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

Background: Access to timely data on suicide is crucial to support suicide prevention. A real-time suicide surveillance (RTSS) system enables public health teams and allied agencies to review information following suicides promptly and take action quickly. Aims: The aim of this paper was to report on an evaluation of an RTSS system in South Yorkshire, England. Method: The system was reviewed, and outcome data were analyzed for 2019 and 2020 based on recorded suspected suicides, a stakeholder focus group, evaluation of postvention bereavement service outcomes, and lessons learned. Results: The benefits of RTSS included rapid response to emerging trends, identifying clusters, effective bereavement support, information to inform measures to mitigate risk, and supporting evaluation of interventions. The challenges faced included limited resources, data quality, consistency across places, and linkages with coronial processes. Limitations: This was an evaluation of one RTSS system based on routinely collected data covering one area, South Yorkshire, and hence some data limitations, and direct comparison with other services or against a control group was not possible. Conclusion: The RTSS system has led to better support for suicidal people and a responsive, timely, and effective service for those bereaved by suicide, all of which are likely to lead to enhanced well-being and community resilience.

Aims: We investigated the association between problematic use of alcohol and/or drugs (PUAD) and the incidence, urgency, and mode of discharge for a subsequent episode of self-harm (SH) or suicidal ideation (SI). Methods: This was a retrospective population-based cohort study of individuals admitted to hospital for an index episode of SH/SI (2010-2014) using linked data from hospital admissions and emergency department (ED) presentations. The outcome variables were (1) subsequent presentation to the ED for SH/SI, (2) triage category, and (3) mode of departure. Key predictors were PUAD. Results: In total, 23,007 individuals were admitted to hospital for an index SH/SI, of whom 8% had a subsequent presentation to an ED for SH/SI within a year. The odds of subsequent presentation was increased in those with problematic alcohol use (AOR 1.62, 95% CI 1.36, 1.92), drug use (AOR 1.28, 95% CI 1.07, 1.53), and mental health diagnoses (AOR 1.63, 95% CI 1.44, 1.85). Those with problematic alcohol use were more likely to be assigned to the most urgent triage categories (AOR 1.84, 95% CI 1.32, 2.56). Limitations: Defining SH and PUAD using administrative data is challenging, and the true prevalence is likely to be underestimated. Conclusion: The findings underscore the importance of drug health intervention as a key component of self-harm prevention.

Background: The integrated motivational-volitional (IMV) model of suicidal behavior posits that defeat leads to suicidal ideation through increased vulnerability for feelings of entrapment. One potentially important vulnerability factor for the development of feelings of defeat is socially prescribed perfectionism. Aims: The current study investigated these relationships in a sample of 313 US adults. Method: Mediation and parallel mediation analyses were conducted to determine the relationships between defeat, entrapment, social prescribed perfectionism, negative social comparison, and rejection sensitivity. Results: Findings indicated that socially prescribed perfectionism was significantly related to defeat through both negative social comparison and rejection sensitivity even when controlling for depression symptoms. Negative social comparison and rejection sensitivity were related to entrapment through feelings of defeat. This relationship was strongest when analyzing externalized (vs. internalized) entrapment. Limitations: The findings were limited by the cross-sectional study design as well as the relatively homogeneous sample. Implications and future directions are discussed.

Background: Although suicide prevention programs have been shown to change suicide-related knowledge and attitudes, relatively little is known about their effects on actual behavior. Aims: Therefore, the focus of the present study was on improving participating school staff's practical and communication skills. Method: Suicide prevention workshops for students in grades 8-10 (N = 200) and a gatekeeper training program for school staff (N = 150) were conducted in 12 secondary schools in Germany. Schools were alternately assigned to one of three interventions (staff, students, or both trained) or to a waitlist control group. Results: School staff undergoing the training showed increased action-related knowledge, greater self-efficacy when counseling students in need and augmented counseling skills, and also had more conversations with students in need. Although students participating in the workshops did not seek help more frequently, they provided help to their peers more often in the conditions in which both students and school staff or only the latter had been trained. Limitations: The generalizability of the results is constrained by high dropout rates due to the COVID-19 pandemic and the relatively small sample size. Conclusion: A combination of suicide prevention programs for school staff and students appears to be most effective.

Background: A four-level community-based intervention aiming simultaneously to improve the care for depression and to prevent suicidal behavior has been implemented in the German city Munich. Aims: Changes in suicide rates in Munich during 2009-2014 were analyzed with respect to a 10-year baseline. The same was true for a control region (Cologne) and Germany minus Munich. Method: The interventions included training of primary care providers, a public awareness campaign, training of community facilitators, and support for patients and relatives. Analyses included repeated-measures, generalized linear models. Results: In Munich, the suicide rate significantly decreased during the intervention period compared to baseline (percentage change = -15.0%; p < .001, 198 compared to 222 suicides per year). Differences in the change for Munich and the change for the control locations (Cologne; -1.7%; p = .71) and Germany minus Munich (-6.2%; p = .09) were not significant. Limitations: Data on suicide attempts were unavailable. Conclusion: In Munich, a clinically and statistically significant decrease in suicide rate was found. This change was numerically but not significantly larger than in the control regions. The results are promising, however. Because of low suicide base rates and limited power, no strong conclusions can be drawn concerning suicide preventive effects of the intervention.

Background: The relationship between search terms and suicidal ideation is not precisely known. Aims: This study examined the relationship between the types of terms used in web searches and the level of suicidal ideation among individuals who conduct such searches. Methods: A total of 508 Internet users completed a suicidal ideation scale and conveyed to us the words they used when searching for a consultation site. The site was run by the authors using Internet advertisement listings, to consult people via e-mail who had searched for suicide-related words. We divided the users into three groups based on the most salient search terms: suicide method terms, suicide but no method terms, and other terms. Results: The scores on the suicide ideation scale were compared using one-factor analysis of variance, and differences were found between the groups. Users searching for suicide method-related terms had the strongest suicidal ideation. Limitations: This study was limited to users who contacted online consultation sites because of their help-seeking intentions. Conclusion: It is especially important for support organizations to identify Internet users who directly search for suicide methods.

Background: The content of suicide-specific social media posts may impact suicide rates, and putatively harmful and/or protective content may vary by the author's influence. Aims: This study sought to characterize how suicide-related Twitter content differs according to user influence. Method: Suicide-related tweets from July 1, 2015, to June 1, 2016, geolocated to Toronto, Canada, were collected and randomly selected for coding (n = 2,250) across low, medium, or high user influence levels (based on the number of followers, tweets, retweets, and posting frequency). Logistic regression was used to identify differences by user influence for various content variables. Results: Low- and medium-influence users typically tweeted about personal experiences with suicide and associations with mental health and shared morbid humor/flippant tweets. High-influence users tended to tweet about suicide clusters, suicide in youth, older adults, indigenous people, suicide attempts, and specific methods. Tweets across influence levels predominantly focused on suicide deaths, and few described suicidal ideation or included helpful content. Limitations: Social media data were from a single location and epoch. Conclusion: This study demonstrated more problematic content vis-à-vis safe suicide messaging in tweets by high-influence users and a paucity of protective content across all users. These results highlight the need for further research and potential intervention.