Archives of Suicide Research最新文献

Objective: Safety planning for suicide prevention is an important quality metric for Zero Suicide implementation. We describe the development, validation, and application of electronic health record (EHR) programs to measure uptake of safety planning practices across six integrated healthcare systems as part of a Zero Suicide evaluation study.

Methods: Safety planning was documented in narrative notes and structured EHR templates using the Stanley Brown Safety Planning Intervention (SBSPI) in response to a high-risk cutoff score on the Columbia Suicide Severity Rating Scale (CSSRS). Natural Language Processing (NLP) metrics were developed and validated using chart review to characterize practices documented in narrative notes. We applied NLP to measure frequency of documentation in the narrative text and standard programming methods to examine structured SBSPI templates from 2010-2022.

Results: Chart reviews found three safety planning practices documented in narrative notes that were delivered to at least half of patients at risk: professional contacts, lethal means counseling for firearms, and lethal means counseling for medication access/storage. NLP methods were developed to identify these practices in clinical text with high levels of accuracy (Sensitivity, Specificity, & PPV ≥ 82%). Among visits with a high-risk CSSRS, 40% (Range 2-73% by health system) had an SBSPI template within 1 year of implementation.

Conclusions: This is one of the first reports describing development of measures that leverage electronic health records to track use of suicide prevention safety plans. There are opportunities to use the methods developed here in future evaluations of safety planning.

Objective: Suicide is a major global public health concern. While some progress has been made in understanding risk factors for suicidal behavior, other relevant questions have received less attention. One such question relates to the longitudinal course of suicidal behavior amongst individuals with multiple suicide attempts. This systematic review investigated whether there is an increase in the lethality across multiple suicide attempts.

Method: This systematic review followed PRISMA 2020 reporting guidelines. A literature search was conducted in MEDLINE, Embase and PsycINFO electronic databases from inception to August 2023 to identify studies with key terms related to multiple suicide attempts and lethality. The review included longitudinal studies with data on multiple suicide attempts, and any rating of their lethality. Covidence was used to guide the screening and extraction process. A narrative synthesis approach was used to descriptively summarize included studies.

Results: After identifying 828 unique abstracts for screening, 11 studies were included for narrative synthesis. Suicide attempt assessment methods and definitions were heterogenous, often indirectly inferring lethality based on suicide attempt method. Individuals with repeat attempts may be more likely to continue using the same method.

Conclusions: There was no evidence to support increasing lethality across repeat suicide attempts. However, this should be interpreted along with the fact that the evidence base is scarce, heterogenous, and methodologically limited.

Objective: The Transtheoretical Model of Change (TTM) is an established model outlining five stages of change within a psychotherapeutic context: pre-contemplation, contemplation, preparation, action, and maintenance. Research shows that these models benefit patients and clinicians by enhancing their understanding of complex processes and identifying optimal therapeutic support for individuals at specific times. This study aimed to apply the TTM to personal recovery following a suicidal episode.

Method: A meta-synthesis was conducted on qualitative studies that outlined distinct phases or stages of recovery from a suicidal episode. The identified recovery stages were mapped onto corresponding TTM stages.

Results: Recovery processes followed a pattern aligning with TTM stages, but the action, maintenance, and termination stages were not clearly distinguished in the context of personal recovery. A three-stage model was proposed instead: (1) precontemplation, where recovery is not seen as possible or meaningful; (2) contemplation, during which there is growing awareness and consideration of the possibility of recovery and change; and (3) active growth, which is characterized by ongoing progress and engagement in at least one personal recovery process.

Conclusions: The proposed three-stage model condenses the later TTM stages and may better reflect personal recovery from a suicidal episode. Applying the model in clinical settings could help with case conceptualization and inform recovery approaches to an individual's current stage. Future research should evaluate the benefits of incorporating stages of change into suicide-focused recovery interventions to develop more effective interventions.

