-
Brain and Behavior Nov 2021This work was undertaken to define and characterize the role of currently available somatic treatments in psychiatry in either increasing or reducing the risk for... (Review)
Review
OBJECTIVE
This work was undertaken to define and characterize the role of currently available somatic treatments in psychiatry in either increasing or reducing the risk for suicide.
METHODS
Members of the Suicide Prevention Task Group of the National Network of Depression Centers performed a literature review of somatic treatments known to increase or reduce the risk for suicide. The reviews ventured to include all relevant information about the risk for both suicide ideation and completed suicides.
RESULTS
Lithium and clozapine are the only two somatic treatments that have high-quality data documenting their antisuicide effects in mood disorders and schizophrenia, respectively. Lithium discontinuation is also associated with increased suicide risk. Ketamine and esketamine may have a small, but immediate, antisuicide effect. Despite the recent Food and Drug Administration approval of esketamine use in depressed suicidal patients, the small disproportional overrepresentation of suicide in subjects who had received esketamine versus placebo (3 vs. 0 among > 3500 subjects) requires ongoing evaluation. The purported antisuicide effect of electroconvulsive therapy is based on low-quality data. The effect of antidepressants is not at all clear. There appears to be direct evidence for antidepressants increasing suicidal ideation and the risk for suicide over the short-term in young people, but indirect (low quality) evidence that antidepressants reduce suicide risk over the long term.
CONCLUSIONS
Clinicians have an expanding pharmacopeia to address suicide potential in their patients. Some of the agents with documented antisuicide effects may also increase suicidality under specific circumstances.
Topics: Adolescent; Antidepressive Agents; Humans; Schizophrenia; Suicidal Ideation; Suicide, Completed; United States
PubMed: 34661999
DOI: 10.1002/brb3.2381 -
Clinical Psychology & Psychotherapy Sep 2022Research indicates that the emergency department is the primary setting for people to present with suicidal ideation. Attempting to provide interventions for this... (Review)
Review
BACKGROUND
Research indicates that the emergency department is the primary setting for people to present with suicidal ideation. Attempting to provide interventions for this population depends greatly on understanding their needs and life circumstances at the time of presentation to services, therefore enabling more appropriate treatment pathways and services to be provided.
AIM
This review aims to collate, evaluate and synthesize the empirical research focused on the population of people presenting to hospital settings with suicidal ideation.
METHOD
A systematic literature search was performed. Articles that met a specified set of inclusion criteria including participants being over 18, not being admitted to hospital and presenting to an emergency department setting underwent a quality assessment and data analysis. The quality assessment used was the EPHPP Quality Assessment Tool for Quantitative Studies (Thomas et al., 2004).
RESULTS
Twenty-seven articles were included in the review. Studies were quantitative and of reasonable methodological quality (Thomas et al., 2004). The literature was characterized by demographic information, mental health factors associated with the presentation to hospital and treatment pathways or outcomes reported. The reviewed research showed that people presenting to emergency departments with suicidal ideation were varying in age, gender, ethnic background and socio-economic status (SES). Large proportions of studies reported psychosocial factors alongside interpersonal struggles as the main presenting reason. The review highlights large variability across these factors. Mental health diagnosis was common, previous suicide attempt was a risk factor, and treatment pathways were unclear. The review identifies the outstanding gaps and weaknesses in this literature as well as areas in need of future research.
CONCLUSIONS
In conclusion, the review highlights the prevalence of people reporting interpersonal factors as the reason for suicidal ideation and not mental health disorders or diagnosis. Despite this, no mention of trauma or life stories was made in any study assessing this population. Despite a large variation across studies making synthesis difficult, data proves clinically relevant and informative for future practice and guidance on areas needing further research.
Topics: Humans; Suicidal Ideation; Suicide, Attempted; Risk Factors; Mental Disorders; Hospitals
PubMed: 35716391
DOI: 10.1002/cpp.2761 -
The International Journal of Eating... Mar 2021Suicidality in eating disorders (EDs) is high, and identification of therapeutically targetable traits associated with past, current, and future suicidality is of...
OBJECTIVE
Suicidality in eating disorders (EDs) is high, and identification of therapeutically targetable traits associated with past, current, and future suicidality is of considerable clinical importance. We examined overall and ED subtype-specific associations among suicidal ideation, suicide attempts, and general and specific aspects of emotion dysregulation in a large sample of individuals with ED, at presentation for treatment and 1-year follow-up.
