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Choo TH, Wall M, Brodsky BS, Herzog S, Mann JJ, Stanley B, Galfalvy H. Temporal prediction of suicidal ideation in an ecological momentary assessment study with recurrent neural networks. J Affect Disord 2024; 360:268-275. [PMID: 38795778 DOI: 10.1016/j.jad.2024.05.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/04/2024] [Accepted: 05/18/2024] [Indexed: 05/28/2024]
Abstract
INTRODUCTION Ecological Momentary Assessment (EMA) holds promise for providing insights into daily life experiences when studying mental health phenomena. However, commonly used mixed-effects linear statistical models do not fully utilize the richness of the ultidimensional time-varying data that EMA yields. Recurrent Neural Networks (RNNs) provide an alternative data analytic method to leverage more information and potentially improve prediction, particularly for non-normally distributed outcomes. METHODS As part of a broader research study of suicidal thoughts and behavior in people with borderline personality disorder (BPD), eighty-four participants engaged in EMA data collection over one week, answering questions multiple times each day about suicidal ideation (SI), stressful events, coping strategy use, and affect. RNNs and mixed-effects linear regression models (MEMs) were trained and used to predict SI. Root mean squared error (RMSE), mean absolute percent error (MAPE), and a pseudo-R2 accuracy metric were used to compare SI prediction accuracy between the two modeling methods. RESULTS RNNs had superior accuracy metrics (full model: RMSE = 3.41, MAPE = 42 %, pseudo-R2 = 26 %) compared with MEMs (full model: RMSE = 3.84, MAPE = 56 %, pseudo-R2 = 16 %). Importantly, RNNs showed significantly more accurate prediction at higher values of SI. Additionally, RNNs predicted, with significantly higher accuracy, the SI scores of participants with depression diagnoses and of participants with higher depression scores at baseline. CONCLUSION In this EMA study with a moderately sized sample, RNNs were better able to learn and predict daily SI compared with mixed-effects models. RNNs should be considered as an option for EMA analysis.
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Affiliation(s)
- Tse-Hwei Choo
- Mental Health Data Science Division, New York State Psychiatric Institute, New York, NY, United States of America; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America.
| | - Melanie Wall
- Mental Health Data Science Division, New York State Psychiatric Institute, New York, NY, United States of America; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Beth S Brodsky
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, United States of America
| | - Sarah Herzog
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, United States of America
| | - J John Mann
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, United States of America
| | - Barbara Stanley
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, United States of America
| | - Hanga Galfalvy
- Mental Health Data Science Division, New York State Psychiatric Institute, New York, NY, United States of America; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
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Rhee TG, Bommersbach TJ, Rosenheck RA, Nierenberg AA, McIntyre RS. National trends and correlates of treatment resistance in major depressive episode and associated suicidal ideation and behaviors among adults in the United States. J Affect Disord 2024; 358:342-349. [PMID: 38734245 DOI: 10.1016/j.jad.2024.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE To examine recent 12-year trends in prevalence of suicidal ideation and behaviors (SIBs) among US adults experiencing a past-year treatment-resistant depression (TRD). METHODS Using data from the National Survey of Drug Use and Health, we estimated the annual percentage of individuals aged ≥18 with TRD who reported past-year SIBs, and estimated linear trends adjusting for potentially confounding factors from 2009 to 2020. RESULTS Of estimated 237.5 million US adults, 7.1 % met diagnostic criteria for a past-year major depressive episode (MDE) between 2009 and 2020. Of these, 9.7 % met criteria for TRD. The proportion reporting past-year suicidal ideation in TRD ranged from 39.5 % (95 % confidence interval [CI], 32.1-47.3 %) in 2009-2010 to 43.4 % (95 % CI, 36.7-503 %) in 2019-2020, with an average annual percent change (AAPC) of 1.3 % (95 % CI, -0.7 % to 3.3 %). The prevalence of past-year suicide attempts in TRD was 7.3 % across the study period (AAPC, 0.1 %; 95 % CI, -4.3 % to 4.7 %). Past-year SIBs were significantly associated with an increased likelihood of meeting criteria for TRD among adults with MDE (adjusted odds ratio [AOR], 1.53; 95 % CI, 1.35-1.75 for suicidal ideation; AOR, 2.17; 95 % CI, 1.79-2.62 for suicide attempts). No significant differences were observed between 2019 and 2020, reflecting the COVID-19 pandemic. CONCLUSION Among individuals with TRD, proportions of SIBs are high. These findings underscore an urgent need for suicide prevention efforts in this high-risk population, including preventive services across diverse settings and accessibility to evidence-based pharmacological and non-pharmacological interventions.
