – 15% of the variance in group status.  Non-Recent Effect size differences between non-recent groups on measures assessing suicidal ideation and nonsuicidal self-injury are outlined in Table 41. Since suicidal ideation was not measured in nonsuicidal participants, between-group comparisons using nonsuicidal groups were removed from analyses. A small effect size difference (d = .38) in suicidal ideation was obtained between ideator and attempter groups. Large (d = 1.05), moderate (d = .57), and moderate (d = .60) effect size differences in history of nonsuicidal self-injury were obtained comparing nonsuicidal and attempter, nonsuicidal and ideator, and ideator and attempter groups, respectively.  70 Nonsuicidal and Attempter Groups To determine whether nonsuicidal self-injury differentiated between non-recent nonsuicidal and non-recent attempter groups, this variable was first entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). This analysis revealed that lifetime history of nonsuicidal self-injury accounted for unique and significant variance in explaining group status, over and above the covariates. As outlined in Table 42, entering this variable into a forward method (LR) model revealed that lifetime nonsuicidal self-injury accounted for 23 – 32% of the variance in group status.  Nonsuicidal and Ideator Groups  To determine whether nonsuicidal self-injury differentiated between non-recent nonsuicidal and non-recent ideator groups, this variable was first entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). This analysis revealed that lifetime history of nonsuicidal self-injury accounted for unique and significant variance in explaining group status, over and above the covariates. As outlined in Table 42, entering this variable into a forward method (LR) model revealed that lifetime nonsuicidal self-injury accounted for 06 – 11% of the variance.  Ideator and Attempter Groups To determine whether suicidal ideation and nonsuicidal self-injury differentiated between lifetime nonsuicidal and lifetime ideator groups, these variables were first entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that both suicidal ideation as well as lifetime history of nonsuicidal self-injury accounted for unique and significant variance in explaining group status, over and above the covariates.  71 A forward method (LR) logistic regression model was then used to determine whether suicidal ideation or nonsuicidal self-injury, or both would account for significant and unique variance in differentiating ideator and attempter groups. As outlined in Table 42, both suicidal ideation and nonsuicidal self-injury each accounted for significant and unique variance in group status, together explaining a total 9 – 14% of the variance.  Recent Effect size differences between recent groups on measures assessing suicidal ideation and nonsuicidal self-injury are outlined in Table 43Table 41. Since suicidal ideation was not measured in nonsuicidal participants, between-group comparisons using nonsuicidal groups were removed from analyses. A small effect size difference (d = .38) in suicidal ideation was obtained between ideator and attempter groups. Large (d = 1.14), moderate (d = .75), and moderate (d = .64) effect size differences in history of nonsuicidal self-injury were obtained comparing nonsuicidal and attempter, nonsuicidal and ideator, and ideator and attempter groups, respectively.  Nonsuicidal and Attempter Groups To determine whether nonsuicidal self-injury differentiated between recent nonsuicidal and recent attempter groups, this variable was first entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). This analysis revealed that lifetime history of nonsuicidal self-injury accounted for unique and significant variance in explaining group status, over and above the covariates. As outlined in Table 44, entering lifetime nonsuicidal self-injury into a forward method (LR) model revealed that lifetime nonsuicidal self-injury accounted for 15 – 32% of the variance in group status.  72 Nonsuicidal and Ideator Groups  To determine whether nonsuicidal self-injury differentiated between recent nonsuicidal and recent ideator groups, this variable was first entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). This analysis revealed that lifetime history of nonsuicidal self-injury accounted for unique and significant variance in explaining group status, over and above the covariates. As outlined in Table 44, entering lifetime history of nonsuicidal self-injury into a forward method (LR) model revealed that lifetime nonsuicidal self-injury accounted for 11 – 15% of the variance.  Ideator and Attempter Groups To determine whether suicidal ideation and nonsuicidal self-injury differentiated between lifetime nonsuicidal and lifetime ideator groups, these variables were first entered into a logistic regression model which included the three covariate variables (DAST, GSES, and ABSPBI). These analyses revealed that lifetime history of nonsuicidal self-injury, but not suicidal ideation, accounted for unique and significant variance in explaining group status, over and above the covariates. As outlined in Table 44, a forward method (LR) logistic regression model using lifetime history of nonsuicidal self-injury revealed that lifetime history of nonsuicidal self-injury accounted for a total 9 – 13% of the variance.  Recent and Non-Recent As outlined in Table 45, weak to large effect size differences (d range = .22 – .95) were obtained comparing non-recent ideators to recent ideators on measures of suicidal ideation and nonsuicidal self-injury. Similarly, small to large effect size differences (d range = .27 – .87) were obtained comparing non-recent attempters to recent attempters on measures of suicidal ideation and nonsuicidal self-injury.  73 Chapter 9: Discussion This study examined the relationship between self-reported executive functioning, history of suicidal ideation, and suicide attempts using a large online sample. We focused on executive functioning because of its importance in mediating thought-behaviour relationships, and its potential for distinguishing those who have versus have not acted on suicidal thoughts.  Large differences in self-reported executive functioning were found between recent ideators and recent attempters, but not between lifetime attempters and lifetime ideators or between non-recent attempters and non-recent ideators. Logistic regression analyses revealed that the relationship of self-reported executive functioning to recent suicidal ideation and recent suicide attempts was largely, though not completely, explained by participants’ sense of self-efficacy, history of suspected brain injury, and history of drug abuse. Taken together, the findings from this study suggest that self-reported executive functioning might be uniquely associated with a recent history of suicide attempts, over and above recent suicidal ideation.  One possible explanation of these results is that impaired executive functioning represents a state risk factor for suicide attempts. Executive functioning abilities such as planning, decision making, and self-monitoring are crucial for daily functioning and their impairment has been associated with an increased likelihood of engaging in high-risk and harmful behaviours (Brower & Price, 2001; Elliott, 2003; Grant, Contoreggi, & London, 2000; Pennington & Ozonoff, 1996). Furthermore, as previously discussed, studies using suicidal populations have demonstrated that performance on objective measures of decision making differentiates suicide attempters from both patient and healthy controls (Richard-Devantoy et al., 2013). Viewed in this context, individuals with suicidal ideation and impaired executive functioning might be at a greater risk of attempting suicide due to their diminished ability to 74 engage in protective cognitive strategies such as generating alternative coping strategies, accurately assessing the consequences of prospective behaviours, and inhibiting maladaptive emotional and behavioural responses.   An alternative explanation of these findings is that recent suicide attempters have a more negative view of themselves, including their executive functioning abilities, as a result of their recent suicide attempt. In line with this explanation, large differences between recent attempters and recent ideators were observed on a measure designed to assess general self-efficacy (i.e. the GSES). General self-efficacy along with history of drug abuse and suspected brain injury also accounted for much of the relationship between self-reported executive functioning and recent ideator vs. recent attempter status. These findings are consistent with studies documenting that poor self-esteem is associated with a history of suicide attempts in adolescents both cross-sectionally (Wild, Flisher, & Lombard, 2004) as well as longitudinally (Wichstrøm, 2000). That being said, caution is required in interpreting the relationship between self-efficacy and recent history of suicide attempts since self-efficacy was assessed by asking participants to rate the extent to which they identified with sentences describing successful problem solving, the ability to generate alternative strategies when faced with problems, and persevering with one’s goals when faced with difficulties – abilities considered central to the construct of executive functioning. It is therefore possible that the measure used to assess self-efficacy might have also assessed participants’ perception of their executive functioning abilities. This limitation might extend beyond the specific measure used since the constructs of self-efficacy and executive functioning may not be completely independent, with research suggesting that self-efficacy night mediate the relationship between executive functioning abilities and behaviour (McAuley et al., 2011). 75 A second approach to clarifying whether general negative reporting explains the differences in executive functioning between recent attempters and recent ideators is to examine differences on the DASS depression scale. The DASS depression scale was designed to measure depression symptomatology including dysphoria, hopelessness, and self-deprecation, and can therefore be used to assess general negative reporting. Examining scores obtained by recent attempters and recent ideators on the DASS depression scale revealed that both groups endorsed experiencing elevated levels of depression, with large differences obtained comparing recent attempters and recent ideators to nonsuicidal participants. In contrast, however, small differences in depression symptomatology were found comparing recent attempters and recent ideators. General negative reporting therefore does not seem to explain the large differences observed in executive functioning comparing recent attempters to recent ideators since both groups obtained similar scores on the DASS depression scale. Recent attempters might also report worse executive functioning due to the physical impact the suicide attempt had on attempters’ cognitive functioning. Specifically, since nearly all suicide methods have the potential to cause physical damage to the nervous system, it is possible that the difference in reported executive functioning might result from the nervous system damage attempters sustained during their recent suicide attempt. Additionally, given that recovery from a traumatic brain injury is most accelerated in the first 12-months post-injury (Christensen et al., 2008; Novack, Alderson, Bush, Meythaler, & Canupp, 2000), this explanation might account for the negligible-small differences in executive functioning obtained comparing lifetime and non-recent attempter and ideator groups. History of brain injury represents one way of assessing for neurological damage and large differences between recent attempters and recent ideators would be expected to account for the differences obtained between 76 these groups in reported executive functioning. In contrast, however, our study found only minor differences in history of suspected brain injury when comparing attempters and ideators across lifetime, non-recent, and recent groups. A potential limitation of this finding is the lack of empirical validation the ABSPBI has received in accurately identifying individuals with a history of suspected brain injury. Although the lack of empirical support for the ABSPBI limits the conclusions that can be obtained about the relationship between brain injury, suicide attempts, and executive functioning, this limitation extends to other self-report measures of brain injury since, to our knowledge, no self-report measure has been shown to accurately assess for history of brain injury. It therefore remains unclear whether suicide attempters report impaired cognitive functioning as a result of the physical damage sustained from the suicide attempt. Research examining the accuracy of self-reported inventories in identifying brain injury as well as the cognitive sequlae experienced by suicide attempters is therefore encouraged.  There are unfortunately few studies to compare the findings of this study to since, to our knowledge, no other study has compared self-reported executive functioning in suicide ideators and attempters. Loyo et al., (2013) were the only study to assess self-reported executive functioning in a sample with a history of suicide attempts. This study found that suicide attempters with depression and anxiety reported worse perceived executive functioning on several BRIEF-A scales compared to patient and healthy controls with no histories of suicide attempts. It remains unclear, however, whether the reported differences in their study are due to a history of suicide attempts, suicidal ideation, or both. Of the studies that did compare ideators to attempters (previously described in Chapter 3), all studies used objective measures of executive functioning. Despite comparing ideators to attempters, however, it is difficult to conclude the extent to which the results of our study overlap with those using objective measures, especially 77 given that findings from several studies have demonstrated that objective and subjective measures of executive functioning minimally overlap with one another (Barkley, 2012; Chaytor et al., 2006; Odhuba et al., 2005; Strauss et al., 2006).  In addition to differences in executive functioning, this study also found that several non-executive functioning scales differentiated between suicide attempters and suicide ideators. Specifically, large differences between recent attempters and recent ideators were observed on the UPPS-P (lack of) premeditation, negative urgency, and positive urgency scales. Notably, recent attempters differed most from recent ideators on these three UPPS-P scales to a greater extent than on any other scale administered in this study. Logistic regression analyses found that both lack of premeditation and negative urgency, but not positive urgency, were uniquely predictive of recent ideator vs. recent attempter status, over and above history of suspected brain injury, drug abuse, and participants’ general self-esteem. The UPPS-P lack of premeditation scale was also the only scale to differentiate between lifetime attempters and ideators as well as non-recent attempters and ideators, though to a much lesser degree than recent attempters and recent ideators. These findings are similar to those obtained in other studies using the UPPS scales with suicidal populations (Klonsky & May, 2010). Specifically, Klonsky and May (2010) found that the UPPS lack of premeditation scale was the only UPPS scale that differentiated lifetime attempters from lifetime ideators across large samples of university students, high school students, and active military personnel. Our study replicates these findings, namely that lack of premeditation differentiates lifetime attempters from ideators, as well as extends their results by suggesting that lack of premeditation more strongly differentiates recent, rather than non-recent, attempters from ideators. Similarly, our study failed to find evidence that negative urgency differentiated lifetime and non-recent attempters from lifetime and non-recent ideators. However, 78 our study did find large differences between recent attempters and recent ideators on the UPPS-P negative urgency scale and that this difference remained robust when controlling for history of suspected brain injury, drug abuse, and general self-efficacy. Viewed together, these results support that lack of premeditation is uniquely associated with both non-recent and recent history of suicide attempts, over and above suicidal ideation, as well as highlight the possibility that negative urgency may represent an important state risk factor for suicide attempts.  