METHOD
Using registry data from 2,406 patients, scores on the Difficulties in Emotion Dysregulation Scale (DERS) at initial registration were examined as predictors of recent suicidal ideation and self-report lifetime suicide attempts. Associations were examined in the full sample and in each ED subtype. In 406 patients, initial DERS scores were examined as predictors of suicidality at 1-year follow-up.
RESULTS
Overall DERS was associated with suicidal ideation and suicide attempts, even when adjusting for ED psychopathology and current depression. Perceived lack of emotion regulation strategies showed unique associations with suicidal ideation and suicide attempts, both in the full sample and in most ED subtypes. Initial DERS was also associated with follow-up suicidal ideation and suicide attempts, although this association did not remain when adjusting for past suicidality.
DISCUSSION
Results suggest that emotion dysregulation may be a potential mechanism contributing to suicidality in EDs, beyond the effects of ED psychopathology and current depression. Although the prevalence of suicidality differs across ED subtypes, emotion dysregulation may represent a risk trait for future suicidality that applies transdiagnostically. Results support addressing emotion dysregulation in treatment in order to reduce suicidality.
Topics: Adolescent; Child; Emotions; Feeding and Eating Disorders; Female; Humans; Risk Factors; Suicidal Ideation; Suicide; Suicide, Attempted
PubMed: 33205495
DOI: 10.1002/eat.23410 -
Rhode Island Medical Journal (2013) May 2022Individuals with psychosis-spectrum conditions have strikingly high rates of suicidal thoughts and behaviors, especially in the early stages of illness. Given increasing...
Individuals with psychosis-spectrum conditions have strikingly high rates of suicidal thoughts and behaviors, especially in the early stages of illness. Given increasing rates of suicide among adolescents, and given that psychosis symptoms often emerge during this developmental period, it is important that practitioners working with adolescents are attuned to the intersection of psychotic experiences and suicide risk. Furthermore, youth with emerging signs of psychosis often struggle with other mental health concerns that are linked to suicidal thoughts and behaviors, including depression, anxiety, mania, trauma, and substance use. Taken together, these factors indicate that identifying early signs of psychosis can be critical for addressing suicide risk, and psychosis-spectrum symptoms are important experiences to include in safety planning for youth. Herein we discuss considerations for safety planning for adolescents experiencing psychosis-spectrum symptoms, drawn from clinical observations and pilot data collected from adolescents in a psychiatric inpatient unit and their families.
Topics: Adolescent; Anxiety; Humans; Psychotic Disorders; Substance-Related Disorders; Suicidal Ideation; Suicide; Suicide Prevention
PubMed: 35476732
DOI: No ID Found -
International Journal of Environmental... May 2021Theoretical models of suicide are based on risk factors associated with suicide, such as psychiatric pathology, genetics, epigenetics, functional brain disorders, and...
Theoretical models of suicide are based on risk factors associated with suicide, such as psychiatric pathology, genetics, epigenetics, functional brain disorders, and impaired decision making. In current clinical practice, the predominant risk model is the medical model, which posits that treating suicide risk is primarily a matter of treating psychiatric disorders. However, even comprehensive risk factor models cannot overcome the basic problem that, by their nature, they cannot accommodate the suicidal person's psychological experience of suicidality. Risk factor models do not translate into effective treatment models. Suicide risk is highly personal and fluid, and is related to individual vulnerabilities and to person-specific events triggering suicidal thoughts and actions. Clinicians need treatment models that are meaningful to suicidal patients. Understanding the single person's suicidality requires a patient-centered approach. Therapeutic interventions that effectively reduce the risk of suicidal behavior have been developed from general principles of psychotherapy. Therapy process factors associated with effective therapies are working alliance, validation of the individual patient's thoughts and feelings, active treatment engagement. Psychological therapies need patients who are active participants in a collaborative working relationship between therapist and patient. The goal must be to jointly develop a meaningful understanding of the suicidal crisis. In view of the limited personal resources in health care systems it is important that effective therapies are brief and effective. Future research must aim to improve our understanding of the factors involved in effective therapies in order to optimize treatments for individuals at risk. This may also include the integration of biological risk factors in psychological treatment models.
Topics: Humans; Mental Disorders; Models, Theoretical; Motivation; Suicidal Ideation; Suicide Prevention
PubMed: 34067531
DOI: 10.3390/ijerph18105301 -
Social Psychiatry and Psychiatric... Oct 2022Thailand has one of the highest suicide rates in Southeast Asia; yet, little is known about suicidality among lesbian, gay, bisexual, trans, queer, intersex, and other...