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Affiliation(s)
- Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, USA; Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, USA.
| | | | - Robert A Rosenheck
- VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
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Levi-Belz Y, Blank C, Groweiss Y, Neria Y. The impact of PTSD symptoms on suicide ideation in time of terror and war: A nationwide prospective study on the moderating role of loneliness. Psychiatry Res 2024; 338:115996. [PMID: 38823164 DOI: 10.1016/j.psychres.2024.115996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/03/2024]
Abstract
The terrorist attack of October 7, 2023, and its accompanying war have increased the risk for posttraumatic stress symptoms (PTSS) and suicide ideation (SI). In this national prospective cohort study, we examined the extent to which a sense of loneliness moderates the association between PTSS and SI in the wake of the October 7th attack and the Israel-Hamas war. A representative sample of 710 Israeli adults (362 female, 51.1 %) aged 18-85 (M = 41.01, SD = 13.72) participated in a longitudinal study assessing depression, current SI, and loneliness at two time points: T1, one month before the attack (August 2023) and T2 (November 2023), one month after the attack. We found two significant interactions in which a sense of loneliness at T2 moderated the link between both PTSS at T1 and T2 and current SI at T2. Specifically, the level of PTSS contributed to current SI at T2 more strongly among individuals reporting higher loneliness levels than those reporting low loneliness levels. Clinicians treating individuals coping with high PTSS levels should attend to their patients' sense of loneliness, as it comprises a significant risk factor for current SI and may be considered an important target in treatment.
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Affiliation(s)
- Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel; Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel.
| | - Carmel Blank
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel; Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | - Yoav Groweiss
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Yuval Neria
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University Irving Medical Center, NY, USA
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Yang Y. Lifetime use of multiple substances and youth suicide risk: assessing the role of depressive symptoms using structural equation modeling. Public Health 2024; 234:71-76. [PMID: 38964128 DOI: 10.1016/j.puhe.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/22/2024] [Accepted: 06/03/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES This study assessed the direct and indirect effects (via depressive symptoms) of lifetime use of a broad range of substances on suicide risk among US adolescents. STUDY DESIGN This was a cross-sectional study. METHODS Data from the 2021 Youth Risk Behavior Survey were used (N = 12,303, 48.7% female). Associations between five types of substance use (cigarette, e-cigarette, alcohol, marijuana, and prescription pain medicine) and three dimensions of suicide risk (suicidal ideation, suicide plan, and suicide attempt) were measured by multivariate logistic regression models. The role of depressive symptoms was further examined by structural equation modeling. RESULTS Almost three in five (57.5%) adolescents had used one or more substances in their lifetime (18.1% one type, 12.2% two types, 13.1% three types, 10.2% four types, and 3.8% five types). Adolescents using five substances were up to 16 times more likely to experience suicidal ideation and behaviors. Depressive symptoms significantly linked the pathway from substance use to suicide risk, resulting in much stronger indirect effects than the direct effects. Collectively, the five substance use behaviors and depressive symptoms explained about 60.4% of variance in suicidal ideation, 53.6% of variance in suicide plan, and 55.0% of variance in suicide attempt. CONCLUSIONS Lifetime use of multiple substances is significantly correlated with suicidal ideation and behaviors among adolescents via the pathway of depressive symptoms. Routine screening for a broad range of substance use behaviors is needed to identify adolescents at risk for suicide and accessible mental health services could potentially attenuate the linkage between substance use and suicide risk.
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Affiliation(s)
- Yingwei Yang
- Social Science Research Institute, Duke University, Durham, NC, USA.
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Frajerman A, Goueslard K, Quantin C, Jollant F. Unintentional Intoxication or Injury and Risk for Self-Harm in Adolescents and Young Adults. JAMA Psychiatry 2024:2820774. [PMID: 38959012 PMCID: PMC11223050 DOI: 10.1001/jamapsychiatry.2024.1692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/25/2024] [Indexed: 07/04/2024]
Abstract
This cohort study explores the risk of nonfatal self-harm in French adolescents and young adults hospitalized for unintentional intoxication or injury.
