Archives of Suicide Research最新文献

Objectives: Universal screening for suicide risk has not been shown to reduce suicide rates or reliably predict suicide, but there have been few studies assessing other potential benefits of this practice. We aimed to investigate the feasibility of implementing a universal inpatient suicide risk screening protocol and determine if a positive suicide screen was predictive of the need for psychiatric admission, and if it reduced the length of stay prior to psychiatric admission.

Methods: We conducted a retrospective chart review of non-psychiatric admissions over 1 year at a tertiary care academic hospital. We calculated the proportion of patients screening positive for suicidal ideation (SI), and among those screening positive, the proportion receiving a psychiatric consult and being admitted to psychiatry. Length of stay among groups was determined. We performed chi square analysis and adjusted multivariate logistic regression comparing different demographics.

Results: 97.2% of patients were screened, with 2.6% screening positive. Of these patients, 44.6% received a psychiatric consultation and 9.2% were admitted to psychiatry. Psychiatric admissions who screened positive for SI averaged 5.7 days until transfer to psychiatry, compared to 17.9 days for those who screened negative. Suicide risk screening had a sensitivity of 62.0%, specificity of 97.6%, positive predictive value of 9.2%, and a negative predictive value of 99.8% for psychiatric admission.

Conclusions: Universal suicide risk screening is feasible and may help identify patients requiring psychiatric care sooner, reducing length of stay of those requiring psychiatric admission.

Objective: Disclosure of self-injurious thoughts and behaviors (SITBs) can serve as a catalyst to receiving mental health and lifesaving care; yet, many young people do not disclose these experiences to their therapists. In this study we aimed to identify barriers to adolescents disclosing their SITBs to their therapists and to compare these barriers across non-disclosure of suicidal ideation, suicidal behavior, and non-suicidal self-injury.

Method: Participants (n = 292) all had lived experience of at least one SITB and were an average age of 15.55 years, with the majority identifying as cisgender girls (68.15%). Using inductive content analysis of open-ended responses, six main categories of disclosure barriers were identified.

Results: These overarching barriers were: Agency Theft, Irrelevance, Therapeutic (Mis)Alliance, Internalized Stigma, Anticipated Stigma, and Lacking Disclosure Self-Efficacy. The majority (85.29%) of subordinate barriers were common across the three SITBs.

Conclusions: Adolescents may hesitate to disclose their SITBs to their therapists for many reasons; prioritizing the therapeutic relationship and working collaboratively with adolescents could be instrumental in not only fostering disclosure but also an overall more positive therapeutic experience.

Firearm availability is correlated with increased risk of suicide but its link with suicidal ideation remains unclear. Previous studies are limited by retrospective reports and prospective designs with lengthy gaps between assessments that are ill-suited for measuring fluctuations in suicidal ideation. This study used ecological momentary assessment (EMA) to repeatedly assess suicidal ideation in a sample of 138 U.S. adults (81 handgun owners, 57 non-owners). Participants received six EMA prompts per day for 28 consecutive days. Results revealed no group differences in the frequency, maximum amplitude, or variability of suicidal ideation across male and female handgun owners and non-owners. Stability of suicidal ideation significantly differed across groups, however (F(1,132) = 4.5, p = 0.036); male handgun owners had the strongest stability and male non-owners had the weakest stability. Stability of suicidal ideation was significantly lower when participants reported a firearm was nearby as compared to when no firearm was nearby (F(4,17732) = 5.6, p < 0.001). Results suggest firearm availability increases reactivity to the environment, slows recovery from acutely elevated risk states, and may increase vulnerability to sudden shifts to higher risk states characterized by increased probability of suicidal behavior. Although these effects were observed in both handgun owners and non-owners, they disproportionately impact handgun owners because they report being near firearms more often.

Objective: Poor sleep quality exacerbates suicidal ideation. Depression, anxiety, and stress may play important roles in this relationship. However, the underlying mechanisms remain unknown.

Method: A total of 2,598 young men were recruited for a cross-sectional study focusing on a range of sociodemographic factors, emotions, sleep quality, and suicidal ideation. Parallel, serial, and moderated mediation models were used to determine whether depression, anxiety, and stress mediated the relationship between poor sleep quality and suicidal ideation.