PURPOSE
Thailand has one of the highest suicide rates in Southeast Asia; yet, little is known about suicidality among lesbian, gay, bisexual, trans, queer, intersex, and other gender and sexually diverse (LGBTQI +) people living in the region, who may experience elevated risk for suicide. We sought to identify the prevalence of lifetime suicidal attempts and ideation among a nationally recruited sample of LGBTQI + people in Thailand. We further examined the relationship between levels of sexual/gender stigma and suicidal attempt and ideation.
METHODS
Data were derived from a national online survey of Thai LGBTQI + individuals between January and March 2018. Multivariable logistic regression was used to examine the relationship between sexual/gender stigma scales, adapting a previously validated instrument, and suicide attempt and ideation.
RESULTS
Among 1,290 LGBTQI + participants, the median age was 27 years. The prevalence of suicide attempt and ideation was 16.8% and 50.7%, respectively. In multivariable analyses, after adjusting for potential confounders, experiences of perceived and enacted sexual/gender stigma were independently and positively associated with suicide attempt (adjusted odds ratio [AOR] = 1.25; 95% confidence interval CI:1.10-1.41 and AOR = 1.31; 95% CI:1.11-1.55, respectively) and ideation (AOR = 1.30; 95% CI:1.17-1.43 and AOR = 1.34; 95% CI:1.14-1.58, respectively).
CONCLUSION
One-sixth of the sample reported a suicide attempt, while a half reported ever contemplating suicide. Both experiences of perceived and enacted sexual/gender stigma were associated with lifetime suicide attempt and ideation. Multi-level interventions are needed to decrease stigma and in turn suicide among LGBTQ + people in Thailand, including anti-discrimination policies and support for mental health and well-being.
Topics: Adult; Female; Humans; Sexual Behavior; Sexual and Gender Minorities; Suicidal Ideation; Suicide, Attempted; Thailand
PubMed: 35599251
DOI: 10.1007/s00127-022-02292-0 -
Journal of Affective Disorders Jan 2022Suicide rates within the construction industry are disproportionately high and there is accumulating evidence suggesting that young apprentices working in this industry...
BACKGROUND
Suicide rates within the construction industry are disproportionately high and there is accumulating evidence suggesting that young apprentices working in this industry may be particularly vulnerable. This study examined the presence of suicidal ideation and exposure to suicidal behaviours in construction industry apprentices, and explored associations between suicidal ideation and other demographic, workplace, and psychosocial factors.
METHODS
A large sample of apprentices were recruited for the study (N = 1402). The study employed a cross-sectional survey design. In addition to demographic items, the survey asked questions relating to suicidal ideation in the past year, exposure to suicidal behaviours, substance use, stress management, workplace bullying, psychological distress, and well-being.
RESULTS
Nearly one third of apprentices reported suicidal ideation in the previous year, and approximately half to two-thirds knew someone who had either attempted or died by suicide. Suicidal ideation was associated with knowing someone who had attempted suicide, greater psychological distress, substance use, and poorer well-being.
LIMITATIONS
The response rate was low. There were also portions of missing data. Multiple imputation was used to help overcome this, and results from the sensitivity analyses are presented. The cross-sectional design is another limitation.
CONCLUSION
Suicidal ideation in construction apprentices is common and is associated with poorer overall mental health and well-being, substance use, and knowing others who have attempted suicide. These findings can help inform the development of tailored workplace suicide prevention activities for apprentices at-risk of suicide and poor mental health.
Topics: Construction Industry; Cross-Sectional Studies; Humans; Risk Factors; Suicidal Ideation; Suicide, Attempted
PubMed: 34710501
DOI: 10.1016/j.jad.2021.10.073 -
Suicide & Life-threatening Behavior Aug 2022Rumination and emotion-related impulsivity predict suicidal ideation, suicide attempts, and nonsuicidal self-injury (NSSI). Because rumination and emotion-related...
INTRODUCTION
Rumination and emotion-related impulsivity predict suicidal ideation, suicide attempts, and nonsuicidal self-injury (NSSI). Because rumination and emotion-related impulsivity, though, are highly correlated, we consider their unique vs. conjoint influence on suicidal ideation and self-harm.