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Affiliation(s)
- Ariel Frajerman
- Department of Psychiatry, Faculty of Medicine, Paris-Saclay University and Academic Hospital (Centre Hospitalier Universitaire) Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Karine Goueslard
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Fabrice Jollant
- Department of Psychiatry, Faculty of Medicine, Paris-Saclay University and Academic Hospital (Centre Hospitalier Universitaire) Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
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DiVietro S, Hunter AA, Schwab-Reese L, Green C, Aseltine R. Disparities Among Pediatric Firearm Suicides in the United States: An Analysis of the National Violent Death Reporting System, 2014 to 2018. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:3308-3319. [PMID: 38366858 DOI: 10.1177/08862605241229719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Suicide is a leading cause of death in the United States (U.S.), with firearms being the predominant method. This study examines the racial disparity and disproportionality of pediatric firearm suicide from 2014 to 2018 in 17 U.S. states. We used the National Violent Death Reporting System to quantify the burden of pediatric firearm suicide by race/ethnicity and gender and assessed themes among decedents aged 10 to 17 years. Racial disparity and disproportionality were measured using the Disparity Index and Disproportionality Representation Index, respectively. Decedents were primarily non-Hispanic White (NHW, 77.5%) and male (84.0%). NHW children died at a rate that was 1.3 times greater than expected based on their proportion in the general population and were 2.6 times more likely to die by firearm suicide than non-Hispanic Black (NHB) children. NHB children were less likely to disclose suicide intention, suggesting that this group may require more active screening intervention. Qualitative analysis revealed unsafe firearm storage as a common theme among these deaths. Differences in age with respect to social media use and precipitating factors such as bullying and arguments with parents were also identified as contributing factors. Results of this study support the expansion of interventions such as lethal means restriction counseling and implementation of safer firearm storage laws.
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Affiliation(s)
- Susan DiVietro
- Injury Prevention Center, Connecticut Children's Medical Center, Hartford, CT, USA
- University of Connecticut, Farmington, CT, USA
| | - Amy A Hunter
- Injury Prevention Center, Connecticut Children's Medical Center, Hartford, CT, USA
- University of Connecticut, Farmington, CT, USA
| | | | - Christa Green
- Medical University of South Carolina, Charleston, SC, USA
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Papini S, Hsin H, Kipnis P, Liu VX, Lu Y, Girard K, Sterling SA, Iturralde EM. Validation of a Multivariable Model to Predict Suicide Attempt in a Mental Health Intake Sample. JAMA Psychiatry 2024; 81:700-707. [PMID: 38536187 PMCID: PMC10974695 DOI: 10.1001/jamapsychiatry.2024.0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/16/2024] [Indexed: 07/04/2024]
Abstract
Importance Given that suicide rates have been increasing over the past decade and the demand for mental health care is at an all-time high, targeted prevention efforts are needed to identify individuals seeking to initiate mental health outpatient services who are at high risk for suicide. Suicide prediction models have been developed using outpatient mental health encounters, but their performance among intake appointments has not been directly examined. Objective To assess the performance of a predictive model of suicide attempts among individuals seeking to initiate an episode of outpatient mental health care. Design, Setting, and Participants This prognostic study tested the performance of a previously developed machine learning model designed to predict suicide attempts within 90 days of any mental health outpatient visit. All mental health intake appointments scheduled between January 1, 2012, and April 1, 2022, at Kaiser Permanente Northern California, a large integrated health care delivery system serving over 4.5 million patients, were included. Data were extracted and analyzed from August 9, 2022, to July 31, 2023. Main Outcome and Measures Suicide attempts (including completed suicides) within 90 days of the appointment, determined by diagnostic codes and government databases. All predictors were extracted from electronic health records. Results The study included 1 623 232 scheduled appointments from 835 616 unique patients. There were 2800 scheduled appointments (0.17%) followed by a suicide attempt within 90 days. The mean (SD) age across appointments was 39.7 (15.8) years, and most appointments were for women (1 103 184 [68.0%]). The model had an area under the receiver operating characteristic curve of 0.77 (95% CI, 0.76-0.78), an area under the precision-recall curve of 0.02 (95% CI, 0.02-0.02), an expected calibration error of 0.0012 (95% CI, 0.0011-0.0013), and sensitivities of 37.2% (95% CI, 35.5%-38.9%) and 18.8% (95% CI, 17.3%-20.2%) at specificities of 95% and 99%, respectively. The 10% of appointments at the highest risk level accounted for 48.8% (95% CI, 47.0%-50.6%) of the appointments followed by a suicide attempt. Conclusions and Relevance In this prognostic study involving mental health intakes, a previously developed machine learning model of suicide attempts showed good overall classification performance. Implementation research is needed to determine appropriate thresholds and interventions for applying the model in an intake setting to target high-risk cases in a manner that is acceptable to patients and clinicians.
