Archives of Suicide Research最新文献

Introduction: Suicide is the leading cause of non-accidental death for Native American young people ages 15-24. Alarmingly, suicide rates have continued to rise over the past decade despite ongoing prevention efforts. This shortcoming has urged some scholars to (re)examine dominant theoretical models to better direct suicide prevention efforts in tribal communities.

Method: Using Indigenous Wholistic Theory, this study used an algorithmic approach to identify a broader set of factors associated with suicidal ideation among Native American high school students in California (n = 2,609). Data were drawn from the 2019-2020 California Healthy Kids Survey, a statewide school-based dataset. Lasso penalized regression was employed to select the most predictive variables for suicidal ideation from a set of 17 candidate factors.

Results: Ten predictors were retained in the final model: depressive symptoms; school-based victimization; sexual and gender minority status; lifetime use of alcohol, vapes, and cannabis; breakfast consumption; access to alcohol and other drugs; and parent education level.

Conclusion: A combination of factors spanning individual, emotional-social, mental-political, and physical-economic domains predicted individualized risk for experiencing suicidal ideation. These findings underscore the need to move beyond psycho-centric models and toward more comprehensive understandings of suicide-related behavior among Native American youth.

Objective: Self-directed violence with suicidal intent is one of the main causes of maternal mortality. We aimed to evaluate the impact of several predictors on suicidal ideation (SI) in postpartum women.

Methods: A cohort of 1,822 women, over 18 years old, was assessed in two Brazilian cities with contrasting sociodemographic profiles. Participants were followed from pregnancy (22nd-25th weeks) until postpartum (mean = 116.8 days, SD = 81.5 after delivery). The main outcome was SI assessed using item-10 of the Edinburgh Postpartum Depression Scale. Potential predictors of SI were allocated into seven different domains: sociodemographic characteristics, environmental stressors and social support during pregnancy, maternal mental health during pregnancy and postpartum, substance use during pregnancy, obstetric data, and newborn characteristics.

Results: SI prevalence was 3.1%. In the univariate analysis, having more children, lower family income, lower education, history of depression, stressors during pregnancy (perceived stress, hopelessness, anxiety, depression, alcohol use, smoking and history of violence, greater number of stressful events, lower social support, and racially discriminatory experience), newborn with low APGAR in the first minute, non-breastfeeding, and postpartum depression, were positively associated with SI. In the multiple predictors model (X² = 136,502; df = 6; p < 0.001), only racial discrimination during pregnancy (PR: 1.13; 95% CI 1.01-1.27) and postpartum depression (PR: 1.23; 95% CI 1.20-1.27) remained associated with SI.

Conclusions: Although racial discrimination was not assessed in the postpartum, such experiences during pregnancy seem to contribute to an increased risk of SI among depressed postpartum women. This underscores the importance of addressing racial disparities and fostering an inclusive and supportive environment to safeguard maternal mental health.

Objective: Previous research has identified loneliness as a risk factor for suicidal ideation and attempt but has lacked studies using representative samples of adolescents. We aimed to address this evidence gap by using a nationally representative sample of US adolescents to investigate whether loneliness is longitudinally associated with suicide-related outcomes.

Method: We analyzed data on 17,751 participants in the National Longitudinal Study of Adolescent to Adult Health (Add Health) aged 11-21 years at baseline. We used multivariable logistic regression to test the longitudinal association between baseline loneliness (1995; aged 11-21 years) and past-year suicidal ideation and suicide attempt measured six years later (2001-2002; aged 18-28 years) and 13 years later (2008-2009; aged 24-34 years) adjusted for socio-demographic and clinical characteristics.

Results: Adolescents with higher levels of loneliness aged 11-21 years were 1.97 times more likely to report suicidal ideation six years later (OR_adj1=1.97, 95% CI [1.45, 2.67], p < 0.001), but this association was no longer significant after adjustment (OR_adj2=1.10, 95% CI [0.75, 1.61], p = 0.62). They were also significantly more likely to report suicidal ideation at 13-year follow-up (OR_adj1=2.22, 95% CI [1.71, 2.89], p < 0.001), even after adjustment (OR_adj2=1.36, 95% CI [1.00, 1.86], p = 0.049). However, there was no association between loneliness and suicide attempt at either follow-up point.

Conclusions: Loneliness aged 11-21 years predicts suicidal ideation (but not suicide attempt) 13 years later, suggesting a need for interventions delivered at the start of adolescence to prevent the onset of distressing suicidal ideation later in adolescence and young adulthood.

