Suicide and Life-Threatening Behavior最新文献

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: Active duty service members who are psychiatrically hospitalized for suicide are at the highest risk for suicide death following discharge. It is essential to test brief treatments that can be delivered during the short length of stay in inpatient psychiatry. Written Exposure Therapy, a brief treatment for posttraumatic stress disorder (PTSD), was augmented with Crisis Response Planning (WET + CRP) to address PTSD and suicidal ideation (SI).

Methods: This randomized controlled trial evaluated the efficacy of the WET + CRP plus treatment as usual (n = 47; TAU) compared with TAU alone (n = 48) in reducing SI, PTSD symptoms, and rehospitalization among suicidal patients with at least moderate PTSD symptoms admitted to an inpatient psychiatric unit. PTSD symptoms and SI were assessed with clinician-administered interviews and self-report.

Results: Participants were primarily male (61.1%) and active duty/reserve (93.7%). There were no significant group differences in clinician-assessed SI presence and PTSD symptom severity (the primary outcomes) or self-reported SI severity. WET + CRP demonstrated significant reductions in self-reported PTSD symptom severity compared with TAU; these reductions were the strongest during the month following discharge.

Conclusions: Although the findings were not fully consistent with hypotheses, WET + CRP is feasible to deliver to suicidal, psychiatrically hospitalized service members and warrants additional study.

Trial registration: ClinicalTrials.gov Identifier: NCT04225130.

Background: Patient navigation (PN), paired with the safety planning intervention (SPI), may allay mechanisms that theoretically underlie suicide among sexual and gender minorities (SGM). This paper describes (a) the iterative development of a theory-informed PN + SPI intervention (QueerCare) to prevent suicide among at-risk SGM youth and young adults and (b) a case series examining the feasibility and acceptability of study procedures, measures, and QueerCare.

Methods: Seven initial QueerCare modules and a glossary of terms were drafted. Seven participants completed the case series. Feasibility and acceptability over 3 months were examined by triangulating multi-method data.

Results: The study procedures and measures in the at-risk population were feasible and sensitive, provided that remote safety monitoring and parental consent waivers were in place. QueerCare was feasible, helpful, and appropriate based on satisfaction ratings and four emerging themes: matched identity care, internalized barriers, support, and flexibility valued. Two additional modules and guardian materials were created. Suicidal crisis management protocols were continuously refined.

Conclusion: QueerCare was developed as a highly flexible modular intervention to meet the needs of SGM youth and young adults and prevent repeat suicide attempts in this population. Findings indicate study procedures, measures, and QueerCare were feasible and acceptable based on triangulated data.

Trial registration: This study was registered under ClinicalTrials.gov identifier NCT04757649.

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.

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: Although nonsuicidal self-injury (NSSI) is more common among military veterans than adult civilians, little is known about NSSI disorder among veterans.

Method: The present study explored NSSI characteristics among veterans meeting criteria for current NSSI disorder (N = 41) and the relationship between NSSI methods and functions.

Results: Participants reported a pattern of past-year NSSI engagement characterized by frequent and severe NSSI, a short interval between NSSI urges and behavior, and moderate or greater subjective distress and interference in family relationships, social relationships, and work/school. Psychiatric comorbidities were common, and nearly half of participants reported a suicide attempt history. Participants used an average of four NSSI methods, the most common being wall-punching (85.4%), and endorsed an average of eight distinct functions of NSSI, predominantly for intrapersonal reasons. Regardless of the specific method used, the most common reason that veterans with NSSI disorder engaged in NSSI was to help themselves cope with negative emotions.

Conclusions: Findings suggest certain NSSI characteristics are similar among veterans and civilians with current NSSI disorder (e.g., NSSI functions) and differ between them (e.g., NSSI methods). Further research is necessary in order to replicate and expand upon these findings with nationally representative samples and better understand NSSI functions among veterans.

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: 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.

Aims: To describe users of the Canada Suicide Prevention Service textline (now "988"), explore their perceived impact of the service and identify characteristics of interventions associated with a greater likelihood of positive effects of exchanges.

Methods: Data from 146 transcripts were analyzed using quantitative content analysis, and data were associated with counselor assessments and pre- and post-intervention questionnaire responses. Suicide risk was assessed using the Suicidal Ideation Attributes Scale (SIDAS).

Results: 78.8% of texters exhibited "severe" suicidal ideation on SIDAS, with 26.7% reporting specific plans for suicide. Complete risk assessments were often not conducted, but counselors extensively explored texters' resources and discussed potential solutions. Positive emotional changes were associated with counselors' thorough exploration of resources. Only one technique, "Reinforcing a strength or positive action of the texter," was significantly associated with positive outcomes.

Limitations: Low response rates to post-intervention survey questions may affect the representativity of participants compared to all textline texters.

Conclusion: A large proportion of texters reported they were less upset and were better able to cope with their problems after the text exchange. However, there is a need for more training and supervision to ensure that adequate suicide risk assessments are conducted, or the development of shorter assessment procedures.