Suicide and Life-Threatening Behavior最新文献

Purpose: To assess temporal patterns of Veteran suicide deaths from 2001 to 2021.

Methods: Data from Veterans Affairs (VA) and Department of Defense (DoD) administrative sources and the VA/DoD Mortality Data Repository identified 133,867 Veteran suicides from 2001 to 2021. Incidence Rate Ratios (IRRs) and Joinpoint regression assessed patterns of Veteran suicide across seasons, days of the week, and 14 holidays; overall and by sex and age.

Results: Incidence of Veteran suicide was highest in summers and on Mondays. Veteran suicide incidence was lower on six holidays: Martin Luther King Jr. Day (IRR = 0.82, 95% CI = 0.73-0.93), Presidents' Day (IRR = 0.88, 0.78, 0.99), Memorial Day (IRR = 0.89, CI = 0.79-0.99), Labor Day (IRR = 0.88, CI = 0.78-0.98), Thanksgiving (IRR = 0.81, CI = 0.71-0.92), and Christmas (IRR = 0.78, CI = 0.68-0.89). Suicide incidence was elevated on New Year's Day (IRR = 1.17, CI = 1.05-1.31), particularly among Veterans 25-34 years old (IRR = 1.64, CI = 1.19-2.26). An increasing trend in daily average suicides was indicated from December 30th to January 1st (β = 1.79, p < 0.05). Both seasonal and day of the week effects were present in most subpopulations. Holiday effects were most prevalent among men and varied by age.

Conclusions: Veteran suicide incidence was elevated in summer months, on Mondays, and on New Year's Day. Temporal patterns differed by sex and age. Findings can inform ongoing Veteran suicide prevention efforts.

Introduction: Service members with mental health difficulties and access to a firearm are at an increased risk for suicide. Mental healthcare providers are well-positioned to discuss firearms and create safety plans; however, many service members do not seek treatment. This study aims to identify potential sociodemographic predictors of recent mental healthcare utilization among firearm-owning service members who report past month distress.

Methods: The sample included 268 US military service members. Participants reported whether they attended at least one behavioral health visit in the 3 months prior to participation.

Results: Females, individuals of a racial background other than Black or White, older individuals, and those who have never been active-duty were more likely to have attended a session. Additionally, the likelihood of utilization was higher among those who reported past week wish to die and suicidal behaviors in the past year.

Conclusion: While certain service members are less likely to have utilized mental healthcare, findings suggest that those with suicidal ideation and access to a firearm are likely to engage in at least one appointment. As such, providing mental healthcare providers with training and resources for promoting secure firearm storage is an important avenue for suicide prevention.

Background: This study investigated the trajectories of interpersonal stress and psychological pain and their effects on self-harm behaviors in adolescents and explored the reciprocal associations between interpersonal stress and NSSI/SA.

Methods: The participants included 1149 adolescents (50.3% women; M_age = 12.86, SD = 0.69) who participated in three waves of data collection. Latent class growth models and cross-lagged panel models were used to identify subgroups of individuals and interactions between interpersonal stress and NSSI/SA.

Results: Controlling for sex and age, compared to the low interpersonal stress class, the moderate to high and increasing classes have higher risks of NSSI and SA. Compared to adolescents in the low increasing feelings with high increasing avoidance class, those in the low increasing feelings with low decreasing avoidance class reported lower probabilities of NSSI and SA. Pain avoidance and painful feelings mediated the pathway from interpersonal stress to NSSI/SA, whereas pain arousal mediated the pathway from NSSI/SA to interpersonal stress.

Conclusions: Shared impact of interpersonal stress and distinct effects of psychological pain over time on maintaining and distinguishing self-harm behaviors were found. Adolescent crisis interventions should simultaneously focus on building social networks within the school context and regulating maladaptive minds.

Introduction: Individuals who are depressed, have suicide attempts, and a substance use disorder (SUD) may have different patterns of suicidal thoughts and behaviors and respond differently to cues associated with suicide and death.

