Crisis-The Journal of Crisis Intervention and Suicide Prevention最新文献

Background: Despite increasing use of Google Ads in public health campaigns, few studies have described their use in suicide prevention and/or examined application to lethal means safety (LMS), a priority for suicide prevention efforts in military veterans. Aims: The objective of this study was to evaluate the effectiveness of an LMS campaign for US veterans by analyzing engagement rates across different types of Google Ad search terms included in the campaign. Methods: We conducted a secondary data analysis of Google Ads from July 2022 and May 2023 in Keep It Secure, the Department of Veterans Affairs (VA) first national LMS campaign. Our primary outcome was click-through rate (CTR). Our predictor variable was category of Google search. Categories were identified from the user queries employing a team-based immersion/crystallization process, an inductive, iterative qualitative approach. We then used generalized mixed modeling to compare CTR across search categories. Results: Using Google Ads, the campaign resulted in a total of 1,849,077 impressions and 342,747 clicks to the campaign website, for an overall 18.5% CTR of 59,587 unique searches, and we categorized 47,387 into 10 categories (Firearm Storage, General VA Inquiries, Veteran Resources, Suicide Prevention, Mental Health, Crisis Line, Suicidal Ideation, Safety Class, Firearm Policy, and Homelessness). Campaign engagement varied significantly across categories (p < .001). Searches related to general VA inquiries (30.0% CTR) and veteran resources (23.0% CTR) demonstrated the highest engagement, whereas firearm storage (4.6% CTR) and suicidal ideation (1.3% CTR) were the lowest. Limitations: Since this study was a secondary analysis, causal inferences cannot be made. Conclusions: Google Ads resulted in high overall engagement in an LMS educational campaign. For LMS outreach to veterans who are not in acute crisis, a "side-door" approach targeting people searching for general VA information and veteran benefits and resources may be more effective than using firearm or suicide-related keywords.

Background: Burns are a major global public health issue, causing 180,000 deaths worldwide each year. Self-inflicted burns are more prevalent in low- and middle-income countries and are associated with high morbidity and mortality. Understanding its frequency, demographics, and contributing factors is critical for prevention. Aims: To determine the frequency, demographic distribution, methods, and outcomes of self-inflicted burns (self-harm and suicide) in Pakistan. Methods: This scoping review followed Arksey and O'Malley's framework. We searched MEDLINE (PubMed), Google Scholar, SCOPUS, PakMediNet, and gray literature via Open Access Theses and Dissertations up to December 2023. Studies on self-inflicted burns in Pakistan were included without date restrictions. Two reviewers independently screened articles, and data were extracted using a structured form and analyzed descriptively. Results: A total of 67 studies were included, comprising 1,684 cases of self-inflicted burns of 50,283 total burn cases (3.35%). Of 67 studies, two focused solely on self-inflicted burns, 19 on burns generally, and 46 on suicide/self-harm involving burns. Of these, 39% (n = 661) were suicide and 61% (n = 1,023) were self-harm. Sex distribution was reported in 33 studies, with 443 males and 564 females affected. The method of self-inflicted burns was specified in 21 studies, including 11 studies on self-immolation and 10 on fire/flame burns. Mortality data were reported in eight studies, indicating a 42% mortality rate (143/340 cases) and a 54.7% survival rate (186/340 cases). Only 25% of the studies had authors from a mental health background, and psychiatric comorbidities or referrals to psychiatric services were rarely documented. Sociodemographic and clinical variables (age, occupation, marital status, burn extent) were frequently not reported. Limitations: A key limitation is the reliance on authors' classification of intent, which may be subject to misclassification. Discussion: Self-inflicted burns are a significant public health concern in Pakistan, particularly among females. Incomplete reporting of age, occupation, and burn extent limits understanding of at-risk groups. A national surveillance system is needed to track trends and identify high-risk populations. Integrating psychiatric evaluations into burn care can enhance outcomes and suicide prevention.