Results: Direct and indirect effects of poor sleep quality on suicidal ideation were observed. Depression, anxiety, and stress mediated the relationship between poor sleep quality and suicidal ideation (β_Depression = 0.166, 95% confidence interval [CI]: 0.144, 0191; β_Anxiety = 0.153, 95% CI: 0.130, 0.177; β_Stress = 0.176, 95% CI: 0.154, 0.200). The serial mediation model indicated that depressive and stress symptoms co-play a serial mediating role in the relationship between poor sleep quality and suicidal ideation (β_a = 0.049, 95% CI: 0.036, 0.062; β_b = 0.099, 95% CI: 0.080, 0.120). The moderated mediation model revealed that the mediating role of stress on the relationship between poor sleep quality and suicidal ideation was moderated by depression (β = 0.173, 95% CI: 0.150, 0.197). Self-reported measures and the study's cross-sectional design preclude the causal inferences reported.

Conclusions: The findings of this study prompt clinical and scientific researchers to consider the interplay among affective disorders when investigating etiological and psychological factors that may contribute to suicidal ideation.

Background: The objectives of this study were to investigate the relationship between perinatal risk factors and suicidal ideation and attempts in young adults in Pelotas, Brazil.

Methods: The data were collected from the 1993 Pelotas Birth Cohort study. Every pregnant woman who gave birth in one of the hospitals in Pelotas Brazil in 1993 was invited to participate in the study. The current study uses perinatal data collected in 1993, and follow-ups at ages 18 and 22. The primary outcome was lifetime suicide attempts with past month suicide ideation a secondary outcome. The association between perinatal predictors and suicidal ideation or lifetime suicide attempts was investigated using hierarchical logistic regression.

Findings: There was an analytic sample size of 3493. The perinatal factors association with lifetime suicide attempts were sex (OR = 2.25 CI: 1.76-2.89), paternal education at birth (OR = 0.60, 95%CI: 0.36-0.99), maternal education (9-11 years OR = 2.81, 95%CI: 1.41-5.59, & 0-8 years OR = 2.21, 95%CI: 1.07-4.58), support from friends or neighbors at birth (OR = 0.36 95%CI: 0.17-0.77), and maternal smoking during pregnancy (OR = 1.41, 95%CI: 1.10-1.79). Patterns of associations were broadly similar with suicidal ideation. Interactions between sex and the perinatal factors paternal education, maternal education, smoking and support from friends were assessed and found to be not significant.

Conclusion: Several factors during the perinatal period are associated with risk of lifetime suicide attempts and ideation in young adults in Brazil. Early-life factors associated with suicide-related concerns in early adulthood were similar to those observed in studies from high-income settings.

Background: Suicide and self-harm are global disease burden that contributes significantly to years of lost life and mortality. Despite the increasing rates of suicide and self-harm in Nigeria, this topic is understudied.

Methods: A mixed-methods design was adopted. Study 1 interviewed n = 18 participants (n = 11 clinicians; n = 5 patients with a history of self-harm and suicide ideation; and n = 2 caregivers). All interviews were audio-recorded, transcribed verbatim, and analyzed using IPA. Study 2 surveyed n = 562 non-clinical sample about their tolerance toward self-harm and the data was analyzed using One-way ANOVA in SPSS.

Results: Study 1 qualitative findings showed substance use, perceived rejection and social isolation were considered predisposing factors for suicide and self-harm. Cultural and religious beliefs shaped help-seeking behaviours. Although Study 2 found no significant differences in demographic characteristics concerning public tolerance toward persons with a history of self-harm, 64% believed that individuals who died by suicide would face punishment after death; 51% believed that victims of attempted suicide are a source of shame to their families; and 33.8% agreed that dying by suicide is the correct behaviour.

Conclusions: Patients with a history of self-harm and suicidal ideation consider family members and close friends as valuable sources of support. Due to the potential clinical implication of cultural and religious beliefs, as shown in the present study's findings, the authors recommend a co-development of culturally appropriate psychological intervention for persons with a history of self-harm and suicidal ideation to be tested in randomized control trials.