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Affiliation(s)
- Santiago Papini
- Division of Research, Kaiser Permanente Division of Research, Oakland, California
- Department of Psychology, University of Hawaiʻi at Mānoa, Honolulu
| | - Honor Hsin
- The Permanente Medical Group, Kaiser Permanente, San Jose, California
| | - Patricia Kipnis
- Division of Research, Kaiser Permanente Division of Research, Oakland, California
| | - Vincent X. Liu
- Division of Research, Kaiser Permanente Division of Research, Oakland, California
| | - Yun Lu
- Division of Research, Kaiser Permanente Division of Research, Oakland, California
| | - Kristine Girard
- The Permanente Medical Group, Kaiser Permanente, San Jose, California
| | - Stacy A. Sterling
- Division of Research, Kaiser Permanente Division of Research, Oakland, California
| | - Esti M. Iturralde
- Division of Research, Kaiser Permanente Division of Research, Oakland, California
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Levi-Belz Y, Shoval-Zuckerman Y, Blank C, Groweiss Y, Neria Y. The moderating role of belongingness in the contribution of depression to suicide ideation following the October 7, 2023, terrorist attack in Israel: A nationwide prospective study. J Affect Disord 2024; 356:292-299. [PMID: 38615841 DOI: 10.1016/j.jad.2024.04.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION With >1300 civilians murdered, the terrorist attack of October 7 is one of the deadliest terrorist attacks in modern history. Previous research documented a sharp increase in depression in the aftermath of the attacks and the military conflict that followed. In this national prospective cohort study, we examined to what extent perceived belongingness (PB) moderates the association between depression and suicide ideation (SI) in the wake of the October 7th terrorist attack. METHODS A representative sample of 710 Israeli adults (of them, 362 females, 51.1 %), Jews (557, 79.9 %), and Arabs (153, 20.1 %), aged 18-85 (M = 41.01, SD = 13.72) completed questionnaires assessing depression, current SI, and perceived belongingness at two timepoints: T1 (in August 2023) and T2 (in November 2023). RESULTS Perceived belongingness at T1 predicted SI at T2 beyond demographic and trauma-related characteristics. Importantly, we found a significant interaction in which a PB at T1 moderated the link between depression and current SI at T2. Specifically, the level of depression at T2 contributed to current SI-T2 more strongly for individuals with low PB levels than for individuals with high PB levels. DISCUSSION Our study highlights the impact of PB on SI following the October 7th terrorist attack. Clinicians treating individuals coping with depression should attend to their patients' sense of belongingness, as low PB comprises a significant risk factor for current SI. Moreover, community and national initiatives that could increase levels of PB among the citizens may help to diminish suicide risk in the aftermath of the attack.
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Affiliation(s)
- Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel; Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel.
| | | | - Carmel Blank
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel; Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | - Yoav Groweiss
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Yuval Neria
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University Irving Medical Center, NY, USA
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Haroz EE, Bajaj MA, Nestadt PS, Campo JV, Wilcox HC. Clinician Perspectives on Suicide Safety Planning and Its Implementation. Arch Suicide Res 2024:1-11. [PMID: 38949292 DOI: 10.1080/13811118.2024.2370852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
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.
