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Bahlmann L, Lübbert M, Zerekidze A, Schulz A, Kastner UW, Sobanski T, Walter M, Wagner G. Does trait impulsivity differentiate impulsive from non-impulsive suicide attempts? J Psychiatr Res 2025; 188:200-208. [PMID: 40449227 DOI: 10.1016/j.jpsychires.2025.05.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Revised: 05/23/2025] [Accepted: 05/27/2025] [Indexed: 06/03/2025]
Abstract
BACKGROUND Suicide poses a major public health concern, with impulsive suicide and suicide attempts representing a particularly difficult subset of cases for effective suicide prevention. The relationship between impulsive suicidal behavior (ISB) and impulsivity as a trait, which can be assessed by specific questionnaires, is still unclear. This study, therefore aimed to investigate this association by comparing the degree of trait impulsivity as well as clinical and demographic variables in individuals with ISB to those with non-impulsive suicidal behavior (NISB). METHODS We included 130 adult inpatients admitted to a psychiatric ward of three psychiatric hospitals in Thuringia, Germany after a suicide attempt. Three distinct criteria were applied to define ISB, considering time- and planning-related aspects, as well as prior suicidal attempts using the Suicide Intent Scale and a structured clinical interview. Trait impulsivity was assessed using the Urgency, Premeditation, Perseverance, Sensation- Seeking (UPPS) Impulsive Behavior Scale. RESULTS No significant differences in the four UPPS impulsivity components controlling for multiple clinical and suicide specific variables were observed between the ISB and NISB groups across all three criteria as well as in clinical and demographic variables. CONCLUSION These findings underscore the complexity of the relationship between ISB and the various facets of impulsivity. They further highlight the need to improve standardized assessment methods to better identify individuals at risk for ISB and to develop effective intervention strategies to prevent such individuals from engaging in suicidal behavior during acute crises.
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Affiliation(s)
- Lydia Bahlmann
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, 07743, Germany
| | - Marlehn Lübbert
- Department of Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
| | - Ani Zerekidze
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, 07743, Germany
| | - Alexandra Schulz
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Thüringen-Kliniken, "Georgius Agricola" GmbH, Saalfeld, Germany
| | - Ulrich W Kastner
- Department of Psychiatry, Addiction, Psychotherapy and Psychosomatics, Klinikum am Europakanal, Erlangen, Germany
| | - Thomas Sobanski
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Thüringen-Kliniken, "Georgius Agricola" GmbH, Saalfeld, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, 07743, Germany; Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, 39118, Germany; German Center for Mental Health (DZPG), Site Jena Magdeburg Halle, Germany; Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Site Jena Magdeburg Halle, Germany
| | - Gerd Wagner
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, 07743, Germany; Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Site Jena Magdeburg Halle, Germany.
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McHugh R, McLafferty M, Brown N, Ward C, Walsh CP, Bjourson AJ, McBride L, Brady J, O'Neill S, Murray EK. The mediating role of impulsivity on suicidal behaviour among higher education students with depression and substance abuse disorders. Alcohol 2025; 124:89-96. [PMID: 39826864 DOI: 10.1016/j.alcohol.2025.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 12/19/2024] [Accepted: 01/13/2025] [Indexed: 01/22/2025]
Abstract
BACKGROUND Alcohol and drug dependent individuals have consistently exhibited elevated impulsivity and some studies have indicated that impulsivity recorded in young adults predicts future alcohol abuse. Research also indicates that depressed individuals with higher impulsivity are more likely to report suicidal ideation even when they are less depressed, which may indicate that impulsivity could more strongly predict suicidality than severity of depressive symptoms. OBJECTIVE The aim of this study was to investigate the mediating role of impulsivity on suicidal behaviour and self-harm among students with depression, alcohol and substance abuse disorders. MATERIALS AND METHODS Participants were first-year undergraduate students (n = 1829) across Ulster University (NI) and Letterkenny Institute of Technology - now known as Atlantic Technological University Donegal (ROI), who were recruited as part of the World Mental Health International College Student Initiative. Participants completed an online survey utilising the WMH-Composite International Diagnostic Interview Screening Scales (CIDI-SC). Mediation analyses were conducted in three different stages. RESULTS A high prevalence of depression and substance use disorders, suicidal ideation, plans, attempts and self-harm were observed. Impulsivity was found to partially mediate the association between depression and suicidal behaviours and substance use disorders and suicidal behaviours. Impulsivity was significantly associated with suicide ideation, attempts and self-harm, but not suicide plans. Males were more likely to be impulsive, and higher levels of depression and substance use disorders were related to higher impulsivity. CONCLUSIONS The main findings of this study reinforce the role of impulsivity in mediating the relationship between depression and suicidality and substance use and suicidality. College wellbeing services may consider whether screening for impulsivity, rather than for example substance abuse, could be more beneficial and less prone to under-reporting, when assessing for suicide risk among vulnerable students.
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Affiliation(s)
- Rachel McHugh
- School of Psychology, Ulster University, Coleraine BT52 1SA, UK.
| | - Margaret McLafferty
- Personalised Medicine Centre, School of Medicine, C-TRIC, Altnagelvin Hospital, Ulster University, Derry/Londonderry BT47 6SB, UK; Department of Nursing and Health Care, Atlantic Technological University (ATU), F92 FC93 Letterkenny, Ireland.
| | - Natasha Brown
- Department of Nursing and Health Care, Atlantic Technological University (ATU), F92 FC93 Letterkenny, Ireland.
| | - Caoimhe Ward
- Personalised Medicine Centre, School of Medicine, C-TRIC, Altnagelvin Hospital, Ulster University, Derry/Londonderry BT47 6SB, UK.
| | - Colum P Walsh
- Department of Biomedical and Clinical Sciences, Linköping University, SE-581 83 Linköping, Sweden.
| | - Anthony J Bjourson
- Personalised Medicine Centre, School of Medicine, C-TRIC, Altnagelvin Hospital, Ulster University, Derry/Londonderry BT47 6SB, UK.
| | - Louise McBride
- Department of Nursing and Health Care, Atlantic Technological University (ATU), F92 FC93 Letterkenny, Ireland.
| | - John Brady
- Western Health and Social Care Trust, Tyrone and Fermanagh Hospital, Omagh BT79 0NS, UK.
| | - Siobhan O'Neill
- School of Psychology, Ulster University, Coleraine BT52 1SA, UK. sm.o'
| | - Elaine K Murray
- Personalised Medicine Centre, School of Medicine, C-TRIC, Altnagelvin Hospital, Ulster University, Derry/Londonderry BT47 6SB, UK.
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Gualtieri S, Lombardo S, Sacco MA, Verrina MC, Tarallo AP, Carbone A, Costa A, Aquila I. Suicide in Italy: Epidemiological Trends, Contributing Factors, and the Forensic Pathologist's Role in Prevention and Investigation. J Clin Med 2025; 14:1186. [PMID: 40004717 PMCID: PMC11857011 DOI: 10.3390/jcm14041186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2024] [Revised: 01/31/2025] [Accepted: 02/06/2025] [Indexed: 02/27/2025] Open
Abstract
Suicide in Italy represents a serious public health problem, with significant data highlighting the urgency for prevention interventions. According to the epidemiological data, in the two-year period 2020-2021, 7422 suicides were recorded, representing an increase compared to previous years. Suicide is the most extreme self-harm. The contributing factors that surround this event are multiple, typically in conditions of serious distress or psychological distress, in particular in people suffering from serious psychiatric and/or mental disorders, such as depression. The role of the forensic pathologist in the context of suicide is crucial for ascertaining the contributing factors of death and for understanding the circumstances that lead to the suicidal act. Forensic medicine plays a crucial role in the analysis and understanding of suicides, addressing both the legal and medical implications. The aim of this study was to accurately describe the phenomenon of suicide in Italy. The accuracy of the review was very important in paying attention to the large difference in how the phenomenon manifests itself in the male population compared to the female population. The different ages at which suicide is committed were highlighted. The geographical difference between the North and the South and between the more urbanized areas compared to the rural areas where suicide is committed was analyzed. This scientific work also aimed to explore how forensic pathologists contribute to the resolution of complex forensic investigations. Psychological autopsy is an investigative method used primarily in cases of violent or questionable death, with the aim of understanding the psychological and social circumstances that led to an individual's death. This practice is distinct from forensic autopsy, which focuses on the physical analysis of the body to determine the cause of death. The role of forensic pathologists in investigating suicide cases is crucial, as they not only determine the cause of death but also analyze the psychological implications that may have led to the extreme act. The main objective of a forensic pathologist in these cases is to gather and interpret evidence that can help understand the psychological and social context that influenced the decision to commit suicide, identifying any warning signs and underlying motivations and factors that may have contributed to the suicide. This approach provides valuable information for prevention, enhancing the understanding of the psychological mechanisms behind suicide and supporting targeted interventions in the future. The manuscripts also have an explanatory purpose and may have a therapeutic role in helping surviving relatives understand suicide. Knowledge of the messages contained in suicide notes could be useful for suicide prevention programs.
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Affiliation(s)
| | | | | | | | | | | | | | - Isabella Aquila
- Department of Medical and Surgical Sciences, Institute of Legal Medicine, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (S.G.); (S.L.); (M.A.S.); (M.C.V.); (A.P.T.); (A.C.); (A.C.)
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Rasmussen S, Martin B, Cramer RJ. Multidimensional Impulsivity and Suicidal Behaviour: A Partial Test of the Integrated Motivational-Volitional (IMV) Model of Suicide. Arch Suicide Res 2025; 29:26-44. [PMID: 38411534 DOI: 10.1080/13811118.2024.2322118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Suicide remains a public health problem within the United Kingdom (UK) and globally. Impulsivity is a key risk factor within the Integrated Motivational-Volitional Model (IMV) of Suicide warranting further study. The current study applied a multi-dimensional impulsivity framework (UPPS-P) to differentiate suicidality subgroups within an IMV framework (i.e., no suicidal behavior, suicidal ideation only, and suicide attempt). Impulsivity subscales were evaluated as moderators of the suicidal ideation-future suicide attempt link. METHOD Adults living in the UK (N = 1027) completed an online survey addressing demographics, impulsivity, psychological distress, and lifetime suicidal behavior. We used analysis of variance (ANOVA) and linear regression with simple slopes analyses to investigate study objectives. RESULTS Data analyses revealed that: (1) four impulsivity subtypes (negative urgency, positive urgency, lack of premeditation, sensation-seeking) differentially distinguished suicidal behavior groups; (b) negative urgency, positive urgency, and lack of premeditation were meaningfully associated with suicide outcomes, and (c) negative urgency served as a moderator of the suicidal ideation-future attempt link. CONCLUSIONS Urgency, regardless of positive or negative valence, is important for understanding differences in lifetime suicidal behavior. Sensation-seeking may play a protective role for direct suicidal behavior. Negative urgency may be the most prominent aspect of impulsivity when considered as an IMV moderator. Findings are contextualized with respect to impulsivity and IMV frameworks. Clinical implications involve accounting for negative urgency in suicide risk assessment and intervention.
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Stubbing J, Tolin DF, Sain KS, Everhardt K, Rudd MD, Diefenbach GJ. Borderline Personality Traits Do Not Moderate the Relationship Between Depression, Beliefs, and Suicidal Thoughts and Behaviors. Arch Suicide Res 2025; 29:223-237. [PMID: 38683542 DOI: 10.1080/13811118.2024.2345168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Adults with clinically significant borderline personality disorder traits (BPTs) are at high risk of experiencing suicidal thoughts and behaviors (STBs). STBs among those with BPTs have been associated with suicidal beliefs (e.g., that one is unlovable or that distress is intolerable). However, the extent to which suicidal beliefs uniquely mediate the relationship between emotional distress and STBs among individuals with BPTs is not known. Individuals admitted to an inpatient unit (N = 198) with recent STBs completed assessments of BPTs, depression, suicidal beliefs, suicidal ideation, and suicide attempt history. Moderated mediation models were used to explore whether suicidal beliefs mediated the relationship between depression and STBs conditional on BPTs. Suicidal patients with versus without BPTs reported stronger suicidal beliefs and more severe STBs (i.e., suicidal ideation, lifetime attempts). Exploratory moderated mediation analysis demonstrated that suicidal beliefs mediated the relationship between depression and suicidal ideation as well as suicide attempts. The mediation effect of suicidal beliefs on the depression-ideation and depression-attempt relationship was not significantly moderated by BPTs. This study was cross-sectional and therefore the estimated mediation models must be considered exploratory. Longitudinal research will be needed to assess the potential causal mediation of suicidal beliefs on the relationship between depression and STBs. The results of this study suggest that suicidal beliefs may play a significant role in the relationship between depression and STBs for inpatients with a history of suicidality regardless of BPTs. This suggests suicidal beliefs may be an important treatment target for adults with a history of STBs.
