Archives of Suicide Research最新文献

Objective: Text-based crisis services often gather information on users' suicide risk prior to intervention. Suicide.ca's crisis chat service uses a triage questionnaire combining a screening question on suicidal intent with the Suicidal Ideation Attributes Scale (SIDAS) to help identify users at highest risk. This study aimed to: (1) evaluate the SIDAS's psychometric properties in a real-world setting; and (2) assess its predictive validity in identifying users likely to be classified as high risk by counselors; and (3) examine whether combining the SIDAS with the suicidal intent question improves detection of high-risk users.

Method: At triage, users completed the French version of the SIDAS along with questions on age, gender, and suicidal intent. Data from 1,480 users who subsequently received crisis intervention were analyzed. Predictive validity was evaluated using counselors' suicide risk assessments.

Results: Confirmatory factor analysis replicated the unifactorial structure of the SIDAS. All items showed satisfactory factor loadings except item 2. Internal consistency was good (ω = .80). ROC analysis showed low sensitivity and specificity in differentiating high- vs low-risk users. Adding the SIDAS (cutoff ≥ 32) to the suicidal intent item in a hierarchical regression yielded a statistically significant but modest increase in explained variance.

Conclusions: The SIDAS showed similar psychometric performance in a real-world context. While a revised cutoff improved prediction slightly, its added value in identifying users deemed high risk by counselors appears limited. The clinical utility of the SIDAS and implications of using a revised cutoff for triage in text-based intervention services will be discussed.

Objective: Understanding patterns of suicide risk over the course of development can aid our ability to prevent suicide. Our community-based study examined changes in suicide risk status and predictors of changes in risk status in a sample of 521 adolescents over six assessments between the start of middle school and young adulthood (ages 12-22).

Methods: Suicidal thoughts and behaviors (STB) were measured with the Diagnostic Interview Schedule for Children and the Moods and Feelings Questionnaire. Latent transition analysis (LTA) was utilized to evaluate transitions in suicide risk status over the course of development. Nine risk factors' initial values and change over time were modeled as predictors in the LTA.

Results: Latent class analysis identified a four-class model of developmental suicide risk patterns: Class 1: Infrequent STB (73-87% of participants), Class 2: Diminishing STB (1-17% of participants), Class 3: Escalating STB (6-16% of participants), and Class 4: Consistently High STB (1-5% of participants). LTA demonstrated that infrequent STB members and escalating STB members were likely to maintain their risk class across time points.

Conclusions: Classification of STB trajectories demonstrated self-worth and family involvement were salient variables affecting transitions in risk over time and suggest prevention targets early in adolescence that could have impact on suicide risk in adulthood.

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.

Objective: Worldwide helplines are considered an important part of suicide prevention strategies. Nevertheless, evidence regarding the impact of suicide prevention helplines on the suicidality of its users remains limited and is frequently confronted with methodological issues. This study aimed to assess the impact of crisis calls on callers' levels of crisis and suicidality both immediately after the call and at follow-up compared to before the call. After the call, the satisfaction of the callers with the intervention was also assessed.

Methods: A pre-post study, generated automatically by a telephone system, was conducted in order to compare the level of crisis and suicidality (operationalized by five indicators: hopelessness, entrapment, controllability, suicidal intent, and social support) experienced by callers before and immediately after the call and at follow-up (one to two weeks after the call).

Results: Callers (n = 487) showed significant improvement in their level of crisis (p < .001, d = -0.31), hopelessness (p < .001, d = -0.22), entrapment (p < .001, d = -0.25), suicide intent (p < .001, d = -0.37), and social support (p < .001, d = 0.33) after the call compared to before the call. Improvements were also found at follow-up compared to pretest. The satisfaction of callers with the helpline was high.

Conclusions: This study adds to the growing evidence on suicide prevention helplines and addresses some important methodological issues in helpline research. Furthermore, it shows promising results regarding the potential supportive impact of helplines on callers who feel suicidal.