Objective: Nearly 50,000 Americans die each year from suicide, despite suicide death being a rare event in the context of health risk assessment and modeling. Prior research has underscored the need for contextualizing suicide risk models in terms of their potential uses and generalizability. This sensitivity analysis makes use of the Maryland Suicide Data Warehouse (MSDW) and illustrates how results inform clinical decision support.

Method: A cohort of 1 million living control patients were extracted from the MSDW in addition to 1,667 patients who had died by suicide between the years 2016 and 2019 according to the Maryland Office of the Medical Examiner (OCME). Data were extracted and aggregated as part of a 4-year retrospective design. Binary logistic and two penalized regression models were deployed in a repeated fivefold cross-validation. Model performances were evaluated using sensitivity, positive predictive value (PPV), and F1, and model coefficients were ranked according to coefficient size.

Results: Several features were significantly associated with patients having died by suicide, including male sex, depressive and anxiety disorder diagnoses, social needs, and prior suicidal ideation and suicide attempt. Cross-validated binary logistic regression outperformed either ridge or LASSO (least absolute shrinkage and selection operator) models but generally achieved low-to-moderate PPV and sensitivity across most thresholds and a peak F1 of 0.323.

Conclusions: Suicide death prediction is constrained by the context of use, which determines the best balance of precision and recall. Predictive models must be evaluated close to the level of intervention. They may not hold up to different needs at different levels of care.

Mental health problems and suicide risk among veterinarians and veterinary nurses are well documented in the literature. Data on veterinary assistants have been overlooked, however. In addition, information on Portuguese veterinary professionals is lacking. An online sample of 833 Portuguese veterinary professionals (443 veterinarians, 287 nurses, and 103 assistants) completed self-report questionnaires about suicide risk and mental health between December 2022 and March 2023. Descriptive analysis revealed that 3.5% of respondents attempted suicide during their lifetime; 17.2% experienced extremely severe depression and suicidal ideation; 17.8% and 27.0% experienced extremely severe stress and anxiety, respectively; and 27.4% and 27.7% reported burnout and compassion fatigue, respectively. Multiple linear regression analysis revealed that professionals with a history of mental illness history; with current clinical symptoms of depression, anxiety, and stress; and working more than 40 hours per week experienced greater levels of burnout, compassion fatigue, and suicide ideation. Other variables such as being a woman, being a veterinary assistant, and disagreeing with motives for euthanasia also predicted some mental health problems. Mental health problems in the Portuguese veterinary professionals are a major health concern. These professionals are at higher risk for suicide, and clinical implications and guidelines are discussed.

Objective: The safety planning intervention is an evidence-based practice shown to reduce suicide risk, but implementation of high-quality safety planning has proven challenging. We aimed to understand clinician perspectives on the safety planning intervention to inform future implementation efforts.

Method: This cross-sectional survey of clinicians who care for patients at risk of suicide in an academic medical center asked about comfort levels and fidelity to components of the safety planning intervention and assessed implementation barriers and facilitators. We used exploratory data analysis and regression analysis to explore clinician perspectives and assess the relationship between formal training and implementation.

Results: Ninety-two clinicians responded to the survey. Two-thirds of participants (64.9%) endorsed using all six core elements of the safety planning intervention. Participants who reported receiving formal training in safety planning were significantly more likely to report being comfortable completing a safety plan (p < .001); those with higher levels of comfort were significantly more likely to endorse using all of the core elements of the safety planning intervention (p < .001).

Conclusions: Training in the evidence-based safety planning intervention is associated with clinician comfort and awareness of the core elements of the intervention. Our results suggest that there are gaps in clinician training and that formal safety planning intervention training could have a positive effect on clinician comfort and treatment fidelity.

Objectives: Adolescent suicidal behavior is highly prevalent in pediatric psychiatric emergency departments, and there is a growing occurrence of such behavior among preadolescent children. This study aims to examine the psychosocial factors associated with nonfatal suicidal behaviors in children (<12 years old) and adolescents (aged 12-18), to gain insight into unique and shared characteristics of suicidal behavior across these two age groups.

Method: This study investigates the psychosocial characteristics associated with suicidal ideation and behaviors in an emergency department sample of 183 children and adolescents aged 7-18 years in Israel. Participants completed a diagnostic interview, and self-report and parent-report questionnaires of psychosocial measures. Cross-sectional correlational and regression analyses were used to determine significant correlates of suicidal outcomes within the two age groups.

