Suicide and Life-Threatening Behavior最新文献

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.

Introduction: Bipolar disorder, socioeconomic deprivation, and social isolation are major risk factors for suicide. The interpersonal theory of suicide (IPTS) posits perceived burdensomeness and thwarted belongingness as proximal causes of suicidal thoughts and behaviors, while the social determinants of health (SDOH) framework highlights distal socioeconomic factors. Studies of suicidality in bipolar disorder have used the IPTS and the SDOH framework, but few have integrated them to explore connections between distal and proximal factors.

Methods: This study examined perceived burdensomeness and thwarted belongingness as mediators of the relationship between cumulative socioeconomic risk and suicide risk. Participants were 171 outpatients in a United States (U.S.) bipolar clinic (mean age = 39.0, 69.6% female, 73.7% Black/African American).

Results: Cumulative socioeconomic risk, perceived burdensomeness, and thwarted belongingness were positively associated with suicide risk. Perceived burdensomeness mediated the relationship between cumulative socioeconomic risk and suicide risk, but thwarted belongingness did not.

Conclusion: Findings broadly suggest the IPTS and the SDOH framework can be fruitfully integrated to guide research and prevent suicide. The pathway from cumulative socioeconomic risk to suicide risk via perceived burdensomeness warrants further attention, particularly for individuals diagnosed with bipolar disorder. Implications for future studies of the IPTS, SDOH, and suicidality are discussed.

Introduction: Secure firearm storage has been proposed as a suicide prevention method within the military; however, secure storage practices are uncommon. Service members may perceive limited value in secure storage as a suicide prevention tool and threat-related factors may influence such perceptions.

Method: A nationally representative sample of firearm-owning military service members (n = 719) was recruited between December 3, 2021 and January 4, 2022 to complete a self-report survey by Ipsos using their KnowledgePanel calibration approach to optimize representativeness.

Results: Threat sensitivity was associated with less perceived suicide prevention value across all within-home storage practices as well as out-of-home storage. Defensive firearm ownership was associated with less perceived out-of-home storage value. Contrary to expectations, PTSD symptoms were associated with greater perceived suicide prevention value across all storage practices and intolerance of uncertainty was associated with greater perceived out-of-home storage value.

Discussion: Perceptions of, sensitivity to, and reactions to threat represent a complicated confluence of factors that may influence firearm views and behaviors in disparate ways. Viewing the world as dangerous and other people as a threat may limit perceived suicide prevention value for secure storage and increase the drive for firearm access.

Introduction: The period following discharge from psychiatric hospitalization is one of particularly elevated suicide risk. It is essential to better understand risk factors for suicide during this period; however, retention and compliance in longitudinal research can be a challenge with high-risk populations.

Methods: We examined compliance rates in the six-month period following psychiatric hospital discharge among 174 adults (149 psychiatric patients and 25 healthy controls) across three data collection methods: ecological momentary assessment (EMA), weekly clinical assessment phone calls, and clinical follow-up assessments at two- and six-months post-discharge. We examined whether clinical and demographic characteristics influenced compliance rates.

Results: Results suggested low rates of EMA compliance, but strong rates of completion of weekly phone calls and follow-up assessments. Compared to psychiatric patients, healthy controls completed more EMA and weekly phone calls, but not follow-up assessments. Participants who met current diagnostic criteria for a major depressive episode and who scored above the clinical threshold for borderline personality disorder symptoms had lower EMA compliance rates.

Conclusions: These findings have important implications for strategies to improve patient engagement in research during this high-risk period.

Objective: The study aims to investigate the efficacy of sertraline medication plus dialectical behavior therapy (DBT) in reducing nonsuicidal self-injury (NSSI) behavior and depression among adolescents.

Methods: Participants were 100 adolescents with depression and NSSI behaviors, 50 of whom received sertraline medication plus DBT and 50 of whom received sertraline medication plus cognitive behavioral therapy (CBT) for 12 weeks.

Results: During 6 months post intervention, 26 (57.8%) participants did not report having engaged in any form of NSSI in the sertraline + DBT group and 15 (32.6%) in the sertraline + CBT group, showing significant difference. The sertraline + DBT group and the sertraline + CBT group exhibited significant difference regarding the proportions of cutting skin and biting self. The scores of anxiety, depression, aggression against self in four modified overt aggression scale categories, and Personal and Social Performance were notably lower in the sertraline + DBT group than those in the sertraline + CBT group at 6 months post intervention.

Conclusion: Sertraline medication plus DBT could decrease NSSI episodes and improve symptoms of anxiety and depression for adolescents, and these changes were comparable to those of CBT. More importantly, DBT was demonstrated better clinical improvements at 6-month follow-up.

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.