Suicide and Life-Threatening Behavior最新文献

Introduction: Suicide remains a leading cause of death in the U.S., and firearms are one of the most lethal methods of suicide. This study examines personal and contextual factors that predict suicide with a firearm compared to other methods across stages of adulthood.

Methods: Data on adult suicide decedents from 2009 to 2019 were obtained from Colorado's National Violent Death Reporting System (NVDRS) data (N = 11,512). The dataset includes incident and person characteristics collected by law enforcement and coroners. Zip code level data were integrated from the American Community Survey.

Results: Age, sex, race, marital status, military service, substance use, suicide attempt history, mental health, and location characteristics (population density, as well as age, education, veteran status, and household status of population) predicted suicide by firearm. Risk was particularly high for males in older adulthood. We further explored age-specific models (young, middle-aged, and older adults) to determine salient risk factors for each group.

Conclusion: This study highlights the need for comprehensive suicide prevention approaches that consider both individual and contextual risk factors, as well as unique risks in each stage of adulthood.

Introduction: Borderline personality disorder (BPD) is a disorder of pervasive emotion dysregulation associated with high rates of self-injurious thoughts and behaviors (SITB). Understanding specific emotion states in relation to SITB is important for effective intervention.

Methods: The current study examined whether, and how, the specific emotion of shame contributes to suicide ideation and urges to engage in non-suicidal self-injury (NSSI) both directly, and indirectly via anger, among individuals with BPD. Participants (N = 100) were enrolled in a 6-month comprehensive dialectical behavior therapy (DBT) program and provided daily ratings of shame, anger, suicide ideation, and urges for NSSI.

Results: We found that higher daily ratings of shame and anger were directly associated with higher same-day ratings of both suicidal ideation and urges for NSSI. Furthermore, anger partially mediated the relationships between shame and both suicidal ideation and urges for NSSI.

Conclusion: These findings highlight shame and anger as potential antecedents of SITB among individuals with BPD. Clinical approaches, such as DBT, that include personalized, ongoing, clinical assessment of these specific affective states may be particularly important for treatment of SITB.

Objective: Military sexual trauma (MST) has been identified as a risk factor for suicidal behavior. To inform suicide prevention efforts within the Veterans Health Administration (VHA), this study evaluates predictors of non-fatal suicide attempts (NFSAs) among VHA patients who experienced MST.

Methods: For VHA patients in fiscal year (FY) 2019 who previously screened positive for a history of MST, documented NFSAs were assessed. Using multivariable logistic regression, demographic, clinical, and VHA care utilization predictors of NFSAs were assessed.

Results: Of the 212,215 VHA patients who screened positive for MST prior to FY 2019 and for whom complete race, service connection, and rurality information was available, 1742 (0.8%) had a documented NFSA in FY 2019. In multivariable logistic regression analyses, total physical and mental health morbidities were not associated with NFSA risk. Predictors of a documented NFSA included specific mental health diagnoses [adjusted odds ratio (aOR) range: 1.28-1.94], receipt of psychotropic medication prescriptions (aOR range: 1.23-2.69) and having a prior year emergency department visit (aOR = 1.32) or inpatient psychiatric admission (aOR = 2.15).

Conclusions: Among VHA patients who experienced MST, specific mental health conditions may increase risk of NFSAs, even after adjustment for overall mental health morbidity. Additionally, indicators of severity of mental health difficulties such as receipt of psychotropic medication prescriptions and inpatient psychiatric admissions are also associated with increased risk above and beyond risk associated with diagnoses. Findings highlight targets for suicide prevention initiatives among this vulnerable group within VHA and may help identify patients who would benefit from additional support.

Introduction: Non-suicidal self-injury (NSSI) urges and behaviors are associated with lower perceived social support and related constructs (e.g., perceived rejection). However, no studies have examined the concordance of retrospective (baseline) and ecological momentary assessment (EMA) perceived social support assessments. Retrospective and EMA reports are often only weakly to moderately correlated; measurement approaches may, therefore, impact observed associations between variables. We tested whether average EMA-reported perceived emotional social support uniquely predicts EMA-reported NSSI urges and behaviors above baseline-reported retrospective self-report of perceived emotional social support alone.

