Suicide and Life-Threatening Behavior最新文献

Introduction: Risk factors for suicide after parental suicide may include points in the lifecourse when reminders of the deceased trigger grief resurgence. We hypothesized that risk of suicide attempt and suicide is elevated among suicide-bereaved offspring on reaching the age at which a parent died by suicide.

Methods: We conducted a self-controlled case series (SCCS) study using national register data on all individuals bereaved by parental suicide living in Denmark from 1980 to 2016. We compared relative incidence of our combined outcome (any secondary-care episode of self-harm or suicide) during the exposure period (2 years centred on the birthday representing age correspondence) and the 15-year unexposed periods either side. We repeated these models for offspring bereaved by parental non-suicide death as an indirect comparison.

Results: Risk of self-harm or suicide was elevated on reaching the age at parental suicide (n = 188; IRR_adj: 2.02, 95% CI: 1.21-3.38) relative to flanking periods, but not at parental non-suicide death (n = 734; IRR_adj: 0.76; 95% CI: 0.39-1.50).

Conclusions: Reaching the age at which a parent died by suicide appears to represent a vulnerable period for suicidality, countering public perceptions that time heals linearly. This indicates a need for support in the lead up to age correspondence.

Introduction: This study aimed to adapt and expand an evidence-based lethal means counseling intervention for peer-delivery among firearm owning Veterans. We further sought to assess Veteran interventionists' fidelity to motivational interviewing (MI) in the context of the adapted intervention.

Methods: An iterative expert panel comprised of experts in suicide prevention, lethal means counseling, MI, and Veteran peer engagement (N = 9) informed intervention adaptation. Experts rated the appropriateness of the adapted intervention, named Peer Engagement and Exploration of Responsibility and Safety (PEERS), and associated interventionist training plan across six criteria. Veteran interventionists (N = 3) were trained to deliver PEERS and their fidelity to MI in the context of PEERS was evaluated.

Results: Expert panelists' average rating was 7.6 (out of 9). Ratings across all criteria (e.g., quality of the training plan; perceived ability of interventionists to engage in the intervention) were high. Interventionists' composite MI fidelity scores suggested most were client-centered, but not MI-competent in their delivery.

Conclusion: Findings suggest that PEERS is an appropriate lethal means counseling intervention for firearm owning Veterans that can be somewhat feasibly delivered by Veteran interventionists. This intervention could help expand the reach and effectiveness of lethal means counseling.

Introduction: One factor that can influence whether someone will engage in secure firearm storage is having a suicide exposure (SE). Daruwala et al. (2018) examined this and found that individuals with an SE, without considering perceived closeness, did not significantly differ from those who did not have an SE in their firearm storage practices. Thus, the present study aimed to replicate and extend the research of Daruwala et al. (2018) by examining if the method of suicide (by firearm or other means) and closeness of suicide decedent relate to secure firearm storage practices.

Methods: 308 male firearm owners completed self-report measures assessing SE, perceived closeness to decedent, and current firearm storage practices. Chi square and logistic regression analyses were conducted.

Results: Suicide loss exposure, regardless of method used in suicide, did not relate to firearm storage practices in this sample. We also found that there was no association between perceived closeness to the decedent who died by suicide by firearm and secure storage, without considering age.

Conclusions: Results underscore the difficulty in helping male firearm owners develop personally salient reasons to increase safety with firearms. Implications for clinical care, firearm safety, and public health initiatives are explored.

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.

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: 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.

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: Suicidal thoughts and behaviors often onset during adolescence, constituting a major public health concern. Despite rising rates in youth, psychotherapeutic and pharmacological treatment outcomes remain meager, indicating a need to identify modifiable risk factors. Experts suggest sleep may serve as a promising clinical indicator of risk and treatment progress, yet few studies have examined acute temporal associations between sleep and suicidal ideation.

Methods: Participants were depressed and suicidal adolescents (age 13-19, n = 311) attending an intensive outpatient program (IOP). Patients completed weekly self-report assessments of sleep, depression, and suicidal ideation throughout IOP, with an average of 5 assessments over 30 days.

Results: Greater overall sleep difficulties, as well as within-person increases in sleep difficulties, were predictive of greater depression severity and suicidal ideation at subsequent assessments, above and beyond previous levels of symptoms. The reverse associations were not found. Inclusion of within-person changes in sleep difficulties significantly improved model fit compared to inclusion of overall sleep difficulties alone.

Discussion: This study provides additional evidence for a prospective relationship between worsening sleep difficulties and suicidal ideation in an IOP youth sample. Worsening sleep may be an important clinical indicator of subsequent depression and suicide risk among adolescents in treatment.

Background: People bereaved by suicide are at increased risk of suicide. Potential explanations include changes in the cognitive availability of suicide after suicide bereavement, but this has been under-investigated. This study aimed to investigate how suicide bereavement influences thoughts about suicide, including methods considered.

Method: We interviewed 20 UK-based adultswho reported having been preoccupied by the suicide of a close contact, analyzing qualitative data using reflexive thematic analysis.

Results: We identified four main themes: divergent changes in views about suicide as an option; impact of the method used on consideration of own potential method of suicide (including an aversion to the same method); experience of suicidal ideation as a means of understanding the deceased's state of mind; and thoughts related to reunion with the deceased.

Conclusions: Our findings suggest that the trauma of exposure to a close contact's suicide can modify the cognitive availability of suicide in divergent ways, including suicide being perceived as a more or less acceptable option, and a tension between the two. These insights assist clinicians in sensitive exploration of suicide bereavement and in risk mitigation. They suggest revisions to existing models of cognitive availability and the potential for psychological interventions that modify the cognitive availability of suicide.

Introduction: This study aims to investigate the psychosocial characteristics of suicide deaths in Korea according to population inflow and outflow, and to identify high-risk suicide groups by regional type in order to establish tailored suicide prevention plans for each region.

Methods: The analysis included 4193 suicide deaths from four regional types in Korea. The data source was a comprehensive survey of suicide deaths through police investigation records from the Korean government. The analysis involved collecting demographic variables, suicide-related variables, and stress variables at the time of death for suicide deaths in each region and conducting cross-analysis and multinomial logistic regression analysis.

Results: Across all regions, factors such as male gender, unemployment, hanging in one's own home, and mental health problems were prevalent. However, in population-inflow urban areas, early-middle age and economic problems were higher, in population-outflow urban areas, late-middle age and economic problems were more prominent. Additionally, in both inflow and outflow rural areas, there was a relatively higher proportion of old age and physical health problems.

Conclusions: This study is significant for confirming common and specific factors influencing suicide in each region, and for proposing considerations when formulating tailored suicide prevention plans for local communities.