Background: In 2018, the Missouri Department of Mental Health was awarded a five-year federal grant to provide immediate mental health services to adults 25 years and older presenting at emergency departments (EDs) or admitted to inpatient psychiatric units (IPUs) for suicide attempts or suicidal ideation. Trained suicide prevention professionals from two mental health agencies were placed in hospitals or immediately contacted by hospital staff to recruit suicidal adults into mental health services, eliminating the need for patients to follow-up on referrals themselves. Aims: This article explored the effectiveness of these programs in reducing suicide attempts, IPU hospitalization, ED visits and suicidal ideation. Method: The researchers used a repeated-measures design to explore changes in these outcome variables between program intake and three months after intake. Results: Analyses revealed highly significant reductions of all outcome variables regardless of age, gender identity, race, referral source, or provider. Limitations: Due to limited funding, the research design could not include a control-group design or methods to reduce attrition at follow-up. Conclusion: The findings from this continuity-of-care approach suggest program replication within other hospital systems.

Background: Suicide remains a leading cause of early mortality, particularly among young adults under 35 years, with college students showing high rates of suicidal ideation and attempts. Student-veterans represent a unique group facing distinct stressors that may increase suicide risk compared to their nonmilitary counterparts. Aims: This study aimed to examine the relationships among military service history and suicidal ideation, planning, and attempts among college students. Specifically, this investigation tested whether depressive symptoms and feelings of belonging mediate these relationships. Method: To answer these questions, this study analyzed data from 119,664 respondents aged 18-45 years drawn from the 2020-2021 Healthy Minds Study, a national survey of mental health among US college students. Generalized structural equation modeling was used to test the mediating influence of depression (PHQ-9 scores) and belonging on the relationship between military service and suicide outcomes, adjusting for covariates and the complex sampling design. Results: Military service was significantly associated with higher levels of suicidal ideation (β = .391, 95% CI [0.095, 0.684]) and suicide planning (β = .531, 95% CI [0.123, 0.940]), but not suicide attempts (β = .637, 95% CI [-0.057, 1.360]). Depression and low belonging were strong predictors of suicidality. Indirect-effect analysis indicated that belonging was the only significant mediator of the association between military service and suicidal outcomes. Limitations: The limitations of this study include the cross-sectional design, self-reported data, voluntary participation of institutions, and relatively low prevalence of suicide attempts which reduced statistical power. Future longitudinal and qualitative studies are needed to validate findings and explore moderating factors. Conclusion: Military-affiliated college students have higher risk for suicidal ideation and planning. This relationship was partially explained by reduced feelings of belonging. Interventions to increase campus social integration among student-veterans have the potential to mitigate suicide risk in this population.

Background: The relative risk of subsequent suicidal behaviors (and suicide mortality) is high following an episode of hospital-treatment for suicidal behavior. This study evaluated the effectiveness of telehealth aftercare interventions in reducing suicidal behaviors. Methods: A systematic review was conducted using 13 online databases (from inception until July 2024). Analyses included narrative synthesis and random effects meta-analyses based on study design. Risk of bias was assessed by Cochrane tools. Results: We identified n = 14 studies involving n = 14,420 participants. Pooled effect estimates compared to usual treatment showed nonsignificantly reduced suicidal behavior in nonrandomized controlled trials (RR, 0.676 [CI 95% 0.453-1.008]), (7 studies), but no difference in randomized controlled trials (RR, 0.929 [CI 95% 0.734-1.175]) (6 studies, one study precluded analysis). The overall risk of bias was high across studies. Limitations: Many studies were underpowered, telehealth was often delivered in combination with other interventions, and the mode of telehealth was limited to telephone. Conclusions: Telehealth does not appear to confer benefit above usual treatment for suicidal behavior during follow-up, although the small number of studies and high risk of bias limits confidence in the precision of estimates of effect size. Further research might use well-designed studies to examine different clinical end points for suicidal behavior (number of or time to events) or other outcomes (retention in aftercare or other healthcare treatment).

