Suicide and Life-Threatening Behavior最新文献

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.

Objective: The purpose of this study was to validate and provide detailed norms on suicide images commonly used in experimental suicide research, and to examine whether appraisals of suicide images varied based on image features and prior suicidal thoughts and behaviors (STBs).

Method: Young adults (N = 264) rated the extent to which images depicted someone "trying to kill themselves on purpose or who did kill themselves on purpose" (i.e., suicide ratings). Suicide ratings were examined descriptively and with bivariate and multivariable statistics.

Results: Suicide images demonstrated construct validity at image and aggregate levels. Further, suicide images looked more like suicide than pleasant, neutral, and interpersonal violence images, bs ≥ 5.653, ts ≥ 52.505, ps < 0.001. Among suicide images, suicide ratings were higher for images without compared to with gore, b = 0.269, t = 7.714, p < 0.001, and for images depicting high lethality methods (e.g., hanging, firearm) compared to the grand mean of all methods, bs ≥ 0.235, ts ≥ 3.316, ps < 0.001. Suicide ratings of suicide images were not associated with prior STBs.

Conclusion: Using valid suicide images, like those tested in the current study, could improve behavioral methods designed to study processes related to STBs.

Background: We continue to have limited success in identifying Veterans at high risk of suicide, due in part to reticence of disclosing suicidal ideation.

Aims: This study used a simulated groups experimental design to evaluate the MMPI-3's ability to assess suicide risk underreporting in Veterans with past-month death/suicide ideation.

Materials and methods: Thirty-nine Veterans (53.85% men) were randomized to standard and simulated underreporting groups and provided valid data on the MMPI-3 and collateral measures. We examined (1) whether simulated underreporting on the MMPI-3 (indexed by L and K scale scores) impacts SUI scale scores, (2) if these effects generalize to underreporting on extratest suicide and non-suicide measures, and (3) if MMPI-3 L and K scales incrementally predict and differentiate between Veterans with recent death/suicide ideation who were instructed to answer honestly and those instructed to underreport.

Results: Groups scored significantly differently on K (g = 0.99: M_simulation = 57.83, M_standard = 43.72), but not L. Underreporting captured by K generalized to lower MMPI-3 SUI scale scores (g = 2.00; M_simulation = 46.33, M_standard = 66.81) and collateral measures of suicide risk (g = 0.69-0.79). K scores significantly predicted group membership and added incrementally to L.

Discussion: The limitations and clinical implications of these findinga are discussed.

Conclusion: MMPI-3 K, but not L, scale scores most reliably capture defensive reporting of suicidal ideation and intent and psychopatholpgy, more boradly. However a signifcant amount of underreporrting of suicidal ideation and intent may go undetected.

Trial registration: ClinicalTrials.gov identifier: NCT04896151.

Introduction: Sleep disorder symptoms are associated with suicidal ideation, and wakefulness in the middle of the night is associated with an increased risk for suicide, potentially due to deficits in cognitive control. Little is known about daily-level associations among sleep and suicide or about the role of cognitive control in these associations.

Methods: Veterans (n = 32) with past-month suicidal ideation in a residential treatment unit were assessed for 28 days using the suicide visual analogue scale (S-VAS) to assess suicidal urges, a daily sleep diary, and self-reported cognitive control.

Results: Wakefulness in the middle of the night (1-4 a.m.) was associated with the most severe suicidal ideation. Nocturnal wakefulness and sleep quality were each associated with next-day suicidal ideation intensity. Self-reported cognitive control deficits were associated with more intense suicidal ideation. The association between nocturnal wakefulness and suicidal ideation was partially accounted for by self-reported impulsive behavior (7% of variance).

Conclusions: Veterans reported the highest suicidal ideation in the middle of the night. These findings suggest the importance of assessing sleep, suicidal ideation, and cognitive control among veterans and the need to consider nocturnal wakefulness as an indicator of heightened risk for suicide among veterans.

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.

Background: Firearms are the leading means of suicide in the United States. Research on those who survive injuries associated with intentional self-harm gunshot wounds (GSWs) is limited.

Aims: This study explores differences between patients and injury/event characteristics of cases involving nonfatal intentional self-harm GSWs compared to control cases that sustained nonfatal GSWs that did not involve intentional self-harm.

Method: Analyses used multivariable logistic regression using the Firearm Injury Surveillance Study data (1993-2021). The complex survey structure of the data was accounted for in analysis, producing nationally representative estimates.

Results: There were an estimated 113,012 (95% CI: [53,807.58, 172,216]) nonfatal intentional self-harm GSW injuries seen in U.S. emergency departments between 1993 and 2021, with differences in adjusted odds ratios across sex and incident characteristics. Intentional self-harm shootings were estimated to have an 84% (95% CI: [76.5, 94.1]) case fatality rate. Each year, an estimated average of 3897 patients survive intentional self-harm GSWs in the United States.

Conclusion: Survival of intentional self-harm GSWs is a rare, but nonzero outcome that merits further study.

Introduction: Emotional variability has been identified as a risk factor for adolescent psychopathology. This study explored the cross-sectional and prospective associations between emotional variability and suicidal ideation and examined the moderating role of parent-adolescent connectedness.

Methods: Participants included 108 Taiwanese late adolescents (Mage = 18.53, SDage = 0.39; 64% female) who completed ecological momentary assessment (EMA) over 14 days, and baseline and follow-up assessments over 6 months.

Results: Results indicated that while negative emotional (NE) and positive emotional (PE) variability were not associated with suicidal ideation at baseline, both predicted increased suicidal ideation 6 months later. Furthermore, parent-adolescent connectedness moderated the relationship between NE variability and suicidal ideation, with high connectedness mitigating the adverse effects of NE variability.

Conclusions: These findings suggest that emotional variability is a key predictor for the development of suicidal ideation and highlight the protective role of parent-adolescent connectedness. Interventions promoting family connectedness may be effective in reducing suicidal risk among emotionally variable youth.

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.