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Martinson A, Roberge EM, Wong S, Pruitt R, Perkins J, Clinton-Lont J. Safety and Tolerability of a Brief Cognitive-Behavioral Therapy for Chronic Pain Group for Veterans at Increased Risk for Suicide. Mil Med 2024:usae548. [PMID: 39671512 DOI: 10.1093/milmed/usae548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 10/18/2024] [Accepted: 11/28/2024] [Indexed: 12/15/2024] Open
Abstract
INTRODUCTION Chronic pain is a significant risk factor for suicide, especially among Veterans. The aim of this study is to evaluate the safety (i.e., the occurrence of suicidal behavior after treatment) and tolerability (i.e., treatment completion) of a Brief Cognitive-Behavioral Therapy for Chronic Pain (Brief CBT-CP) group in primary care among a sample of Veterans with chronic noncancer pain deemed to be at an increased risk for suicide. MATERIALS AND METHODS Chart review was used to assess suicide history and treatment completion among Veterans who participated in a Brief CBT-CP group within a Primary Care-Mental Health Integration Clinic at a Veteran Affairs Medical Center. Suicide risk was stratified into 3 categories: Minimal (no current suicidal ideation or history of suicidal behavior), Elevated (current suicidal ideation or history of suicidal behavior), and High Risk (current suicidal ideation and history of suicidal behavior). Safety was assessed as the absence of suicidal behavior during and after Brief CBT-CP sessions. Tolerability was defined as completion of at least 4/6 sessions. RESULTS Of the 261 Veterans who participated in a Brief CBT-CP group, 24.9% of Veterans were identified to be at Elevated Risk for suicide, and 1.5% of Veterans were identified to be at High Risk. Brief CBT-CP was identified as safe, as no deaths (by suicide or otherwise) or suicidal behaviors were observed while Veterans engaged in the treatment sessions. In fact, following completion of Brief CBT-CP, a 24.2% reduction in relative risk of suicidal behaviors was observed in the overall sample. Brief CBT-CP was also tolerable, with nearly 90% of Veterans completing at least 4 sessions (n = 229). CONCLUSIONS Brief CBT-CP appears to be a safe and well-tolerated treatment for Veterans with chronic noncancer pain who are also at risk for suicide.
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Affiliation(s)
- Amber Martinson
- Mental Health Department, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
- Department of Psychiatry, University of Utah, Salt Lake City, UT 84112, USA
| | - Erika M Roberge
- Mental Health Department, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
- Department of Psychiatry, University of Utah, Salt Lake City, UT 84112, USA
| | - Shan Wong
- Mental Health Department, West Palm Beach VA Medical Center, West Palm Beach, FL 33410, USA
| | - Rebecca Pruitt
- Mental Health Department, Alaska VA Health Care System, Anchorage, AK 99504, USA
| | - John Perkins
- Mental Health Department, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
| | - Jamie Clinton-Lont
- Mental Health Department, VA Salt Lake City Health Care System, Salt Lake City, UT 84108, USA
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Schimpf MG, Gershengoren L, Moschenross D, Winston H, Simpson SA. Consultation-Liaison Case Conference: Assessment and Management of a Physician With Thoughts of Suicide. J Acad Consult Liaison Psychiatry 2024; 65:482-488. [PMID: 38844207 DOI: 10.1016/j.jaclp.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/19/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024]
Abstract
We present the case of a physician who engages with a peer response team and discloses suicidal ideation while himself seeing patients in the hospital. Top experts in consultation-liaison psychiatry provide guidance for this clinical case based on their experience and a review of the available literature. Key teaching topics include a general approach to suicide risk assessment, peer response programs for healthcare workers, and ethical and clinical considerations in treating colleagues. Consultation-liaison psychiatrists should be familiar with suicide risk management, take a pro-active approach to addressing modifiable risk factors, and keep in mind unique challenges of treating colleagues referred for care.
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Affiliation(s)
| | | | - Darcy Moschenross
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Helena Winston
- Department of Behavioral Health Services, Denver Health, Denver, CO
| | - Scott A Simpson
- Department of Behavioral Health Services, Denver Health, Denver, CO; Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO.
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Peiper LJ, Cramer RJ, Cacace SC, Peters A, Corral AR, Post AF, Prowten SD, Moxie J. Development and implementation of a self-directed violence prevention training program for correctional behavioral health providers: a clinical trial study protocol. Pilot Feasibility Stud 2024; 10:107. [PMID: 39118161 PMCID: PMC11308153 DOI: 10.1186/s40814-024-01533-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Self-directed violence (SDV) comprises both suicide and self-injury and represents a pressing problem among incarcerated persons. Negative impacts of SDV in correctional settings also extend to behavioral health clinicians (BHCs) (e.g., job turnover). Correctional SDV risk assessment and management standards include staff training as part of the comprehensive approach. The Core Competency Model for Corrections (CCM-C) is a novel, evidence-informed training program for BHCs covering both clinician self-management and clinical care skills. METHODS This pilot trial is a type 3 hybrid implementation-effectiveness approach. It will employ a wait-list control sequential cross-over design. Participants (N = 50-100) will be BHCs employed by the North Carolina Department of Adult Corrections. Following stratification for years of clinical experience, BHCs will be randomly assigned to (1) a training group that receives CCM-C immediately and (2) a wait-list control receiving CCM-C approximately 6 weeks later. Electronically administrated survey evaluation will occur across baseline and two follow-up (i.e., 2 weeks after each training session) time points. DISCUSSION The primary outcome is feasibility assessed through collaboration with a Corrections Advisory Panel and feedback from BHCs. Secondary effectiveness outcomes that will be evaluated over time include SDV-related knowledge, attitudes, stigma, and intent to use training content. We will examine a tertiary outcome, namely compassion fatigue. Clinical trial limitations and impacts are discussed. TRIAL REGISTRATION Clinicaltrials.gov, NCT06359574. This study was registered on 04/05/2024.
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Affiliation(s)
- Lewis J Peiper
- NC Department of Adult Correction, 831 W. Morgan Street, Raleigh, NC, 27699, USA
| | - Robert J Cramer
- Department of Epidemiology and Community Health, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA.
| | - Sam C Cacace
- Department of Epidemiology and Community Health, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA
| | - Ava Peters
- Department of Epidemiology and Community Health, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA
| | - Adria R Corral
- NC Department of Adult Correction, 831 W. Morgan Street, Raleigh, NC, 27699, USA
| | - Abigail F Post
- Department of Epidemiology and Community Health, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA
| | - Skyler D Prowten
- Department of Epidemiology and Community Health, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA
| | - Jessamyn Moxie
- Department of Epidemiology and Community Health, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC, 28223, USA
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Tio ES, Misztal MC, Felsky D. Evidence for the biopsychosocial model of suicide: a review of whole person modeling studies using machine learning. Front Psychiatry 2024; 14:1294666. [PMID: 38274429 PMCID: PMC10808719 DOI: 10.3389/fpsyt.2023.1294666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024] Open
Abstract
Background Traditional approaches to modeling suicide-related thoughts and behaviors focus on few data types from often-siloed disciplines. While psychosocial aspects of risk for these phenotypes are frequently studied, there is a lack of research assessing their impact in the context of biological factors, which are important in determining an individual's fulsome risk profile. To directly test this biopsychosocial model of suicide and identify the relative importance of predictive measures when considered together, a transdisciplinary, multivariate approach is needed. Here, we systematically review the emerging literature on large-scale studies using machine learning to integrate measures of psychological, social, and biological factors simultaneously in the study of suicide. Methods We conducted a systematic review of studies that used machine learning to model suicide-related outcomes in human populations including at least one predictor from each of biological, psychological, and sociological data domains. Electronic databases MEDLINE, EMBASE, PsychINFO, PubMed, and Web of Science were searched for reports published between August 2013 and August 30, 2023. We evaluated populations studied, features emerging most consistently as risk or resilience factors, methods used, and strength of evidence for or against the biopsychosocial model of suicide. Results Out of 518 full-text articles screened, we identified a total of 20 studies meeting our inclusion criteria, including eight studies conducted in general population samples and 12 in clinical populations. Common important features identified included depressive and anxious symptoms, comorbid psychiatric disorders, social behaviors, lifestyle factors such as exercise, alcohol intake, smoking exposure, and marital and vocational status, and biological factors such as hypothalamic-pituitary-thyroid axis activity markers, sleep-related measures, and selected genetic markers. A minority of studies conducted iterative modeling testing each data type for contribution to model performance, instead of reporting basic measures of relative feature importance. Conclusion Studies combining biopsychosocial measures to predict suicide-related phenotypes are beginning to proliferate. This literature provides some early empirical evidence for the biopsychosocial model of suicide, though it is marred by harmonization challenges. For future studies, more specific definitions of suicide-related outcomes, inclusion of a greater breadth of biological data, and more diversity in study populations will be needed.
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Affiliation(s)
- Earvin S. Tio
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Melissa C. Misztal
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel Felsky
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Livingston WS, Tannahill HS, Meter DJ, Fargo JD, Blais RK. The Association of Military Sexual Harassment/Assault With Suicide Ideation, Plans, Attempts, and Mortality Among US Service Members/Veterans: A Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:2616-2629. [PMID: 35763372 DOI: 10.1177/15248380221109790] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Suicide rates continue to increase among service members/veterans. Military sexual harassment/assault (MSH/A) may increase risk of suicide, but little is known about the collective magnitude of associations between MSH/A and suicide outcomes, including ideation, plan, attempt, and mortality. The current meta-analysis addressed this literature gap while testing potential moderators of gender, marital status, discharge status, and military branch. PsycINFO, PubMed, Dissertations/Theses, relevant citation lists, and conference brochures were reviewed for papers that included quantitative analyses in English, U.S. military samples, and measures of MSH/A and suicide ideation/plan/attempt/mortality. The search resulted in 22 studies (N = 10,898,875) measuring the association of MSH/A with suicide ideation (k = 15), plans (k = 1), attempts (k = 14), and mortality (k = 2), with papers published from 2007-2021. MSH/A was associated with suicide ideation (r ¯ = .14) and attempts (r ¯ = .11, ps < .05). The association of MSH/A and suicide ideation and attempts was higher among women relative to men, those identifying as married versus not married, those actively serving compared to discharged, and those reporting service in the Air Force relative to all other branches. The association of MSH/A with suicide plans and mortality was not calculated due to the small number of studies reporting those effect sizes (ks = 1-2). The effect sizes observed suggest MSH/A is part of a larger network of risk factors for suicide. Moderators indicate that suicide risk is higher among specific groups, and prevention strategies would be most effective if they targeted these individuals. This research area would be strengthened by additional studies of plans and mortality.