Method: Implicit affective reactions to visual cues suggestive of suicide and death (as well as to pleasant, unpleasant, and neutral cues), were compared among three groups of hospitalized adults: (a) depressed patients without the histories of suicidal behavior (depression only), (b) depressed patients with suicide attempts, but no current substance abuse disorder (SA), and (c) depressed patients with both suicide attempts and substance use disorder (SA + SUD).

Results: The SA group demonstrated higher positive evaluations of visual cues associated with suicide and death when compared to the SA + SUD group. The SA + SUD group demonstrated the lowest positive evaluation of suicide-related stimuli as well as less positive evaluation of visual cues of generally unpleasant stimuli.

Conclusion: Differences observed between SA and SA + SUD participants underscore differences in responses to cues related to suicide, which may reflect differences in mechanisms of risk.

Introduction: Nonsuicidal self-injury (NSSI) and suicidal ideation (SI) are widespread mental health concerns among adolescents. As fear of negative evaluation (FNE) and self-disgust are also common psychological phenomena among adolescents, existing research suggests that there may be reciprocal predictive relationships between FNE and NSSI/SI with self-disgust playing a mediating role. This study aimed to investigate the reciprocal relationships between FNE and NSSI, as well as FNE and SI, and the mediating role of self-disgust.

Method: Random intercept cross-lagged panel models (RI-CLPMs) were employed. A total of 515 Chinese secondary school students (50.7% boys; baseline M_age = 12.31 years, SD = 0.81) completed self-report questionnaires regarding FNE, self-disgust, NSSI, and SI. The assessment was conducted in four waves, 6 months apart.

Results: The results were as follows: (1) There were bidirectional relations between FNE and NSSI through self-disgust. (2) There was a unidirectional association from FNE to SI via self-disgust.

Conclusion: These findings have expanded the theoretical understanding of adolescent NSSI and SI, and highlighted the importance of offering personalized psychological counseling and therapy services at the intrapersonal level for adolescents.

Introduction: This study sought to better understand discussions of emergency dispatches (i.e., activation of local crisis services to conduct a welfare check) and the circumstances under which Veterans Crisis Line (VCL) callers and responders feel they are able contribute to (collaboration) and agree upon (consent) the decision to initiate an emergency dispatch.

Methods: Semi-structured interviews gathered data on veterans' (n = 40) experiences receiving an emergency dispatch and VCL responders' (n = 35) perspectives on initiating dispatches. Data were analyzed using a thematic analysis approach.

Results: Veterans calling the VCL were often seeking emotional support and were surprised to receive a suicide risk assessment and emergency dispatch. Responders reported they strive for collaboration and consent prior to sending a dispatch, but the crisis setting challenged this ideal. Overall, veterans and responders described similar features of the ideal, collaborative conversation about dispatches yet noted threats to achieving collaboration: complex standard operating procedures, responder training quality, and responder lack of comfort with de-escalation.

Conclusions: Increasing veteran awareness of VCL services, altering the timing and type of suicide risk assessment, enhancing de-escalation skill, increasing consistency of VCL responder proficiencies, and revising guidelines for dispatch disclosure were identified as ways to improve collaboration and consent around emergency dispatches.

Introduction: Parents play crucial roles in monitoring and supporting youth who have been hospitalized after suicide attempts, but their adjustment in the period following hospitalization has been understudied. This study assessed the adjustment and impacts on mothers during the year following hospitalization.

Method: Participants included 135 mothers of suicidal adolescents and 117 mothers of adolescents hospitalized for other reasons. The Structured Clinical Interview for DSM (SCID) and the Child and Adolescent Impact Assessment were used to assess psychiatric diagnoses of Major Depressive Disorder [MDD], Generalized Anxiety Disorder [GAD], and Post-Traumatic Stress Disorder [PTSD], and impacts on caregivers at one, three, six, and 12 months after hospitalization.