Methods: 93 young adults (ages 18-34) with past-month NSSI urges or behaviors and lifetime NSSI behaviors completed a semi-structured interview, self-report surveys, and a 2-week EMA protocol.

Results: Baseline- and EMA-reported perceived emotional social support were positively correlated (Kendall's tau-b = 0.51). Average EMA-reported social support was uniquely associated with EMA-reported NSSI urges but not NSSI behaviors.

Conclusions: EMA-reported perceived emotional social support captured information not represented by baseline reports alone, but improvement in model fit was modest. EMA-reported social support may further improve the estimation of EMA-reported NSSI urges if modeled as a proximal predictor of NSSI. Further work is needed to clarify temporal directions between social support and NSSI urges. Limitations are discussed.

Introduction: Firearms are the most frequent means of youth suicide for the 14-18-year-old age group, and adolescent firearm access confers substantial increases in the risk of suicidal behaviors. There have been significant increases in firearm purchases and firearm violence in the United States since the onset of the COVID-19 pandemic.

Methods: This study uses four time points of nationally representative data from the Youth Risk Behavior Survey (YRBS) from 2015 to 2021 to examine the differential associations of reporting having carried a firearm and suicide-related outcomes, after controlling for relevant demographic factors. As a sensitivity analysis, we examined whether a similar risk pattern was seen for the probability of reporting depressed mood.

Results: Results reveal significant increases in suicide-related outcomes among students who reported carrying a firearm and no significant increases among those who did not. Unlike the suicide-related outcomes, increases in depressed mood overtime were not limited to students who carried firearms, suggesting that the risk associated with firearms may be specific to suicide-related outcomes.

Conclusions: Carrying a firearm is associated with significant increases in the risk of suicidal ideation and behaviors among youth and this risk has increased between 2015 and 2021. Implications for youth suicide prevention and directions for future research are discussed.

Objectives: Suicide by sodium nitrite may be an emerging trend in the United States. Our mixed-methods study aims to: (1) describe the rates of suicides secondary to sodium nitrite self-poisoning in the United States between 2018 and 2020 and (2) characterize the use of sodium nitrite as a suicide method.

Methods: Using NVDRS data, descriptive statistics, population-based incident rates/year and incidence estimates across 50 states were calculated. An inductive thematic analysis characterized the use of sodium nitrite as a suicide method on review of medical examiner and law enforcement reports.

Results: 260 incidents were identified as suicides secondary to self-poisoning with sodium nitrite/nitrate across 37 states and 1 territory-69% of which occurred in 2020. The typical victim was a white male student with a known depressive disorder and a history of suicidal thoughts (n = 120). The annual suicide rate using sodium nitrite increased from 0.01-0.09/100,000 person-years over the three-year period. Online forums were used to share knowledge on the procurement and preparation of sodium nitrite poisoning.

Conclusions: Sodium nitrite self-poisoning is an increasingly used planned suicide method among young people. Further studies are required to identify the impact of means safety interventions on the incidence of sodium nitrite self-poisoning incidents.

Introduction: Researchers have traditionally tested the benefits of social support, showing that it promotes positive health outcomes. There is a lack of research assessing the deleterious impact of poor social support. Low familial support can serve as a stressor in the lives of adolescents, ultimately fostering negative emotions and maladaptive coping, such as attempted suicide.

Methods: Guided by general strain theory, this study uses two waves of data from the National Study of Adolescence to Adult Health (N = 13,827; n = 7105 for females, n = 6722 for males) to test the effect of low familial support on depressive symptomatology and whether the latter mediates the effect of low familial support on suicide attempt for both males and females.