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Affiliation(s)
| | | | - Diana J Meter
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Jamison D Fargo
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Rebecca K Blais
- Department of Psychology, Utah State University, Logan, UT, USA
- Psychology Department, Arizona State University,Tempe, AZ, USA
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11
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Levis M, Levy J, Dufort V, Russ CJ, Shiner B. Dynamic suicide topic modelling: Deriving population-specific, psychosocial and time-sensitive suicide risk variables from Electronic Health Record psychotherapy notes. Clin Psychol Psychother 2023; 30:795-810. [PMID: 36797651 PMCID: PMC11172400 DOI: 10.1002/cpp.2842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
In the machine learning subfield of natural language processing, a topic model is a type of unsupervised method that is used to uncover abstract topics within a corpus of text. Dynamic topic modelling (DTM) is used for capturing change in these topics over time. The study deploys DTM on corpus of electronic health record psychotherapy notes. This retrospective study examines whether DTM helps distinguish closely matched patients that did and did not die by suicide. Cohort consists of United States Department of Veterans Affairs (VA) patients diagnosed with Posttraumatic Stress Disorder (PTSD) between 2004 and 2013. Each case (those who died by suicide during the year following diagnosis) was matched with five controls (those who remained alive) that shared psychotherapists and had similar suicide risk based on VA's suicide prediction algorithm. Cohort was restricted to patients who received psychotherapy for 9+ months after initial PTSD diagnoses (cases = 77; controls = 362). For cases, psychotherapy notes from diagnosis until death were examined. For controls, psychotherapy notes from diagnosis until matched case's death date were examined. A Python-based DTM algorithm was utilized. Derived topics identified population-specific themes, including PTSD, psychotherapy, medication, communication and relationships. Control topics changed significantly more over time than case topics. Topic differences highlighted engagement, expressivity and therapeutic alliance. This study strengthens groundwork for deriving population-specific, psychosocial and time-sensitive suicide risk variables.
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Affiliation(s)
- Maxwell Levis
- White River Junction VA Medical Center, Hartford, Vermont, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Joshua Levy
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Vincent Dufort
- White River Junction VA Medical Center, Hartford, Vermont, USA
| | - Carey J. Russ
- White River Junction VA Medical Center, Hartford, Vermont, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Brian Shiner
- White River Junction VA Medical Center, Hartford, Vermont, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- National Center for PTSD Executive Division, Hartford, Vermont, USA
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12
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Kaurin A, Dombrovski AY, Hallquist MN, Wright AGC. Suicidal urges and attempted suicide at multiple time scales in borderline personality disorder. J Affect Disord 2023; 329:581-588. [PMID: 36781143 PMCID: PMC10693674 DOI: 10.1016/j.jad.2023.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND There is strong evidence for an enduring suicidal diathesis among individuals with a history of suicide attempts, particularly among people diagnosed with borderline personality disorder (BPD). However, the progression of suicidal crises among people predisposed to suicidal behavior remains poorly understood. METHODS Via multilevel structural equation modeling we tested the hypothesis that a history of attempted suicide predicts a stronger dynamic link between affect and impulsivity with suicidal ideation (i.e., suicidal urges) - both moment-to-moment and day-to-day. 153 patients diagnosed with BPD, 105 of whom had a history of medically serious suicide attempts completed a 21-day ecological momentary assessment protocol (17,926 total assessments). RESULTS Individuals with higher average levels of negative affect reported more suicidal thoughts. Moments characterized by more negative affect, hostility, impulsivity, and less positive affect were also characterized by elevated suicidal ideation. For hostility and positive affect, these significant links generalized to the daily level. At the same time, for negative affect and hostility the within-person coupling was stronger among attempters in comparison to non-attempters, and these effects did not significantly differ across timescales. LIMITATIONS Follow-up studies replicating our findings of the dysregulation-suicidality nexus in clinically more diverse samples are needed. CONCLUSIONS The diathesis for suicidal behavior manifests in tighter dynamic links between negative affect or hostility and suicidal ideation. Because these within-person links were amplified in attempters compared to non-attempters, differential coupling patterns may index potentially lethal processes that generalize beyond BPD reflecting distinct diathesis components.
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Affiliation(s)
| | | | - Michael N Hallquist
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, USA
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13
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Frey JJ, Osteen PJ, Sharpe TL, Mosby AO, Joiner T, Ahmedani B, Iwamoto D, Nam B, Spencer‐Thomas S, Ko J, Ware OD, Imboden R, Cornette MM, Gilgoff J. Effectiveness of man therapy to reduce suicidal ideation and depression among working-age men: A randomized controlled trial. Suicide Life Threat Behav 2023; 53:137-153. [PMID: 36373571 PMCID: PMC10100179 DOI: 10.1111/sltb.12932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 08/07/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This randomized controlled trial of the online intervention, man therapy (MT), evaluated efficacy to reduce suicidal ideation (SI) and depression among working-aged men. METHOD Five-hundred and fifty-four men enrolled and 421 completed all surveys. Control Condition men explored the Healthy Men Michigan (HMM) website and Intervention Condition men explored HMM and MT. Hypotheses included men who used MT would report decreased SI and depression over time compared to Control Condition men. RESULTS Latent growth curve modeling revealed improvements in SI (slope = -0.23, p < 0.001, 95% CI: -0.29, -0.16) and depression (slope = -0.21, p < 0.001, 95% CI: -0.23, -0.18) over time for men in both groups; however, there was no difference in slope based on group assignment. Depression, lifetime suicide attempts, and interpersonal needs were associated with SI. Interpersonal needs and poor mental health were associated with depression. No group differences in change in risk and protective factors over time were observed. MT sub-group analyses revealed significant improvements in risk and protective factors. CONCLUSION While a direct effect of MT versus HMM on SI or depression was not observed, men in both groups improved. Results suggest online screening might play a role in reducing SI and depression among men and there are potential benefits to MT related to mental health, social support, and treatment motivation.
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Affiliation(s)
- Jodi J. Frey
- School of Social WorkUniversity of MarylandBaltimoreMarylandUSA
| | | | - Tanya L. Sharpe
- Factor‐Inwentash Faculty of Social WorkUniversity of TorontoTorontoOntarioCanada
| | - Amanda O. Mosby
- School of Social WorkUniversity of MarylandBaltimoreMarylandUSA
| | - Thomas Joiner
- Department of PsychologyFlorida State UniversityTallahasseeUtahUSA
| | - Brian Ahmedani
- Center for Health Policy and Health ServicesHenry Ford Health SystemDetroitMichiganUSA
| | - Derek Iwamoto
- Department of PsychologyUniversity of MarylandCollege ParkMarylandUSA
| | - Boyoung Nam
- Graduate School of Social WelfareYonsei UniversitySeoulSouth Korea
| | | | - Jungyai Ko
- Department of Social WelfareHallym UniversitySeoulSouth Korea
| | - Orrin D. Ware
- School of Social WorkUniversity of MarylandBaltimoreMarylandUSA
| | - Rachel Imboden
- School of Social WorkUniversity of MarylandBaltimoreMarylandUSA
| | - Michelle M. Cornette
- Center for Deployment PsychologyUniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Jon Gilgoff
- School of Social WorkUniversity of MarylandBaltimoreMarylandUSA
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14
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Linthicum KP, Ribeiro JD. Suicide plan prevalence, recurrence, and longitudinal association with nonfatal suicide attempt. Suicide Life Threat Behav 2022; 52:1062-1073. [PMID: 35851502 DOI: 10.1111/sltb.12901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/22/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Each year, millions of people develop suicide plans. These plans are assumed to indicate imminent suicide risk, yet this has rarely been tested. The present study seeks to address two questions: (1) how prevalent are specific thoughts of suicide plans among individuals with a history of suicidal thoughts and behaviors and (2) do suicide plans confer risk of future suicide attempts in the short term? METHODS Secondary data analysis was performed on a longitudinal dataset (N = 1021). Prevalence and frequencies of suicide planning features (i.e., method, time, place) at baseline and 3, 14, and 28 days post-baseline were calculated. Logistic regressions were conducted to assess whether suicide plans confer risk of suicide attempts across a 28-day follow-up period. RESULTS Suicide planning more commonly involved thoughts of method than place and/or time. High variability in suicide planning was evident and thoughts of suicide plans frequently recurred. Contrary to assumptions, suicide plans displayed weak associations with nonfatal suicide attempt across the 28-day follow-up period. CONCLUSIONS Suicide plans appear heterogeneous in nature. They do not appear to play a strong role in predicting nonfatal suicide attempts. Re-evaluation of the central role that suicide plans occupy within clinical risk assessments may be warranted.
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Affiliation(s)
- Kathryn P Linthicum
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Jessica D Ribeiro
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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15
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Anvar S, Swerdlow BA, Jobes D, Timpano KR, Mandel AA, Kleiman E, Joiner T, Johnson SL. Emotion-related impulsivity and suicidal ideation: Towards a more specific model. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:1219-1235. [PMID: 35912940 PMCID: PMC9560962 DOI: 10.1111/bjc.12383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/22/2022] [Accepted: 07/04/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Suicidal ideation is a pervasive and painful experience that varies considerably in its phenomenology. Here, we consider how one key risk variable might inform our understanding of variation in suicidal ideation: emotion-related impulsivity, the trait-like tendency towards unconstrained speech, behaviour, and cognition in the face of intense emotions. We hypothesized that emotion-related impulsivity would be tied to specific features, including severity, perceived lack of controllability, more rapidly fluctuating course, higher scores on a measure of acute suicidal affective disturbance, and more emotional and cognitive disturbance as antecedents. METHODS We recruited two samples of adults (Ns = 421, 221) through Amazon Mechanical Turk (MTurk), with oversampling of those with suicidal ideation. Both samples completed psychometrically sound self-report measures online to assess emotion- and non-emotion-related dimensions of impulsivity and characteristics of suicidal ideation. RESULTS One form of emotion-related impulsivity related to the severity, uncontrollability, dynamic course, and affective and cognitive precursors of ideation. CONCLUSIONS Despite limitations of the cross-sectional design and self-report measures, the current findings highlight the importance of specificity in considering key dimensions of impulsivity and suicidal ideation.
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Affiliation(s)
- Sarah Anvar
- University of California, Berkeley, California, USA
| | | | - David Jobes
- American University, Washington, District of Columbia, USA
| | | | | | - Evan Kleiman
- Rutgers University, New Brunswick, New Jersey, USA
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16
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Koga Y, Kawano K, Kawashima D. Does Video Game Play Elevate Suicide Risk? A Cross‐sectional Study of Japanese Young Adults
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2. JAPANESE PSYCHOLOGICAL RESEARCH 2022. [DOI: 10.1111/jpr.12442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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17
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Chammas F, Januel D, Bouaziz N. Inpatient suicide in psychiatric settings: Evaluation of current prevention measures. Front Psychiatry 2022; 13:997974. [PMID: 36386981 PMCID: PMC9650354 DOI: 10.3389/fpsyt.2022.997974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 12/01/2022] Open
Abstract
The risk of suicide in psychiatric hospitals is 50 times higher than in the general population, despite patient safety being a priority for any hospital. However, to date, due to the complexity of assessing suicide risk, there has been no consensus on the suicide prevention measures that should be in place in hospitals. The aim of this work is: To provide an overview of the progress that has been made in the field of inpatient suicide prevention in recent years; discuss the problems that remain; and suggest potential future developments. As new clinical dimensions (notably anhedonia, psychological pain and hopelessness) develop, they should become new therapeutic targets. Team training (like the Gatekeeper Training Program) and the latest advances in suicide risk assessment (such as the Collaborative Assessment and Management of Suicidality) should be implemented in psychiatric wards. Suicide prevention plans (e.g., ASSIP, SAFE-T, etc.) represent easy-to-administer, low-cost interventions. The Mental Health Environment of Care Checklist has been proven effective to reduce suicide risk at hospitals. Furthermore, the types of psychotherapy recommended to reduce suicide risk are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). There are several pharmacological treatments for suicide risk, such as lithium and clozapine, which have been shown to be effective in the long term, as well as ketamine and esketamine, which are more effective in the short term. Following some encouraging recent results, buprenorphine may also be proposed to patients with a suicide risk. Triple chronotherapy rapidly improves depressive symptoms over 9 weeks. Regarding brain stimulation techniques, rTMS has proven to be effective in alleviating multiple dimensions of suicidality.