This study also demonstrated that lifetime history of NSSI is strongly linked to history of suicidal ideation and suicide attempts. Specifically, medium differences in lifetime NSSI were found between attempters and ideators across lifetime, non-recent, and recent groups, with attempters reporting a greater lifetime frequency of NSSI. Furthermore, NSSI also reliably differentiated ideators from nonsuicidal participants across lifetime, non-recent, and recent groups. The relationship of NSSI to either suicidal ideation or suicide attempts could not be explained by history of suspected brain injury, drug abuse, or general self-efficacy, with NSSI consistently accounting for unique variance in group status. The importance of NSSI in predicting suicide attempts is well documented in the empirical literature. Cross-sectional research using four large samples of adolescents and adults has shown that NSSI is more strongly related to a history of suicide attempts than commonly-cited risk factors for suicide such as depression, anxiety, and borderline personality disorder (Klonsky, May, & Glenn, 2013). Longitudinal research has replicated these results and found that NSSI is a stronger predictor of future suicide attempts than past suicide attempts (Asarnow et al., 2011; Guan, Fox, & Prinstein, 2012; Wilkinson, Kelvin, Roberts, Dubicka, & Goodyer, 2011). The results of this study confirm that lifetime NSSI is uniquely associated with a lifetime history of suicide attempt, irrespective of the recency of the attempt.  79 Findings from this study have important clinical implications. A central aim of suicide risk assessment is to identify who among those thinking about suicide is most likely to act on their thoughts. Current suicide risk assessment protocols largely focus on assessing variables such as depression, anxiety, and emotional dysregulation which an increasing body of research suggests are more predictive of suicidal thoughts than suicidal acts (Kessler, Borges, & Walters, 1999; Nock et al., 2013; Nock, Borges, & Ono, 2012). In contrast, the results of our study suggest that executive functioning and some impulsivity scales seem to be more strongly associated with both lifetime and recent suicide attempts. Suicide assessment protocols might therefore benefit from including questions that assess participants’ executive functioning abilities and impulsivity alongside existing measures.  There are several limitations to this study. First, the cross-sectional design used in this study precludes the examination of the temporal relationship between the measured variables of interest and the onset of suicidal ideation and attempts. An inability to establish the temporal sequence of events significantly limits the conclusions that can be drawn from the study since observed differences between nonsuicidal, ideator, and attempter groups could reflect predisposing factors for suicidal ideation and attempts (i.e. risk factors), the result of suicidal ideation and attempts, or both. Prospective longitudinal research examining the relationship of executive functioning and impulsivity to suicidal ideation and attempts is therefore required to clarify whether these variables predict future suicidal ideation and suicide attempts.  Second, the results of this study are also limited by the small sample size of recent attempters. Although the small sample was expected given the prevalence of past-12 month suicide attempts in the general population, caution should be used in interpreting the results of this study since using a small sample limits the generalizability of the findings to this population. 80 However, despite the small sample size of recent attempters used in this study, the large effect sizes obtained between recent attempter and ideators on measures of executive functioning and impulsivity suggest the presence of a possible large difference between these two groups and therefore encourage future research.  Finally, this study relied solely on self-reported information to assess variables of interest. Unlike objective measures, the utility of self-reported information can be limited if participants are unwilling to either disclose or accurately report their experiences. Using self-report measures of executive functioning also limits our ability to integrate the study’s findings with the existing literature on executive functioning and suicide since the vast majority of studies have primarily relied on objective rather than subjective measures to assess executive functioning. In planning future studies we aim to incorporate both subjective and objective measures of executive functioning to more completely assess the relationship of executive functioning to suicidal ideation and suicide attempts.  81 Table 1. Studies Assessing the Performance of Individuals with a History of Suicide Attempt on the Iowa Gambling Task Author Location Study type Sample type Age N Findings        Bridge et al., 2012 U.S. Cross-sectional Emergency Department patients and Outpatient 13-18,  Mean age =15.6 40 attempters;  40 patient controls Attempters < patient controls on net score, third score (card choice 41-60), and last score (card choice 81-100).         Gilbert et al., 2011 U.S. Cross-sectional  Inpatients and Outpatient; Bipolar 18-62,  Mean age =42.2 28 attempters; 39 patient controls Attempters = patient controls.        Gorlyn et al., 2013 U.S.  Cross-sectional Inpatients and Community; Major Depressive Disorder Mean age =35.1 26 attempters (6 violent,  20 non-violent);  46 patient controls;  42 healthy controls 1. Attempters = patient controls = healthy controls. 2. Violent attempters = non-violent attempters = patient controls = healthy controls.        Homaifar et al., 2012 U.S. Cross-sectional Military veterans; TBI 29-75,  Mean age =51.2 18 attempters; 29 patient controls Attempters = patient controls.        Jollant et al., 2005 France, Switzerland Cross-Sectional Clinical 19-70 Mean age =40.7 32 violent attempters; 37 nonviolent attempters; 25 patient controls; 82 healthy controls 1. Violent and non-violent attempters < healthy controls on the fifth score and net score.  2. Violent attempters < patient controls on the fifth score and net score.        Jollant, Guillaume, Jaussent, France, Switzerland Cross-sectional Clinical 18-75, Mean age =32.4 171 attempters (52 violent, 119 nonviolent); Attempters < patient controls on net score. 82 Author Location Study type Sample type Age N Findings Bellivier, et al., 2007 146 patient controls        Jollant et al., 2010 UK Cross-sectional Community, Males only 22-59, Mean age =36.5 13 attempters; 12 patient controls; 15 healthy controls Attempters < patient controls = healthy controls on second score (card choice 21-40), last score (card choice 81-100), and net score.         Jollant et al., 2013 France Cross-sectional Emergency Department patients Mean age =38.5 151 attempters;  81 patient controls; 144 healthy controls 1. Healthy controls > patient controls and attempters on all variables. 2. Attempters < patient controls on last score (card choice 81-100).        Legris et al., 2012 Canada Cross-sectional Community; Borderline Personality Disorder (BPD); Females only 18-51, Mean age =31.7 Attempters and non-attempters not reported;  41 patients with BPD; 41 healthy controls Attempters = patient controls.        Loyo et al., 2013 Mexico Cross-Section Emergency Department patients and Community; Depression and Anxiety 18-41, Mean age =23.95 25 attempters; 25 patient controls; 25 healthy controls Attempters < patient controls = healthy controls on first score (card choice 1-20) and last score (card choice 81-100).        Malloy-Diniz et al., 2009 Brazil Cross-sectional Community Mean age =38.7 17 attempters; 19 patient controls; 53 healthy controls Attempters < patient controls < healthy controls on third score (card choice 41-60), fourth score 83 Author Location Study type Sample type Age N Findings (card choice 61-80), last score (card choice 81-100), and net score.         Martino et al., 2011 Argentina Cross-sectional Outpatient; Bipolar Mean age =40.0 22 attempters; 63 patient controls Attempter > patient controls on selecting cards from deck A and fewer cards from deck C        Oldershaw et al., 2009 UK Cross-sectional Community 12-18, Mean age =15.8 52 self-harm (28 attempters, 26 non-attempters); 22 patient controls; 57 healthy controls Attempters = patient controls.        Westheide et al., 2008 Germany Cross-sectional Emergency Department patients 19-58, Mean age =37.2 29 attempters (15 with suicidal ideation, 14 without suicidal ideation); 29 healthy controls Attempters with ideation < attempters without ideation = healthy controls on net score.       84 Table 2. Studies Assessing the Performance of Individuals with a History of Suicide Attempt on the Stroop Test Author Location Study type Sample type Age N Findings        Barrett et al., 2011 Norway Cross-sectional Inpatients and Outpatient; Schizophrenia Mean age =31.8 53 attempters; 121 patient controls Attempters = patient controls.        Becker et al., 1999 Germany Cross-sectional Inpatient, Outpatient, and Community Mean age =38.3 31 attempters; 31 patient controls  Attempters > patient controls on time reading suicide-related words        Burton et al., 2011 U.S. Cross-sectional Inpatients 18-60, Mean age =37.5 37 attempters; 40 ideators Attempters < ideators on interference total correct T-score.        Cha et al., 2010 U.S. Cross-sectional and longitudinal Emergency Department patients Mean age =34.6 68 attempters; 56 patient controls 1. Attempters > patient controls interference of suicide-related words. 2. Interference of suicide-related words associated with suicide attempt in past week but not past month, year, or lifetime.  3. Attentional bias toward suicide-related stimuli predicted suicide attempts during follow-up period.         Gilbert et al., 2011 U.S. Cross-sectional  Inpatients and Outpatient; Bipolar 18-62,  Mean age =42.2 28 attempters; 39 patient controls Attempters = patient controls        85 Author Location Study type Sample type Age N Findings Harkavy-Friedman et al., 2006 U.S. Cross-sectional Emergency Department patients, Inpatients, and Outpatient; Bipolar 18-57, Mean age =33.7 51 attempters (32 with BPI, 19 with BPII); 58 healthy controls  Attempters with BPI > attempters with BPI = healthy controls on percent error.         Keilp et al., 2001 U.S. Cross-sectional Community Mean age =40.1 15 high-lethality attempters;  14 low-lethality attempters;  21 patient controls; 22 healthy controls High-lethality attempters > healthy controls on interference.         Keilp et al., 2008 U.S. Cross-sectional Community; Major Depressive Episode Mean age = 38.0 42 high-lethality attempters; 53 low-lethality attempters; 83 patient controls; 66 healthy controls 1. High-lethality attempters < low-lethality attempters = patient controls < healthy controls on percent interference.  2. High-lethality attempters = low-lethality attempters = patient controls < healthy controls on reaction time colour-word items and number correct word items.        Keilp et al., 2013 U.S. Cross-sectional Clinical;  Major Depressive Episode Mean age =36.3 72 attempters; 80 patient controls; 56 healthy controls Attempters > patient controls = healthy controls on interference.         86 Author Location Study type Sample type Age N Findings Legris et al., 2012 Canada Cross-sectional Community; Borderline Personality Disorder (BPD); Females only 18-51, Mean age =31.7 Attempters and non-attempters not reported;  41 patients with BPD; 41 healthy controls Interference negatively correlated with lifetime suicide attempts.        Loyo et al., 2013 Mexico Cross-Section Emergency Department patients and Community;  Depression and Anxiety 18-41, Mean age =23.95 25 attempters; 25 patient controls; 25 healthy controls 1. Attempters > healthy controls on response time in interference condition and reading errors. 2. Attempters = patient controls = healthy controls on emotional Stroop.        Malloy-Diniz et al., 2009 Brazil Cross-sectional Community Mean age =38.7 17 attempters; 19 patient controls; 53 healthy controls Attempters = patient controls < healthy controls on colour naming, word colour naming, colour/word interference and all error scores for these conditions.         Raust et al., 2007 France Cross-sectional  Inpatient and Community 18-65, Mean age =42.5 30 attempters; 39 healthy controls Attempters < healthy controls on word, colour, word-colour conditions.         Richard-Devantoy et al., 2012 France Cross-sectional Inpatient and Community 65+, Mean age =76.0 20 attempters; 20 patient controls; 20 healthy controls 1. Attempters = patient controls > healthy controls on interference score. 2. Attempters > patient controls > healthy controls on errors.        87 Author Location Study type Sample type Age N Findings Richard-Devantoy et al., 2014 U.S. Cross-sectional Inpatient 60+, Mean age =68.1 17 high-lethality attempters; 14 low-lethality attempters; 16 ideators; 38 patient controls; 17 healthy controls 1. High and low-lethality attempters > ideators = patient controls = healthy controls on time to complete inhibition condition.  2. High and low-lethality attempters > patient controls on uncorrected errors and time to execute the naming condition.     88 Table 3. Studies Assessing the Performance of Individuals with a History of Suicide Attempt on the Trail Making Test – Part B Author Location Study type Sample type Age N Findings        Burton et al., 2011 U.S. Cross-sectional Inpatients 18-60, Mean age =37.5 37 attempters; 40 ideators Attempters = ideators on T-score        Ellis et al., 1992 U.S. Cross-sectional Emergency Department patients Mean age =35.9 20 attempters; 27 patient controls Attempters > patient controls         Harkavy-Friedman et al., 2006 U.S. Cross-sectional Emergency Department patients, Inpatients, and Outpatient; Bipolar 18-57, Mean age =33.7 51 attempters (32 with BPI, 19 with BPII); 58 healthy controls  Attempters with BPI = Attempters with BPII = healthy controls        Keilp et al., 2001 U.S. Cross-sectional Community Mean age =40.1 15 high-lethality attempters;  14 low-lethality attempters;  21 patient controls; 22 healthy controls High-lethality attempters = low-lethality attempters = patient controls = health controls        Keilp et al., 2013 U.S. Cross-sectional Clinical;  Major Depressive Episode Mean age =36.3 72 attempters; 80 patient controls; 56 healthy controls Attempters = patient controls = healthy controls        King et al., 2000 U.S.  Cross-sectional Emergency Department patients;  50-84, Mean age =66.7 18 attempters; 29 patient controls; 30 healthy controls Attempters = patient controls = healthy controls 89 Author Location Study type Sample type Age N Findings Major Depression        Martino et al., 2011 Argentina Cross-sectional Outpatient; Bipolar Mean age =40.0 22 attempters; 63 patient controls Attempters = patient controls        Nangle et al., 2006 Ireland Cross-sectional Outpatient; Schizophrenia Mean age =45.8 28 attempters; 50 patient controls Attempters < patient controls        Potkin et al., 2003 U.S. Cross-sectional and longitudinal Inpatient and Outpatient; Schizophrenia Mean age =36.3 Total n=188; Number of lifetime attempters not reported;  52 not currently suicidal; 69 moderately suicidal or recently attempted suicide 1. Attempters and currently suicidal = nonsuicidal 2. Minimal (r=<.10) correlation between Trails B and lifetime suicide attempts        Richard-Devantoy et al., 2012 France Cross-sectional Inpatient and Community 65+, Mean age =76.0 20 attempters; 20 patient controls; 20 healthy controls Attempters = patient controls > healthy controls        Yen et al., 2008 Taiwan Cross-sectional Outpatient;  Bipolar Mean age =40.8 9 with history of attempt or ideation in past 12-months; 87 without history of attempt or ideation in past 12-months 12-month attempters/ideators = 12-month non-attempters/non-ideators    90  Table 4. Studies Assessing the Performance of Individuals with a History of Suicide Attempt on Measures of Verbal Fluency Author Location Study type Sample type Age N Findings        Audenaert et al., 2002 Belgium Cross-sectional Emergency Department patients; Major Depressive Disorder 18-50, Mean age =27.2 20 attempters; 20 healthy controls Attempters < healthy controls on phonemic and semantic fluency.           Barrett et al., 2011 Norway Cross-sectional Inpatients and Outpatients; Schizophrenia Mean age =31.8 53 attempters; 121 patient controls Attempters = patient controls on semantic fluency.   Phonemic fluency not administered.        Burton et al., 2011 U.S. Cross-sectional Inpatients 18-60, Mean age =37.5 37 attempters; 40 ideators Attempters = ideators on phonemic and semantic fluency.        Harkavy-Friedman et al., 2006 U.S. Cross-sectional Emergency Department patients, Inpatients, and Outpatients; Bipolar 18-57, Mean age =33.7 51 attempters (32 with BPI, 19 with BPII); 58 healthy controls  BPI attempters = BPII attempters < healthy controls on phonemic fluency.  Semantic fluency not administered.         Keilp et al., 2001 U.S. Cross-sectional Community Mean age =40.1 15 high-lethality attempters;  14 low-lethality attempters;  21 patient controls; 1. High lethality < low-lethality = patient controls on phonemic fluency 2. High lethality < patient controls on semantic fluency 91 Author Location Study type Sample type Age N Findings 22 healthy controls        Keilp et al., 2013 U.S. Cross-sectional Clinical;  Major Depressive Episode Mean age =36.3 72 attempters; 80 patient controls; 56 healthy controls Attempters = patient controls < healthy controls on phonemic and semantic fluency        Kim et al., 2003  U.S.  Cross-sectional Inpatients 18-65, Mean age =35.2 200 with lifetime suicidal ideation/attempts; 133 patient controls Lifetime ideation/attempts = patient controls on phonemic fluency.  Lifetime ideation/attempts > patient controls on semantic fluency.        King et al., 2000 U.S.  