Suicide and Life-Threatening Behavior最新文献

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: 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.

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.

Introduction: As an important transdiagnostic factor, intolerance of uncertainty (IU) can predict suicidal ideation (SI). But little is known about the underlying mechanisms. The present study examined the chain mediating roles of three maladaptive cognitive emotion regulation (CER) strategies and psychache in the relation between IU and SI, as well as gender differences.

Methods: A number of 1532 Chinese adolescents (43.1% males; baseline mean age = 15.00 years, SD = 1.57) completed self-report questionnaires on IU, self-blame, rumination, catastrophizing, psychache and SI for two waves, 6 months apart.

Results: The results indicated that IU predicted SI through psychache and the serial mediation of the three maladaptive CER strategies and psychache, but IU did not predict SI through the three maladaptive CER strategies. The relation between IU and catastrophizing, the relation between catastrophizing and psychache, and the relation between psychache and SI were stronger among females than males.

Conclusion: The results advance our understanding of how IU predicts SI, highlighting the importance of psychache in the development of SI.

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.

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: The interpersonal-psychological theory of suicidal behavior (IPTSB) is widely applied to explain non-fatal suicide behaviors, but yet to be tested empirically with a Ghanaian sample.

Aims: Using a total of 800 junior high school students (JHS) in the Greater Accra Region of Ghana, this study tests the utility of the IPTSB with the aim of having a better understanding of how suicide behavior is occurring among this young generation of Ghanaians.

Materials and methods: The study used the WHO-CIDI's self-reported measures on suicide behavior and the Interpersonal needs questionnaire, which measures the elements of the IPTSB. Structural equation modeling was performed using Mplus to test the overall fit of the model as well as associations among the predictor variables and outcome variables.

Results: The study found the IPTSB was significant for explaining 12-month and lifetime suicide behaviors in the sample. Also, 12-month suicide attempt was significantly associated with increased 12-month suicide ideation, increased acquired capability and increased perceived burdensomeness. In addition, 12-month suicide ideation was significantly associated with increased thwarted belongingness and increased perceived burdensomeness.

Discussion and conclusion: This study provides new information for clinicians and policy makers working to reduce suicide behavior among Ghanaian adolescents.

Objective: To examine factors associated with the choice of public location over home to die by suicide.

Methods: This study used a case-control design. Data on suicides that occurred between 2001 and 2017 in Australia were extracted from the National Coronial Information System. Cases were suicides that occurred in public places and controls were suicides that occurred at home. Logistic regression models were used to estimate the associations between suicide location and several sociodemographic variables, depending on whether hotel rooms were included in or excluded from public places.

Results: In total, 25.2% of 42,656 suicides occurred in public places including hotel rooms, 69.3% at home, and 5.4% in nonpublic places other than at home (e.g., inpatient ward or correctional facilities). Excluding suicides in hotel rooms from public places, 1.6% points of suicides in public places moved to nonpublic places other than at home. In multivariable regression models regardless of scenarios, males (compared with females) had higher odds of dying by suicide in public places, while those who were divorced/separated/widowed (compared with married people), those who were older (aged 30-54, and aged 55 and above, compared with under 30 years), and those who were unemployed or not in the labor force (compared with employed people) had lower odds of suicide in public places.

Conclusion: The findings should be used to inform the design of strategies to prevent suicides in public places.

Introduction: Veterans Crisis Line (VCL) responders may initiate emergency dispatches when individuals are at high risk for suicide, risk cannot be reduced, and self-transportation to emergency care is not possible. The purpose of this study was to understand veterans' experiences of emergency dispatches following a crisis line contact.

Methods: Forty veterans (29 men; 11 women) who contacted VCL and received an emergency dispatch were recruited. Participants completed semi-structured interviews exploring their experience of the VCL contact and receiving a dispatch. Transcriptions were analyzed using descriptive thematic analysis.

Results: Individuals who received an emergency dispatch recognized that VCL provides a resource that helped them cope with overwhelming distress and suicidal thoughts when they had nobody to turn to while connecting them with healthcare, which may have saved their lives. They also noted that there were problems with police involvement that reduced autonomy, were perceived as hostile, and may have prevented them from contacting VCL again.

Conclusions: VCL is meeting a core need for veterans who are at high risk for suicide by facilitating coping during crises and connection with care. However, policy makers, responders, and researchers need to consider the potential negative impact of police involvement and consider alternative responses.

Introduction: This study evaluated hypothetical participation in temporary voluntary removal of firearms from the home to reduce future suicide risk in 408 adult male firearm owners.

Methods: A delay discounting approach was applied to evaluate the degree to which these choices were influenced by two dimensions of reinforcer efficacy-delay and magnitude. The decision-making task sampled choice behavior across various durations of temporary voluntary removal of firearms (Delay) and differences in stated potential risk of suicide (Magnitude) as a result of that choice.

Results: Results of mixed-effects modeling indicated that the subjective value of immediate access to a firearm was differentially sensitive to both delay and magnitude. Additionally, the scaling of these effects was linked to various other indicators of firearm-specific safety (e.g., use of trigger locks) and suicidality risk (e.g., intolerance of uncertainty).

Conclusions: These results provide additional support for behavioral models of decision-making (i.e., delay discounting) when evaluating how specific environmental arrangements and framing may support (or potentially discourage) engagement in means safety activities, inclusive of temporary firearms access restriction. These findings suggest that further analysis of the ecological underpinnings of these choices may help to guide more targeted efforts to engage with firearm owners in safety planning when there are concerns about the potential for suicide.