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Affiliation(s)
- Francesca Chammas
- Centre de Recherche Clinique, EPS Ville-Evrard, Neuilly-sur-Marne, France
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18
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Kaurin A, Dombrovski AY, Hallquist MN, Wright AG. Momentary interpersonal processes of suicidal surges in borderline personality disorder. Psychol Med 2022; 52:2702-2712. [PMID: 33298227 PMCID: PMC8190164 DOI: 10.1017/s0033291720004791] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Suicide rates are high in borderline personality disorder (BPD) where interpersonal problems trigger intense affective dysregulation and impulses to act on suicidal thoughts. To date, however, no study has examined how interpersonal stressors contribute to momentary within-person links among affect and impulsivity with suicidal ideation (SI), and how those links vary over time in people's daily lives. METHODS A total of 153 individuals diagnosed with BPD and 52 healthy controls completed a 21-day ecological momentary assessment protocol. Of these 153 individuals with BPD, 105 had a history of suicide attempts. Multilevel structural equation modeling was used to examine dynamic links among interpersonal perceptions, affect, state impulsivity, and suicidal intent. RESULTS Aggregated across interactions, lower perceived warmth in others was associated with SI. This direct relationship, however, did not extend to momentary within-person associations. Instead, interpersonal conflicts were linked to SI indirectly via greater negative affect and lower positive affect. While a robust within-person link between interpersonal perceptions and impulsivity emerged, impulsivity did not account for the relationship between interpersonal perceptions and SI. CONCLUSION This intensive longitudinal study illustrates momentary interpersonal signatures of an emerging suicidal crisis. Among people with BPD at high risk for suicide, interpersonal triggers initiate a cascade of affective dysregulation, which in turn gives rise to SI.
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Affiliation(s)
| | | | - Michael N. Hallquist
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill
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19
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Risk-Taking Behavior among Suicide Attempters. J Clin Med 2022; 11:jcm11144177. [PMID: 35887941 PMCID: PMC9320022 DOI: 10.3390/jcm11144177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 01/10/2023] Open
Abstract
Background: Suicidal behavior is a major mental health concern both for the individual and for the public health. Among others, suicidal behavior is associated with impulsivity, risk taking, pain tolerance, and a state of overarousal. In the present study, we investigated if suicide attempters (SAs) reported higher scores for risk-taking when compared with healthy controls (HC) of the general population. Methods: A total of 616 individuals (mean age: 27.07 years; 51.5% females) took part in the study; of those, 240 (39%) were individuals with a suicide attempt (SA) within a time lapse of one to three months, and 376 (61%) were healthy controls (HC). Participants completed a series of self-rating questionnaires covering sociodemographic information, risk-taking (Risk-Taking Questionnaire 18; RT-18), and suicidal behavior (Suicide Behaviors Questionnaire-Revised; SBQ-R). Results: Compared with HCs, individuals with SA reported higher risk-taking and suicidal behavior scores. The risk-taking questionnaire yielded a four-factor solution: Thrill and sensation seeking; Cautious procedure; Cautious decision making; Impulsive behavior. Compared with HCs, SAs showed the highest scores for thrill and sensation seeking and impulsive behavior. Conclusions: Compared with healthy controls, individuals reporting a recent suicide attempt also reported a higher propensity to thrill and sensation seeking and impulsive behavior as a proxy of risk-taking behavior. The present results corroborate the notion that, among others, suicide attempts appeared to be less related to premeditation, but rather to impulsive and thus spontaneous behavior.
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20
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Christensen LeCloux M, Aguinaldo LD, Lanzillo EC, Horowitz LM. Provider opinions of the acceptability of Ask Suicide-Screening Questions (ASQ) Tool and the ASQ Brief Suicide Safety Assessment (BSSA) for universal suicide risk screening in community healthcare: Potential barriers and necessary elements for future implementation. J Behav Health Serv Res 2022; 49:346-363. [PMID: 35266079 DOI: 10.1007/s11414-022-09787-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 10/18/2022]
Abstract
A convenience sample of community health care providers (N = 19) was asked to preview and rate the acceptability of the Ask Suicide-Screening Questions (ASQ) tool and the ASQ Brief Suicide Safety Assessment (BSSA) guide. Providers were also asked about potential barriers to implementation. The majority of participants stated they would be comfortable screening for suicide with the ASQ tool (78.9%; N = 15), that they would recommend the ASQ tool and the BSSA to colleagues (84.2%; N = 16), and that they were "satisfied" or "highly satisfied" with the ASQ and BSSA (88.2%; N = 13). Barriers to implementation reported included a lack of knowledge regarding suicide risk screening and lack of access to behavioral health resources. Education regarding the ASQ, the BSSA, and suicide risk screening are highlighted as crucial elements for future implementation.
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Affiliation(s)
| | | | | | - Lisa M Horowitz
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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21
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Beach VL, Gissandaner TD, Schmidt AT. The UPPS Model of Impulsivity and Suicide: A Systematic Literature Review. Arch Suicide Res 2022; 26:985-1006. [PMID: 33650464 DOI: 10.1080/13811118.2021.1892002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Suicide is a leading cause of death worldwide. Although inconsistent, impulsivity has been identified as a risk factor for suicidal thoughts and behaviors, and these inconsistent findings can largely be attributed to varying operationalizations of impulsivity. As such, the UPPS model of impulsivity provides a clear definition of impulsivity and its associated features that may provide utility in clarifying unreliable findings between impulsivity and suicide. This review aimed to summarize relevant information pertaining to the UPPS model of impulsivity and suicide. METHODS This systematic review followed the a priori guide outlined by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Articles were gathered from PsycINFO, PsycArticles, Scopus, and PubMed. RESULTS Twenty-eight articles were reviewed and analyzed. Most articles reviewed reported on indirect (i.e., through mediators and moderators) associations between the UPPS dimensions and suicidal behaviors. Additionally, results noted limited between-group differences in UPPS facets among individuals with a history of suicide attempts and those without a history of suicide attempts, those with a history of suicide attempts and individuals with suicide ideation, and those with suicide ideation and those without suicide ideation, with the exception of lack of premeditation. DISCUSSION The results of this review indicate support for the UPPS model of impulsivity as a theoretical starting point when examining the relation between impulsivity and suicide. Further, findings are helpful for clinicians and case conceptualization. Particularly, suicide risk assessment and treatment would be impacted based on impulsivity traits and suicide history.
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22
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Shorub E, Omar AN, Elshahawi H, Naoum D, Elsahrawy T, Elhawary Y. Impulsivity and psychiatric comorbidity as risk factors for suicide attempts in borderline personality disorder. S Afr J Psychiatr 2022; 28:1544. [PMID: 35747342 PMCID: PMC9210139 DOI: 10.4102/sajpsychiatry.v28i0.1544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/08/2021] [Indexed: 11/01/2022] Open
Abstract
Background: Addressing the risk of suicidality in borderline personality disorder (BPD) is a crucial issue. The notion that impulsive individuals are more likely to plan for suicide attempts is important for many reasons in both theoretical and clinical decision-making.Aim: The aim of this study was to investigate potential risks of suicidality in BPD and to correlate it to impulsivity.Setting: The study was conducted at the Institute of Psychiatry, Ain Shams University and Al Mashfa Private Hospital.Methods: Ninety-one participants were included in the study: 30 patients were diagnosed as BPD without axis I comorbidities, 31 BPD patients had psychiatric comorbidities and 30 healthy subjects were assessed by using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), Suicide Behavior Questionnaire-Revised (SBQ-R), the Arabic version of Barratt’s Impulsiveness Scale-11 (BIS-11) and Global Assessment of Functioning scale.Results: There was a significant difference in suicidality using the SBQ-R between the healthy controls and BPDs without and with comorbidities. Healthy controls showed low suicidality in only 3.3%, while it was higher in both groups of BPD. The total score of BIS was as follows: 62.5 (±10.1 SD) in group A, 79.4 (±12 SD) in group B and 80.3 (±12.5 SD) in group C, which denote mild, moderate and moderate-to-severe degree of impulsivity in group A, B and C, respectively. Suicidality was positively correlated with (AI item: lack of span Attention in Attentional Facet) (r = 0.489, p = 0.006), (PI item: lack of self-control in planning facet) (r = 0.401, p = 0.028), as well as (MII item: lack perseverance in holding off impulsive acts in motor facet) (r = 0.471, p = 0.009).Conclusion: Proper assessment of associated psychiatric comorbidities and impulsivity among BPD patients will help preventing of future suicidal attempts.
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Affiliation(s)
- Eman Shorub
- Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Abdel Nasser Omar
- Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Heba Elshahawi
- Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Tarek Elsahrawy
- Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Yomna Elhawary
- Department of Neurology and Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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23
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García-Martínez C, Oliván-Blázquez B, Fabra J, Martínez-Martínez AB, Pérez-Yus MC, López-Del-Hoyo Y. Exploring the Risk of Suicide in Real Time on Spanish Twitter: Observational Study. JMIR Public Health Surveill 2022; 8:e31800. [PMID: 35579921 PMCID: PMC9157318 DOI: 10.2196/31800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/22/2021] [Accepted: 02/24/2022] [Indexed: 11/15/2022] Open
Abstract
Background Social media is now a common context wherein people express their feelings in real time. These platforms are increasingly showing their potential to detect the mental health status of the population. Suicide prevention is a global health priority and efforts toward early detection are starting to develop, although there is a need for more robust research. Objective We aimed to explore the emotional content of Twitter posts in Spanish and their relationships with severity of the risk of suicide at the time of writing the tweet. Methods Tweets containing a specific lexicon relating to suicide were filtered through Twitter's public application programming interface. Expert psychologists were trained to independently evaluate these tweets. Each tweet was evaluated by 3 experts. Tweets were filtered by experts according to their relevance to the risk of suicide. In the tweets, the experts evaluated: (1) the severity of the general risk of suicide and the risk of suicide at the time of writing the tweet (2) the emotional valence and intensity of 5 basic emotions; (3) relevant personality traits; and (4) other relevant risk variables such as helplessness, desire to escape, perceived social support, and intensity of suicidal ideation. Correlation and multivariate analyses were performed. Results Of 2509 tweets, 8.61% (n=216) were considered to indicate suicidality by most experts. Severity of the risk of suicide at the time was correlated with sadness (ρ=0.266; P<.001), joy (ρ=–0.234; P=.001), general risk (ρ=0.908; P<.001), and intensity of suicidal ideation (ρ=0.766; P<.001). The severity of risk at the time of the tweet was significantly higher in people who expressed feelings of defeat and rejection (P=.003), a desire to escape (P<.001), a lack of social support (P=.03), helplessness (P=.001), and daily recurrent thoughts (P=.007). In the multivariate analysis, the intensity of suicide ideation was a predictor for the severity of suicidal risk at the time (β=0.311; P=.001), as well as being a predictor for fear (β=–0.009; P=.01) and emotional valence (β=0.007; P=.009). The model explained 75% of the variance. Conclusions These findings suggest that it is possible to identify emotional content and other risk factors in suicidal tweets with a Spanish sample. Emotional analysis and, in particular, the detection of emotional variations may be key for real-time suicide prevention through social media.
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Affiliation(s)
| | - Bárbara Oliván-Blázquez
- Department of Psychology and Sociology, University of Zaragoza, Institute for Health Research Aragón, Zaragoza, Spain
| | - Javier Fabra
- Department of Computer Science and Systems Engineering, Aragón Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain
| | - Ana Belén Martínez-Martínez
- Department of Nursing and Physiatry, Institute for Health Research Aragón, University of Zaragoza, Zaragoza, Spain
| | - María Cruz Pérez-Yus
- Department of Psychology and Sociology, University of Zaragoza, Institute for Health Research Aragón, Zaragoza, Spain
| | - Yolanda López-Del-Hoyo
- Department of Psychology and Sociology, University of Zaragoza, Institute for Health Research Aragón, Zaragoza, Spain
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Bauder CR, Hay JM, McClung JG, Starkey AG, Bryan CJ. Content Analysis of Warning Signs Identified as Part of Crisis Response Planning in a Community Sample of Gun Owners and Non-owners. Front Psychiatry 2022; 13:867332. [PMID: 35530030 PMCID: PMC9069156 DOI: 10.3389/fpsyt.2022.867332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background Assessing for and identifying those at imminent risk for suicide continues to present challenges, especially as many who die do not interact with specialty mental health treatment preceding suicide. Suicide-specific interventions in healthcare settings have been found to improve suicide-related outcomes, yet little is known about the confluence of behavioral, cognitive, emotional, and physiological indicators of emotional distress as they correspond to other key risk characteristics and high-risk groups like gun owners. Aim The purpose of this content analysis was to examine self-identified warning signs of distress between gun owners and non-owners through crisis response planning (CRP). Methods Participants completed a collaborative CRP. Warning signs were categorized as being either behavioral, cognitive, emotional, or physiological in nature. Bivariate logistic regression models were used to examine associations between firearm ownership and variables of interest. Participants were evenly split between men (n = 44) and women (n = 44) and were predominantly white (67.1%) with a mean age of 35.9 (SD = 13.6). Results Emotional warning signs of distress (68.2%) were reported slightly more often than behavioral (65.9%) followed by physiological (52.3%), and cognitive (46.6%). Firearm owners were significantly more likely to be male (OR = 2.5, 95%CI [1.07-6.0]). All participants were about a fourth as likely to report both a behavioral and physiological warning sign concurrently (OR = 0.26, 95% CI [0.09-0.67]). Conclusion Similarities and departures in warning signs of emotional distress may inform future research exploring both self-reported warning signs and related self-management strategies identified through suicide-specific interventions, particularly among high-risk groups such as gun owners.