Cross-sectional Emergency Department patients;  Major Depression 50-84, Mean age =66.7 18 attempters; 29 patient controls; 30 healthy controls Attempters = patient controls = healthy controls on phonemic fluency.  Semantic fluency not administered.        Martino et al., 2011 Argentina Cross-sectional Outpatient; Bipolar Mean age =40.0 22 attempters; 63 patient controls Attempters = patient controls on phonological fluency  Semantic fluency not administered.        Nangle et al., 2006 Ireland Cross-sectional Outpatient; Schizophrenia Mean age =45.8 28 attempters; 50 patient controls Attempters > patient controls on phonological fluency  Semantic fluency not administered.        Potkin et al., 2003 U.S. Cross-sectional Inpatient and Outpatient; Schizophrenia Mean age =36.3 Total n=188; Number of lifetime attempters not reported;  Current attempters/ideators = Not currently ideating patient controls on phonemic and semantic fluency.  92 Author Location Study type Sample type Age N Findings and longitudinal 52 not currently suicidal patient controls; 69 moderately suicidal or recently attempted suicide        Richard-Devantoy et al., 2012 France Cross-sectional Inpatient and Community 65+, Mean age =76.0 20 attempters; 20 patient controls; 20 healthy controls 1. Attempters = patient controls < healthy controls on phonemic fluency 2. Attempters < healthy controls on semantic fluency        Richard-Devantoy et al., 2013 France Cross-sectional Community 18-65, Mean age =41.4  35 attempters; 31 patient controls; 37 healthy controls 1. Attempters = patient controls < healthy controls on phonemic fluency 2. Attempters < patient controls = healthy controls on semantic fluency        Yen et al., 2008 Taiwan Cross-sectional Outpatient;  Bipolar Mean age =40.8 9 with history of attempt or ideation in past 12-months; 87 without history of attempt or ideation in past 12-months Past-12 month attempters/ideators = past 12-month non-attempters/ideators on phonemic fluency.  Semantic fluency not administered.    93 Table 5. Studies Assessing the Performance of Individuals with a History of Suicide Attempt on the Wisconsin Card Sorting Test Author Location Study type Sample type Age N Findings        Burton et al., 2011 U.S. Cross-sectional Inpatients 18-60, Mean age =37.5 37 attempters; 40 ideators Attempters > ideators on total errors, T-score.        Ellis et al., 1992 U.S. Cross-sectional Emergency Department patients Mean age =35.9 20 attempters; 27 patient controls Attempters = patient controls.        Gilbert et al., 2011 U.S. Cross-sectional  Inpatients and Outpatients; Bipolar 18-62,  Mean age =42.2 28 attempters; 39 patient controls Attempters = patient controls        Homaifar et al., 2012 U.S. Cross-sectional Military veterans; TBI 29-75,  Mean age =51.2 18 attempters; 29 patient controls 1. Attempters < patient controls on perseverative errors. 2. Attempters = patient controls on failure to maintain set.           Huber et al., 2012 Germany Cross-sectional Emergency Department patients and Inpatients  Mean age =24.5 Total n = 152. Unknown number of lifetime attempters.  Suicidality at admission correlated with completed categories and perseveration errors.         Keilp et al., 2001 U.S. Cross-sectional Community Mean age =40.1 15 high-lethality attempters;  14 low-lethality attempters;  1. High-lethality attempters < low-lethality attempters = patient controls on failure to maintain set.  94 Author Location Study type Sample type Age N Findings 21 patient controls; 22 healthy controls 2. High-lethality attempters = low-lethality attempters = patient controls = healthy controls on categories, percent error, and perseverative error        Keilp et al., 2013 U.S. Cross-sectional Clinical;  Major Depressive Episode Mean age =36.3 72 attempters; 80 patient controls; 56 healthy controls Attempters = patient controls = healthy controls        Kim et al., 2003  U.S.  Cross-sectional Inpatients 18-65, Mean age =35.2 200 with lifetime suicidal ideation/attempts; 133 patient controls Lifetime suicidal ideation/attempts < lifetime nonsuicidal on perseverative errors.          King et al., 2000 U.S.  Cross-sectional Emergency Department patients;  Major Depression 50-84, Mean age =66.7 18 attempters; 29 patient controls; 30 healthy controls Attempters = patient controls = healthy controls        Loyo et al., 2013 Mexico Cross-Section Emergency Department patients and Community;  Depression and Anxiety 18-41, Mean age =23.95 25 attempters; 25 patient controls; 25 healthy controls Attempters = patient controls = healthy controls on classic WCST and emotional WCST        95 Author Location Study type Sample type Age N Findings Malloy-Diniz et al., 2009 Brazil Cross-sectional Community Mean age =38.7 17 attempters; 19 patient controls; 53 healthy controls Attempters = patient controls < healthy controls on total correct, perseverative errors, categories completed, and failure in maintaining set        Martino et al., 2011 Argentina Cross-sectional Outpatient; Bipolar Mean age =40.0 22 attempters; 63 patient controls Attempters = patient controls        McGirr et al., 2012 U.S.  Cross-sectional Inpatients and Community 65+, Mean age =69.2 14 high-lethality attempters; 20 low-lethality attempters; 29 patient controls; 30 healthy controls 1. High-lethality attempters > low-lethality attempters = healthy controls on total errors, percent perseverative errors, and percent conceptual-level responses 2. High-lethality attempters < patient controls on percent conceptual-level responses.         Miranda et al., 2012 U.S.  Cross-sectional Community 18-22, Mean age =18.3 13 attempters; 32 healthy controls Attempters = healthy controls        Yen et al., 2008 Taiwan Cross-sectional Outpatient;  Bipolar Mean age =40.8 9 with history of attempt or ideation in past 12-months; 87 without history of attempt or ideation in past 12-months Past-12 month ideators/attempters = past-12 month nonsuicidal  96 Table 6. Demographic Information for All Participants  All Participants (N=543)     Mean SD Age  34.6 11.5     N % Sex   Male 243 44.8 Female 300 55.2    Race/Ethnicity   African 24 4.4 East-Asian 46 8.5 European/Caucasian 422 77.7 Indian/South Asian 3 0.6 Latin-American/Hispanic 20 3.7 Middle Eastern 4 0.7 Native American 8 1.5 Other 16 2.9    Sexual Orientation   Straight (Heterosexual) 430 79.2 Bisexual 72 13.3 Gay (Homosexual) 27 5.0 Questioning 6 1.1 Other 8 1.5    Marital Status   Single 292 53.8 Married/Common-law 170 31.3 97  All Participants (N=543)     N % Divorced/Separated 60 11.0 Widowed 9 1.7 Other 12 2.2    Highest Level of Education   Some high school 3 0.6 High school graduate/GED 47 8.7 Some college or university 225 41.4 College or university graduate 176 32.4 Some graduate or professional school after college 29 5.3 Master’s degree 54 9.9 Doctoral degree 9 1.7    Yearly Household Income    Less than $5,000 26 4.8 $5,000 - $9,999 20 3.7 $10,000 - $19,999 68 12.5 $20,000 - $29,999 93 17.1 $30,000 - $39,999 70 12.9 $40,000 - $49,999 72 13.3 $50,000 - $59,999 46 8.5 $60,000 - $74,999 42 7.7 $75,000 - $99,999 52 9.6 More than $100,000 35 6.4 Do not wish to answer 19 3.5 98 Table 7. Demographic Information for Lifetime Nonsuicidal, Ideator, and Attempter Groups  Nonsuicidal  (n=180) Ideator (n=197) Attempter (n=166)   Inferential Statistics             Mean SD Mean SD Mean SD  F ω2 p Age  37.4 a 13.1 33.5 b 10.9 32.9 b 9.7  5.97* .03 <.005             N % N % N %  χ2 Φ p Sex           Male 102 56.7 a 89  45.2 a 52 31.3 b  22.45 .20 <.001 Female 78  43.3 a 108  54.8 a 114  68.7 b                Race/Ethnicity           African 11 6.1 a 5 2.5 a 8 4.8 a  16.65 .18 >.25 East-Asian 17 9.4 a 20 10.2 a 9 5.4 a     European/Caucasian 134 74.4 a 156 79.2 a 132 79.5 a     Indian/South Asian 6 3.3 a 1 0.5 a 2 1.2 a     Latin-American/Hispanic 3 1.7 a 5 2.5 a 9 5.4 a     Middle Eastern 2 1.1 a 3 1.5 a 1 0.6 a     Native American 7 3.9 a 7 3.6 a 3 1.8 a     Other 11 6.1 a 5 2.5 a 2 1.2 a                           99  Nonsuicidal  (n=180) Ideator (n=197) Attempter (n=166)   Inferential Statistics             N % N % N %  χ2 Φ p Sexual Orientation           Straight (Heterosexual) 166 92.2 a 155 78.7 b 109 65.7 c  40.23 .27 <.001 Bisexual 7 3.9 a 25 12.7 b 40 24.1 c     Gay (Homosexual) 5 2.8 a 12 6.1 a 10 6.0 a     Questioning 1 0.6 a 2 1.0 a 3 1.8 a     Other 1 0.6 a 3 1.5 a 4 2.4 a                Marital Status           Single 93 51.7 a 117 59.4 a 82 49.4 a  23.27 .21 <.005 Married/Common-law 71 39.4 a 49 24.9 b 50 30.1a , b     Divorced/Separated 13 7.2 a 19 9.6 a , b 28 16.9 b     Widowed 2 1.1 a 6 3.0 a 1 0.6 a     Other 1 0.6 a 6 3.0 a 5 3.0 a                Highest Level of Education           Some high school 2 1.1 a 0 0.0 a 1 0.6 a  26.87 .22 <.01 High school graduate/GED 12 6.7 a 17 8.6 a 18 10.8 a     Some college or university 62 34.4 a 77 39.1 a 86 51.8 b     College or university graduate 68 37.8 a 73 37.1 a 35 21.1 b                100  Nonsuicidal  (n=180) Ideator (n=197) Attempter (n=166)   Inferential Statistics             N % N % N %  χ2 Φ p Some graduate or professional school after college 12 6.7 a 5 2.5 a 12 7.2 a     Master’s degree 21 11.7 a 17 8.6 a 12 7.2 a     Doctoral degree 3 1.7 a 4 2.0 a 2 1.2 a                Yearly Household Income            Less than $5,000 9 5.0 a 7 3.6 a 10 6.0 a  33.40 .25 <.05 $5,000 - $9,999 2 1.1 a 8 4.1 a , b 10 6.0 b     $10,000 - $19,999 17 9.4 a 25 12.7 a 26 15.7 a     $20,000 - $29,999 22 12.2 a 39 19.8 a 32 19.3 a     $30,000 - $39,999 25 13.9 a 28 14.2 a 17 10.2 a     $40,000 - $49,999 22 12.2 a 27 13.7 a 23 13.9 a     $50,000 - $59,999 18 10.0 a 21 10.7 a 7 4.2 a     $60,000 - $74,999 19 10.6 a 11 5.6 a 12 7.2 a     $75,000 - $99,999 27 15.0 a 13 6.6 b 12 7.2 a , b     More than $100,000 12 6.7 a 10 5.1 a 13 7.8 a     Do not wish to answer 7 3.9 a 8 4.1 a 4 2.4 a     *Welch’s F reported Note. Dimensional group differences were examined using a one-way analysis of variance and Omega squared (ω2) effect size with post-hoc Bonferroni correction. Categorical group differences were examined using Pearson chi-square tests and Cramer’s phi coefficients (Φ). For each row, means/proportions that do not share a superscript are significantly different than one another at p<.05. 101 Table 8. Demographic Information for Non-Recent (>12 month) Nonsuicidal, Ideator, and Attempter Groups  Nonsuicidal (n=180) Ideator (n=136) Attempter (n=103)  Inferential Statistics             Mean SD Mean SD Mean SD  F ω2 p Age  37.4 a 13.1 33.1 a 11.0 33.8 a 10.2  4.59 .02 <.05             N % N % N %  χ2 Φ p Sex           Male 102 56.7 a 60 44.1 a , b 32 31.1 b  17.65 .21 <.001 Female 78 43.3 a 76 55.9 a , b 71 68.9 b                Race/Ethnicity           African 11 6.1 a 5 3.7 a 4 3.9 a  13.99 .18 >.45 East-Asian 17 9.4 a 18 13.2 a 6 5.8 a     European/Caucasian 134 74.4 a 102 75.0 a 82 79.6 a     Indian/South Asian 0 0.0 a 1 0.7 a 2 1.9 a     Latin-American/Hispanic 6 3.3 a 4 2.9 a 5 4.9 a     Middle Eastern 3 1.7 a 0 0.0 a 0 0.0 a     Native American 2 1.1 a 2 1.5 a 2 1.9 a     Other 7 3.9 a 4 2.9 a 2 1.9 a                           102  Nonsuicidal (n=180) Ideator (n=136) Attempter (n=103)  Inferential Statistics             N % N % N %  χ2 Φ p Sexual Orientation           Straight (Heterosexual) 166 92.2 a 105 77.2 b 69 67.0 b  31.78 .28 <.001 Bisexual 7 3.9 a 20 14.7 b 25 24.3 b     Gay (Homosexual) 5 2.8 a 9 6.6 a 7 6.8 a     Questioning 1 0.6 a 1 0.7 a 1 1.0 a     Other 1 0.6 a 1 0.7 a 1 1.0 a                Marital Status           Single 93 51.7 a , b 84 61.8 b 46 44.7 a  20.46 .22 <.01 Married/Common-law 71 39.4 a 36 26.5 b 37 35.9 a , b     Divorced/Separated 13 7.2 a 10 7.4 a 18 17.5 b     Widowed 2 1.1 a 4 2.9 a 0 0.0 a     Other 1 0.6 a 2 1.5 a 2 1.9 a                Highest Level of Education           Some high school 2 1.1 a 0 0.0 a 0 0.0 a  24.84 .24 <.05 High school graduate/GED 12 6.7 a 9 6.6 a 13 12.6 a     Some college or university 62 34.4 a 58 42.6 a , b 56 54.4 b     College or university graduate 68 37.8 a 46 33.8 a , b 21 20.4 b                103  Nonsuicidal (n=180) Ideator (n=136) Attempter (n=103)  Inferential Statistics             N % N % N %  χ2 Φ p Some graduate or professional school after college 12 6.7 a 3 2.2 a 5 4.9 a     Master’s degree 21 11.7 a 17 12.5 a 6 5.8 a     Doctoral degree 3 1.7 a 3 2.2 a 2 1.9 a                Yearly Household Income            Less than $5,000 9 5.0 a 3 2.2 a 4 3.9 a  26.22 .25 >.15 $5,000 - $9,999 2 1.1 a 4 2.9 a 3 2.9 a     $10,000 - $19,999 17 9.4 a 16 11.8 a 17 16.5 a     $20,000 - $29,999 22 12.2 a 25 18.4 a 18 17.5 a     $30,000 - $39,999 25 13.9 a 21 15.4 a 15 14.6 a     $40,000 - $49,999 22 12.2 a 24 17.6 a 15 14.6 a     $50,000 - $59,999 18 10.0 a 17 12.5 a 5 4.9 a     $60,000 - $74,999 19 10.6 a 7 5.1 a 6 5.8 a     $75,000 - $99,999 27 15.0 a 7 5.1 b 9 8.7 a , b     More than $100,000 12 6.7 a 8 5.9 a 9 8.7 a     Do not wish to answer 1.9 1.9 a 1.9 1.9 a 1.9 1.9 a     *Welch’s F reported Note. Dimensional group differences were examined using a one-way analysis of variance and Omega squared (ω2) effect size with post-hoc Bonferroni correction. Categorical group differences were examined using Pearson chi-square tests and Cramer’s phi coefficients (Φ). For each row, means/proportions that do not share a superscript are significantly different than one another at p<.05104 Table 9. Demographic Information for Recent (<12 Month) Nonsuicidal, Ideator, and Attempter Groups  Nonsuicidal (n=180) Ideator (n=61) Attempter (n=21)  Inferential Statistics             Mean SD Mean SD Mean SD  F ω2 p Age  37.4 a 13.1 34.4 a , b 10.8 27.5 b 7.17  10.9* .04 <.01             N % N % N %  χ2 Φ p Sex           Male 102 56.7 a 29 47.5 a 10 47.6 a  1.89 .09 >.35 Female 78 43.3 a 32 52.5 a 11 52.4 a                Race/Ethnicity           African 11 6.1 a 0 0.0 a 1 4.8 a  14.26 .23 >.25 East-Asian 17 9.4 a 2 3.3 a 1 4.8 a     European/Caucasian 134 74.4 a 54 88.5 a 16 76.2 a     Indian/South Asian 6 3.3 a 1 1.6 a 2 9.5 a     Latin-American/Hispanic 3 1.7 a 0 0.0 a 0 0.0 a     Middle Eastern 2 1.1 a 1 1.6 a 1 4.8 a     Native American 7 3.9 a 3 4.9 a 0 0.0 a     Other 11 6.1 a 0 0.0 a 1 4.8 a                           105  Nonsuicidal (n=180) Ideators (n=61) Attempters (n=21)  Inferential Statistics             N % N % N %  χ2 Φ p Sexual Orientation           Straight (Heterosexual) 166 92.2 a 50 82.0 a , b 15 71.4 b  15.98 .25 <.05 Bisexual 7 3.9 a 5 8.2 a 3 14.3 a     Gay (Homosexual) 5 2.8 a 3 4.9 a 1 4.8 a     Questioning 1 0.6 a 1 1.6 a 0 0.0 a     Other 1 0.6 a 2 3.3 a , b 2 9.5 b                Marital Status           Single 93 51.7 a 33 54.1 a 14 66.7 a  23.01 .30 <.01 Married/Common-law 71 39.4 a 13 21.3 b 3 14.3 a , b     Divorced/Separated 13 7.2 a 9 14.8 a 4 19.0 a     Widowed 2 1.1 a 2 3.3 a 0 0.0 a      Other 1 0.6 a 4 6.6 b 0 0.0 a , b                Highest Level of Education           Some high school 2 1.1 a 0 0.0 a 1 4.8 a  15.19 .24 >.20 High school graduate/GED 12 6.7 a 8 13.1 a 3 14.3 a     Some college or university 62 34.4 a 19 31.1 a 11 52.4 a     College or university graduate 68 37.8 a 27 44.3 a 6 28.6 a                106  Nonsuicidal (n=180) Ideator (n=61) Attempter (n=21)  Inferential Statistics             N % N % N %  χ2 Φ p Some graduate or professional school after college 12 6.7 a 2 3.3 a 0 0.0 a     Master’s degree 21 11.7 a 4 6.6 a 0 0.0 a     Doctoral degree 3 1.7 a 1 1.6 a 0 0.0 a                Yearly Household Income            Less than $5,000 9 5.0 a 4 6.6 a 3 14.3 a  27.46 .32 >.10 $5,000 - $9,999 2 1.1 a 4 6.6 a , b 2 9.5 b     $10,000 - $19,999 17 9.4 a 9 14.8 a 3 14.3 a     $20,000 - $29,999 22 12.2 a 14 23.0 a 5 23.8 a     $30,000 - $39,999 25 13.9 a 7 11.5 a 1 4.8 a     $40,000 - $49,999 22 12.2 a 3 4.9 a 3 14.3 a     $50,000 - $59,999 18 10.0 a 4 6.6 a 1 4.8 a     $60,000 - $74,999 19 10.6 a 4 6.6 a 0 0.0 a     $75,000 - $99,999 27 15.0 a 6 9.8 a 1 4.8 a     More than $100,000 12 6.7 a 2 3.3 a 1 4.8 a     Do not wish to answer 7 3.9 a 4 6.6 a 1 4.8 a     *Welch’s F reported Note. Dimensional group differences were examined using a one-way analysis of variance and Omega squared (ω2) effect size with post-hoc Bonferroni correction. Categorical group differences were examined using Pearson chi-square tests and Cramer’s phi coefficients (Φ). For each row, means/proportions that do not share a superscript are significantly different than one another at p<.05. 