Individuals at clinical high-risk for psychosis (CHR-P) are at increased risk for suicide. However, the relationship between attenuated positive symptoms and suicidal ideation are not well understood, particularly as they interact over time. The current study addressed this gap in the literature. We hypothesized that greater attenuated symptoms would be concurrently and prospectively associated with suicidal ideation. Further, we hypothesized that suspiciousness and perceptual abnormalities would have the strongest relationship with suicidal ideation. Within-person variation in symptoms and suicidal ideation were examined across 24 treatment sessions for individuals at CHR-P. Attenuated positive symptoms (unusual thought content, suspiciousness, grandiose ideas, perceptual abnormalities, and disorganized communication) and suicidal ideation were assessed at each session. Logistic mixed effect models examined concurrent and time-lagged relationships between symptoms and suicidal ideation among 36 individuals at CHR-P. Results indicated that suicidal ideation was more likely during weeks when participants reported more severe total attenuated positive symptoms. Further, suspiciousness was uniquely associated with suicidal ideation, both concurrently and at the following session. Post hoc models examined the reverse direction of this relationship, demonstrating that suicidal ideation also prospectively predicted suspiciousness at the following session. These results suggest that within-person attenuated symptoms, particularly suspiciousness, are associated with suicidal ideation among individuals at CHR-P. However, the bidirectional relationship between suspiciousness and suicidal ideation raises questions about causal nature of this relationship. Further research is needed to examine the dynamic interplay of suspiciousness and suicidal ideation.

Objectives: To evaluate whether a history of incarceration was associated with increased odds of suicidal ideation and suicide attempts, and to determine if this association was further strengthened when combined with a history of solitary confinement.

Methods: We collected cross-sectional data from a general population sample in New York City and Baltimore in March 2017. Participants were categorized based on their history of incarceration and solitary confinement: (1) no incarceration, (2) incarceration-only, and (3) incarceration plus solitary confinement. We compared these three groups, utilizing hierarchical adjustments for sociodemographic factors and adverse childhood experiences. Missing data were accounted for utilizing multiple imputation via chained equation.

Results: A total of 1221 individuals were analyzed. Those who experienced both incarceration and solitary confinement consistently had higher odds of suicidal ideation (OR, 2.80; 95% CI, 1.43 to 5.48) and suicide attempts (OR, 6.98; 95% CI, 2.77 to 17.61) than never incarcerated individuals. Those who experienced incarceration without solitary confinement had higher odds of suicide attempts (OR, 3.77; 95% CI, 1.35 to 10.56) than never incarcerated individuals, whereas this association was not evident for suicidal ideation. Solitary confinement increased the odds of suicidal ideation even compared to incarceration without solitary confinement (OR, 2.71; 95% CI, 1.09 to 6.74).

Conclusions: Our findings support the need to address the higher likelihood of suicide-related outcomes among those in contact with the criminal justice system, and to consider alternatives to solitary confinement.

Objective: In Pakistan, a predominantly Muslim country, information on the patterning of suicidal thoughts and behaviors, as well as associated public perceptions and opinions, is limited. We sought to advance knowledge on suicide and self-harm in Pakistan with a large, online survey.

Method: Leveraging results from a twelve-item online survey (N = 5,157) circulated by the largest English language newspaper in Pakistan, we assessed personal experiences, opinions, and attitudes toward help-seeking in the context of suicide. We calculated proportions with 95% confidence intervals for endorsed responses and implemented binomial generalized linear models with odds ratios to assess differing response tendencies by age, gender, and urban/rural residence.

Results: Personal experiences related to suicide and self-harm as well as encounters in social circles were common. Mental illness tended to be recognized as a high likelihood contributor to suicide death over and above nonviolent interpersonal problems. Most considered suicide a way to escape pain, and few considered suicide to be immoral. Barriers to help-seeking included social deterrents, inaccessibility, and unaffordability. Women and youth emerged as higher risk groups, though the status of rural Pakistanis remained unclear.

Conclusion: The survey provides a preliminary basis for considering the unique experiences and perspectives of the public in shaping suicide prevention and intervention efforts in Pakistan.