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Affiliation(s)
- Christina Rose Bauder
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH, United States
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25
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Lawson SG, Lowder EM, Ray B. Correlates of suicide risk among Black and White adults with behavioral health disorders in criminal-legal systems. BMC Psychiatry 2022; 22:163. [PMID: 35246077 PMCID: PMC8895515 DOI: 10.1186/s12888-022-03803-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/19/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Adults with behavioral health disorders in criminal-legal systems are at heightened risk of suicide relative to the general population. Despite documented racial disparities in criminal processing and behavioral health treatment, few studies have examined racial differences in suicide risk in this already high-risk population. This study examined 1) the correlates of suicide risk in this population overall and by race and 2) the moderating role of race in these associations. METHODS We investigated correlates of clinician-rated suicide risk at baseline in a statewide sample of 2,827 Black and 14,022 White adults with criminal-legal involvement who engaged in community-based behavioral health treatment. Regression-based approaches were used to model suicide risk and test for evidence of interaction effects. RESULTS Findings showed the strongest correlates of suicide risk were greater behavioral health needs, evidence of self-harm, and a primary mental health diagnosis or co-occurring diagnosis. In race-specific analyses, correlates of suicide risk were mostly similar for both Black and White clients, with a couple exceptions. Interaction terms testing between-group effects on correlates of suicide risk were non-significant. CONCLUSIONS Adults with behavioral health disorders in criminal-legal systems experience similar risk factors for suicide as the general population. Similar to prior research, we found that Black adults, in particular, are at lower risk for suicide overall. Contrary to expectations, we found similarities in correlates of suicide risk across race in our sample of felony-level adults with behavioral health disorders in the criminal-legal system. Prior research shows that behavioral health professionals should be cognizant of cultural factors when developing a comprehensive approach to suicide care and treatment. Our findings show correlates of suicide risk are largely stable in Black and White adults involved in criminal-legal systems, suggesting culturally responsive treatment for suicide risk should target shared risk factors.
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Affiliation(s)
- Spencer G Lawson
- School of Criminal Justice, Michigan State University, East Lansing, MI, USA.
| | - Evan M Lowder
- Department of Criminology, Law and Society, George Mason University, Fairfax, VA, USA
| | - Bradley Ray
- Division for Applied Justice Research, RTI International, Research Triangle Park, NC, USA
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Mennicke A, Kaniuka AR, Pruneda P, Cramer RJ. Substance use-related suicide after release from correctional, behavioral health, and healthcare facilities using national violent death reporting system data. Suicide Life Threat Behav 2022; 52:132-146. [PMID: 34708427 DOI: 10.1111/sltb.12813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Suicide and substance use are prevalent problems among persons discharged from facilities. This study (1) articulated rates of substance-related suicide deaths among those discharged correctional, behavioral health, and healthcare facilities, and (2) identified factors associated with substance-related suicide deaths unique to, or generalizing across, facility discharge. METHODS We used data from the National Violent Death Reporting System. Suicide deaths (N = 105,968) were aggregated from 2003 to 2017. Chi-square and independent samples t-tests were used to examine associations between drug/alcohol-related deaths and each correlate. Logistic regression was employed to identify the most robust substance-related suicide death-related factors. RESULTS Suicide deaths were commonly marked as being substance-related: 69% from correctional institutions, 54% from behavioral health facilities, 45% from those not released from a facility, and 39% from healthcare facilities. Regression models indicated housing interruptions and interpersonal stressors increased odds of the suicide death being marked as substance-related across discharge categories. Each discharge category also had unique predictors, underscoring the need for tailored prevention. CONCLUSIONS Substance-related suicide deaths are particularly common among adults discharged from correctional and behavioral health facilities. Findings are discussed with respect to community-focused, discharge planning, and clinical care suicide prevention strategies.
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Affiliation(s)
- Annelise Mennicke
- University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Andrea R Kaniuka
- University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Phoebe Pruneda
- University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Robert J Cramer
- University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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Cramer RJ, Kaniuka AR, Yada FN, Diaz-Garelli F, Hill RM, Bowling J, Macchia JM, Tucker RP. An analysis of suicidal thoughts and behaviors among transgender and gender diverse adults. Soc Psychiatry Psychiatr Epidemiol 2022; 57:195-205. [PMID: 34106286 DOI: 10.1007/s00127-021-02115-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Suicidal thoughts and behaviors (STBs) remain a pressing public health problem for transgender and gender diverse (TGD) persons. The goal of this study was to apply social-ecological and minority stress frameworks to identify individual and interpersonal-level TGD-specific STB risk and protective factors. METHODS This is a secondary analysis of the 2015 United States Transgender Health Survey, a comprehensive cross-sectional health assessment of a national sample of TGD adults (N = 27,658). Chi-square and Analysis of Variance (ANOVA) were used to identify bivariate correlates of 12-month and lifetime suicidal ideation (SI) and suicide attempt (SA). Logistic regression was employed to identify the strongest STB risk and protective factors across levels. RESULTS Sexual minority identification, racial minority identification, and having a disability were lifetime STB risk factors. TGD identity, sexual minority identification, racial minority identification (SA only), lower education, lower income, military experience, having a disability, and being uninsured were 12-month STB risk factors. Psychological distress was the most robust STB risk factor. Workplace discrimination, family rejection, healthcare discrimination, and childhood bias-based victimization were lifetime STB risk factors. All forms of discrimination and victimization (with the exception of family rejection for SI) were 12-month STB risk factors. Family and coworker support were protective factors for lifetime SA (but not SI) and all 12-month STBs. Being less out about TGD identity was a protective factor for STBs (except for 12-month SI). CONCLUSION Findings support social-ecological and minority stress STB risk frameworks. Recommendations are provided for a comprehensive approach to TGD suicide prevention.
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Affiliation(s)
- Robert J Cramer
- Department of Public Health Sciences, UNC Charlotte, 9201 University Blvd., Charlotte, NC, 28233, USA.
| | - Andrea R Kaniuka
- Department of Public Health Sciences, UNC Charlotte, 9201 University Blvd., Charlotte, NC, 28233, USA
| | - Farida N Yada
- Department of Public Health Sciences, UNC Charlotte, 9201 University Blvd., Charlotte, NC, 28233, USA
| | - Franck Diaz-Garelli
- Department of Public Health Sciences, UNC Charlotte, 9201 University Blvd., Charlotte, NC, 28233, USA
| | - Ryan M Hill
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jessamyn Bowling
- Department of Public Health Sciences, UNC Charlotte, 9201 University Blvd., Charlotte, NC, 28233, USA
| | - James M Macchia
- Virginia Consortium Program in Clinical Psychology, Norfolk, USA
| | - Raymond P Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
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28
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Cramer RJ, Franks M, Cunningham CA, Bryan CJ. Preferences in Information Processing: Understanding Suicidal Thoughts and Behaviors among Active Duty Military Service Members. Arch Suicide Res 2022; 26:169-186. [PMID: 32369420 DOI: 10.1080/13811118.2020.1760156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The present study examined Preferences in Information Processing (PIP), an emerging model of understanding suicidal thoughts and behaviors (STBs), in a clinical military sample for the first time. Constructs of need for affect (NFA; i.e., extent to which one engages or avoids emotional content) and need for cognition (NFC; i.e., extent of preference for and enjoyment of cognitive effort) are central individual differences of the PIP model hypothesized to be associated with STBs. Data (n = 200 active duty personnel) were drawn from medical records and self-report questionnaires from two outpatient treatment settings in a military hospital. Primary findings include: (1) moderate positive bivariate associations of NFA avoidance with mental health symptoms and lifetime STBs; (2) consistent patterns in which NFA approach buffers the negative associations of depression with life STBs, clinical suicide risk, perceived burdensomeness and thwarted belonging. Recommendations are offered for military suicide prevention, and future suicide theory testing.
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Cacace S, Smith EJ, Cramer RJ, Meca A, Desmarais SL. Military self-stigma as a mediator of the link between military identity and suicide risk. MILITARY PSYCHOLOGY 2021; 34:237-251. [PMID: 38536295 PMCID: PMC10013367 DOI: 10.1080/08995605.2021.1994329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/09/2021] [Indexed: 10/19/2022]
Abstract
US military Veterans are at greater risk for suicide than those who have never served in the US military. Recent federal calls include the need to investigate military-specific suicide risk and protective factors among military-affiliated populations. To date, no study has examined the link between military identity, self-stigma, and suicide risk. The current study used a nationally representative sample of post-Vietnam US military Veterans (N = 1,461) in order to determine relationships between military identity, self-stigma, and suicide risk. Idealism (OR = 0.86) with less odds of elevated suicide risk, whereas individualism (OR = 1.15) and military self-stigma (OR = 1.39) were associated with increased odds of elevated suicide risk. Military self-stigma was found to mediate the relationship between military identity components and suicide risk. Implications for conceptualization of military Veteran identity, suicide prevention, and future research are discussed.
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Affiliation(s)
- Sam Cacace
- Department of Public Health Sciences, University of North Carolina, Charlotte, North Carolina, USA
| | - Emily J. Smith
- Center for Family and Community Engagement, NC State University, Raleigh, North Carolina, USA
| | - Robert J. Cramer
- Department of Public Health Sciences, University of North Carolina, Charlotte, North Carolina, USA
| | - Alan Meca
- Department of Psychology, University of Texas, San Antonio, Texas, USA
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Rugo-Cook KF, Kerig PK, Crowell SE, Bryan CJ. Fluid vulnerability theory as a framework for understanding the association between posttraumatic stress disorder and suicide: A narrative review. J Trauma Stress 2021; 34:1080-1098. [PMID: 34881461 DOI: 10.1002/jts.22782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022]
Abstract
Suicide is a persistent issue in the United States and across the globe. A large body of published research shows that posttraumatic stress disorder (PTSD) increases the risk of suicidal ideation, suicidal behaviors, and death by suicide. However, the existing literature examining why that association might pertain is widely dispersed across disciplines (e.g., psychology, nursing) and lacks an integrative theoretical framework, making it difficult to conceptualize the current state of science in this area. Therefore, the primary aims of this narrative review were to (a) provide a comprehensive and interdisciplinary critique of the current state of knowledge regarding mechanisms that underlie the association between PTSD and suicide and (b) organize that knowledge according to a specified theoretical framework. The framework guiding this review is "fluid vulnerability theory," a diathesis-stress model of suicide that emphasizes the dynamic nature of suicide risk across cognitive, emotional, behavioral, and physiological domains. A summary of the findings, including patterns that emerged, gaps that remain, and recommendations for the advancement of science and practice in this area are addressed in this narrative review.