107 Table 10. Descriptive Statistics for All Participants on Study Measures  All Participants (N=543)       Mean SD Skew. Kurt. BRIEF-A     Global Executive Composite 117.67 28.41 0.36 -0.72 Behavior Regulation Index (BRI) 49.23 12.36 0.44 -0.68 Inhibit 12.98 3.30 0.46 -0.60 Shift 10.22 2.98 0.36 -0.69 Emotional Control 16.94 5.53 0.42 -0.86 Self-Monitor 9.08 2.66 0.73 -0.24 Metacognition Index (MI) 68.44 17.57 0.32 -0.78 Initiate 14.31 4.12 0.27 -0.77 Working Memory 13.31 3.93 0.44 -0.71 Plan/Organize 16.80 4.67 0.43 -0.71 Task Monitor 9.85 2.58 0.25 -0.62 Organization of Materials 14.17 4.52 0.33 -0.89 BSI     Total Score 8.06 6.33 1.05 0.61 DASS     Subscales Total 33.84 27.74 0.67 -0.47 Depression 13.41 12.54 0.66 -0.79 Anxiety 7.64 7.95 1.15 0.67 Stress 12.79 10.21 0.68 -0.36 DAST     Total Score 12.79 10.21 2.35 5.71 DERS     Subscales Total 85.07 25.75 0.36 -0.41 Non-Acceptance 14.49 6.58 0.61 -0.52 Goal Directed 14.56 5.28 0.17 -0.83 Impulse Control 12.16 5.51 0.92 0.09 Emotional Awareness 14.11 4.63 0.54 0.28 108  All Participants (N=543)       Mean SD Skew. Kurt. Emotion Regulation 19.34 7.95 0.45 -0.67 Emotional Clarity 10.41 3.75 0.77 0.35 FrSBe     Subscales Total 105.68 25.25 0.12 -0.71 Apathy 35.87 9.80 0.12 -0.64 Disinhibition 30.58 8.13 0.28 -0.56 Executive Dysfunction 39.24 10.20 0.30 -0.46 GSES     Total Score 29.92 5.91 -0.56 0.52 Lifetime NSSI Frequency     Total Score 1.98 1.32 1.11 -0.12 UPPS-P     Subscales Total 125.88 26.99 1.12 -0.12 Negative Urgency 28.62 8.07 0.20 -0.21 (Lack of) Premeditation 20.41 5.50 -0.01 -0.57 (Lack of) Perseverance  21.46 5.98 0.36 -0.21 Sensation Seeking 28.73 8.38 0.32 -0.18 Positive Urgency 26.65 9.99 -0.02 -0.75  109 Table 11. Descriptive and Inferential Statistics for Lifetime Nonsuicidal, Ideator, and Attempter Groups on Study Measures  Nonsuicidal (n=180) Ideator (n=197) Attempter (n=166)  Inferential Statistics             Mean SD Mean SD Mean SD  F ω2 p BRIEF-A           Global Executive Composite 103.21 23.42 122.02 25.98 128.19 29.88  45.86* .13  <.001 Behavior Regulation Index (BRI) 43.01 9.88 50.66 11.52 54.26 12.96  47.4* .14  <.001 Inhibit 11.51 2.80 13.43 3.07 14.05 3.53  33.65* .10  <.001 Shift 8.99 2.58 10.66 2.82 11.04 3.16  27.73* .08  <.001 Emotional Control 14.17 4.47 17.36 5.30 19.43 5.54  50.14* .14  <.001 Self-Monitor 8.33 2.27 9.22 2.63 9.73 2.90  13.68* .04  <.001 Metacognition Index (MI) 60.19 14.91 71.36 16.23 73.93 18.58  37.03* .11  <.001 Initiate 12.32 3.37 15.10 3.89 15.54 4.34  40.56* .11  <.001 Working Memory 11.62 3.43 13.86 3.59 14.48 4.23  29.83* .09  <.001 Plan/Organize 14.79 3.90 17.45 4.41 18.20 5.02  31.18* .09  <.001 Task Monitor 9.01 2.36 10.14 2.54 10.41 2.66  15.40 .05  <.001 Organization of Materials 12.44 3.91 14.80 4.52 15.30 4.59  21.82 .07  <.001             Mean SD Mean SD Mean SD  t  p BSI           Total Score 0.00** 0.00** 6.81 5.58 9.54 6.84  2.72  <.001            110  Nonsuicidal (n=180) Ideator (n=197) Attempter (n=166)  Inferential Statistics             Mean SD Mean SD Mean SD  F ω2 p DASS           Subscales Total 19.97 21.91 38.25 26.91 43.64 28.59  45.99* .13  <.001 Depression 7.32 9.65 15.58 12.31 17.42 13.16  43.39* .12  <.001 Anxiety 4.38 6.27 8.28 7.31 10.42 9.04  30.52* .09  <.001 Stress 8.27 8.34 14.38 10.47 15.80 10.13  34.72* .10  <.001 DAST           Total Score 0.83 1.40 1.37 2.02 1.82 2.35  12.44* .04  <.001 DERS           Subscales Total 72.65 21.76 88.75 23.78 94.11 27.02  31.51* 0.12  <.001 Non-Acceptance 11.35 4.80 15.41 6.71 16.79 6.82  35.62* 0.12  <.001 Goal Directed 12.75 4.92 15.52 5.26 15.36 5.23  13.11 0.05  <.001 Impulse Control 10.06 4.37 12.31 5.39 14.24 5.96  22.87* 0.09  <.001 Emotional Awareness 13.44 4.49 14.42 4.85 14.47 4.47  2.25 0.01  >.10 Emotion Regulation 15.65 6.53 20.44 7.42 22.01 8.54  29.52* 0.11  <.001 Emotional Clarity 9.39 3.40 10.65 3.56 11.24 4.10  9.02 0.04  <.001 FrSBe           Subscales Total 93.71 23.21 109.42 22.86 114.22 25.34  36.03 .11  <.001 Apathy 31.27 9.04 37.69 8.92 38.69 9.87  33.76 .11  <.001 Disinhibition 27.01 7.19 31.32 7.78 33.56 8.10  32.74 .10  <.001 Executive Dysfunction 35.43 9.33 40.41 9.64 41.97 10.58  21.30 .07  <.001 111  Nonsuicidal (n=180) Ideator (n=197) Attempter (n=166)  Inferential Statistics             Mean SD Mean SD Mean SD  F ω2 p GSES           Total Score 31.67 5.34 29.68 5.93 28.30 6.00  15.04 .05  <.001 Lifetime NSSI Frequency           Total Score 1.30 0.84 1.93 1.09 2.78 1.53  65.76* .20  <.001 UPPS-P           Subscales Total 116.83 24.74 125.74 24.88 135.84 28.36  23.18 .08  <.001 Negative Urgency 25.00 7.22 29.14 7.17 31.94 8.40  35.69* .12  <.001 (Lack of) Premeditation 19.75 5.07 19.54 5.44 22.15 5.64  12.61 .04  <.001 (Lack of) Perseverance  19.41 5.37 21.95 5.60 23.11 6.41  19.16* .06  <.001 Sensation Seeking 28.28 8.20 28.53 8.44 29.45 8.50  0.92 .00  >.35 Positive Urgency 24.39 8.54 26.58 9.70 29.19 11.18  10.09* .03  <.001             N % N % N %  χ2 Φ p ABSPBI           Suspected Brain Injury 44 24.4 73 37.1 72 43.4  14.33 .16 <.001 *Welch’s F reported  **Participants endorsing no lifetime history of suicidal ideation or suicide attempts were not administered the Beck Scale for Suicidal ideation (BSI). Independent samples t-tests are reported comparing ideator to attempter groups are reported.    112 Table 12. Descriptive and Inferential Statistics for Non-Recent (>12 months) Nonsuicidal, Ideator, and Attempter Groups on Study Measures  Nonsuicidal (n=180) Ideator (n=136) Attempter (n=103)  Inferential Statistics             Mean SD Mean SD Mean SD  F ω2 p BRIEF-A           Global Executive Composite 103.21 23.42 119.46 26.60 120.36 27.75  21.75 .09  <.001 Behavior Regulation Index (BRI) 43.01 9.88 49.38 11.93 51.16 12.33  22.45* .09  <.001 Inhibit 11.51 2.80 13.31 3.02 13.40 3.41  19.57* .08  <.001 Shift 8.99 2.58 10.37 2.93 10.30 3.02  12.25* .05  <.001 Emotional Control 14.17 4.47 16.61 5.25 18.28 5.36  24.42* .10  <.001 Self-Monitor 8.33 2.27 9.10 2.66 9.17 2.72  5.18 .02  <.01 Metacognition Index (MI) 60.19 14.91 70.07 16.07 69.20 17.07  18.57 .08  <.001 Initiate 12.32 3.37 14.61 3.83 14.32 3.97  17.97 .07  <.001 Working Memory 11.62 3.43 13.62 3.59 13.77 3.93  16.76 .07  <.001 Plan/Organize 14.79 3.90 17.13 4.31 16.95 4.64  15.36* .06  <.001 Task Monitor 9.01 2.36 10.04 2.56 9.77 2.43  7.56 .03  <.001 Organization of Materials 12.44 3.91 14.67 4.49 14.40 4.43  12.84 .05  <.001             Mean SD Mean SD Mean SD  t  p BSI           Total Score 0.00** 0.00** 5.07 3.95 6.67 4.66  2.88  <.005            113  Nonsuicidal (n=180) Ideator (n=136) Attempter (n=103)  Inferential Statistics             Mean SD Mean SD Mean SD  F ω2 p DASS           Subscales Total 19.97 21.91 31.13 24.99 33.56 23.71  14.84* .06  <.001 Depression 7.32 9.65 12.06 11.04 12.58 11.12  11.97* .05  <.001 Anxiety 4.38 6.27 6.88 6.66 8.04 7.93  10.46* .04  <.001 Stress 8.27 8.34 12.19 9.88 12.94 8.68  12.49* .05  <.001 DAST           Total Score 0.83 1.40 1.22 1.79 1.50 1.80  6.02* .02  <.001 DERS           Subscales Total 72.65 21.76 84.56 22.68 88.06 27.05  13.92 0.07  <.001 Non-Acceptance 11.35 4.80 14.50 6.53 15.69 6.66  17.96* 0.09  <.001 Goal Directed 12.75 4.92 14.81 4.98 14.45 5.17  6.05 0.03  <.005 Impulse Control 10.06 4.37 11.65 5.05 13.00 6.08  8.64* 0.05  <.001 Emotional Awareness 13.44 4.49 14.33 4.83 14.34 4.58  1.55 0.00  >.20 Emotion Regulation 15.65 6.53 18.81 6.86 20.06 8.45  11.47* 0.06  <.001 Emotional Clarity 9.39 3.40 10.46 3.45 10.53 4.17  3.76 0.02  <.05 FrSBe           Subscales Total 93.71 23.21 105.93 22.90 107.09 24.30  15.28 .06  <.001 Apathy 31.27 9.04 36.05 8.62 35.62 9.46  13.44 .06  <.001 Disinhibition 27.01 7.19 30.75 7.82 31.92 7.93  16.78 .07  <.001 Executive Dysfunction 35.43 9.33 39.13 9.27 39.54 10.10  8.61 .04  <.001 114  Nonsuicidal (n=180) Ideator (n=136) Attempter (n=103)  Inferential Statistics             Mean SD Mean SD Mean SD  F ω2 p GSES           Total Score 31.67 5.34 30.51 5.48 29.98 5.15  3.76 .01  <.05 Lifetime NSSI Frequency           Total Score 1.30 0.84 1.86 1.06 2.65 1.47  41.44* .19  <.001 UPPS-P           Subscales Total 116.83 24.74 125.56 24.45 130.91 27.64  11.00 .05  <.001 Negative Urgency 25.00 7.22 28.52 7.46 30.38 8.10  18.73 .08  <.001 (Lack of) Premeditation 19.75 5.07 19.40 5.10 21.24 5.63  4.03 .01  <.05 (Lack of) Perseverance  19.41 5.37 21.39 5.38 21.81 6.04  7.98 .03  <.001 Sensation Seeking 28.28 8.20 29.70 8.07 29.44 8.35  1.33 .00  >.25 Positive Urgency 24.39 8.54 26.55 9.75 28.05 11.18  4.88* .02  <.001             N % N % N %  χ2 Φ p ABSPBI           Suspected Brain Injury 44 24.4 48 35.3 45 43.7  11.64 .17 <.005 *Welch’s F reported  **Participants endorsing no lifetime history of suicidal ideation or suicide attempts were not administered the Beck Scale for Suicidal ideation (BSI). Independent samples t-tests are reported comparing ideator to attempter groups are reported.    115 Table 13. Descriptive and Inferential Statistics for Recent (<12 months) Nonsuicidal, Ideator, and Attempter Groups on Study Measures  Nonsuicidal (n=180) Ideator (n=61) Attempter (n=21)  Inferential Statistics             Mean SD Mean SD Mean SD  F ω2 p BRIEF-A           Global Executive Composite 103.21 23.42 127.74 23.74 152.33 31.47  53.74 .29  <.001 Behavior Regulation Index (BRI) 43.01 9.88 53.52 10.09 63.90 12.55  55.55 .29  <.001 Inhibit 11.51 2.80 13.69 3.18 16.33 3.31  33.12 .20  <.001 Shift 8.99 2.58 11.31 2.47 13.05 3.15  35.14 .21  <.001 Emotional Control 14.17 4.47 19.02 5.06 22.76 4.76  49.29 .27  <.001 Self-Monitor 8.33 2.27 9.51 2.56 11.76 3.16  21.59 .14  <.001 Metacognition Index (MI) 60.19 14.91 74.21 16.36 88.43 19.42  42.34 .24  <.001 Initiate 12.32 3.37 16.20 3.83 19.00 4.64  50.72 .28  <.001 Working Memory 11.62 3.43 14.41 3.54 17.14 4.77  31.34 .19  <.001 Plan/Organize 14.79 3.90 18.15 4.57 21.86 4.92  36.53 .21  <.001 Task Monitor 9.01 2.36 10.36 2.50 12.05 2.87  18.84 .12  <.001 Organization of Materials 12.44 3.91 15.10 4.63 18.38 4.44  25.06 .16  <.001             Mean SD Mean SD Mean SD  t  p BSI           Total Score 0.00** 0.00** 10.70 6.66 13.86 8.85  3.15  >.10            116  Nonsuicidal (n=180) Ideator (n=61) Attempter (n=21)  Inferential Statistics             Mean SD Mean SD Mean SD  F ω2 p DASS           Subscales Total 19.97 21.91 54.11 24.26 66.43 35.06  59.06* .35  <.001 Depression 7.32 9.65 23.44 11.40 26.62 14.31  61* .36  <.001 Anxiety 4.38 6.27 11.41 7.78 18.10 11.23  32.41* .27  <.001 Stress 8.27 8.34 19.26 10.15 21.71 11.82  37.9* .26  <.001 DAST           Total Score 0.83 1.40 1.69 2.45 4.05 3.48  11.48* .17  <.001 DERS           Subscales Total 72.65 21.76 98.64 23.61 111.33 22.61  38.64 0.27  <.001 Non-Acceptance 11.35 4.80 17.57 6.70 20.13 7.20  25.47* 0.25  <.001 Goal Directed 12.75 4.92 17.19 5.56 18.53 4.96  19.41 0.15  <.001 Impulse Control 10.06 4.37 13.87 5.89 16.87 4.78  19.73* 0.17  <.001 Emotional Awareness 13.44 4.49 14.62 4.95 15.33 5.37  1.95 0.01  >.10 Emotion Regulation 15.65 6.53 24.30 7.35 26.47 7.52  39.84 0.28  <.001 Emotional Clarity 9.39 3.40 11.09 3.81 14.00 3.68  13.91 0.11  <.001 FrSBe           Subscales Total 93.71 23.21 117.18 20.95 136.76 19.14  51.47 .28  <.001 Apathy 31.27 9.04 41.33 8.56 46.00 7.68  47.99 .26  <.001 Disinhibition 27.01 7.19 32.59 7.61 40.48 7.28  39.66 .23  <.001 Executive Dysfunction 35.43 9.33 43.26 9.90 50.29 7.76  34.25 .20  <.001 117  Nonsuicidal (n=180) Ideator (n=61) Attempter (n=21)  Inferential Statistics             Mean SD Mean SD Mean SD  F ω2 p GSES           Total Score 31.67 5.34 27.82 6.50 23.29 6.17  26.81 .16  <.001 Lifetime NSSI Frequency           Total Score 1.30 0.84 2.10 1.14 3.05 1.60  22.9* .22  <.001 UPPS-P           Subscales Total 116.83 24.74 126.15 26.01 160.05 21.71  29.38 .18  <.001 Negative Urgency 25.00 7.22 30.52 6.32 38.38 8.22  41.25 .24  <.001 (Lack of) Premeditation 19.75 5.07 19.85 6.19 26.38 5.24  14.67 .09  <.001 (Lack of) Perseverance  19.41 5.37 23.21 5.92 27.52 5.48  27.17 .17  <.001 Sensation Seeking 28.28 8.20 25.92 8.70 31.57 9.02  3.89 .02  <.05 Positive Urgency 24.39 8.54 26.64 9.64 36.19 9.02  17.03 .11  <.001             N % N % N %  χ2 Φ p ABSPBI           Suspected Brain Injury 44 24.4 25 41.0 12 57.1  13.19 .22 <.005 *Welch’s F reported  **Participants endorsing no lifetime history of suicidal ideation or suicide attempts were not administered the Beck Scale for Suicidal ideation (BSI). Independent samples t-tests are reported comparing ideator to attempter groups are reported.   118 Table 14. Differences in Drug Abuse, Global Self-Efficacy, and Suspected Brain Injury between Lifetime Nonsuicidal, Ideator, and Attempter Groups  Nonsuicidal vs. Attempter Nonsuicidal vs.  Ideator Ideator vs. Attempter      d (.95CI) d (.95CI) d (.95CI) DAST    Total Score .51 (.29-.72) a .31 (.10-.51) a , b .21 (.00-.41) b GSES    Total Score .59 (.37-.80) a .35 (.14-.55) b .24 (.03-.45) b      Φ Φ Φ ABSPBI    Suspected brain injury  .20  .14 .06 Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05. Phi coefficients greater than .06 are significant at p<.05.   Table 15. Differences in Drug Abuse, Global Self-Efficacy, and Suspected Brain Injury between Non-Recent (> Past-12 Months) Nonsuicidal, Ideator, and Attempter Groups  Nonsuicidal vs. Attempter Nonsuicidal vs.  Ideator Ideator vs. Attempter      d (.95CI) d (.95CI) d (.95CI) DAST    Total Score .40 (.16-.65) a .24 (.01-.46) a .16 (-.10-.41) a GSES    Total Score .32 (.07-.56) a .22 (-.01-.44) a .10 (-.16-.36) a      Φ Φ Φ ABSPBI    Suspected brain injury  .20  .12 .09 Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05. Phi coefficients greater than .09 are significant at p<.05.  119 Table 16. Differences in Drug Abuse, Global Self-Efficacy, and Suspected Brain Injury between Recent (< Past-12 Months) Nonsuicidal, Ideator, and Attempter Groups  Nonsuicidal vs. Attempter Nonsuicidal vs.  Ideator Ideator vs. Attempter      d (.95CI) d (.95CI) d (.95CI) DAST    Total Score .97 (.42-1.5) a .38 (.08-.68) b .73 (.19-1.25) a , b GSES    Total Score 1.47 (1.00-1.94) a .68 (.38-.97) b .80 (.30-1.3) b      Φ Φ Φ ABSPBI    Suspected brain injury  .22  .16 .14 Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05. Phi coefficients greater than .14 are significant at p<.05.   Table 17. Differences in Drug Abuse, Global Self-Efficacy, and Suspected Brain Injury between Non-Recent (> Past-12 Months) and Recent (< Past-12 Months) Ideator and Attempter Groups  Non-Recent Ideator vs.  Recent Ideator Non-Recent Attempter vs.  Recent Attempter     d (.95CI) d (.95CI) DAST   Total Score .21 (-.10-.51) .78 (.25-1.3) GSES   Total Score .46 (.16-.77) 1.25 (.76-1.75)     Φ Φ ABSPBI   Suspected brain injury  .05 .10 Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05. Phi coefficients are not significant at p<.05.  120 Table 18. Differences in Executive Functioning between Lifetime Nonsuicidal, Ideators, and Attempter Groups  Nonsuicidal vs. Attempter Nonsuicidal vs.  Ideator Ideator vs. Attempter      d (.95CI) d (.95CI) d (.95CI) BRIEF-A    Global Executive Composite .93 (.70-1.15) a .76 (.55-.97) a .22 (.01-.43) b Behavior Regulation Index (BRI) .97 (.75-1.19) a .72 (.51-.92) a .29 (.08-.50) b Inhibit .80 (.57-1.01) a .65 (.45-.86) a .19 (-.02-.40) b Shift .71 (.49-.92) a .62 (.41-.82) a .13 (-.08-.33) b Emotional Control 1.04 (.81-1.27) a .65 (.44-.86) b .38 (.17-.59) c Self-Monitor .53 (.32-.75) a .36 (.16-.57) a , b .18 (-.02-.39) b Metacognition Index (MI) .81 (.59-1.03) a .72 (.51-.93) a .15 (-.06-.35) b Initiate .82 (.60-1.04) a .77 (.56-.98) a .11 (-.10-.31) b Working Memory .74 (.52-.96) a .64 (.43-.85) a .15 (-.05-.36) b Plan/Organize .75 (.53-.97) a .64 (.43-.85) a .16 (-.05-.36) b Task Monitor .56 (.34-.77) a .45 (.24-.65) a .11 (-.10-.31) b Organization of Materials .66 (.44-.87) a .54 (.34-.75) a .11 (-.09-.32) b FrSBe    Subscales Total  .86 (.65-1.08) a .66 (.45-.87) a .20 (.00-.41) b Apathy .80 (.58-1.02) a .69 (.49-.90) a .11 (-.10-.32) b Disinhibition .85 (.63-1.07) a .56 (.35-.76) a .29 (.08-.50) b Executive Dysfunction .66 (.45-.88) a .51 (.30-.71) a .16 (-.05-.36) b Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05.      121 Table 19. Predicting Lifetime Group Status Over and Above Covariates from Executive Functioning Scales              β SE β Wald’s χ2 df p Nonsuicidal vs. Attempter Status      BRIEF-A – Emotional Control .161 .027 35.25 1 <.000 FrSBe – Apathy .041 .014 8.20 1 <.005 R2 = .23 (Hosmer and Lemeshow), .23 (Cox & Snell), .31 (Nagelkerke).        Nonsuicidal vs. Ideator Status      BRIEF-A – Emotional Control .071 .026 7.38 1 <.01 BRIEF-A – Initiate .157 .036 19.46 1 <.000 R2 = .13 (Hosmer and Lemeshow), .14 (Cox & Snell), .17 (Nagelkerke).       Ideator vs. Attempter Status      BRIEF-A – Emotional Control .070 .020 12.56 1 <.000 R2 = .03 (Hosmer and Lemeshow), .04 (Cox & Snell), .05 (Nagelkerke).      122 Table 20. Differences in Executive Functioning between Non-Recent (> Past-12 Months) Nonsuicidal, Ideator, and Attempter Groups  Nonsuicidal vs. Attempter Nonsuicidal vs.  Ideator Ideators  vs. Attempter      d (.95CI) d (.95CI) d (.95CI) BRIEF-A    Global Executive Composite .67 (.42-.92) a .64 (.41-.86) a .04 (-.22-.29) b Behavior Regulation Index (BRI) .71 (.45-.96) a .57 (.35-.80) a , b .15 (-.11-.40) b Inhibit .59 (.34-.84) a .61 (.39-.84) a .03 (-.23-.28) b Shift .46 (.21-.70) a .49 (.27-.72) a .02 (-.23-.28) b Emotional Control .81 (.56-1.07) a .49 (.27-.72) b .31 (.06-.57) b Self-Monitor .33 (.09-.58) a .30 (.08-.53) a .03 (-.22-.29) b Metacognition Index (MI) .57 (.32-.81) a .62 (.40-.85) a .05 (-.20-.31) b Initiate .54 (.30-.79) a .62 (.40-.85) a .08 (-.18-.33) b Working Memory .59 (.35-.84) a .55 (.33-.78) a .04 (-.21-.30) b Plan/Organize .49 (.24-.74) a .56 (.34-.79) a .04 (-.22-.30) b Task Monitor .31 (.07-.55) a , b .42 (.20-.65) a .11 (-.14-.37) b Organization of Materials .46 (.22-.70) a .52 (.30-.75) a .06 (-.19-.32) b FrSBe    Subscales Total .57 (.33-.82) a .52 (.30-.75) a .05 (-.21-.31) b Apathy .48 (.24-.73) a .53 (.30-.76) a .05 (-.21-.30) b Disinhibition .65 (.40-.89) a .49 (.27-.72) a .15 (-.10-.41) b Executive Dysfunction .43 (.19-.68) a .39 (.17-.61) a .04 (-.21-.30) b Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05.        123 Table 21. Predicting Non-Recent (> Past-12 Months) Group Status Over and Above Covariates from Executive Functioning Scales              β SE β Wald’s χ2 df p Nonsuicidal vs. Attempter Status      BRIEF-A – Emotional Control .16 .03 35.57 1 <.001 R2 = .13 (Hosmer and Lemeshow), .14 (Cox & Snell), .19 (Nagelkerke).        Nonsuicidal vs. Ideator Status      BRIEF-A – Inhibit .12 .05 4.94 1 <.05 BRIEF-A – Initiate  .11 .04 6.61 1 <.05 R2 = .9 (Hosmer and Lemeshow), .10 (Cox & Snell), .14 (Nagelkerke).     