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.

Objective: Contemporary approaches to suicide assessment and treatment incorporate reasons for living (RFL) and reasons for dying (RFD). This study qualitatively explored individuals' self-described RFL and RFD in the context of suicidal thinking and behaviors.

Method: Within a community United Kingdom (UK) sample, adults (N = 331, aged 16+) responded to eight open-ended questions probing their experiences of suicide, defeat, and entrapment. Utilizing these data, which were collected from a larger online survey examining risk and protective factors for suicidal behaviors, this study explored RFL and RFD within these narratives. After the research team established an initial code book, RFL and RFD codes were subsequently analyzed through inductive and deductive thematic analyses.

Results: The present study identified five complimentary RFD-RFL themes: (1) Hopelessness-Hopefulness, (2) Stress of Responsibilities-Duty to Responsibilities, (3) Social Disconnection-Social Connection, (4) Death as Sin-Desire for an Afterlife, and (5) Temporary Escapes as Coping-Entrapment (i.e., a lack of escape). Three subthemes within the RFD theme Entrapment were General/Unspecified, By Feelings, and Within Self.

Conclusions: Identified themes reflect the existing quantitative RFL and RFD literature. The identified RFL and RFD themes are discussed with reference to their clinical applications in advancing suicide-specific assessments and interventions. We propose a dimensional framework for RFD and RFL which informs future suicidal behaviors research and practice.

Objective: Suicidality is a critical public health concern, especially among emerging adults who have experienced trauma. However, limitations remain in understanding the associations of suicidal risk and stress-responding. The current study experimentally evaluated the extent to which suicidal thoughts and behaviors (lifetime ideation/attempts, past-year suicidal ideation, threat of suicide attempt, likelihood of suicide in the future) were associated with self-reported psychological and physiological reactivity to a trauma-relevant stress induction task via breathing tasks.

Method: The sample comprised 94 trauma-exposed undergraduate students (M_age = 20.30; 61.7% women) who completed a laboratory-based, within-subjects study. Participants completed both a voluntary hyperventilation challenge and a normal breathing control task and reported psychological and physiological reactivity before and after each trauma-relevant stress induction task.

Results: An overall path model indicated past-year suicidal ideation was significantly positively associated with psychological reactivity (β = .51); no other associations were significant.

Conclusions: Identifying patterns between stress-responding and suicidal thoughts and behaviors may allow researchers and clinicians to develop programs to reduce the risk of suicide in young adults in the future, especially among those who are trauma-exposed.

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.

The weeks following an inpatient psychiatric hospitalization are known to be the highest-risk time for suicide. Interventions are needed that are well-matched to the dynamic nature of suicidal thoughts and easily implementable during this high-risk time. We sought to determine the feasibility and acceptability of a novel registered clinical trial that combined three brief in-person sessions to teach core cognitive-behavioral therapy (CBT) skills during hospitalization followed by smartphone-based ecological momentary intervention (EMI) to facilitate real-time practice of the emotion management skills during the 28 days after hospital discharge. Results from this pilot study (N = 26) supported some aspects of feasibility and acceptability. Regarding feasibility, 14.7% of all screened inpatients met study eligibility criteria. Half (50.3%) of those who were ineligible were ineligible because they were not part of the population for whom this treatment was designed (e.g., symptoms such as psychosis rendered them ineligible for the current study). Those who were otherwise eligible based on symptoms were primarily ineligible due to inpatient stays that were too short. Nearly half (48%) of study participants did not receive all three in-person sessions during their hospitalization. Among enrolled participants, rates of engagement with the smartphone-based assessment and EMI prompts were 51.47%. Regarding acceptability, quantitative and qualitative data supported the perceived acceptability of the intervention, and provided recommendations for future iterations. Well-powered effectiveness (and effectiveness-implementation) studies are needed to determine the effects of this promising and highly scalable intervention approach.