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Affiliation(s)
- Kelsi F Rugo-Cook
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Patricia K Kerig
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Sheila E Crowell
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Craig J Bryan
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
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31
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Ahmed N, Barlow S, Reynolds L, Drey N, Begum F, Tuudah E, Simpson A. Mental health professionals' perceived barriers and enablers to shared decision-making in risk assessment and risk management: a qualitative systematic review. BMC Psychiatry 2021; 21:594. [PMID: 34823487 PMCID: PMC8613998 DOI: 10.1186/s12888-021-03304-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Risk assessment and risk management are fundamental processes in the delivery of safe and effective mental health care, yet studies have shown that service users are often not directly involved or are unaware that an assessment has taken place. Shared decision-making in mental health systems is supported by research and advocated in policy. This systematic review (PROSPERO: CRD42016050457) aimed to explore the perceived barriers and enablers to implementing shared decision-making in risk assessment and risk management from mental health professionals' perspectives. METHODS PRISMA guidelines were followed in the conduct and reporting of this review. Medline, CINAHL, EMBASE, PsycINFO, AMED and Internurse were systematically searched from inception to December 2019. Data were mapped directly into the Theoretical Domains Framework (TDF), a psychological framework that includes 14 domains relevant to behaviour change. Thematic synthesis was used to identify potential barriers and enablers within each domain. Data were then matched to the three components of the COM-B model: Capability, Opportunity, and Motivation. RESULTS Twenty studies met the eligibility criteria. The findings of this review indicate that shared decision-making is not a concept commonly used in mental health services when exploring processes of risk assessment and risk management. The key barriers identified were 'power and best interest' (social influences) and 'my professional role and responsibility' (social/professional role and identity). Key enablers were 'therapeutic relationship' (social influences) and 'value collaboration' (reinforcement). The salient barriers, enablers and linked TDF domains matched COM-B components 'opportunity' and 'motivation'. CONCLUSION The review highlights the need for further empirical research to better understand current practice and mental health professionals' experiences and attitudes towards shared decision-making in risk assessment and risk management.
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Affiliation(s)
- Nafiso Ahmed
- Centre for Mental Health Research, School of Health Sciences, City University of London, Northampton Square, London, EC1V 0HB UK
| | - Sally Barlow
- Centre for Mental Health Research, School of Health Sciences, City University of London, Northampton Square, London, EC1V 0HB UK
| | - Lisa Reynolds
- School of Nursing, Midwifery and Allied Health, Buckinghamshire New University, 106 Oxford Rd, Uxbridge, UB8 1NA UK
| | - Nicholas Drey
- Centre for Health Services Research, School of Health Sciences, City University of London, Northampton Square, London, EC1V 0HB UK
| | - Fareha Begum
- Centre for Mental Health Research, School of Health Sciences, City University of London, Northampton Square, London, EC1V 0HB UK
| | - Elizabeth Tuudah
- Health Service and Population Research, David Goldberg Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Alan Simpson
- Health Service and Population Research, David Goldberg Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, 111 Denmark Hill, London, SE5 8AZ UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, James Clerk Maxwell Building, King’s College London, 57 Waterloo Road, London, SE1 8WA UK
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Cramer RJ, Gunn LH, Kaniuka AR, Rasmussen S. Making the Case for a Preferences in Information Processing Model of Suicide. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2021. [DOI: 10.1521/jscp.2021.40.4.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: In recent years, practice friendly models of suicidal behavior have emerged in the form of “ideation-to-action” frameworks. These frameworks focus on processes influencing both the formation of suicidal ideation and the translation of that ideation to suicide attempt and death. In this paper, we proffer an emerging model of suicide, Preferences in Information Processing (PIP), to augment contemporary suicide theories. First, we provide a primer on dual-process models of information processing theory and research as the foundation for the PIP. Next, drawing on a number of initial cross-sectional studies, we outline a rationale and examples of how preferences in motivated affect (i.e., Need for Affect) and cognition (i.e., Need for Cognition) may be integrated into existing ideation-to-action frameworks. Methods: We conducted secondary analysis of our pooled community sample PIP data. Results: We present new findings suggesting Need for Affect avoidance and Need for Cognition may be clinically relevant for persons at escalated risk for suicide. Discussion: The PIP offers new testable propositions within ideation-to-action suicide frameworks. We end with recommendations for a research agenda to further investigate the potential validation and utility of a PIP approach to suicidology.
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33
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Furnes D, Gjestad R, Mehlum L, Hodgekins J, Kroken RA, Oedegaard K, Mellesdal L. Borderline Personality Disorder: What Predicts Acute Psychiatric Readmissions? J Pers Disord 2021; 35:481-493. [PMID: 31682191 DOI: 10.1521/pedi_2019_33_459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Individuals diagnosed with borderline personality disorder (BPD) often struggle with chronic suicidal thoughts and behaviors and have frequent acute psychiatric admissions. Prevention of serial admissions and disruptions in long-term treatment strategies is needed. This study explored predictors of how frequently and how quickly patients diagnosed with BPD are readmitted after an index psychiatric admission. The authors identified self-harming behavior as a predictor of readmission frequency, whereas depression and hallucinations and delusions predicted time elapsed between the index admission and the first readmission. The authors recommend that predictors of readmissions should be carefully monitored and treated following index admission.
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Affiliation(s)
- Desiré Furnes
- Centre for Research and Education in Forensic Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rolf Gjestad
- Centre for Research and Education in Forensic Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Lars Mehlum
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Joanne Hodgekins
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Rune A Kroken
- Norment, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Norway
| | - Ketil Oedegaard
- Norment, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Norway.,K. G. Jebsen Centre for Research on Neuropsychiatric Disorders, Bergen, Norway
| | - Liv Mellesdal
- National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Noway
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Sawhney R, Joshi H, Gandhi S, Jin D, Shah RR. Robust suicide risk assessment on social media via deep adversarial learning. J Am Med Inform Assoc 2021; 28:1497-1506. [PMID: 33779728 PMCID: PMC8279792 DOI: 10.1093/jamia/ocab031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/06/2021] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The prevalence of social media for sharing personal thoughts makes it a viable platform for the assessment of suicide risk. However, deep learning models are not able to capture the diverse nature of linguistic choices and temporal patterns that can be exhibited by a suicidal user on social media and end up overfitting on specific cues that are not generally applicable. We propose Adversarial Suicide assessment Hierarchical Attention (ASHA), a hierarchical attention model that employs adversarial learning for improving the generalization ability of the model. MATERIAL AND METHODS We assess the suicide risk of a social media user across 5 levels of increasing severity of risk. ASHA leverages a transformer-based architecture to learn the semantic nature of social media posts and a temporal attention-based long short-term memory architecture for the sequential modeling of a user's historical posts. We dynamically generate adversarial examples by adding perturbations to actual examples that can simulate the stochasticity in historical posts, thereby making the model robust. RESULTS Through extensive experiments, we establish the face-value of ASHA and show that it significantly outperforms existing baselines, with the F1 score of 64%. This is a 2% and a 4% increase over the ContextBERT and ContextCNN baselines, respectively. Finally, we discuss the practical applicability and ethical aspects of our work pertaining to ASHA, as a human-in-the-loop framework. DISCUSSION AND CONCLUSIONS Adversarial samples can be helpful in capturing the diverse nature of suicidal ideation. Through ASHA, we hope to form a component in a larger human-in-the-loop infrastructure for suicide risk assessment on social media.
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Affiliation(s)
| | - Harshit Joshi
- Cluster Innovation Centre, University of Delhi, New Delhi, India
| | - Saumya Gandhi
- Computer Science, Visvesvaraya National Institute of Technology, Nagpur, India
| | - Di Jin
- Computer Science and Artificial Intelligence Lab, Massachussetts Institute of Technology, Cambridge, Massachussetts USA
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35
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Rasmussen S, Cramer RJ, McFadden C, Haile CR, Sime VL, Wilsey CN. Sexual Orientation and the Integrated Motivational-Volitional Model of Suicidal Behavior: Results from a Cross-Sectional Study of Young Adults in the United Kingdom. Arch Suicide Res 2021; 25:439-457. [PMID: 31769357 DOI: 10.1080/13811118.2019.1691693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Sexual orientation minority (i.e., lesbian, gay, bisexual, queer, and other; LGBQ+) persons represent a vulnerable population with respect to suicide-related behavior. An emerging theory of suicide, the Integrated Motivational-Volitional Model of Suicide (IMV), is utilized in the present study to examine sexual orientation, as well as a number of other IMV-defined pre-motivational factors (i.e., demographics, psychological distress and personality), as they impact the IMV motivational factors of defeat, entrapment, and suicidal ideation/intent. The present investigation featured a cross-sectional online survey of young adults (ages 18-34 years; n = 418; 27% identified as LGBTQ+) across the United Kingdom. The key findings included: (1) high rates of 12-month suicidal ideation prevalence (54.5%) and willingness to enact a future suicide attempt (60.8%); (2) bisexual and other (e.g., pansexual)-identifying sexual minority persons reported higher levels of IMV-related outcomes (e.g., internal entrapment, defeat); (3) sexual orientation accounted for significant variance in predicting motivational constructs controlling for a number of other pre-motivational factors; (4) other sexual minority status, compared to heterosexual identity, predic all motivational outcomes, and; (5) extraversion, agreeableness, and emotional stability emerged as pre-motivational protective factors for varying motivational outcomes. Findings are discussed with respect to the suicide and sexual minority theories, as well as tailored suicide prevention efforts and future research.
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Cramer RJ, Johnson KL, Nobles MR, Holley SR, Desmarais SL, Gemberling TM, Wright S, Wilsey CN, Van Dorn RA. Lifetime Suicide-Related Behavior, Violent Victimization, and Behavioral Health Outcomes: Results From a Vulnerable Population Needs Assessment. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:5860-5871. [PMID: 30261811 DOI: 10.1177/0886260518801941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study is concerned with two risk factors that have been independently associated with poor behavioral health: (a) lifetime suicide-related behavior (SRB) and (b) interpersonal violence victimization experiences. The purpose of this article was to assess whether the combination of SRB (ideation, attempt) and violent victimization exacerbates behavioral health symptom risk. This pattern is examined across three vulnerable population samples: community-based adults, college students, and bondage and sadomasochism (BDSM) community members. Data from a community health and sexuality survey (n = 2,175) were collected as a health needs assessment in partnership with the National Coalition for Sexual Freedom; latent class analysis (LCA) was then employed to identify intersectionality. This paper builds on prior findings yielding two distinct violence-related classes: (a) SRB only and (b) violent victimization + SRB. Controlling for demographic covariates, analyses revealed a consistent pattern in which the violent victimization + SRB subgroup displayed significantly worse behavioral health outcomes, including symptoms of depression, anxiety, general distress, and posttraumatic stress. Membership in any of the three available samples did not moderate the latent class-behavioral health associations, suggesting the additive impact of lifetime victimization + SRB is equitable across samples. Results are consistent with social-ecological framing of shared suicide-interpersonal violence falling under the same category of public health concerns sharing risk factors and health outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Susan Wright
- National Coalition for Sexual Freedom, Baltimore, MD, USA
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Hwang M, Lee YJ, Lee M, Kang B, Lee YS, Hwang J, Woo SI, Hahn SW. Relationship Between the Loudness Dependence of the Auditory Evoked Potential and the Severity of Suicidal Ideation in Patients with Major Depressive Disorder. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:323-333. [PMID: 33888661 PMCID: PMC8077063 DOI: 10.9758/cpn.2021.19.2.323] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 11/18/2022]
Abstract
Objective The loudness dependence of the auditory evoked potential (LDAEP) is a reliable indicator that is inversely related to central serotonergic activity, and recent studies have suggested an association between LDAEP and suicidal ideation. This study investigated differences in LDAEP between patients with major depressive disorder and high suicidality and those with major depressive disorder and low suicidality compared to healthy controls. Methods This study included 67 participants: 23 patients with major depressive disorder with high suicidality (9 males, mean age 29.3 ± 15.7 years, total score of SSI-BECK ≥ 15), 22 patients with major depressive disorder with low suicidality (9 males, mean age 42.2 ± 14.4 years, total score of SSI-BECK ≤ 14), and 22 healthy controls (11 males, mean age 31.6 ± 8.7 years). Participants completed the following assessments: Patient Health Questionnaire-9, Beck Depression Inventory-II, Beck Scale for Suicidal ideation, State Anxiety Scale of the State-Trait Anxiety Inventory, Beck Anxiety Inventory, and LDAEP (measured at electrode Cz). Results There were no sex-related differences among groups (p = 0.821). The high-suicidality group exhibited significantly higher LDAEP compared to the low-suicidality group (0.82 ± 0.79 vs. 0.26 ± 0.36, p = 0.014). No significant differences were found between the control and high-suicidality (p = 0.281) or the control and low-suicidality groups (p = 0.236). Conclusion LDAEP was applied to demonstrate the association between serotonergic activity and suicidal ideation and suicide risk in major depression and may be a candidate of biological marker for preventing suicide in this study.