Objective: Socioeconomic status deprivation is known to be associated with self-harm in Western countries but there is less information about this association in Low and Middle Income Countries (LMIC). One way of investigating this is to assess the prevalence of indicators of financial stress in people who self-harm. We have assessed the prevalence and correlates of day-to-day financial hardships amongst individual presenting with non-fatal self-harm to hospitals in Sri Lanka.

Methods: Data on non-fatal self-harm presentations were collected from an ongoing surveillance project in 52 hospitals in Sri Lanka. A questionnaire captured data on two forms of financial stress: unmet need (i.e., costs and bills that cannot be paid) and required support (i.e., steps taken to cover costs, such as selling belongings). Additional data on demographic, economic and clinical characteristics were also collected.

Results: The sample included 2516 individuals. Both forms of financial stress were very common, with pawning/selling items (47%) and asking family or friends for money (46%) in order to pay bills or cover costs being commonly reported. Greater financial stress was associated with being aged 26-55 years, limited education, and low socioeconomic position. Financial stress was greater in women than men after adjusting for other factors.

Conclusion: The results indicate that financial stress is commonly reported amongst individuals presenting to hospital with non-fatal self-harm in Sri Lanka, especially women. The research highlights a need to attend to financial stress both within self-harm prevention and aftercare.

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: The goal of this study was to evaluate whether concepts from the cultural theory of suicide operate as culturally specific motivational and volitional moderators on the pathways to suicidal ideation and suicide behavior as described by the integrated motivational-volitional theory within a sample of international students.

Methods: International students (n = 444) were recruited through email advertisements to complete an online survey evaluating entrapment (feelings of being trapped and unable to escape; this could be internal or external), cultural stress, cultural support, idioms of distress, cultural sanctions of suicide, and suicidal ideation and attempts.

Results: Two moderated regression models with 5,000 bootstrapped bias-corrected samples were conducted. Cultural stress was a significant moderator of the relationship between entrapment and suicidal ideation, but cultural support did not moderate the same pathway. Contrary to hypotheses, neither idioms of distress nor cultural sanctions significantly moderated the relationship between suicidal ideation and suicide attempts, although both exhibited a direct main effect. Exploratory post hoc analyses among those with suicidal ideation suggest that cultural sanctions may moderate the relationship between suicidal ideation and attempts when ideation is high.

Conclusion: Experiences of cultural stress may exacerbate the risk for suicide among international students, but the role of other cultural factors is unclear. Further research is needed to identify how cultural components and experiences impact suicide risk among international students.

Suicide is a significant public health concern globally, and deficits in problem-solving ability have been identified as an important risk factor for suicide. Through a comprehensive meta-analysis, this study aims to quantitatively synthesize the relationship between self-appraised problem-solving ability as measured by the Problem Solving Inventory (PSI) and suicidal ideation as indicated by measures of hopelessness and suicidal thoughts. The heterogeneity metrics suggested that the PSI and its subscales relate to suicide-related variables, though the strength and direction of these relationships vary across studies and populations. Despite this variability, the total PSI scale demonstrated the strongest combined effect, indicating its potential utility in suicide risk assessment. There were no significant moderating effects of age or gender composition across the studies, indicating that the relationship between perceived problem-solving abilities and suicide-related outcomes is consistent across age and gender groups. The strong association between perceived problem-solving competencies and reduced hopelessness highlights the potential of targeted interventions to enhance these skills. Such interventions could form a vital component of suicide-prevention strategies, aimed at bolstering the ability to cope with stress and adversity.HIGHLIGHTSTotal PSI scale had the largest combined effect on suicide-related variables.Self-appraised problem-solving has a pronounced association with hopelessness.Findings highlight the potential of interventions to enhance problem-solving.

Background: This study examined the implementation of structured suicide risk screening by a large state physician health monitoring program (PHP).

Methods: Physicians (n = 363; 87 women; 44.78 years-old, SD = 13.75) were screened for suicide risk with the Columbia Suicide Severity Rating Scale (C-SSRS) at PHP intake and at 2-weeks, 3-months, 1-year, 2-years, 3-years after initiating monitoring, and following any sentinel events. The PHP response was recorded at each timepoint.