Results: Higher rates of MDD, GAD, and PTSD, and greater impacts were evidenced closer in time to the hospitalization. There were few overall differences between mothers of youth with and without suicidal behavior. However, family history of suicidal behavior was related to higher rates of MDD and PTSD, and greater severity of youth suicidal thoughts and behavior over the follow-up was related to greater impact upon mothers of suicidal youth.

Conclusions: This study highlights the mental health struggles of mothers of suicidal and other hospitalized youth and underscores the importance of support for caregivers.

Background: Despite the bidirectional relationship between alcohol use and STB, the two issues are often treated separately in adolescent inpatient psychiatric hospitals, highlighting the need for brief interventions that address both alcohol use and STB in an integrated fashion.

Aims: This study tested the feasibility, acceptability, and preliminary effectiveness of a brief integrated Alcohol and Suicide Intervention for Suicidal Teens (iASIST) with a post-discharge mHealth booster for adolescents in inpatient psychiatric treatment.

Methods: We conducted an RCT of iASIST relative to an attention-matched comparison condition with adolescents hospitalized following STB (N = 40).

Results: iASIST demonstrated feasibility and acceptability and mixed models indicated that both groups had significant decreases in substance use over the 3-month follow-up, but post-intervention group differences were not significant. In terms of cannabis use, however, iASIST participants significantly improved over time. Intervention group participants showed a significant decrease in suicide plans from baseline to follow-up, which was not the case for control group participants.

Discussion: Study findings suggest a larger RCT is warranted to test the effectiveness of the iASIST intervention.

Conclusion: iASIST shows promise in its ability to target the public health problems of alcohol use and STB in an integrated fashion with a high-risk adolescent population receiving acute psychiatric care.

Background: Self-injurious urges are arguably the clearest antecedents of engaging in self-injurious behaviors (SIBs; e.g., binge eating, self-induced vomiting, cutting, burning). However, self-injurious urges demonstrate great heterogeneity, and it is unknown which are most closely linked to SIBs. This study aims to identify latent profiles of self-injurious urges and subsequently examine associations between profiles and engagement in SIBs.

Method: Adults (N = 124) who reported engaging in at least three SIBs in the past month completed six surveys a day assessing self-injurious urges for 14 days (6600 responses). Latent profiles were constructed using within-person intensity, variability, peak, duration, relative frequency, and overall stability of self-injurious urges over the EMA period.

Results: Five distinct profiles were identified: "sustained," "muted," "sudden-onset," "volatile," and "virtually absent." SIB frequency differed across profiles, H(4) = 41.11, p < 0.001; η² = 0.31, 95% CI [0.19, 0.48], and Dunn's post-hocs indicated those in the "volatile" profile engaged in more SIBs than other profiles.

Conclusion: Findings support the presence of meaningful profiles of self-injurious urges and suggest these profiles differ in levels of SIB engagement. Future work should prospectively examine associations between profile membership and engagement in SIBs and identify treatment targets to intervene on SIBs.

Background: One mainstay of psychiatric treatment for suicidal crises is inpatient psychiatric hospitalization. Despite the need to secure immediate safety and stabilization, inpatient treatment for acutely suicidal patients remains diagnosis-specific, which may fail to directly target and adequately manage suicidal behavior as a symptom and reason for admission or treatment. The post-discharge period is a high-risk period for repeat suicide attempts or death by suicide, but overburdened workforce and high patient turnover make it difficult to provide suicide-specific treatment.

Methods: In response to this need, we developed the Suicide Prevention Inpatient Group Treatment (SPIGT), a four-module, group-based intervention, which provides evidence-supported concrete tools and psychoeducation to directly address suicidality. To assess feasibility and acceptability of implementation, the SPIGT was piloted on an inpatient psychiatric unit starting in 2016. Group participants were given optional, anonymous surveys after each module. Unit clinicians also completed optional, anonymous surveys to assess their attitudes towards the intervention.

Results: Results indicate that participants responded very favorably to each module, and that unit clinicians felt that the implementation of this intervention was feasible and acceptable.

Conclusion: The SPIGT shows promise as a scalable suicide-specific, brief intervention, which addresses an unmet and critical need in suicide prevention.