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Affiliation(s)
- Mingyu Hwang
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yeon Jung Lee
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Minji Lee
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Byungjoo Kang
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yun Sung Lee
- Department of Medical Sciences, Graduate School of Soonchunhyang University, Asan, Korea
| | - Jaeuk Hwang
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sung-Il Woo
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sang-Woo Hahn
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Monahan MF, Karver MS. Are they ready yet?: A theory-driven evaluation of suicide risk assessment trainings in psychology graduate programs. J Clin Psychol 2021; 77:1614-1628. [PMID: 34004040 DOI: 10.1002/jclp.23171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/22/2021] [Accepted: 04/12/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The present study sought to understand the state of suicide risk assessment trainings in clinical psychology graduate programs. METHODS We surveyed 167 clinical psychology doctoral students' behavioral competency in responding to suicidal clients and their attitudes, perceived behavioral control, subjective norms, and intentions related to suicide risk assessment. Hypotheses were tested using path analysis. RESULTS Ninety six percent of participants reported receiving some type of suicide risk assessment training at their program. Results provided partial support for significant relationships between attitudes, perceived behavioral control, subjective norms, and intentions. Unexpectedly, amount of training in suicide risk assessments was not related to theory of planned behavior variables including behavioral competency. CONCLUSION These findings have implications regarding the effectiveness of current suicide risk assessment training practices and ways to improve trainings to help increase the number of clinical psychologists competent in suicide risk assessment and management.
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Affiliation(s)
- Maureen F Monahan
- New York State Psychiatric Institute, New York, New York, USA.,Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Marc S Karver
- Department of Psychology, University of South Florida, Tampa, Florida, USA
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O'Brien KHM, Nicolopoulos A, Almeida J, Aguinaldo LD, Rosen RK. Why Adolescents Attempt Suicide: A Qualitative Study of the Transition from Ideation to Action. Arch Suicide Res 2021; 25:269-286. [PMID: 31608796 DOI: 10.1080/13811118.2019.1675561] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To ameliorate the public health problem of adolescent suicide, it is imperative to go beyond simply establishing which factors increase risk. Multiple factors often interact in such a way that escalates suicide risk, and some combinations may be particularly perilous. Therefore, it is essential to examine the sequence and interplay of these various contributors to understand how they interact to confer risk. To enhance our understanding of this process, we used qualitative in-depth interviews with 20 psychiatrically hospitalized adolescents who had recently made a suicide attempt to investigate the factors that contributed to their attempts. In this qualitative analysis we 1) identified 16 separate factors that contributed to their suicide attempts, and 2) focused on the sequence and interplay between these factors in order to better understand why adolescents attempt suicide, with specific attention to which factors facilitated the transition from suicide ideation to action. Findings demonstrated that the strain caused by historical, sociocultural, and interpersonal factors alone was not enough to result in adolescents attempting suicide. For all but two participants, it was the interaction of intrapersonal factors that appeared to distort cognitions and/or elevate emotions to the point where they became intolerable and suicide became a viable option. These intrapersonal factors appeared to be the catalyst in the process from suicide ideation to action. Our findings suggest the need for specific strategies that address cognitive distortions, emotion dysregulation, and feelings of invalidation and entrapment as potential targets for interventions and prevention practices with adolescents at risk for suicide.
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Abstract
Negative life events may be a major precipitating factor for suicide and may differ across sociodemographic groups. We used data from the National Violent Death Reporting System (NVDRS) to explore whether age, gender, current mental illness, and disclosure around suicide predicted adult decedents' precipitants for suicide. Method: An NVDRS data set was used that included 58,247 adults who died by suicide between 2005 and 2010. Multivariate logistic regression was used to explore the relationship between sociodemographic characteristics and precipitating factors while controlling for the impact of other factors. Results: Age group (18-34, 35-64, or ≥ 65), sex, current mental illness, and disclosure around suicide significantly predicted various precipitants. Males were more likely than females to have most precipitating factors, particularly a criminal legal problem (odds ratio [OR]: 2.76), job problem (OR: 1.97), or financial problem (OR: 1.42). While younger decedents had more crises and intimate partner problems, middle-aged decedents had more loss of housing (OR: 1.87) and financial (OR: 1.81) and job-related (OR: 1.35) precipitants than the younger group. The odds of a physical health issue increased successively with each age group. Identified mental illness was associated most strongly with a job (OR: 1.43) or physical health problem (OR: 1.35). Individuals who disclosed suicidal ideation had a higher incidence of all precipitants. Conclusions: The precipitants to suicide appear to vary according to individuals' demographic factors, current mental illness, and disclosure of intent. Our understanding of suicide may be enhanced by exploring the causal pathway behind these relationships.
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41
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Paashaus L, Forkmann T, Glaesmer H, Juckel G, Rath D, Schönfelder A, Teismann T. From decision to action: Suicidal history and time between decision to die and actual suicide attempt. Clin Psychol Psychother 2021; 28:1427-1434. [PMID: 33687121 DOI: 10.1002/cpp.2580] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/01/2021] [Indexed: 11/07/2022]
Abstract
A substantial proportion of suicide attempts seem to be realized in a sudden manner. However, it is unclear how suicide attempters showing a rapid transition from the decision to die to acting differ from suicide attempters showing a slower transition regarding their suicidal history. The main aim of this study was to determine the proportion of suicide attempters, who reported a rapid transition (≤5, ≤10, ≤180 min) between their decision to die and their actual attempt. Furthermore, attempter groups (≤ vs. >5, ≤ vs. >10 and ≤ vs. >180 min) were compared regarding suicidal history (ideation, plans, and number of lifetime as well as 12 month suicide attempts) as well as depression, hopelessness and trait impulsivity. In total, 118 inpatients (62.7% female; age: M = 38.71, SD = 14.71) hospitalized due to a recent suicide attempt were assessed using structured clinical interview measures assessing suicidal history and self-report instruments. Thirty-six percent reported a time period of ≤5 min, 44% a time period of ≤10 min and 73% a time period of ≤180 min between their decision to die and their attempt. Participants with a rapid transition (≤5, ≤10, ≤180 min) did not differ from participants with a slower transition (>5, >10, >180 min) regarding suicidal history, depression, hopelessness and trait impulsivity. Taken together, a rapid transition seems common, but nevertheless, rapidly realized suicide attempts cannot necessarily be characterized as impulsive.
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Affiliation(s)
- Laura Paashaus
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany.,Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL-University Hospital, Ruhr-Universität Bochum, Bochum, Germany
| | - Dajana Rath
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Antje Schönfelder
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
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Davarinejad O, Mohammadi Majd T, Golmohammadi F, Mohammadi P, Radmehr F, Alikhani M, Motaei T, Moradinazar M, Brühl A, Sadeghi Bahmani D, Brand S. Identification of Risk Factors to Predict the Occurrences of Relapses in Individuals with Schizophrenia Spectrum Disorder in Iran. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020546. [PMID: 33440817 PMCID: PMC7827717 DOI: 10.3390/ijerph18020546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 02/03/2023]
Abstract
Schizophrenia Spectrum Disorder (SSD) is a chronic psychiatric disorder with a modest treatment outcome. In addition, relapses are commonplace. Here, we sought to identify factors that predict relapse latency and frequency. To this end, we retrospectively analyzed data for individuals with SSD. Medical records of 401 individuals with SSD were analyzed (mean age: 25.51 years; 63.6% males) covering a five-year period. Univariate and multivariate Penalized Likelihood Models with Shared Log-Normal Frailty were used to determine the correlation between discharge time and relapse and to identify risk factors. A total of 683 relapses were observed in males, and 422 relapses in females. The Relapse Hazard Ratio (RHR) decreased with age (RHR = 0.99, CI: (0.98–0.998)) and with participants’ adherence to pharmacological treatment (HR = 0.71, CI: 0.58–0.86). In contrast, RHR increased with a history of suicide attempts (HR = 1.32, CI: 1.09–1.60), and a gradual compared to a sudden onset of disease (HR = 1.45, CI: 1.02–2.05). Gender was not predictive. Data indicate that preventive and therapeutic interventions may be particularly important for individuals who are younger at disease onset, have a history of suicide attempts, have experienced a gradual onset of disease, and have difficulties adhering to medication.
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Affiliation(s)
- Omran Davarinejad
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran; (O.D.); (M.A.)
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah 6719851451, Iran; (T.M.M.); (F.G.); (P.M.); (F.R.); (T.M.); (M.M.)
| | - Tahereh Mohammadi Majd
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah 6719851451, Iran; (T.M.M.); (F.G.); (P.M.); (F.R.); (T.M.); (M.M.)
| | - Farzaneh Golmohammadi
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah 6719851451, Iran; (T.M.M.); (F.G.); (P.M.); (F.R.); (T.M.); (M.M.)
| | - Payam Mohammadi
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah 6719851451, Iran; (T.M.M.); (F.G.); (P.M.); (F.R.); (T.M.); (M.M.)
| | - Farnaz Radmehr
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah 6719851451, Iran; (T.M.M.); (F.G.); (P.M.); (F.R.); (T.M.); (M.M.)
| | - Mostafa Alikhani
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran; (O.D.); (M.A.)
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah 6719851451, Iran; (T.M.M.); (F.G.); (P.M.); (F.R.); (T.M.); (M.M.)
| | - Tayebeh Motaei
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah 6719851451, Iran; (T.M.M.); (F.G.); (P.M.); (F.R.); (T.M.); (M.M.)
| | - Mehdi Moradinazar
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah 6719851451, Iran; (T.M.M.); (F.G.); (P.M.); (F.R.); (T.M.); (M.M.)
| | - Annette Brühl
- Center for Affective, Stress and Sleep Disorders (ZASS), University of Basel, 4002 Basel, Switzerland; (A.B.); (D.S.B.)
| | - Dena Sadeghi Bahmani
- Center for Affective, Stress and Sleep Disorders (ZASS), University of Basel, 4002 Basel, Switzerland; (A.B.); (D.S.B.)
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran
- Departments of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35209, USA
| | - Serge Brand
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran; (O.D.); (M.A.)
- Center for Affective, Stress and Sleep Disorders (ZASS), University of Basel, 4002 Basel, Switzerland; (A.B.); (D.S.B.)
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6719851115, Iran
- Department of Sport, Exercise, and Health, University of Basel, 4002 Basel, Switzerland
- School of Medicine, Tehran University of Medical Sciences, Tehran 1416753955, Iran
- Correspondence:
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Brokke SS, Landrø NI, Haaland VØ. Cognitive Control in Suicide Ideators and Suicide Attempters. Front Psychol 2020; 11:595673. [PMID: 33424712 PMCID: PMC7785752 DOI: 10.3389/fpsyg.2020.595673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/04/2020] [Indexed: 11/13/2022] Open
Abstract
There is a need to understand more of the risk factors involved in the process from suicide ideation to suicide attempt. Cognitive control processes may be important factors in assessing vulnerability to suicide. A version of the Stroop procedure, Delis-Kaplan Executive Function System (D-KEFS) Color-Word Interference Test (CWIT) and Behavior Rating Inventory of Executive Function (BRIEF-A) were used in this study to test attention control and cognitive shift, as well as to assess everyday executive function of 98 acute suicidal psychiatric patients. The Columbia Suicide History Form (CSHF) was used to identify a group of suicide ideators and suicide attempters. Results showed that suicide attempters scored lower on attention control than suicide ideators who had no history of attempted suicide. The self-report in the BRIEF-A inventory did not reflect any cognitive differences between suicide ideators and suicide attempters. A logistic regression analysis showed that a poorer attention control score was associated with the suicide attempt group, whereas a poorer cognitive shift score was associated with the suicide ideation group. The results found in this study suggest that suicide attempters may struggle with control of attention or inhibiting competing responses but not with cognitive flexibility.