124 Table 22. Differences in Executive Functioning between Recent (< Past-12 Months) Nonsuicidal, Ideator, and Attempter Groups  Nonsuicidal vs. Attempter Nonsuicidal vs.  Ideator Ideators  vs. Attempter      d (.95CI) d (.95CI) d (.95CI) BRIEF-A    Global Executive Composite 2.03 (1.54-2.51) a 1.01 (.71-1.32) b 1.01 (.51-1.52) b Behavior Regulation Index (BRI) 2.06 (1.57-2.54) a 1.04 (.73-1.34) b 1.02 (.52-1.52) b Inhibit 1.65 (1.17-2.12) a .74 (.45-1.04) b .90 (.40-1.40) b Shift 1.56 (1.08-2.03) a .89 (.59-1.19) b .67 (.17-1.17) b Emotional Control 1.85 (1.37-2.33) a 1.05 (.74-1.35) b .81 (.31-1.31) b Self-Monitor 1.42 (.95-1.89) a .49 (.19-.78) b .93 (.43-1.43) b Metacognition Index (MI) 1.81 (1.33-2.28) a .90 (.60-1.20) b .91 (.41-1.41) b Initiate 1.86 (1.38-2.34) a 1.08 (.77-1.38) b .78 (.28-1.28) b Working Memory 1.54 (1.07-2.01) a .78 (.48-1.08) b .76 (.26-1.26) b Plan/Organize 1.70 (1.23-2.18) a .81 (.51-1.11) b .89 (.39-1.39) b Task Monitor 1.25 (.78-1.71) a .55 (.26-.85) b .69 (.19-1.19) b Organization of Materials 1.44 (.97-1.90) a .64 (.35-.94) b .79 (.29-1.29) b FrSBe    Subscales Total 1.92 (1.44-2.40) a 1.05 (.74-1.35) b .87 (.37-1.37) b Apathy 1.67 (1.19-2.14) a 1.14 (.83-1.44) b .53 (.03-1.03) c Disinhibition 1.84 (1.36-2.32) a .76 (.47-1.06) b 1.08 (.57-1.58) b Executive Dysfunction 1.59 (1.12-2.06) a .84 (.54-1.14) b .75 (.25-1.25) b Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05.        125 Table 23. Predicting Recent (< Past-12 Months) Group Status Over and Above Covariates from Executive Functioning Scales              β SE β Wald’s χ2 df p Nonsuicidal vs. Attempter       BRIEF-A Initiate  .31 .09 10.83 1 <.001 FrSBe - Disinhibition .16 .05 10.94 1 <.001 R2 = .86 (Hosmer and Lemeshow), .27 (Cox & Snell), .55 (Nagelkerke).        Nonsuicidal vs. Ideator       BRIEF-A Emotional Control .12 .04 10.67 1 <.005 FrSBe Apathy .09 .02 17.95 1 <.001 R2 = .29 (Hosmer and Lemeshow), .23 (Cox & Snell), .33 (Nagelkerke).       Ideator vs. Attempter       FrSBe Disinhibition  .14 .04 11.92 1 <.001 R2 = .20 (Hosmer and Lemeshow), .17 (Cox & Snell), .26 (Nagelkerke).       126 Table 24. Differences in Executive Functioning between Non-Recent (> Past-12 Months) and Recent (< Past-12 Months) Ideator and Attempter Groups.   Non-Recent Ideator vs.  Recent Ideator Non-Recent Attempter vs.  Recent Attempter     d (.95CI) d (.95CI) BRIEF-A   Global Executive Composite .32 (.02-.63) a 1.13 (.63-1.61) b Behavior Regulation Index (BRI) .36 (.06-.67) a 1.03 (.54-1.52) b Inhibit .12 (-.18-.43) a .87 (.38-1.35) b Shift .34 (.03-.64) a .91 (.42-1.39) b Emotional Control .46 (.16-.77) a .85 (.37-1.33) b Self-Monitor .16 (-.15-.46) a .92 (.44-1.41) b Metacognition Index (MI) .26 (-.05-.56) a 1.10 (.61-1.59) b Initiate .41 (.11-.72) a 1.15 (.65-1.64) b Working Memory .22 (-.08-.52) a .83 (.35-1.31) b Plan/Organize .23 (-.07-.53) a 1.05 (.56-1.53) b Task Monitor .12 (-.18-.43) a .91 (.42-1.39) b Organization of Materials .09 (-.21-.40) a .90 (.41-1.38) b FrSBe   Subscales Total .50 (.20-.81) a 1.26 (.76-1.75) b Apathy .61 (.30-.92) a 1.30 (.73-1.85) b Disinhibition .24 (-.07-.54) a 1.09 (.60-1.58) b Executive Dysfunction .44 (.13-.74) a 1.10 (.61-1.59) b Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05.      127 Table 25. Differences in Impulsivity between Lifetime Nonsuicidal, Ideators, and Attempter Groups  Nonsuicidal vs. Attempter Nonsuicidal vs.  Ideator Ideator vs. Attempter      d (.95CI) d (.95CI) d (.95CI) UPPS-P            Subscales Total .73 (.52-.95) a .34 (.14-.55) b .39 (.18-.60) b Negative Urgency .88 (.66-1.10) a .58 (.37-.78) b .36 (.15-.56) c (Lack of) Premeditation .45 (.23-.66) a .04 (-.16-.24) b .48 (.28-.69) a (Lack of) Perseverance  .63 (.41-.84) a .46 (.26-.67) a .19 (-.02-.40) b Sensation Seeking .14 (-.07-.35) a .03 (-.17-.23) a .11 (-.10-.32) a Positive Urgency .48 (.27-.69) a .24 (.04-.44) b .25 (.04-.46) b Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05.                 128 Table 26. Predicting Lifetime Group Status Over and Above Covariates from Impulsivity Scales              β SE β Wald’s χ2 df p Nonsuicidal vs. Attempter       UPPS-P – Negative Urgency .11 .02 49.37 1 <.001 R2 = .15 (Hosmer and Lemeshow), .16 (Cox & Snell), .22 (Nagelkerke).        Nonsuicidal vs. Ideator       UPPS-P – Negative Urgency .09 .02 24.03 1 <.001 UPPS-P – (Lack of) Premeditation -.12 .03 18.52 1 <.001 UPPS-P – (Lack of) Perseverance .08 .03 10.92 1 <.001 R2 = .12 (Hosmer and Lemeshow), .14 (Cox & Snell), .18 (Nagelkerke).        Ideator vs. Attempter       UPPS-P – (Lack of) Premeditation .085 .020 18.22 1 <.001 R2 = .04 (Hosmer and Lemeshow), .05 (Cox & Snell), .07 (Nagelkerke).     129 Table 27. Differences in Impulsivity between Non-Recent (>Past-12 Month) Nonsuicidal, Ideators, and Attempter Groups  Nonsuicidal vs. Attempter Nonsuicidal vs.  Ideator Ideator vs. Attempter      d (.95CI) d (.95CI) d (.95CI) UPPS-P            Subscales Total .55 (.31-.80) a .34 (.12-.57) a , b .21 (-.05-.47) b Negative Urgency .72 (.47-.96) a .47 (.24-.69) a , b .25 (-.01-.50) b (Lack of) Premeditation .29 (.04-.53) a , b .07 (-.15-.29) a .35 (.10-.61) b (Lack of) Perseverance  .43 (.19-.68) a .36 (.13-.58) a .07 (-.18-.33) b Sensation Seeking .14 (-.10-.38) a .17 (-.05-.40) a .03 (-.22-.29) a Positive Urgency .35 (.11-.60) a .23 (.01-.46) a .14 (-.12-.40) a Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05.                 130 Table 28. Predicting Non-Recent (> Past-12 Month) Group Status Over and Above Covariates from Impulsivity Scales              β SE β Wald’s χ2 df p Nonsuicidal vs. Attempter       UPPS-P – Negative Urgency .09 .02 27.10 1 <.001 R2 = .09 (Hosmer and Lemeshow), .11 (Cox & Snell), .14 (Nagelkerke).        Nonsuicidal vs. Ideator       UPPS-P – Negative Urgency .07 .02 16.31 1 <.001 R2 = .04 (Hosmer and Lemeshow), .05 (Cox & Snell), .07 (Nagelkerke).        Ideator vs. Attempter       UPPS-P – (Lack of) Premeditation .07 .03 6.70 1 <.01 R2 = .02 (Hosmer and Lemeshow), .03 (Cox & Snell), .04 (Nagelkerke).        131 Table 29. Differences in Impulsivity between Recent (< Past-12 Month) Nonsuicidal, Ideators, and Attempter Groups  Nonsuicidal vs. Attempter Nonsuicidal vs.  Ideator Ideator vs. Attempter      d (.95CI) d (.95CI) d (.95CI) UPPS-P            Subscales Total 1.74 (1.26-2.22) a .37 (.08-.67) b 1.37 (.86-1.87) a Negative Urgency 1.88 (1.4-2.36) a .78 (.48-1.08) b 1.11 (.60-1.61) b (Lack of) Premeditation 1.24 (.77-1.70) a .02 (-.27-.31) b 1.22 (.71-1.72) a (Lack of) Perseverance  1.47 (1.00-1.94) a .69 (.39-.99) b .78 (.28-1.28) b Sensation Seeking .39 (-.06-.84) a .28 (-.01-.57) a .67 (.17-1.17) a Positive Urgency 1.33 (.87-1.80) a .25 (-.04-.54) b 1.08 (.57-1.58) a Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05.               132 Table 30. Predicting Recent (< Past-12 Month) Group Status Over and Above Covariates from Impulsivity Scales              β SE β Wald’s χ2 df p Nonsuicidal vs. Attempter       UPPS-P – Negative Urgency .23 .05 20.24 1 <.001 UPPS-P – Lack of Perseverance .14 .06 4.59 1 <.05 R2 = .77 (Hosmer and Lemeshow), .25 (Cox & Snell), .52 (Nagelkerke).        Nonsuicidal vs. Ideator       UPPS-P – Negative Urgency .16 .03 29.22 1 <.001 UPPS-P – Lack of Premeditation -.11 .04 9.11 1 <.005 R2 = .16 (Hosmer and Lemeshow), .14 (Cox & Snell), .21 (Nagelkerke).        Ideator vs. Attempter       UPPS-P – Negative Urgency .12 .05 6.29 1 <.05 UPPS-P – Lack of Premeditation .13 .06 5.02 1 <.05 R2 = .34 (Hosmer and Lemeshow), .25 (Cox & Snell), .37 (Nagelkerke).      133 Table 31. Differences in Impulsivity between Non-Recent (> Past-12 Months) and Recent (< Past-12 Months) Ideator and Attempter Groups.   Non-Recent Ideator vs.  Recent Ideator Non-Recent Attempter vs.  Recent Attempter     d (.95CI) d (.95CI) UPPS-P           Subscales Total .02 (-.28-.33) a 1.09 (.6-1.58) b Negative Urgency .28 (-.02-.58) a .99 (.50-1.47) b (Lack of) Premeditation .08 (-.22-.39) a .92 (.44-1.40) b (Lack of) Perseverance  .33 (.02-.63) a .96 (.47-1.44) b Sensation Seeking .46 (.15-.76) a .25 (-.22-.72) a Positive Urgency .01 (-.29-.31) a .86 (.35-1.37) b Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05. 134 Table 32. Differences in Clinical Variables between Lifetime Nonsuicidal, Ideator, and Attempter Groups  Nonsuicidal vs. Attempter Nonsuicidal vs.  Ideator Ideator vs. Attempter      d (.95CI) d (.95CI) d (.95CI) DASS            Subscales Total .92 (.70-1.15) a .75 (.54-.96) a .19 (-.01-.40) b Depression .87 (.65-1.09) a .75 (.54-.96) a .14 (-.06-.35) b Anxiety .77 (.55-.99) a .57 (.37-.78) a .26 (.05-.46) b Stress .81 (.59-1.03) a .65 (.44-.86) a .14 (-.07-.34) b DERS            Subscales Total .87 (.62-1.12) a .71 (.47-.94) a .21 (-.02-.44) b Non-Acceptance .92 (.67-1.17) a .70 (.47-.94) a .20 (-.03-.44) b Goal Directed .51 (.27-.75) a .54 (.31-.77) a .03 (-.20-.26) b Impulse Control .80 (.55-1.04) a .46 (.23-.69) b .34 (.11-.57) b Emotional Awareness .22 (-.02-.46) a .21 (-.01-.44) a .01 (-.22-.24) a Emotion Regulation .83 (.58-1.08) a .69 (.45-.92) a .19 (-.04-.43) b Emotional Clarity .50 (.26-.74) a .34 (.11-.57) a , b .16 (-.07-.39) b Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05.            135 Table 33. Predicting Lifetime Group Status Over and Above Covariates from Clinical Scales              β SE β Wald’s χ2 df p Nonsuicidal vs. Attempter       DASS – Anxiety  .05 .01 12.72 1 <.000 DASS – Stress  .09 .03 10.31 1 <.005 DERS – Impulse Control .07 .03 4.67 1 <.05 R2 = .25 (Hosmer and Lemeshow), .24 (Cox & Snell), .32 (Nagelkerke).        Nonsuicidal vs. Ideator       DASS – Depression  .06 .01 19.57 1 <.001 DERS – Non-Acceptance .09 .02 13.38 1 <.001 R2 = .16 (Hosmer and Lemeshow), .17 (Cox & Snell), .23 (Nagelkerke).     136 Table 34. Differences in Clinical Variables between Non-Recent (> Past-12 Month) Nonsuicidal, Ideator, and Attempter Groups.  Nonsuicidal vs. Attempter Nonsuicidal vs.  Ideator Ideator vs. Attempter      d (.95CI) d (.95CI) d (.95CI) DASS            Subscales Total .59 (.34-.84) a .47 (.24-.70) a .10 (-.16-.36) b Depression .50 (.25-.74) a .45 (.23-.68) a .05 (-.21-.30) b Anxiety .50 (.25-.74) a .39 (.16-.61) a ,b .16 (-.10-.41) b Stress .55 (.30-.79) a .42 (.20-.65) a .08 (-.18-.34) b DERS            Subscales Total .66 (.38-.93) a .51 (.26-.76) a .15 (-.14-.43) b Non-Acceptance .72 (.43-1.00) a .54 (.29-.79) a .18 (-.11-.46) b Goal Directed .34 (.07-.61) a , b .41 (.16-.66)  b .07 (-.21-.36) b Impulse Control .53 (.25-.81) a .33 (.08-.58) a , b .24 (-.05-.52) b Emotional Awareness .19 (-.08-.47) a .19 (-.06-.44) a 0.0 (-.06-.06) a Emotion Regulation .57 (.29-.84) a .47 (.22-.72) a .16 (-.13-.44) b Emotional Clarity .31 (.04-.59) a .29 (.04-.54) a .02 (-.26-.30) b Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05.            137 Table 35. Predicting Non-Recent (> Past-12 Month) Group Status Over and Above Covariates from Clinical Scales              β SE β Wald’s χ2 df p Nonsuicidal vs. Attempter       DERS – Non-Acceptance .13 .03 24.77 1 <.001 R2 = .11 (Hosmer and Lemeshow), .12 (Cox & Snell), .16 (Nagelkerke).        Nonsuicidal vs. Ideator       DASS – Depression .04 .01 6.57 1 <.05 DERS – Non-Acceptance  .08 .03 10.36 1 <.005 R2 = .08 (Hosmer and Lemeshow), .10 (Cox & Snell), .13 (Nagelkerke).      138 Table 36. Differences in Clinical Variables between Recent (< Past-12 Month) Nonsuicidal, Ideator, and Attempter Groups.  Nonsuicidal vs. Attempter Nonsuicidal vs.  Ideator Ideator vs. Attempter      d (.95CI) d (.95CI) d (.95CI) DASS            Subscales Total 1.37 (.76-1.97) a 1.44 (1.08-1.79) a .38 (-.13-.88) b Depression 1.39 (.77-1.99) a 1.47 (1.10-1.82) a .23 (-.27-.73) b Anxiety 1.27 (.67-1.85) a .95 (.62-1.27) a , b .64 (.11-1.16) b Stress 1.17 (.59-1.73) a 1.13 (.79-1.46) a .22 (-.29-.71) b DERS            Subscales Total 1.74 (1.18-2.29) a 1.17 (.82-1.52) b .57 (-.02-1.15) c Non-Acceptance 1.25 (.55-1.93) a .99 (.62-1.36) a .36 (-.23-.95) b Goal Directed 1.14 (.60-1.68) a .88 (.53-1.21) a .26 (-.32-.85) b Impulse Control 1.43 (.70-2.14) a .69 (.33-1.03) b .59 (-.02-1.19) b Emotional Awareness .41 (-.13-.94) a .25 (-.08-.58) a .15 (-.43-.74) a Emotion Regulation 1.59 (1.03-2.14) a 1.27 (.92-1.62) a .32 (-.26-.90) b Emotional Clarity 1.31 (.76-1.85) a .48 (.15-.81) b .83 (.24-1.41) a Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05.            139 Table 37. Predicting Recent (< Past-12 Month) Group Status Over and Above Covariates from Clinical Scales              β SE β Wald’s χ2 df p Nonsuicidal vs. Attempter       DASS – Anxiety  .14 .04 14.71 1 <.001 DERS – Impulse Control .17 .06 7.04 1 <.01 R2 = .61 (Hosmer and Lemeshow), .21 (Cox & Snell), .46 (Nagelkerke).        Nonsuicidal vs. Ideator       DASS – Depression  .10 .02 29.98 1 <.001 DERS – Non-Acceptance .12 .04 9.83 1 <.005 R2 = .54 (Hosmer and Lemeshow), .33 (Cox & Snell), .48 (Nagelkerke).       140 Table 38. Differences in Clinical Variables between Non-Recent (> Past-12 Months) and Recent (< Past-12 Months) Ideator and Attempter Groups.   Non-Recent Ideator vs.  Recent Ideator Non-Recent Attempter vs.  Recent Attempter     d (.95CI) d (.95CI) DASS           Subscales Total .93 (.61-1.24) a .98 (.43-1.52) a     Depression 1.02 (.70-1.34) a 1.20 (.70-1.69) a Anxiety .61 (.29-.92) a 1.18 (.68-1.67) b Stress .71 (.40-1.02) a .77 (.25-1.28) a DERS           Subscales Total .61 (.26-.96) a .88 (.32-1.44) a Non-Acceptance .47 (.12-.81) a .66 (.10-1.22) a Goal Directed .46 (.12-.81) a .80 (.23-1.36) a Impulse Control .42 (.07-.76) a .66 (.10-1.21) a Emotional Awareness .06 (-.28-.40) a .21 (-.34-.76) a Emotion Regulation .78 (.43-1.13) a .77 (.21-1.33) a Emotional Clarity .18 (-.17-.52) a .85 (.28-1.41) b Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05.         141 Table 39. Differences in Suicidal ideation and Nonsuicidal Self-Injury between Lifetime Nonsuicidal, Ideators, and Attempter Groups  Nonsuicidal vs. Attempter Nonsuicidal vs.  Ideator Ideator vs. Attempter      d (.95CI) d (.95CI) d (.95CI) BSI    Total Score 0 (0-0)* 0 (0-0)* .43 (.22-.64) Lifetime NSSI Frequency    Total Score 1.18 (.95-1.42) a .65 (.45-.86) b .63 (.42-.84) b *Participants endorsing no lifetime history of suicidal ideation or suicide attempts were not administered the Beck Scale for Suicidal ideation (BSI). Between-group comparisons using nonsuicidal groups are therefore not reported.  Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05.                 142 Table 40. Predicting Lifetime Group Status Over and Above Covariates from Suicidal ideation and Nonsuicidal Self-Injury              β SE β Wald’s χ2 df p Nonsuicidal vs. Attempter       Lifetime NSSI – Total Score .99 .12 63.72 1 <.001 R2 = .28 (Hosmer and Lemeshow), .26 (Cox & Snell), .35 (Nagelkerke).        Nonsuicidal vs. Ideator       Lifetime NSSI – Total Score .74 .14 29.91 1 <.001 R2 = .08 (Hosmer and Lemeshow), .10 (Cox & Snell), .13 (Nagelkerke).        Ideator vs. Attempter       BSI – Total Score .06 .02 8.71 1 <.005 Lifetime NSSI – Total Score .43 .09 25.41 1 <.001 R2 = .10 (Hosmer and Lemeshow), .12 (Cox & Snell), .15 (Nagelkerke).       143 Table 41. Differences in Suicidal Ideation and Nonsuicidal Self-Injury between Non-Recent (> Past-12 Month) Nonsuicidal, Ideators, and Attempter Groups  Nonsuicidal vs. Attempter Nonsuicidal vs.  Ideator Ideator vs. Attempter      d (.95CI) d (.95CI) d (.95CI) BSI    Total Score 0 (0-0)* 0 (0-0)* .38 (.12-.63) Lifetime NSSI Frequency    Total Score 1.05 (.78-1.32) .57 (.35-.8) .60 (.34-.86) *Participants endorsing no lifetime history of suicidal ideation or suicide attempts were not administered the Beck Scale for Suicidal Ideation (BSI). Between-group comparisons using nonsuicidal groups are therefore not reported. Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05.                 144 Table 42. Predicting Non-Recent (> Past-12 Month) Group Status Over and Above Covariates from Suicidal Ideation and Nonsuicidal Self-Injury              β SE β Wald’s χ2 df p Nonsuicidal vs. Attempter       Lifetime NSSI – Total Score .94 .13 50.70 1 <.001 R2 = .25 (Hosmer and Lemeshow), .23 (Cox & Snell), .32 (Nagelkerke).        Nonsuicidal vs. Ideator       Lifetime NSSI – Total Score .63 .14 21.59 1 <.001 R2 = .06 (Hosmer and Lemeshow), .08 (Cox & Snell), .11 (Nagelkerke).        Ideator vs. Attempter       BSI – Total Score .08 .03 5.35 1 <.05 Lifetime NSSI – Total Score .46 .11 17.66 1 <.001 R2 = .09 (Hosmer and Lemeshow), .11 (Cox & Snell), .14 (Nagelkerke).      145 Table 43. Differences in Suicidal Ideation and Nonsuicidal Self-Injury between Recent (< Past-12 Month) Nonsuicidal, Ideators, and Attempter Groups  Nonsuicidal vs. Attempter Nonsuicidal vs.  Ideator Ideator vs. Attempter      d (.95CI) d (.95CI) d (.95CI) BSI    Total Score 0 (0-0)* 0 (0-0)* .38 (-.13-.88) Lifetime NSSI Frequency    Total Score 1.14 (.57-1.7) .75 (.43-1.06) .64 (.11-1.16) *Participants endorsing no lifetime history of suicidal ideation or suicide attempts were not administered the Beck Scale for Suicidal Ideation (BSI). Between-group comparisons using nonsuicidal groups are therefore not reported. Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05.             146 Table 44. Predicting Recent (< Past-12 Month) Group Status Over and Above Covariates from Suicidal Ideation and Nonsuicidal Self-Injury              β SE β Wald’s χ2 df p Nonsuicidal vs. Attempter       Lifetime NSSI – Total Score .94 .17 30.45 1 <.001 R2 = .32 (Hosmer and Lemeshow), .15 (Cox & Snell), .31 (Nagelkerke).        