Results: The analyses reveal that low familial support is positively and significantly associated with depressive symptomatology for male and female adolescents. Regarding suicide attempt, adolescents with lower levels of familial support and higher depressive symptomatology were likely to report attempting suicide. Contrary to theoretical expectations, depressive symptomatology did not mediate the relationship between low familial support and suicide attempt.

Conclusions: Overall, the results provide justification for efforts to provide resources to adolescents who lack familial support.

Purpose: Patients receiving treatment for self-injurious thoughts and behaviors (SITBs) have diverse backgrounds, yet it remains unclear exactly who is represented in the current SITB treatment literature.

Methods: We conducted a systematic review of the past 50 years of randomized controlled trials (RCTs) testing SITB treatments to evaluate sampling practices and reporting of sample characteristics, as well as inclusion of global populations across the included 525 papers. We also assessed changes over the past five decades in these three domains.

Results: SITB RCTs frequently reported age and sex (98.6%-95.1%), less frequently reported race (83.4%-38.6%), socioeconomic status (48.1%-46.1%) and ethnicity (41.9%-8.1%), and rarely reported LGBTQ+ status (3.7%-1.6%). U.S.-based RCTs featured predominantly White, non-Hispanic, and non-LGBTQ+ samples. Most RCTs were conducted in high-income North American or European countries. Sample reporting practices, sample representativeness, and inclusion of global populations modestly and inconsistently improved over time.

Conclusions: There has not been substantial improvement in reporting practices, sample representativeness, or inclusion of global populations in SITB RCTs over the past 50 years. Acknowledging who is being studied and representing diverse populations in SITB treatment research is key to connecting research advances with those who may need it most.

Introduction: There is a need for longitudinal studies that focus on protective factors against suicide in Spain. We analyzed the estimated prevalence of suicidal ideation in a sample of Spanish university students. Second, we explored the relationship between future suicidal ideation, depressive symptoms, suicidal ideation at T1, and meaning in life and its dimensions of meaning and purpose. Third, we analyzed the mediation role of meaning in life between depressive symptoms and suicidal ideation evaluated with Ecological Momentary Assessment (EMA).

Method: In this longitudinal study, a total of 718 Spanish university students were assessed at T1, of whom 279 completed questionnaires along with EMA (T2).

Results: The estimated prevalence of suicidal ideation was 8.4%. Levels of depressive symptoms were positively correlated with suicidal ideation and negatively with meaning in life and its dimensions of meaning and purpose. Meaning in life and its dimensions mediated the relationship between depressive symptoms and subsequent suicidal ideation.

Discussion: There is a high prevalence of suicidal ideation among Spanish university students, and it is associated with depressive symptoms and meaning in life, with the latter acting as a protective factor. Thus, psychotherapeutic prevention programs from a logotherapeutic perspective could help to reduce students' suicide risk.

Introduction: Research has established that suicide-related media can impact suicide rates both positively and negatively, supporting efforts to engage the media in the service of suicide prevention. The goal of the current study is to evaluate the impact of a suicide prevention media campaign implemented April 7-14, 2019 in Oregon.

Methods: Several indices of help-seeking behavior and suicide risk were employed: suicide-related Google Health API searches, National Suicide Prevention Lifeline (Lifeline) (currently known as the 988 Suicide and Crisis Lifeline) call volume, and state suicide mortality data from April 7, 2016-May 6, 2019. Eight states with similar 2016-2018 average suicide rates were compared with Oregon. Bayesian structural time-series modeling in R was used to test intervention effects.

Results: During the 30 days following the start of the campaign, there was a significant increase in Lifeline calls from Oregon area codes (2488 observed vs. 2283 expected calls, p = 0.03). There were no significant changes in suicide mortality or suicide-related Google searches in Oregon.

Conclusions: The campaign appeared to increase help-seeking behavior in the form of Lifeline calls, without any indication of an iatrogenic suicide contagion effect. However, the campaign's potential to reduce suicide mortality was unmet.