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Affiliation(s)
- Silje Støle Brokke
- Clinical Neuroscience Research Group, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Department of Psychiatry, Sørlandet Hospital HF, Kristiansand, Norway
| | - Nils Inge Landrø
- Clinical Neuroscience Research Group, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Division of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Vegard Øksendal Haaland
- Clinical Neuroscience Research Group, Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Department of Psychiatry, Sørlandet Hospital HF, Kristiansand, Norway
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Griffith J, J Bryan C. Deployment Experiences and Suicidal Behaviors Related to Interpersonal Violence Perpetration Among Army National Guard Soldiers. VIOLENCE AND VICTIMS 2020; 35:841-860. [PMID: 33372113 DOI: 10.1891/vv-d-18-00174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
An issue of major policy interest in the U.S. military has been interpersonal violence (IPV), especially relative to the frequent and lengthy deployments of U.S. service members to Iraq and Afghanistan. Lacking, however, are estimates of perpetrators of IPV, in particular, for reservists who have been 30% of the ground combat force. In the present study, Army National Guard soldiers (N = 4,567 in 50 company-sized units) responded to questions about deployment and combat, IPV, and suicidal behaviors. Over a tenth (12.2%) of the soldiers reported having done any aggressive behaviors toward significant others or children during postdeployment. More lengthy and repeated deployments were associated with perpetration of IPV. Having killed or wounded someone and having experienced some form of combat trauma were much more strongly associated with IPV perpetration. Suicidal behaviors were associated with having committed IPV, with the greatest risk associated with suicide attempts. Findings are discussed in terms of underlying mechanisms of both IPV perpetration and suicidal behaviors.
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Affiliation(s)
- James Griffith
- National Center for Veterans Studies, University of Utah, Salt Lake City, Utah
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Wexner Medical Center
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Glenn JJ, Dillon KH, Dennis PA, Patel TA, Mann AJ, Calhoun PS, Kimbrel NA, Beckham JC, Elbogen EB. Post-traumatic symptom severity mediates the association between combat exposure and suicidal ideation in veterans. Suicide Life Threat Behav 2020; 50:1167-1172. [PMID: 32770773 PMCID: PMC7746613 DOI: 10.1111/sltb.12678] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/08/2020] [Accepted: 05/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Previous studies of military veterans have produced mixed findings regarding whether combat exposure is directly related to suicidal ideation or is indirectly related to suicidal ideation via its influence on other factors. The present study used a longitudinal design to test the hypothesis that post-traumatic stress disorder (PTSD) symptom severity mediates the effect of combat exposure on suicidal ideation in veterans. METHOD Participants included 319 post-9/11 veterans (83.4% male; 42.1% White/52.1% Black; Mage = 39.7) assessed at baseline, 6, and 12 months. Structural equation modeling and bootstrapped confidence intervals were employed to examine the direct and indirect relationships between combat exposure, suicidal ideation, and PTSD symptom severity. RESULTS Results from the mediation model, in which demographic variables and non-combat trauma were included as covariates, revealed that the indirect effect of combat exposure on suicidal ideation via PTSD symptom severity was statistically significant, accounting for 64.1% of the covariance between combat exposure and suicidal ideation. CONCLUSIONS This study provides longitudinal evidence that the effects of combat exposure on suicidal ideation are mediated by PTSD symptom severity, suggesting the importance of targeting such symptoms in treatment to mitigate suicide risk among veterans with combat exposure.
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Affiliation(s)
- Jeffrey J. Glenn
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
| | - Kirsten H. Dillon
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Paul A. Dennis
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Tapan A. Patel
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
| | - Adam J. Mann
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
| | - Patrick S. Calhoun
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
- VA Center for Health Services Research in Primary Care, Durham, NC, USA
| | - Nathan A. Kimbrel
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
- VA Center for Health Services Research in Primary Care, Durham, NC, USA
| | - Jean C. Beckham
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Eric B. Elbogen
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
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Kyron MJ, Carrington‐jones P, Page AC, Bartlett J, Lawrence D. Factors differentiating adolescents who consider suicide and those who attempt: Results from a National Survey of Australian Adolescents. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Michael J. Kyron
- Graduate School of Education, The University of Western Australia, Crawley, Western Australia, Australia,
| | - Phoebe Carrington‐jones
- Graduate School of Education, The University of Western Australia, Crawley, Western Australia, Australia,
| | - Andrew C. Page
- Graduate School of Education, The University of Western Australia, Crawley, Western Australia, Australia,
| | - Jennifer Bartlett
- Graduate School of Education, The University of Western Australia, Crawley, Western Australia, Australia,
| | - David Lawrence
- Graduate School of Education, The University of Western Australia, Crawley, Western Australia, Australia,
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Suárez-Colorado YP, Caballero-Domínguez CC, Campo-Arias A. Confirmatory Factor Analysis and Internal Consistency of the Suicidal Ideation Scale of the Center for Epidemiological Studies Depression Among Colombian Adolescents. Psychol Rep 2020; 125:588-598. [PMID: 33143575 DOI: 10.1177/0033294120971771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The current study tested the one-dimensionality of the Center for Epidemiological Studies Depression Scale for Suicidal Ideation (CES-D-SI) and its reliability among high school students in Santa Marta, Colombia. A total of 1,462 tenth and eleventh-grade students from public and private schools completed the CES-D-SI. The students were between 13 and 17 years (M = 16.0, SD = 0.8), 60.3% were female, and 55.3% were in the tenth grade. A confirmatory factor analysis (CFA) was conducted, and the chi-square, root mean square error of approximation (RMSEA), comparative fit index (CFI), Tucker-Lewis index (TLI), and standardized root mean square residual (SRMR) statistics were calculated. The internal consistency of the dimension was calculated using Cronbach's alpha and McDonald's omega coefficients. The results of the CFA were as follows: chi-square = 26.51, df =2, p = .001; RMSEA = .092; 90% confidence interval = .063-.124; CFI = .983; TLI = .950; and SRMR = .019. Cronbach's alpha coefficient was .75, and McDonald's omega coefficient was .77. As conclusions, the scale exhibited a unidimensional structure similar to that in other studies and presented good reliability values. Hence, its use is recommended to screen suicidal ideation in school-aged adolescents in Santa Marta, Colombia.
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Affiliation(s)
- Yuli P Suárez-Colorado
- Escuela de Psicología, Universidad Cooperativa de Colombia, Santa Marta, Magdalena, Colombia
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Yoon S, Park K, Choi KH. The ultra brief checklist for suicidality. J Affect Disord 2020; 276:279-286. [PMID: 32697710 DOI: 10.1016/j.jad.2020.07.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/31/2020] [Accepted: 07/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Accurately identifying patients at an elevated risk of suicide in minimal time is an important mental health issue. Therefore, we developed the Ultra Brief Checklist for Suicidality (UBCS) and reported its psychometric properties. METHODS We studied 544 participants who had completed the UBCS, other self-report measures, and structured clinical interviews by trained interviewers. We explored the psychometric properties of the UBCS's paper-based and online versions by identifying optimal cutoff points, sensitivity, specificity, etc. of all participants. RESULTS The mean score of the UBCS (paper-pencil version) in the no-suicide-risk group was 0.23 (SD = 0.73), while in the Risk-Positive (RP) and the High-Risk (HR) groups it was 3.54 (SD = 3.22) and 6.31 (SD = 3.97), respectively. Optimal cutoff points for the RP and HR groups were 1 (AUC = 0.914) and 3 (AUC = 0.928), respectively. LIMITATIONS The current findings apply only to adults, not to children or adolescents. The original MINI was used as the assessment instrument's reference standard rather than MINI 7.0.2 of DSM-5. Predictive validity was not addressed as this was not a longitudinal cohort study. CONCLUSIONS The UBCS was rigorously tested and validated. More than half the participants completed the UBCS within a minute. It possesses adequate psychometric properties and can be easily administered with minimal clinician time and effort, via paper or Internet. We believe it can contribute to suicide risk identification and timely interventions.
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Affiliation(s)
- Seowon Yoon
- Department of Psychology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, Korea
| | - Kiho Park
- Department of Psychology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, Korea; KU Mind Health Institute, Korea University, Seoul, Korea
| | - Kee-Hong Choi
- Department of Psychology, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, Korea; KU Mind Health Institute, Korea University, Seoul, Korea.
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Jahangard L, Shayganfard M, Ghiasi F, Salehi I, Haghighi M, Ahmadpanah M, Sadeghi Bahmani D, Brand S. Serum oxytocin concentrations in current and recent suicide survivors are lower than in healthy controls. J Psychiatr Res 2020; 128:75-82. [PMID: 32535343 DOI: 10.1016/j.jpsychires.2020.05.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/28/2020] [Accepted: 05/17/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Suicide and suicide attempts are dramatic events both for the individuals concerned and for their social circles. From a psychopathological perspective, suicidal behavior could be understood as a severe breakdown in relations with their social worlds. Oxytocin is a neuropeptide highly involved in the perception of facets of social relationship such as their quality feelings of belongingness, and mutual trust. Given this, we expected that serum oxytocin concentrations would be lower in current and recent suicide survivors than in healthy controls. METHODS A total of 48 participants (mean age: 27 years; 62.5% females) took part in the study. Of these, 16 (62.5% females) survived a suicide attempt 12-24 h ago; 16 (62.5% females) had made a suicide attempt about 12 weeks ago, and 16 (62.5% females) were healthy age- and gender-matched controls. Blood samples were taken in the morning to assess serum oxytocin concentrations. Participants also completed questionnaires covering sociodemographic information and a scale assessing suicidal ideation. RESULTS Compared to healthy controls, suicide survivors had significantly lower serum oxytocin concentrations, but these levels did not differ between current and recent suicide survivors. Compared to healthy controls and recent suicide attempters, current suicide attempters recorded significantly higher scores on the Beck scale for suicidal ideation. Across the sample as a whole, higher scores for suicidal ideation were associated with lower serum oxytocin concentrations. Serum oxytocin concentrations and scores on the Beck scale for suicidal ideation did not differ between females and males. CONCLUSIONS Given that oxytocin is a neurobiological correlate of subjectively perceived quality of social interaction and social relationships, the results support the notion that suicide attempts are closely linked to suicide survivors' perceptions of the quality of their social lives. Speculatively, and based on the serum oxytocin concentrations, it also appears that 12 weeks after a suicide attempt, the survivor's perceived quality of social life has not significantly improved.
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Affiliation(s)
- Leila Jahangard
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehran Shayganfard
- Department of Psychiatry, Arak University of Medical Sciences, Arak, Markazi, Iran
| | - Farahnaz Ghiasi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Iraj Salehi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Haghighi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Ahmadpanah
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Dena Sadeghi Bahmani
- Departments of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA; University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland; Kermanshah University of Medical Sciences (KUMS), Sleep Disorders Research Center, Kermanshah, Iran; Kermanshah University of Medical Sciences (KUMS), Psychiatry Department, Substance Abuse Prevention Research Center, Health Institute, Kermanshah, Iran
| | - Serge Brand
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland; Kermanshah University of Medical Sciences (KUMS), Sleep Disorders Research Center, Kermanshah, Iran; Kermanshah University of Medical Sciences (KUMS), Psychiatry Department, Substance Abuse Prevention Research Center, Health Institute, Kermanshah, Iran; University of Basel, Department of Sport, Exercise, and Health, Division of Sport and Psychosocial Health, Basel, Switzerland; Tehran University of Medical Sciences (TUMS), School of Medicine, Tehran, Iran.
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Correia R, Jackson D. Risk to self: identifying and managing risk of suicide and self-harm. BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2020.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYThis article summarises key areas of research informing understanding of vulnerability factors and risk assessment and management across the lifespan, with particular reference to risk to self (self-harm and suicide). It relates the discussion to people attending sexual assault referral centres (SARCs), but is applicable in a range of clinical settings. Although people accessing SARCs often present with mental health difficulties and various other vulnerabilities, SARC practitioners often do not have specialist training in working with mental health difficulties, including individuals at risk to self. We discuss developmental differences that should be considered when assessing and managing risk to self, and examine relationships between mental health difficulties, risk to self, and rape and/or sexual assault. Finally, we offer advice on how to respond to risk presented by individuals who have experienced sexual violence.
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