Results: Among adolescents, females exhibited a higher prevalence of suicidal thoughts and behaviors, while in children, both boys and girls showed similar rates. Depression correlated with suicidal ideation for both adolescents and children. In children, anxiety and conduct symptoms were associated with suicidal behavior, whereas in adolescents, suicidal behavior was associated with depression and anxiety.

Conclusions: The present findings contribute to the growing understanding of factors associated with suicidal thoughts and behaviors among children in comparison to adolescents. These findings underscore the importance of targeting specific risk factors when developing assessment and intervention strategies tailored to the two age groups.

Objectives: Suicide prevention gatekeeper training (GKT) is considered an important component of an overall suicide-prevention strategy. The primary aim of this study was to conduct the first robust review of systematic reviews of GKT to examine the overall effectiveness of GKT on knowledge, self-efficacy, attitudes, behavioral intentions, and behavioral change. The study also examined the extent to which outcomes were retained long term, the frequency of refresher sessions, and the effectiveness of GKT with Indigenous populations and e-learning delivery.

Methods: For this review of reviews, MEDLINE, PsycINFO, Embase; and the Cochrane Database of Systematic Reviews were searched. ROBIS was applied to assess risk of bias and findings were synthesized using narrative synthesis.

Results: Six systematic reviews were included comprising 61 studies, of which only 10 were randomized controlled trials (RCTs). Immediate positive effects of GKT on knowledge, skills, and self-efficacy were confirmed, including for interventions tailored for Indigenous communities. Evidence was mixed for change in attitude; few studies measured e-learning GKT, retention of outcomes, booster sessions, behavioral intentions, and behavioral change, with some positive results.

Conclusions: Evidence supports the immediate effects of GKT but highlights a need for more high-quality RCTs, particularly for Indigenous and e-learning GKT. This review identified a concerning lack of long-term follow-up assessments at multiple time points, which could capture behavioral change and a significant gap in studies focused on post-training interventions that maintain GKT effects over time.

Suicide is one of the leading causes of death worldwide, and in the perinatal period, the trend is increasing, even up to 100 times in the US. No studies have been carried out with validated instruments despite abundant recommendations to do so. This study aims to determine the prevalence of perinatal suicide risk in Spanish women, as well as the factors associated with it. A cross-sectional study was carried out with 908 women in the perinatal stage. Sociodemographic and obstetric variables, anxiety level (GAD-7), social support (DUKE-UNC), risk of intimate violence (WAST), and suicidal ideation (Paykel) were collected. Crude (OR) and adjusted odds ratios (aOR) were calculated using logistic regression for the main risk factors for suicidal ideation. The prevalence of suicidal ideation was 19.3% (175), and suicide attempt 2.4% (22). In the perinatal stage, the risk factors were anxiety [aOR of 1.08 (95% CI: 1.04-1.31)], experiencing a possible situation of intimate partner violence [aOR of 1.59 (95% CI: 1.04-2.43)], and a risk of PPD [aOR of 3.00 (95% CI: 1.86-4.81)]. Perceived social support appears as a protective factor [aOR of 0.97 (95% CI: 0.95-0.99)], along with skin-to-skin contact with the baby during childbirth [aOR 0.50 (95% CI: 0.28-0.88)]. Conclusions: Presenting anxiety or depression, little social support, and living in a possible situation of intimate partner violence are associated with a greater risk of suicidal ideation during the perinatal stage.

Introduction: Mental health problems seemed to have increased among university students during the COVID-19 pandemic. To deepen our understanding of the pandemic's effects in this population, we conducted qualitative research to investigate any perceived changes in students during the pandemic, differentiating the sample based on the presence or absence of current suicidal ideation (SI).

Methods: A wide sample of Italian university students (n = 1,214) completed an online questionnaire during the COVID-19 pandemic, March 2020-June 2021. We conducted a computer-assisted content analysis of an open-ended question about the perceived changes that occurred to them during the pandemic.

Results: (1) Four thematic clusters were identified: "The psychological impact of the pandemic," "New ties and new loneliness," "An uncertain forethought" and "Discovering the value of relationships." (2) In subjects characterized by severe SI, the state of confinement at home was related to the most intense emotional states and worries. (3) Students with severe SI were different from the others, in particular using the lemma "panic," which was the only psychological state specifically associated with this group.

Conclusions: Students with current severe SI experienced higher level of psychological distress and suffering compared to the other groups during the pandemic.