Background: Nondisclosure of suicidal thoughts is common and impedes suicide prevention. Consistent predictors of suicide disclosure have not been identified, and it is unclear how depression impacts various aspects of disclosure. Disclosure occurs within relationships, but few studies have used social network measures to understand structure, quality, and functional factors influencing disclosure. Aims: This study aimed to understand whether social network characteristics predict likelihood to disclose suicidal thoughts and intent. Methods: N = 87 adults experiencing suicidal ideation and/or depressive, anxious, or psychotic symptoms completed an egocentric social network measure assessing relationship features, likelihood to disclose suicidal thoughts and intent, and perceived benefits and risks of disclosure for each network member. Participants also completed a general suicide help-seeking scale. Generalized estimating equations with participant-level clustering evaluated associations between disclosure likelihood (thoughts and intent) and structural, functional, and quality social characteristics, as well as perceived benefits (e.g., emotional support) and risks (e.g., embarrassment) of disclosure. Spearman's correlations assessed associations between disclosure likelihood and depression symptoms, as well as general help-seeking. Results: On average, networks had 4.7 people (SD = 1.7). Higher closeness and emotional support, but not network size, predicted greater likelihoods of disclosing suicidal thoughts and intent. Depression severity was negatively correlated with disclosure likelihood, and the association between emotional support and disclosure likelihood was attenuated at higher depression levels. Perceived benefits, but not risks, were correlates of disclosure intentions. Limitations: Analyses were cross-sectional; it is unknown how social network changes would influence future disclosure. Most of the participants were not experiencing active suicidal ideation, which limits generalizability to more acutely distressed populations. Conclusions: Social network measurement facilitates understanding of suicide disclosure, and quality and functional aspects of relationships may be more impactful than structural aspects. Depression severity may attenuate the positive influence of emotional support on disclosure. Increasing perceived benefits of disclosure could be a novel suicide prevention strategy.

Background: Accurate classification of intentional death as suicide is essential to target prevention measures appropriately. Unfortunately, manner of death (MOD) for many opioid-related fatalities are unclassified in the United States, and in Maryland, as many as 82% of overdose deaths are classified as undetermined manner. Aims: For opioid-related fatalities in Maryland, leverage death certificate data to develop a model for identifying suicide as MOD among those classified as undetermined by the medical examiner. Method: Demographic and toxicology data were used to develop a classification model for opioid-related deaths where MOD was known, and then applied to a cohort where MOD was undetermined to estimate the likelihood that the intent was suicide. Results: Antidepressants, neuroleptics, oxycodone, benzodiazepines, and acetaminophen were more common in deaths classified as suicide while fentanyl, cocaine, and morphine were more common among accidental deaths. Our classification model correctly identified suicide cases 82% of the time (PPV = 0.82; AUC = 0.90) and expanded the number of suicide cases by 43% when applied to undetermined deaths. Limitations: The accuracy and completeness of death records. Conclusions: Data from standard autopsies can be used to detect additional suicide deaths with good statistical precision. Incorporating clinical information could enhance predictive accuracy and improve classification.

Background: Individuals who have attempted suicide are at high risk of recurrence, necessitating targeted interventions. The Hospital Outreach Postsuicide attempt Engagement (HOPE) program provides psychosocial support postsuicide attempt, aiming to reduce re-presentations including those to the emergency department (ED). This study evaluated the longitudinal outcomes of HOPE participants compared to a matched treatment as usual (TAU) control group within a major health service in Victoria, Australia. Methods: This case-controlled study included 100 HOPE participants and 100 matched TAU participants. ED presentations were analyzed over 4 years (2 years pre- and post-HOPE) to assess frequency, type, and time to re-presentation. Results: There were no significant differences in the overall number of ED presentations between the HOPE and TAU groups. However, HOPE participants exhibited significantly fewer mental health-related ED presentations postintervention. Time to first mental health-related re-presentation did not differ significantly between groups. Limitations: Only participants who completed a minimum level of HOPE program engagement were included, precluding an intention-to-treat analysis. Conclusions: While the HOPE program reduced mental health-related ED presentations, it did not significantly extend the time to re-presentation for suicide attempts. These findings suggest that while beneficial for immediate care needs, HOPE may require integration with long-term community-based support to improve outcomes. Future research should explore broader measures of effectiveness, including patient-reported outcomes and quality of life metrics.

Background: Parents of adolescents with suicide attempts experience psychological distress and often request support. This may be provided through web-based psychoeducation. Aim: To examine the feasibility, acceptability, and use of a psychoeducation website for parents. Method: In a Danish feasibility trial, parents accessed a website during 2023-2024 and completed self-report measures on usage and satisfaction. Results: Among 29 enrolled parents, most visited the website once or twice, usually for less than one hour. Text-based information and video clips were rated as most useful. While around half of the participants indicated that the website did not fully meet their needs, most would recommend it to others. Limitations: Small sample size. Conclusion: The website was accessed and used, although many parents may need additional professional support.