METHOD
Across two samples of adults (N's = 171 and 191), we examined how rumination and emotion-related impulsivity relate to suicidal ideation, suicide attempts, and NSSI. We assess the more general process of repetitive negative thinking and the more specific process of suicide-related rumination. Participants completed the Three-Factor Impulsivity Index and the self-report Columbia-Suicide Severity Rating Scale. Those in sample 1 completed the Perseverative Thinking Questionnaire and the Deliberate Self-Harm Inventory, and those in Sample 2 completed the Suicide Rumination Scale.
RESULTS
Emotion-related impulsivity and both forms of rumination showed robust bivariate correlations with suicidal ideation, suicide attempts, and NSSI. Neither rumination or impulsivity related to suicide attempts controlling for ideation or to NSSI. In multivariable analyses, emotion-related impulsivity but not general rumination was tied to suicidal ideation. In contrast, suicide-related rumination was more directly tied to suicidal ideation than was impulsivity.
CONCLUSIONS
Findings provide support for a more nuanced approach to the forms of impulsivity and rumination related to suicidal ideation.
Topics: Adult; Emotions; Humans; Impulsive Behavior; Risk Factors; Self-Injurious Behavior; Suicidal Ideation; Suicide, Attempted
PubMed: 35257404
DOI: 10.1111/sltb.12849 -
Journal of Psychiatric Research Jun 2021The role of personality as distal risk factor for suicidal thoughts and behavior is still unclear. This review aims to propose two conceptual models that explain the... (Review)
Review
The role of personality as distal risk factor for suicidal thoughts and behavior is still unclear. This review aims to propose two conceptual models that explain the psychological plausibility of Type D personality as distal risk factor and contributor to the transition from general to suicide distress. To support this aim, we performed a systematic review of existing studies on the association between Type D personality and suicidal distress. A systematic search yielded eight studies that reported on Type D personality and suicidal distress. Type D personality was robustly associated with suicidal thoughts and behaviors, across populations and countries. Type D was related to the level/frequency of suicidal ideation in seven studies, and suicide attempt in two studies. Our first theoretical model identifies intra-psychic (depression, alcohol misuse, posttraumatic stress) and interpersonal (low belonging, social isolation, lack of support) vulnerabilities of individuals with Type D that may fuel the development of suicidal thoughts and behaviors. Type D by itself will not account for why people become suicidal, but our second theoretical model suggests that the avoidant-passive tendencies of Type D individuals may result in persistent problem-solving deficits, and, eventually, feelings of entrapment that may contribute to the desire to escape from pain. We conclude that empirical evidence supports the hypothesized link between Type D personality, and suicidal thoughts and behaviors. Our conceptual models - albeit often supported by indirect evidence - further substantiate the plausibility of this link, and offer concrete guidance for future studies. Primarily, more longitudinal research is necessary.
Topics: Humans; Models, Theoretical; Personality; Risk Factors; Suicidal Ideation; Suicide, Attempted; Type D Personality
PubMed: 33882425
DOI: 10.1016/j.jpsychires.2021.03.056 -
Revista Brasileira de Psiquiatria (Sao... Aug 2020Suicide risk (including attempted and completed suicide) should be measured over short periods of time after contacting health services. The objective of this study was...
OBJECTIVE
Suicide risk (including attempted and completed suicide) should be measured over short periods of time after contacting health services. The objective of this study was to identify the patterns of attempted and completed suicides within 24-months of a psychiatric emergency department visit, as well as to investigate predictive risk factors, including sociodemographic and clinical variables, previous suicidal behavior, and service utilization.
METHOD
A convenience sample (n=147), recruited at a general hospital's psychiatric emergency room, included patients with suicidal ideation, suicidal plans or previous suicide attempts. These patients were followed for 24 months, focusing on two main outcomes: attempted and completed suicides.
RESULTS
After six months there were no completed suicides and 36 suicide attempts, while after 24 months there were seven completed suicides and 69 suicide attempts. A final logistic regression model for suicide attempts at 24 months identified somatic pathology and the number of previous psychiatric hospitalizations as predictive factors, with a good area under the receiver operating characteristic curve.
CONCLUSIONS
The findings showed distinct patterns of attempted and completed suicides over time, indicating the importance of a systematic multidisciplinary suicide risk evaluation in psychiatric emergency rooms.
Topics: Adolescent; Adult; Aged; Emergency Service, Hospital; Female; Humans; Logistic Models; Male; Mental Disorders; Middle Aged; Risk Factors; Suicidal Ideation; Suicide; Suicide, Attempted
PubMed: 32491023
DOI: 10.1590/1516-4446-2019-0583