Nonsuicidal vs. Ideator       Lifetime NSSI – Total Score .73 .15 23.39 1 <.001 R2 = .11 (Hosmer and Lemeshow), .10 (Cox & Snell), .15 (Nagelkerke).        Ideator vs. Attempter       Lifetime NSSI – Total Score .53 .20 7.41 1 <.01 R2 = .09 (Hosmer and Lemeshow), .09 (Cox & Snell), .13 (Nagelkerke).      147 Table 45. Differences in Suicidal Ideation and Nonsuicidal Self-Injury between Non-Recent (> Past-12 Months) and Recent (< Past-12 Months) Ideator and Attempter Groups.   Non-Recent Ideator vs.  Recent Ideator Non-Recent Attempter vs.  Recent Attempter     d (.95CI) d (.95CI) BSI   Total Score .95 (.61-1.28) .87 (.33-1.39) Lifetime NSSI Frequency   Total Score .22 (-.08-.52) .27 (-.2-.74) Note. Confidence intervals that do not include 0.00 are significant at p<.05. Cohen’s d that do not share a superscript are significantly different from one another at p<.05. 148       2905 attempts to complete screening survey 450 blocked duplicate attempts 2406 completed screening survey. 808 qualified for study. 19 did not complete captcha 10 did not complete screen 19 completed screen twice 577 completed full survey 134 qualified but declined  17 did not consent 1 did not complete captcha 29 did not complete survey 50 failed attention checks 534 complete data sets 43 flagged one or more BRIEF-A validity scales 180 Lifetime Nonsuicidal 197 Lifetime Ideators 166 Lifetime Attempters Figure 1. MTurk Participant Selection 149 References Alabama Department of Rehabilitation Services. (2006a). Alabama Brief Screening for Probable Head Injury. Alabama Department of Rehabilitation Services. (2006b). Traumatic Brain Injury and Domestic Violence. Retrieved from http://www.rehab.alabama.gov/docs/traumatic-brain-injury/trainer’s-manual---section-and-title-pages.pdf?sfvrsn=0. Accessed on February 15th, 2015 Alvarez, J. A., & Emory, E. (2006). Executive function and the frontal lobes: a meta-analytic review. Neuropsychology Review, 16(1), 17–42. doi:10.1007/s11065-006-9002-x American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., t.). Washington, DC. Anderson, V., Northam, E., & Wrenall, J. (2001). Developmental Neuropsychology: A Clinical Approach (1st Editio.). New York, NY: Psychology Press. Andrés, P. (2003). Frontal cortex as the central executive of working memory: time to revise our view. Cortex; a Journal Devoted to the Study of the Nervous System and Behavior, 39(4-5), 871–95. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14584557 Angst, J., Angst, F., Gerber-Werder, R., & Gamma, A. (2005). Suicide in 406 mood-disorder patients with and without long-term medication: a 40 to 44 years’ follow-up. Archives of Suicide Research : Official Journal of the International Academy for Suicide Research, 9(3), 279–300. doi:10.1080/13811110590929488 150 Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10(2), 176–181. doi:10.1037//1040-3590.10.2.176 Arie, M., Apter, A., Orbach, I., Yefet, Y., & Zalsman, G. (2008). Autobiographical memory, interpersonal problem solving, and suicidal behavior in adolescent inpatients. Comprehensive Psychiatry, 49(1), 22–9. doi:10.1016/j.comppsych.2007.07.004 Arsenault-Lapierre, G., Kim, C. D., & Turecki, G. (2004). Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry, 4, 37. doi:10.1186/1471-244X-4-37 Asarnow, J. R., Porta, G., Spirito, A., Emslie, G., Clarke, G. N., Wagner, K. D., … Brent, D. A. (2011). Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: findings from the TORDIA study. Journal of the American Academy of Child and Adolescent Psychiatry, 50(8), 772–81. doi:10.1016/j.jaac.2011.04.003 Audenaert, K., Goethals, I., Van Laere, K., Lahorte, P., Brans, B., Versijpt, J., … Dierckx, R. (2002). SPECT neuropsychological activation procedure with the Verbal Fluency Test in attempted suicide patients. Nuclear Medicine Communications, 23(9), 907–16. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12195096 Baddeley, A. (1992). Working memory. Science (New York, N.Y.), 255(5044), 556–9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/1736359 151 Baldo, J. V., Schwartz, S., Wilkins, D., & Dronkers, N. F. (2006). Role of frontal versus temporal cortex in verbal fluency as revealed by voxel-based lesion symptom mapping. Journal of the International Neuropsychological Society : JINS, 12(6), 896–900. doi:10.1017/S1355617706061078 Barkley, R. A. (2012). Executive Functions: What They Are, How They Work, and Why They Evolved (1sr ed.). New-York, NY: The Guilford Press. Barkley, R. A., & Fischer, M. (2011). Predicting impairment in major life activities and occupational functioning in hyperactive children as adults: self-reported executive function (EF) deficits versus EF tests. Developmental Neuropsychology, 36(2), 137–61. doi:10.1080/87565641.2010.549877 Barkley, R. A., & Murphy, K. R. (2010). Impairment in occupational functioning and adult ADHD: the predictive utility of executive function (EF) ratings versus EF tests. Archives of Clinical Neuropsychology : The Official Journal of the National Academy of Neuropsychologists, 25(3), 157–73. doi:10.1093/arclin/acq014 Barkley, R. A., & Murphy, K. R. (2011). The Nature of Executive Function (EF) Deficits in Daily Life Activities in Adults with ADHD and Their Relationship to Performance on EF Tests. Journal of Psychopathology and Behavioral Assessment, 33(2), 137–158. doi:10.1007/s10862-011-9217-x Barrett, E. A., Sundet, K., Simonsen, C., Agartz, I., Lorentzen, S., Mehlum, L., … Melle, I. (2011). Neurocognitive functioning and suicidality in schizophrenia spectrum disorders. Comprehensive Psychiatry, 52(2), 156–63. doi:10.1016/j.comppsych.2010.06.001 152 Barrocas, A. L., Hankin, B. L., Young, J. F., & Abela, J. R. Z. (2012). Rates of Nonsuicidal Self-Injury in Youth: Age, Sex, and Behavioral Methods in a Community Sample. Pediatrics, 130(1), 39–45. doi:10.1542/peds.2011-2094 Bechara, A., Damasio, A. R., Damasio, H., & Anderson, S. W. (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition, 50(1-3), 7–15. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8039375 Bechara, A., Tranel, D., Damasio, H., & Damasio, A. R. (1996). Failure to respond autonomically to anticipated future outcomes following damage to prefrontal cortex. Cerebral Cortex (New York, N.Y. : 1991), 6(2), 215–25. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8670652 Beck, A. T., Kovacs, M., & Weissman, A. (1979). Assessment of suicidal intention: the Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology, 47(2), 343–52. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/469082 Beck, A. T., Steer, R. A., & Ranieri, W. F. (1988). Scale for Suicide Ideation: psychometric properties of a self-report version. Journal of Clinical Psychology, 44(4), 499–505. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/3170753 Becker, E. S., Strohbach, D., & Rinck, M. (1999). A specific attentional bias in suicide attempters. The Journal of Nervous and Mental Disease, 187(12), 730–5. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10665467 153 Bertolote, J. M., & Fleischmann, A. (2002). Suicide and psychiatric diagnosis: a worldwide perspective. World Psychiatry : Official Journal of the World Psychiatric Association (WPA), 1(3), 181–5. Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1489848&tool=pmcentrez&rendertype=abstract Bjorner, J. B., Rose, M., Gandek, B., Stone, A. A., Junghaenel, D. U., & Ware, J. E. (2014a). Difference in method of administration did not significantly impact item response: an IRT-based analysis from the Patient-Reported Outcomes Measurement Information System (PROMIS) initiative. Quality of Life Research : An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 23(1), 217–27. doi:10.1007/s11136-013-0451-4 Bjorner, J. B., Rose, M., Gandek, B., Stone, A. A., Junghaenel, D. U., & Ware, J. E. (2014b). Method of administration of PROMIS scales did not significantly impact score level, reliability, or validity. Journal of Clinical Epidemiology, 67(1), 108–13. doi:10.1016/j.jclinepi.2013.07.016 Bogod, N. M., Mateer, C. a, & MacDonald, S. W. S. (2003). Self-awareness after traumatic brain injury: a comparison of measures and their relationship to executive functions. Journal of the International Neuropsychological Society : JINS, 9(3), 450–8. doi:10.1017/S1355617703930104 154 Bora, E., Yucel, M., & Pantelis, C. (2009). Cognitive endophenotypes of bipolar disorder: a meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. Journal of Affective Disorders, 113(1-2), 1–20. doi:10.1016/j.jad.2008.06.009 Bowie, C. R., Reichenberg, A., Patterson, T. L., Heaton, R. K., & Harvey, P. D. (2006). Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity, and symptoms. The American Journal of Psychiatry, 163(3), 418–25. doi:10.1176/appi.ajp.163.3.418 Brener, N. D., Kann, L., McManus, T., Kinchen, S. A., Sundberg, E. C., & Ross, J. G. (2002). Reliability of the 1999 youth risk behavior survey questionnaire. The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine, 31(4), 336–42. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12359379 Bridge, J. A., McBee-Strayer, S. M., Cannon, E. A., Sheftall, A. H., Reynolds, B., Campo, J. V., … Brent, D. A. (2012). Impaired decision making in adolescent suicide attempters. Journal of the American Academy of Child and Adolescent Psychiatry, 51(4), 394–403. doi:10.1016/j.jaac.2012.01.002 Briere, J., & Gil, E. (1998). Self-mutilation in clinical and general population samples: prevalence, correlates, and functions. The American Journal of Orthopsychiatry, 68(4), 609–20. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9809120 Broadbent, D. E., Cooper, P. F., FitzGerald, P., & Parkes, K. R. (1982). The Cognitive Failures Questionnaire (CFQ) and its correlates. The British Journal of Clinical Psychology / the 155 British Psychological Society, 21 (Pt 1), 1–16. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7126941 Brower, M. C., & Price, B. H. (2001). Neuropsychiatry of frontal lobe dysfunction in violent and criminal behaviour: a critical review. Journal of Neurology, Neurosurgery, and Psychiatry, 71(6), 720–6. Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1737651&tool=pmcentrez&rendertype=abstract Brown, G. K., Beck, A. T., Steer, R. A., & Grisham, J. R. (2000). Risk factors for suicide in psychiatric outpatients: a 20-year prospective study. Journal of Consulting and Clinical Psychology, 68(3), 371–7. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10883553 Brown, T. A., Chorpita, B. F., Korotitsch, W., & Barlow, D. H. (1997). Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behaviour Research and Therapy, 35(I), 79–89. doi:10.1016/S0005-7967(96)00068-X Buchsbaum, B. R., Greer, S., Chang, W.-L., & Berman, K. F. (2005). Meta-analysis of neuroimaging studies of the Wisconsin card-sorting task and component processes. Human Brain Mapping, 25(1), 35–45. doi:10.1002/hbm.20128 Burgess, P. W., Alderman, N., Evans, J. J., Emslie, H., & Wilson, B. A. (1998). The ecological validity of tests of executive function. Journal of the International Neuropsychological Society : JINS, 4(6), 547–58. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10050359 156 Burton, C. Z., Vella, L., Weller, J. A., & Twamley, E. W. (2011). Differential effects of executive functioning on suicide attempts. The Journal of Neuropsychiatry and Clinical Neurosciences, 23(2), 173–9. doi:10.1176/appi.neuropsych.23.2.173 Butler, M., Retzlaff, P. D., & Vanderploeg, R. (1991). Neuropsychological test usage. Professional Psychology: Research and Practice, 22(6), 510–512. doi:10.1037//0735-7028.22.6.510 Carey, K. B., Carey, M. P., & Chandra, P. S. (2003). Psychometric evaluation of the alcohol use disorders identification test and short drug abuse screening test with psychiatric patients in India. The Journal of Clinical Psychiatry, 64(7), 767–774. doi:10.4088/JCP.v64n0705 Carlson, S. R., Pritchard, A. a., & Dominelli, R. M. (2013). Externalizing behavior, the UPPS-P Impulsive Behavior scale and Reward and Punishment Sensitivity. Personality and Individual Differences, 54(2), 202–207. doi:10.1016/j.paid.2012.08.039 Cella, D., Riley, W., Stone, A., Rothrock, N., Reeve, B., Yount, S. E., … Hays, R. D. (2010). The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. Journal of Clinical Epidemiology, 63(11), 1179–94. doi:10.1016/j.jclinepi.2010.04.011 Cella, D., Yount, S. E., Rothrock, N., Gershon, R. C., Cook, K. F., Reeve, B., … Rose, M. (2007). The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years. Medical Care, 45(5 Suppl 1), S3–S11. doi:10.1097/01.mlr.0000258615.42478.55 157 Centers for Disease Control and Prevention. (2012). Suicide: Facts at a Glance 2012. Retrieved from http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Suicide+Facts+at+a+Glance#0. Accessed on February 15th, 2015 Cha, C. B., Najmi, S., Park, J. M., Finn, C. T., & Nock, M. K. (2010). Attentional bias toward suicide-related stimuli predicts suicidal behavior. Journal of Abnormal Psychology, 119(3), 616–22. doi:10.1037/a0019710 Chaytor, N., & Schmitter-Edgecombe, M. (2003). The ecological validity of neuropsychological tests: a review of the literature on everyday cognitive skills. Neuropsychology Review, 13(4), 181–97. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15000225 Chaytor, N., Schmitter-Edgecombe, M., & Burr, R. (2006). Improving the ecological validity of executive functioning assessment. Archives of Clinical Neuropsychology : The Official Journal of the National Academy of Neuropsychologists, 21(3), 217–27. doi:10.1016/j.acn.2005.12.002 Christensen, B. K., Colella, B., Inness, E., Hebert, D., Monette, G., Bayley, M., & Green, R. E. (2008). Recovery of Cognitive Function After Traumatic Brain Injury: A Multilevel Modeling Analysis of Canadian Outcomes. Archives of Physical Medicine and Rehabilitation, 89(12 SUPPL.), S3–S15. doi:10.1016/j.apmr.2008.10.002 Ciszewski, S., Francis, K., Mendella, P., Bissada, H., & Tasca, G. a. (2014). Validity and reliability of the Behavior Rating Inventory of Executive Function — Adult Version in a 158 clinical sample with eating disorders. Eating Behaviors, 15(2), 175–181. doi:10.1016/j.eatbeh.2014.01.004 Clark, L. A., Dombrovski, A. Y., Siegle, G. J., Butters, M. A., Shollenberger, C. L., Sahakian, B. J., & Szanto, K. (2011). Impairment in risk-sensitive decision-making in older suicide attempters with depression. Psychology and Aging, 26(2), 321–30. doi:10.1037/a0021646 Cocco, K. M., & Carey, K. B. (1998). Psychometric properties of the Drug Abuse Screening Test in psychiatric outpatients. Psychological Assessment, 10(4), 408–414. doi:10.1037/1040-3590.10.4.408 Cook, K. F., Bamer, A. M., Amtmann, D., Molton, I. R., & Jensen, M. P. (2012). Six patient-reported outcome measurement information system short form measures have negligible age- or diagnosis-related differential item functioning in individuals with disabilities. Archives of Physical Medicine and Rehabilitation, 93(7), 1289–91. doi:10.1016/j.apmr.2011.11.022 Cook, K. F., Molton, I. R., & Jensen, M. P. (2011). Fatigue and aging with a disability. Archives of Physical Medicine and Rehabilitation, 92(7), 1126–33. doi:10.1016/j.apmr.2011.02.017 Coskunpinar, A., Dir, A. L., & Cyders, M. A. (2013). Multidimensionality in impulsivity and alcohol use: A meta-analysis using the UPPS model of impulsivity. Alcoholism: Clinical and Experimental Research, 37(9), 1441–1450. doi:10.1111/acer.12131 Crawford, J. R., & Henry, J. D. (2003). The Depression Anxiety Stress Scales (DASS): normative data and latent structure in a large non-clinical sample. The British Journal of 159 Clinical Psychology / the British Psychological Society, 42, 111–131. doi:10.1348/014466503321903544 Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A., & Gornbein, J. (1994). The Neuropsychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology, 44(12), 2308–2308. doi:10.1212/WNL.44.12.2308 Cyders, M. A. (2011). Impulsivity and the Sexes: Measurement and Structural Invariance of the UPPS-P Impulsive Behavior Scale. Assessment. doi:10.1177/1073191111428762 Cyders, M. A., Smith, G. T., Spillane, N. S., Fischer, S., Annus, A. M., & Peterson, C. (2007). Integration of impulsivity and positive mood to predict risky behavior: development and validation of a measure of positive urgency. Psychological Assessment, 19(1), 107–118. doi:10.1037/1040-3590.19.1.107 Demakis, G. J. (2003). A meta-analytic review of the sensitivity of the Wisconsin Card Sorting Test to frontal and lateralized frontal brain damage. Neuropsychology, 17(2), 255–264. doi:10.1037/0894-4105.17.2.255 Demakis, G. J. (2004). Frontal lobe damage and tests of executive processing: a meta-analysis of the category test, stroop test, and trail-making test. Journal of Clinical and Experimental Neuropsychology, 26(3), 441–50. doi:10.1080/13803390490510149 Derefinko, K., Dewall, C. N., Metze, A. V., Walsh, E. C., & Lynam, D. R. (2011). Do different facets of impulsivity predict different types of aggression? Aggressive Behavior, 37(January), 223–233. doi:10.1002/ab.20387 160 Dombrovski, A. Y., Clark, L. A., Siegle, G. J., Butters, M. A., Ichikawa, N., Sahakian, B. J., & Szanto, K. (2010). Reward/Punishment reversal learning in older suicide attempters. The American Journal of Psychiatry, 167(6), 699–707. doi:10.1176/appi.ajp.2009.09030407 Dombrovski, A. Y., Szanto, K., Siegle, G. J., Wallace, M. L., Forman, S. D., Sahakian, B. J., … Clark, L. A. (2011). Lethal forethought: delayed reward discounting differentiates high- and low-lethality suicide attempts in old age. Biological Psychiatry, 70(2), 138–44. doi:10.1016/j.biopsych.2010.12.025 Dour, H. J., Cha, C. B., & Nock, M. K. (2011). Evidence for an emotion-cognition interaction in the statistical prediction of suicide attempts. Behaviour Research and Therapy, 49(4), 294–8. doi:10.1016/j.brat.2011.01.010 Elliott, R. (2003). Executive functions and their disorders. British Medical Bulletin, 65(1), 49–59. doi:10.1093/bmb/65.1.49 Ellis, T. E., Berg, R. A., & Franzen, M. D. (1992). Neuropsychological performance and suicidal behavior in adult psychiatric inpatients. Perceptual and Motor Skills, 75(2), 639–47. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/1408629 Epp, A. M., Dobson, K. S., Dozois, D. J. A., & Frewen, P. A. (2012). A systematic meta-analysis of the Stroop task in depression. Clinical Psychology Review, 32(4), 316–28. doi:10.1016/j.cpr.2012.02.005 Fries, J. F., Bruce, B., & Cella, D. (2005). The promise of PROMIS: using item response theory to improve assessment of patient-reported outcomes. Clinical and Experimental 161 Rheumatology, 23(5 Suppl 39), S53–7. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16273785 Gilbert, A. M., Garno, J. L., Braga, R. J., Shaya, Y., Goldberg, T. E., Malhotra, A. K., & Burdick, K. E. (2011). Clinical and cognitive correlates of suicide attempts in bipolar disorder: is suicide predictable? The Journal of Clinical Psychiatry, 72(8), 1027–33. doi:10.4088/JCP.10m06410 Glassman, L. H., Weierich, M. R., Hooley, J. M., Deliberto, T. L., & Nock, M. K. (2007). Child maltreatment, non-suicidal self-injury, and the mediating role of self-criticism. Behaviour Research and Therapy, 45(10), 2483–90. doi:10.1016/j.brat.2007.04.002 Godefroy, O., Cabaret, M., Petit-Chenal, V., Pruvo, J. P., & Rousseaux, M. (1999). Control functions of the frontal lobes. Modularity of the central-supervisory system? Cortex; a Journal Devoted to the Study of the Nervous System and Behavior, 35(1), 1–20. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10213531 Golden, C. J., & Freshwater, S. M. (2002). Stroop color and word test. Western Psychological Services. Retrieved from http://v-psyche.com/doc/Clinical Test/Stroop Color and Word Test.doc. Accessed on February 15th, 2015 Gorlyn, M., Keilp, J. G., Oquendo, M. A., Burke, A. K., & Mann, J. J. (2013). Iowa gambling task performance in currently depressed suicide attempters. Psychiatry Research, 207(3), 150–7. doi:10.1016/j.psychres.2013.01.030 162 Grace, J. (2011). Frontal Systems Behavior Scale. In J. S. Kreutzer, J. DeLuca, & B. Caplan (Eds.), Encyclopedia of Clinical Neuropsychology (pp. 1090–1092). New York, NY: Springer New York. doi:10.1007/978-0-387-79948-3 Grace, J., & Malloy, P. F. (2001). Frontal Systems Behavior Scale. Lutz, Florida: Psychological Assessment Resources. Grant, D. A., & Berg, E. (1948). A behavioral analysis of degree of reinforcement and ease of shifting to new responses in a Weigl-type card-sorting problem. Journal of Experimental Psychology, 38(4), 404–411. doi:10.1037/h0059831 Grant, S., Contoreggi, C., & London, E. D. (2000). Drug abusers show impaired performance in a laboratory test of decision making. Neuropsychologia, 38(8), 1180–1187. doi:10.1016/S0028-3932(99)00158-X Gratz, K. L., & Roemer, L. (2004). Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. doi:10.1023/B:JOBA.0000007455.08539.94 Grunbaum, J. A., Kann, L., Kinchen, S. A., Williams, B., Ross, J. G., Lowry, R., & Kolbe, L. (2002). Youth Risk Behavior Surveillance - United States, 2001. Journal of School Health, 72(8), 313–328. doi:10.1111/j.1746-1561.2002.tb07917.x 163 Guan, K., Fox, K. R., & Prinstein, M. J. (2012). Nonsuicidal self-injury as a time-invariant predictor of adolescent suicide ideation and attempts in a diverse community sample. Journal of Consulting and Clinical Psychology, 80(5), 842–9. doi:10.1037/a0029429 Harkavy-Friedman, J. M., Keilp, J. G., Grunebaum, M. F., Sher, L., Printz, D., Burke, A. K., … Oquendo, M. A. (2006). Are BPI and BPII suicide attempters distinct neuropsychologically? Journal of Affective Disorders, 94(1-3), 255–9. doi:10.1016/j.jad.2006.04.010 Heisel, M. J., Flett, G. L., & Besser, A. (2002). Cognitive Functioning and Geriatric Suicide Ideation. American Journal of Geriatric Psychiatry, 10(4), 428–436. doi:10.1097/00019442-200207000-00009 Henry, J. D., & Crawford, J. R. (2004). A meta-analytic review of verbal fluency performance following focal cortical lesions. Neuropsychology, 18(2), 284–95. doi:10.1037/0894-4105.18.2.284 Homaifar, B. Y., Brenner, L. A., Forster, J. E., & Nagamoto, H. (2012). Traumatic brain injury, executive functioning, and suicidal behavior: a brief report. Rehabilitation Psychology, 57(4), 337–41. doi:10.1037/a0030480 Huber, C. G., Schöttle, D., Lambert, M., Hottenrott, B., Agorastos, A., Naber, D., & Schroeder, K. (2012). Brief Psychiatric Rating Scale - Excited Component (BPRS-EC) and neuropsychological dysfunction predict aggression, suicidality, and involuntary treatment in first-episode psychosis. Schizophrenia Research, 134(2-3), 273–8. doi:10.1016/j.schres.2011.12.002 164 Hunter, S. J., & Sparrow, E. P. (2012). Executive Function and Dysfunction : Identification, Assessment and Treatment. Cambridge University Press. Jollant, F., Bellivier, F., Leboyer, M., Astruc, B., Torres, S., Verdier, R., … Courtet, P. (2005). Impaired decision making in suicide attempters. The American Journal of Psychiatry, 162(2), 304–10. doi:10.1176/appi.ajp.162.2.304 Jollant, F., Guillaume, S., Jaussent, I., Bechara, A., & Courtet, P. (2013). When knowing what to do is not sufficient to make good decisions: Deficient use of explicit understanding in remitted patients with histories of suicidal acts. Psychiatry Research, 210(2), 1–6. doi:10.1016/j.psychres.2013.07.011 Jollant, F., Guillaume, S., Jaussent, I., Bellivier, F., Leboyer, M., Castelnau, D., … Courtet, P. (2007). Psychiatric diagnoses and personality traits associated with disadvantageous decision-making. European Psychiatry : The Journal of the Association of European Psychiatrists, 22(7), 455–61. doi:10.1016/j.eurpsy.2007.06.001 Jollant, F., Lawrence, N. S., Olié, E., Guillaume, S., & Courtet, P. (2011). The suicidal mind and brain: a review of neuropsychological and neuroimaging studies. The World Journal of Biological Psychiatry : The Official Journal of the World Federation of Societies of Biological Psychiatry, 12(5), 319–39. doi:10.3109/15622975.2011.556200 Jollant, F., Lawrence, N. S., Olié, E., O’Daly, O., Malafosse, A., Courtet, P., & Phillips, M. L. (2010). Decreased activation of lateral orbitofrontal cortex during risky choices under uncertainty is associated with disadvantageous decision-making and suicidal behavior. NeuroImage, 51(3), 1275–81. doi:10.1016/j.neuroimage.2010.03.027 165 Jurado, M. B., & Rosselli, M. (2007). The elusive nature of executive functions: a review of our current understanding. Neuropsychology Review, 17(3), 213–33. doi:10.1007/s11065-007-9040-z Karzmark, P., Llanes, S., Tan, S., Deutsch, G., & Zeifert, P. (2012). Comparison of the frontal systems behavior scale and neuropsychological tests of executive functioning in predicting instrumental activities of daily living. Applied Neuropsychology. Adult, 19(2), 81–5. doi:10.1080/09084282.2011.643942 Keilp, J. G., Gorlyn, M., Oquendo, M. A., Burke, A. K., & Mann, J. J. (2008). Attention deficit in depressed suicide attempters. Psychiatry Research, 159(1-2), 7–17. doi:10.1016/j.psychres.2007.08.020 Keilp, J. G., Gorlyn, M., Russell, M., Oquendo, M. A., Burke, A. K., Harkavy-Friedman, J. M., & Mann, J. J. (2013). Neuropsychological function and suicidal behavior: attention control, memory and executive dysfunction in suicide attempt. Psychological Medicine, 43(3), 539–51. doi:10.1017/S0033291712001419 Keilp, J. G., Sackeim, H. A., Brodsky, B. S., Oquendo, M. A., Malone, K. M., & Mann, J. J. (2001). Neuropsychological dysfunction in depressed suicide attempters. The American Journal of Psychiatry, 158(5), 735–41. doi:10.1016/j.jad.2005.03.002 Kessler, R. C., Berglund, P., Borges, G., Nock, M., & Wang, P. S. (2005). Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990-1992 to 2001-2003. JAMA : The Journal of the American Medical Association, 293(20), 2487–95. doi:10.1001/jama.293.20.2487 166 Kessler, R. C., Borges, G., & Walters, E. E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry, 56(7), 617–26. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10401507 Kim, C.-H., Jayathilake, K., & Meltzer, H. Y. (2003). Hopelessness, neurocognitive function, and insight in schizophrenia: relationship to suicidal behavior. Schizophrenia Research, 60(1), 71–80. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12505140 King, D. A., Conwell, Y., Cox, C., Henderson, R. E., Denning, D. G., & Caine, E. D. (2000). A neuropsychological comparison of depressed suicide attempters and nonattempters. The Journal of Neuropsychiatry and Clinical Neurosciences, 12(1), 64–70. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10678515 Klonsky, E. D., & May, A. M. (2010). Rethinking impulsivity in suicide. Suicide & Life-Threatening Behavior, 40(6), 612–9. doi:10.1521/suli.2010.40.6.612 Klonsky, E. D., & May, A. M. (2014). Differentiating suicide attempters from suicide ideators: a critical frontier for suicidology research. Suicide & Life-Threatening Behavior, 44(1), 1–5. doi:10.1111/sltb.12068 Klonsky, E. D., May, A. M., & Glenn, C. R. (2013). The relationship between nonsuicidal self-injury and attempted suicide: converging evidence from four samples. Journal of Abnormal Psychology, 122(1), 231–7. doi:10.1037/a0030278 Kolbe, L. J., Kann, L., & Collins, J. L. (1993). Overview of the Youth Risk Behavior Surveillance System. Public Health Reports (Washington, D.C. : 1974), 108 Suppl(2), 2–10. 167 Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1403301&tool=pmcentrez&rendertype=abstract Kreutzer, J. S., DeLuca, J., & Caplan, B. (Eds.). (2011). Encyclopedia of Clinical Neuropsychology. New York, NY: Springer New York. doi:10.1007/978-0-387-79948-3 Lansbergen, M. M., Kenemans, J. L., & van Engeland, H. (2007). Stroop interference and attention-deficit/hyperactivity disorder: a review and meta-analysis. Neuropsychology, 21(2), 251–62. doi:10.1037/0894-4105.21.2.251 Legris, J., Links, P. S., van Reekum, R., Tannock, R., & Toplak, M. (2012). Executive function and suicidal risk in women with Borderline Personality Disorder. Psychiatry Research, 196(1), 101–8. doi:10.1016/j.psychres.2011.10.008 Levenson, M., & Neuringer, C. (1971). Problem-solving behavior in suicidal adolescents. Journal of Consulting and Clinical Psychology, 37(3), 433–6. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/5121823 Lezak, M. D. (2012). Neuropsychological Assessment. New York, NY: Oxford University Press. Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–43. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7726811 168 Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Sydney: Psychology Foundation. Loyo, L., Martínez-Velázquez, E., & Ramos-Loyo, J. (2013). Influence of Emotions on Executive Functions in Suicide Attempters. Suicidology-Online.com, 4, 42–55. Retrieved from http://www.suicidology-online.com/pdf/SOL-2013-4-42-55.pdf Luria, A. R. (1966). Higher Cortical Functions In Man (1st ed.). New-York, NY: Basic Books. Luria, A. R. (1976). The Working Brain: An Introduction To Neuropsychology (1st ed.). New-York, NY: Basic Books. Luszczynska, A., Gutiérrez‐ Doña, B., & Schwarzer, R. (2005). General self‐ efficacy in various domains of human functioning: Evidence from five countries. International Journal of Psychology, 40(2), 80–89. doi:10.1080/00207590444000041 Luszczynska, A., Scholz, U., & Schwarzer, R. (2005). The general self-efficacy scale: multicultural validation studies. The Journal of Psychology, 139(5), 439–57. doi:10.3200/JRLP.139.5.439-457 Maisto, S. A., Carey, M. P., Carey, K. B., Gordon, C. M., & Gleason, J. R. (2000). Use of the AUDIT and the DAST-10 to identify alcohol and drug use disorders among adults with a severe and persistent mental illness. Psychological Assessment, 12(2), 186–192. doi:10.1037/1040-3590.12.2.186 169 Malloy-Diniz, L. F., Neves, F. S., Abrantes, S. S. C., Fuentes, D., & Corrêa, H. (2009). Suicide behavior and neuropsychological assessment of type I bipolar patients. Journal of Affective Disorders, 112(1-3), 231–6. doi:10.1016/j.jad.2008.03.019 Manchester, D., Priestley, N., & Jackson, H. (2004). The assessment of executive functions: coming out of the office. Brain Injury : [BI], 18(11), 1067–81. doi:10.1080/02699050410001672387 Mangeot, S., Armstrong, K., Colvin, A. N., Yeates, K. O., & Taylor, H. G. (2002). Long-term executive function deficits in children with traumatic brain injuries: assessment using the Behavior Rating Inventory of Executive Function (BRIEF). Child Neuropsychology : A Journal on Normal and Abnormal Development in Childhood and Adolescence, 8(4), 271–84. doi:10.1076/chin.8.4.271.13503 Martino, D. J., Strejilevich, S. a, Torralva, T., & Manes, F. (2011). Decision making in euthymic bipolar I and bipolar II disorders. Psychological Medicine, 41(6), 1319–27. doi:10.1017/S0033291710001832 Mathers, C. D., & Loncar, D. (2006). Projections of global mortality and burden of disease from 2002 to 2030. PLoS Medicine, 3(11), e442. doi:10.1371/journal.pmed.0030442 May, A. M., & Klonsky, E. D. (2011). Validity of suicidality items from the Youth Risk Behavior Survey in a high school sample. Assessment, 18(3), 379–81. doi:10.1177/1073191110374285 170 McAuley, E., Mullen, S. P., Szabo, A. N., White, S. M., Wójcicki, T. R., Mailey, E. L., … Kramer, A. F. (2011). Self-regulatory processes and exercise adherence in older adults: Executive function and self-efficacy effects. American Journal of Preventive Medicine, 41(3), 284–290. doi:10.1016/j.amepre.2011.04.014 McCabe, S. E., & Teter, C. J. (2007). Drug use related problems among nonmedical users of prescription stimulants: A web-based survey of college students from a Midwestern university. Drug and Alcohol Dependence, 91, 69–76. doi:10.1016/j.drugalcdep.2007.05.010 McGirr, A., Dombrovski, A. Y., Butters, M. A., Clark, L. A., & Szanto, K. (2012). Deterministic learning and attempted suicide among older depressed individuals: cognitive assessment using the Wisconsin Card Sorting Task. Journal of Psychiatric Research, 46(2), 226–32. doi:10.1016/j.jpsychires.2011.10.001 Merriam, E. P., Thase, M. E., Haas, G. L., Keshavan, M. S., & Sweeney, J. A. (1999). Prefrontal cortical dysfunction in depression determined by Wisconsin Card Sorting Test performance. The American Journal of Psychiatry, 156(5), 780–2. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10327916 Michalczuk, R., Bowden-Jones, H., Verdejo-Garcia, A., & Clark, L. A. (2011). Impulsivity and cognitive distortions in pathological gamblers attending the UK National Problem Gambling Clinic: a preliminary report. Psychological Medicine, 41(12), 2625–2635. doi:10.1017/S003329171100095X 171 Milham, M. P., Banich, M. T., Claus, E. D., & Cohen, N. J. (2003). Practice-related effects demonstrate complementary roles of anterior cingulate and prefrontal cortices in attentional control. NeuroImage, 18(2), 483–93. doi:10.1016/S1053-8119(02)00050-2 Miller, E. K., & Wallis, J. D. (2009). Executive function and higher-order cognition: definition and neural substrates. In L. Squire (Ed.), Encyclopedia of Neuroscience (Vol. 4, pp. 99–104). Oxford: Academic Press. Retrieved from http://www.earlkmiller.org/wp-content/uploads/2013/03/Miller-and-Wallis-Encyclopedia-2009.pdf Miranda, R., Gallagher, M., Bauchner, B., Vaysman, R., & Marroquín, B. (2012). Cognitive inflexibility as a prospective predictor of suicidal ideation among young adults with a suicide attempt history. Depression and Anxiety, 29(3), 180–6. doi:10.1002/da.20915 Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. D. (2000). The unity and diversity of executive functions and their contributions to complex “Frontal Lobe” tasks: a latent variable analysis. Cognitive Psychology, 41(1), 49–100. doi:10.1006/cogp.1999.0734 Monchi, O., Petrides, M., Petre, V., Worsley, K., & Dagher, A. (2001). Wisconsin Card Sorting revisited: distinct neural circuits participating in different stages of the task identified by event-related functional magnetic resonance imaging. The Journal of Neuroscience : The Official Journal of the Society for Neuroscience, 21(19), 7733–41. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11567063 172 Muris, P. (2002). Relationships between self-efficacy and symptoms of anxiety disorders and depression in a normal adolescent sample. Personality and Individual Differences, 32, 337–348. doi:10.1016/S0191-8869(01)00027-7 Nangle, J.-M., Clarke, S., Morris, D. W., Schwaiger, S., McGhee, K. a, Kenny, N., … Donohoe, G. (2006). Neurocognition and suicidal behaviour in an Irish population with major psychotic disorders. Schizophrenia Research, 85(1-3), 196–200. doi:10.1016/j.schres.2006.03.035 Nee, D. E., Wager, T. D., & Jonides, J. (2007). Interference resolution: insights from a meta-analysis of neuroimaging tasks. Cognitive, Affective & Behavioral Neuroscience, 7(1), 1–17. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17598730 Neuringer, C. (1961). Dichotomous evaluations in suicidal individuals. Journal of Consulting Psychology, 25, 445–9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14479241 Neuringer, C. (1964). Rigid Thinking in Suicidal Individuals. Journal of Consulting Psychology, 28(1), 54–8. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14121178 Niemeier, J. P., Perrin, P. B., Holcomb, M. G., Nersessova, K. S., & Rolston, C. D. (2013). Factor structure, reliability, and validity of the Frontal Systems Behavior Scale (FrSBe) in an acute traumatic brain injury population. Rehabilitation Psychology, 58(1), 51–63. doi:10.1037/a0031612 Nieuwenstein, M. R., Aleman, A., & de Haan, E. H. F. (2001). Relationship between symptom dimensions and neurocognitive functioning in schizophrenia: a meta-analysis of WCST and 173 CPT studies. Journal of Psychiatric Research, 35(2), 119–125. doi:10.1016/S0022-3956(01)00014-0 Nock, M. K., Borges, G., & Ono, Y. (Eds.). (2012). Suicide: Global Perspectives from the WHO World Mental Health Serveys (1st ed.). Cambridge, U.K.: Cambridge University Press. Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry, 70(3), 300–10. doi:10.1001/2013.jamapsychiatry.55 Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-Injurious Thoughts and Behaviors Interview: development, reliability, and validity in an adolescent sample. Psychological Assessment, 19(3), 309–17. doi:10.1037/1040-3590.19.3.309 Nock, M. K., Park, J. M., Finn, C. T., Deliberto, T. L., Dour, H. J., & Banaji, M. R. (2010). Measuring the suicidal mind: implicit cognition predicts suicidal behavior. Psychological Science, 21(4), 511–7. doi:10.1177/0956797610364762 Norton, L. E., Malloy, P. F., & Salloway, S. (2001). The Impact of Behavioral Symptoms on Activities of Daily Living in Patients With Dementia. The American Journal of Geriatric Psychiatry, 9(1), 41–48. doi:10.1097/00019442-200102000-00007 Novack, T. A., Alderson, A. L., Bush, B. A., Meythaler, J. M., & Canupp, K. (2000). Cognitive and functional recovery at 6 and 12 months post-TBI. Brain Injury : [BI], 14(11), 987–996. 174 Nyhus, E., & Barceló, F. (2009). The Wisconsin Card Sorting Test and the cognitive assessment of prefrontal executive functions: a critical update. Brain and Cognition, 71(3), 437–51. doi:10.1016/j.bandc.2009.03.005 Odhuba, R. A., van den Broek, M. D., & Johns, L. C. (2005). Ecological validity of measures of executive functioning. The British Journal of Clinical Psychology / the British Psychological Society, 44(Pt 2), 269–78. doi:10.1348/014466505X29431 Oldershaw, A., Grima, E., Jollant, F., Richards, C., Simic, M., Taylor, L., & Schmidt, U. (2009). Decision making and problem solving in adolescents who deliberately self-harm. Psychological Medicine, 39(1), 95–104. doi:10.1017/S0033291708003693 Page, A. C., Hooke, G. R., & Morrison, D. L. (2007). Psychometric properties of the Depression Anxiety Stress Scales (DASS) in depressed clinical samples. The British Journal of Clinical Psychology / the British Psychological Society, 46, 283–297. doi:10.1348/014466506X158996 Peer, E., Paolacci, G., Chandler, J., & Mueller, P. A. (2012). Screening participants from previous studies on Amazon Mechanical Turk and Qualtrics. Unpublished Manuscript. Retrieved from https://experimentalturk.files.wordpress.com/2012/02/screening-amt-workers-on-qualtrics-5-2.pdf. Accessed on February 15th, 2015 Pennington, B. F., & Ozonoff, S. (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 37(1), 51–87. doi:10.1111/j.1469-7610.1996.tb01380.x 175 Pilkonis, P. a, Choi, S. W., Reise, S. P., Stover, A. M., Riley, W. T., & Cella, D. (2011). Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): depression, anxiety, and anger. Assessment, 18(3), 263–83. doi:10.1177/1073191111411667 Pinninti, N., Steer, R. a., Rissmiller, D. J., Nelson, S., & Beck, A. T. (2002). Use of the Beck Scale for Suicide Ideation with psychiatric inpatients diagnosed with schizophrenia, schizoaffective, or bipolar disorders. Behaviour Research and Therapy, 40, 1071–1079. doi:10.1016/S0005-7967(02)00002-5 Potkin, S. G., Anand, R., Alphs, L., & Fleming, K. (2003). Neurocognitive performance does not correlate with suicidality in schizophrenic and schizoaffective patients at risk for suicide. Schizophrenia Research, 59(1), 59–66. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12413643 Rabin, L. A., Roth, R. M., Isquith, P. K., Wishart, H. A., Nutter-Upham, K. E., Pare, N., … Saykin, A. J. (2006). Self- and informant reports of executive function on the BRIEF-A in MCI and older adults with cognitive complaints. Archives of Clinical Neuropsychology : The Official Journal of the National Academy of Neuropsychologists, 21(7), 721–32. doi:10.1016/j.acn.2006.08.004 Raust, A., Slama, F., Mathieu, F., Roy, I., Chenu, A., Koncke, D., … Bellivier, F. (2007). Prefrontal cortex dysfunction in patients with suicidal behavior. Psychological Medicine, 37(3), 411–9. doi:10.1017/S0033291706009111 176 Reid, R. C., Karim, R., McCrory, E., & Carpenter, B. N. (2010). Self-reported differences on measures of executive function and hypersexual behavior in a patient and community sample of men. The International Journal of Neuroscience, 120(2), 120–7. doi:10.3109/00207450903165577 Reid-Arndt, S. a, Nehl, C., & Hinkebein, J. (2007). The Frontal Systems Behaviour Scale (FrSBe) as a predictor of community integration following a traumatic brain injury. Brain Injury : [BI], 21(13-14), 1361–9. doi:10.1080/02699050701785062 Revicki, D. a, Kawata, A. K., Harnam, N., Chen, W.-H., Hays, R. D., & Cella, D. (2009). Predicting EuroQol (EQ-5D) scores from the patient-reported outcomes measurement information system (PROMIS) global items and domain item banks in a United States sample. Quality of Life Research : An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 18(6), 783–91. doi:10.1007/s11136-009-9489-8 Richard-Devantoy, S., Berlim, M. T., & Jollant, F. (2013). A meta-analysis of neuropsychological markers of vulnerability to suicidal behavior in mood disorders. Psychological Medicine, (September), 1–11. doi:10.1017/S0033291713002304 Richard-Devantoy, S., Guillaume, S., Olié, E., Courtet, P., & Jollant, F. (2013). Altered explicit recognition of facial disgust associated with predisposition to suicidal behavior but not depression. Journal of Affective Disorders, 150(2), 590–3. doi:10.1016/j.jad.2013.01.049 Richard-Devantoy, S., Jollant, F., Kefi, Z., Turecki, G., Olié, J. P., Annweiler, C., … Le Gall, D. (2012). Deficit of cognitive inhibition in depressed elderly: a neurocognitive marker of suicidal risk. Journal of Affective Disorders, 140(2), 193–9. doi:10.1016/j.jad.2012.03.006 177 Richard-Devantoy, S., Szanto, K., Butters, M. A., Kalkus, J., & Dombrovski, A. Y. (2014). Cognitive inhibition in older high-lethality suicide attempters. International Journal of Geriatric Psychiatry. doi:10.1002/gps.4138 Roth, R. M., Isquith, P. K., & Gioia, G. A. (2005). BRIEF-A: Behavior Rating Inventory of Executive Function--adult Version: Professional Manual. Psychological Assessment Resources. Salem, R., Bamer, A. M., Alschuler, K. N., Johnson, K. L., & Amtmann, D. (2014). Obesity and symptoms and quality of life indicators of individuals with disabilities. Disability and Health Journal, 7(1), 124–30. doi:10.1016/j.dhjo.2013.10.003 Schwarzer, R., Babler, J., & Kwiatek, P. (1997). The assessment of optimistic self-beliefs: Comparison of the German, Spanish, and Chinese versions of the general self-efficacy scale. Applied Psychology, 46(We 10), 69–88. doi:10.1080/026999497378557 Schwarzer, R., & Jerusalem, M. (1995). Generalized Self-Efficacy Scale. In Measures in health psychology: A user’s portfolio. Causal and control beliefs (pp. 35–37). Windsor, England: NFER-NELSON. Schwarzer, R., Mueller, J., & Greenglass, E. (1999). Assessment of perceived general self-efficacy on the internet: Data collection in cyberspace. Anxiety, Stress & Coping, 12(2), 145–161. doi:10.1080/10615809908248327 Shneidman, E. (1961). Psycho-logic: A personality approach to patterns of thinking. In J. Kegan & G. S. Lesser (Eds.), Contemporary issues in thematic apperception methods. Springfield, 178 Illnois. Retrieved from http://scholar.google.ca.ezproxy.library.ubc.ca/scholar?q=psycho-logic+shneidman&btnG=&hl=en&as_sdt=0,5#0 Sitskoorn, M. M., Aleman, A., Ebisch, S. J. H., Appels, M. C. M., & Kahn, R. S. (2004). Cognitive deficits in relatives of patients with schizophrenia: a meta-analysis. Schizophrenia Research, 71(2-3), 285–95. doi:10.1016/j.schres.2004.03.007 Skinner, H. A. (1982). The drug abuse screening test. Addictive Behaviors, 7(4), 363–71. doi:10.1016/0306-4603(82)90005-3 SmartRisk. (2009). The Economic Burden of Injury in Canada. Toronto, ON. Retrieved from http://www.parachutecanada.org/downloads/research/reports/EBI2009-Eng-Final.pdf Steer, R. a, Rissmiller, D. J., Ranieri, W. F., & Beck, A. T. (1993). Dimensions of suicidal ideation in psychiatric inpatients. Behaviour Research and Therapy, 31(2), 229–236. doi:10.1016/0005-7967(93)90090-H Steer, R. A., Kumar, G., & Beck, A. T. (1993). Self-reported suicidal ideation in adolescent psychiatric inpatients. Journal of Consulting and Clinical Psychology, 61(6), 1096–1099. Stern, A., Pollak, Y., Bonne, O., Malik, E., & Maeir, A. (2013). The Relationship Between Executive Functions and Quality of Life in Adults With ADHD. Journal of Attention Disorders. doi:10.1177/1087054713504133 Stout, J. C., Ready, R. E., Grace, J., Malloy, P. F., & Paulsen, J. S. (2003). Factor analysis of the frontal systems behavior scale (FrSBe). Assessment, 10(1), 79–85. doi:10.1177/1073191102250339 179 Strauss, E., Sherman, E. M. S., & Spreen, O. (2006). A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary (3rd ed.). New York, NY: Oxford University Press. Stroop, J. R. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18(6), 643–662. doi:10.1037/h0054651 Stukenborg, G. J., Blackhall, L., Harrison, J., Barclay, J. S., Dillon, P., Davis, M. A., … Read, P. (2014). Cancer patient-reported outcomes assessment using wireless touch screen tablet computers. Quality of Life Research : An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 23(5), 1603–7. doi:10.1007/s11136-013-0595-2 Sullivan, K., & Bowden, S. C. (1997). Which tests do neuropsychologists use? Journal of Clinical Psychology, 53(7), 657–61. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9356895 Tombaugh, T. N. (2004). Trail Making Test A and B: normative data stratified by age and education. Archives of Clinical Neuropsychology : The Official Journal of the National Academy of Neuropsychologists, 19(2), 203–14. doi:10.1016/S0887-6177(03)00039-8 Tull, M. T., & Roemer, L. (2007). Emotion regulation difficulties associated with the experience of uncued panic attacks: evidence of experiential avoidance, emotional nonacceptance, and decreased emotional clarity. Behavior Therapy, 38(4), 378–91. doi:10.1016/j.beth.2006.10.006 180 U.S. Department of Health and Human Services. (2006). Traumatic Brain Injury Screening: An Introduction. Retrieved from https://tbitac.hrsa.gov/download/ScreeningInstruments508.pdf Velligan, D. I., Ritch, J. L., Sui, D., DiCocco, M., & Huntzinger, C. D. (2002). Frontal Systems Behavior Scale in schizophrenia: relationships with psychiatric symptomatology, cognition and adaptive function. Psychiatry Research, 113(3), 227–36. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12559479 Vriezen, E. R., & Pigott, S. E. (2002). The relationship between parental report on the BRIEF and performance-based measures of executive function in children with moderate to severe traumatic brain injury. Child Neuropsychology : A Journal on Normal and Abnormal Development in Childhood and Adolescence, 8(4), 296–303. doi:10.1076/chin.8.4.296.13505 Waid-Ebbs, J. K., Wen, P.-S., Heaton, S. C., Donovan, N. J., & Velozo, C. (2012). The item level psychometrics of the behaviour rating inventory of executive function-adult (BRIEF-A) in a TBI sample. Brain Injury : [BI], 26(13-14), 1646–57. doi:10.3109/02699052.2012.700087 Weinberg, A., & Klonsky, E. D. (2009). Measurement of emotion dysregulation in adolescents. Psychological Assessment, 21(4), 616–21. doi:10.1037/a0016669 Westheide, J., Quednow, B. B., Kuhn, K.-U., Hoppe, C., Cooper-Mahkorn, D., Hawellek, B., … Wagner, M. (2008). Executive performance of depressed suicide attempters: the role of suicidal ideation. European Archives of Psychiatry and Clinical Neuroscience, 258(7), 414–21. doi:10.1007/s00406-008-0811-1 181 Whiteside, S. P., & Lynam, D. R. (2001). The Five Factor Model and impulsivity: using a structural model of personality to understand impulsivity. Personality and Individual Differences, 30(4), 669–689. doi:10.1016/S0191-8869(00)00064-7 Whiteside, S. P., Lynam, D. R., Miller, J. D., & Reynolds, S. K. (2005). Validation of the UPPS impulsive behaviour scale: a four-factor model of impulsivity. European Journal of Personality, 19(7), 559–574. doi:10.1002/per.556 Wichstrøm, L. (2000). Predictors of adolescent suicide attempts: a nationally representative longitudinal study of Norwegian adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 39(5), 603–10. doi:10.1097/00004583-200005000-00014 Wild, L. G., Flisher, A. J., & Lombard, C. (2004). Suicidal ideation and attempts in adolescents: associations with depression and six domains of self-esteem. Journal of Adolescence, 27(6), 611–24. doi:10.1016/j.adolescence.2004.03.001 Wilkinson, P. O., Kelvin, R., Roberts, C., Dubicka, B., & Goodyer, I. (2011). Clinical and psychosocial predictors of suicide attempts and nonsuicidal self-injury in the Adolescent Depression Antidepressants and Psychotherapy Trial (ADAPT). The American Journal of Psychiatry, 168(5), 495–501. doi:10.1176/appi.ajp.2010.10050718 Williams, J. M. G., & Broadbent, K. (1986). Autobiographical memory in suicide attempters. Journal of Abnormal Psychology, 95(2), 144–9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/3711438 182 Wilson, B. A. (1993). Ecological validity of neuropsychological assessment: Do neuropsychological indexes predict performance in everyday activities? Applied and Preventive Psychology, 2(4), 209–215. doi:10.1016/S0962-1849(05)80091-5 Wilson, B. A., Alderman, N., Burgess, P. W., Emslie, H., & Evans, J. J. (1996). Behavioural Assessment of the Dysexecutive Syndrome. Bury St. Edmunds, Suffolk, England: The Thames Valley Test Company. Witte, T. K., Joiner, T. E., Brown, G. K., Beck, A. T., Beckman, A., Duberstein, P. R., & Conwell, Y. (2006). Factors of suicide ideation and their relation to clinical and other indicators in older adults. Journal of Affective Disorders, 94, 165–172. doi:10.1016/j.jad.2006.04.005 Wood, R. L., & Liossi, C. (2006). The ecological validity of executive tests in a severely brain injured sample. Archives of Clinical Neuropsychology : The Official Journal of the National Academy of Neuropsychologists, 21(5), 429–37. doi:10.1016/j.acn.2005.06.014 World Health Organization. (1999). Facts and figures about suicide. Geneva: World Health Organisation Press Office. Retrieved from http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Facts+and+Figures+About+Suicide#2 World Health Organization. (2014). Preventing Suicide: A Global Imperative. Geneva. Retrieved from http://apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf?ua=1 183 Yen, C.-F., Cheng, C.-P., Ko, C.-H., Yen, J.-Y., Huang, C.-F., & Chen, C.-S. (2008). Suicidality and its association with insight and neurocognition in taiwanese patients with bipolar I disorder in remission. The Journal of Nervous and Mental Disease, 196(6), 462–7. doi:10.1097/NMD.0b013e3181775a3d Zakzanis, K. K., Mraz, R., & Graham, S. J. (2005). An fMRI study of the Trail Making Test. Neuropsychologia, 43(13), 1878–86. doi:10.1016/j.neuropsychologia.2005.03.013 Zandt, F., Prior, M., & Kyrios, M. (2009). Similarities and differences between children and adolescents with autism spectrum disorder and those with obsessive compulsive disorder: executive functioning and repetitive behaviour. Autism : The International Journal of Research and Practice, 13(1), 43–57. doi:10.1177/1362361308097120 Zelazo, P. D., Carter, A., Reznick, J. S., & Frye, D. (1997). Early development of executive function: A problem-solving framework. Review of General Psychology, 1(2), 198–226. doi:10.1037//1089-2680.1.2.198     184 Appendix A. PEBL Demographics Questionnaire  Gender: ____________________________  Date of Birth (YYYY/MM/DD):______________________  Were you born in the United States?           If no, where were you born: __________________________________________                    When did you move to the USA: __________________________________  Race/Ethnicity:                 -South Asian/Indian-South Asian Descent     -Hispanic/Latin American-Hispanic Descent                     Sexual Orientation:                             Current Marital Status:      -law      185            Highest Level of Education  th grade or less                              Master’s degree     degree  Yearly household income (before taxes):            -$9,999            -$19,999            -$29,999           -$39,999            -$49,999            -$59,999            -$75,000                      Occupation: ____________________________________________________________   Are you currently working outside the home?              If yes, how many hours per week do you work: -9 hours 186         -19 hours         -29 hours         -39 hours         -49 hours         -59 hours         -70 hours            How many people (including you) live in your immediate household? _______________        

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