Results: At intake, female physicians reported higher current (p = .025, Cramer's V = .178) and lifetime suicide risk (p = .010, Cramer's V = .163) compared to male physicians. Physicians monitored for substance use disorders (SUD) were more likely to deny any lifetime suicide risk than those monitored for co-occurring SUD and psychiatric disorders (p = .017, Cramer's V = .171), and had lower rates of "moderate" lifetime suicide risk than those monitored for psychiatric disorders only (p = .017, Cramer's V = .171). The PHP offered behavioral health referrals for physicians reporting "low" risk (n = 2) plus safety measures for those with "moderate" (n = 2) and "high" risk (n = 1). One physician reporting "low" risk and four physicians reporting "high" risk were already in-treatment. At 2-weeks and 3-months into monitoring, suicide risk remained "very low" (99.4% and 98.8%) or "low." At 1-year, risk was "very low" for 99.3% of physicians, with two at "moderate" risk. At 2 and 3 years, 100% reported "very low" suicide risk. No suicides occurred among monitored physicians.

Conclusion: PHPs offer support to mitigate suicide risk among physicians. The observed decrease in suicide risk across monitoring may reflect the recovery processes that monitoring is intended to support.

Objective: Individuals with bipolar disorder are at increased risk for suicide, and this can be influenced by a range of biological, clinical, and environmental risk factors. Biological components associated with suicide include DNA modifications that lead to changes in gene expression. Common genetic variation and DNA methylation changes are some of the most frequent types of DNA findings associated with an increased risk of suicide attempt. Importantly, the interplay between genetic predisposition and DNA methylation patterns is becoming more prevalent in genetic studies. We hypothesized that DNA methylation patterns in specific loci already genetically associated with suicide would be altered in individuals with bipolar disorder and a history of suicide attempt.

Method: To test this hypothesis, we searched the literature to identify common genetic variants (N = 34) previously associated with suicidal thoughts and behaviors in individuals with bipolar disorder. We then created a customized sequencing panel that covered our chosen genomic loci. We profiled DNA methylation patterns from blood samples collected from bipolar disorder participants with a history of suicide attempt (N = 55) and without (N = 51).

Results: We identified seven differentially methylated CpG sites and five differentially methylated regions between the two groups. Additionally, we found that DNA methylation changes in MIF and CACNA1C were associated with lethality or number of suicide attempts. Finally, we identified three meQTLs in SIRT1, IMPA2, and INPP1.

Conclusions: This study illustrates that DNA methylation is altered in individuals with bipolar disorder and a history of suicide attempts in regions known to harbor suicide-related variants.

Objective: Research gaps persist in understanding the underlying sociodemographic patterning of hospital-presenting self-injury (HPSI) in South Korea. Our research aims to understand the relationship between HPSI and gender over time in relation to its sociodemographic attributes.

Method: The study utilized the Korea National Hospital Discharge In-depth Injury Survey (KNHDIS) from 2004 to 2021. The change in the age-standardized rate per 100,000 Koreans over age groups and their gender distribution was examined. Logistic regression models were employed to understand the association between gender and HPSI.

Results: The study encompassed 497,882 injury patients, with 13,139 HPSI patients. The age-standardized rate per 100,000 was similar across years, and significantly higher in older age groups over 70. Also, the HPSI rate was higher in women (43.01, 95% CI: 40-46.08) than in men (36.65, 95% CI: 34.03-39.28). This gender pattern was consistent across years but showed an opposite trend over age 50, where men experience more HPSI. Gender gaps showed a decreasing trend over time, except for the 2019-2021 period in which HPSI rates rose disproportionately among adolescent girls and elderly men. Regression models confirmed these patterns, where the odds ratio of women on HPSI was 1.76 (95% CI: 1.46-2.16) in the fully adjusted model, it was 4.33 (95% CI: 3.64-5.14) in age group ≤20 and 0.39 (95% CI: 0.34-0.44) in age group >80.

Conclusions: The gender pattern of HPSI varies significantly by age group. Further research is imperative to delve into the root causes of these differences.