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Boggs JM, Richards J, Simon G, Aguirre-Miyamoto EM, Barton LJ, Beck A, Beidas RS, Bruschke C, Buckingham ET, Buttlaire S, Clarke G, Coleman K, Flores JP, Frank C, Penfold RB, Richardson L, Ryan JM, Schoenbaum M, Sterling S, Stewart C, Yarborough BJH, Yeh HH, Ahmedani B. Suicide Screening, Risk Assessment, and Lethal Means Counseling During Zero Suicide Implementation. Psychiatr Serv 2024; 75:638-645. [PMID: 38566561 DOI: 10.1176/appi.ps.20230211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE The authors measured implementation of Zero Suicide (ZS) clinical practices that support identification of suicide risk and risk mitigation, including screening, risk assessment, and lethal means counseling, across mental health specialty and primary care settings. METHODS Six health care systems in California, Colorado, Michigan, Oregon, and Washington participated. The sample included members ages ≥13 years from 2010 to 2019 (N=7,820,524 patients). The proportions of patients with suicidal ideation screening, suicide risk assessment, and lethal means counseling were estimated. RESULTS In 2019, patients were screened for suicidal ideation in 27.1% (range 5.0%-85.0%) of mental health visits and 2.5% (range 0.1%-35.0%) of primary care visits among a racially and ethnically diverse sample (44.9% White, 27.2% Hispanic, 13.4% Asian, and 7.7% Black). More patients screened positive for suicidal ideation in the mental health setting (10.2%) than in the primary care setting (3.8%). Of the patients screening positive for suicidal ideation in the mental health setting, 76.8% received a risk assessment, and 82.4% of those identified as being at high risk received lethal means counseling, compared with 43.2% and 82.4%, respectively, in primary care. CONCLUSIONS Six health systems that implemented ZS showed a high level of variation in the proportions of patients receiving suicide screening and risk assessment and lethal means counseling. Two opportunities emerged for further study to increase frequency of these practices: expanding screening beyond patients with regular health care visits and implementing risk assessment with lethal means counseling in the primary care setting directly after a positive suicidal ideation screening.
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Affiliation(s)
- Jennifer M Boggs
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Julie Richards
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Gregory Simon
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Erika M Aguirre-Miyamoto
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Lee J Barton
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Arne Beck
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Rinad S Beidas
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Cambria Bruschke
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Edward T Buckingham
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Stuart Buttlaire
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Gregory Clarke
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Karen Coleman
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Jean P Flores
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Catherine Frank
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Robert B Penfold
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Laura Richardson
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Jacqueline M Ryan
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Michael Schoenbaum
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Stacy Sterling
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Christine Stewart
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Bobbi Jo H Yarborough
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Hsueh-Han Yeh
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
| | - Brian Ahmedani
- Kaiser Permanente Colorado, Aurora (Boggs, Beck, Buckingham, Richardson); Kaiser Permanente Washington, Seattle (Richards, Simon, Penfold, Stewart); Kaiser Permanente Southern California, Pasadena (Aguirre-Miyamoto, Barton, Coleman); Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago (Beidas); Kaiser Permanente Program Office, Oakland, California (Bruschke); Kaiser Permanente Northern California, Oakland (Buttlaire, Sterling); Kaiser Permanente Northwest, Portland, Oregon (Clarke, Ryan, Yarborough); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Flores); Henry Ford Health System, Detroit (Frank, Yeh, Ahmedani); NIMH, Bethesda (Schoenbaum)
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11
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Kirshenbaum JS, Pagliaccio D, Bitran A, Xu E, Auerbach RP. Why do adolescents attempt suicide? Insights from leading ideation-to-action suicide theories: a systematic review. Transl Psychiatry 2024; 14:266. [PMID: 38937430 PMCID: PMC11211511 DOI: 10.1038/s41398-024-02914-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 06/29/2024] Open
Abstract
Suicide is a leading cause of death among adolescents, and recent suicide theories have sought to clarify the factors that facilitate the transition from suicide ideation to action. Specifically, the Interpersonal Theory of Suicide (IPTS), Integrated Motivational-Volitional Model (IMV), and Three Step Theory (3ST) have highlighted risk factors central to the formation of suicidal ideation and suicidal behaviors, which is necessary for suicide death. However, these models were initially developed and tested among adults, and given core socioemotional and neurodevelopmental differences in adolescents, the applicability of these models remains unclear. Directly addressing this gap in knowledge, this systematic review aimed to (1) describe the evidence of leading ideation-to-action theories (i.e., IPTS, IMV, 3ST) as they relate to suicide risk among adolescents, (2) integrate ideation-to-action theories within prevailing biological frameworks of adolescent suicide, and (3) provide recommendations for future adolescent suicide research. Overall, few studies provided a complete test of models in adolescent samples, and empirical research testing components of these theories provided mixed support. Future research would benefit from integrating neurodevelopmental and developmentally sensitive psychosocial frameworks to increase the applicability of ideation-to-action theories to adolescents. Further, utilizing real-time monitoring approaches may serve to further clarify the temporal association among risk factors and suicide.
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Affiliation(s)
- Jaclyn S Kirshenbaum
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - David Pagliaccio
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Alma Bitran
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Elisa Xu
- Department of Psychiatry, Columbia University, New York, NY, USA
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, USA.
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, USA.
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12
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O'Connor M, Sutton A, Hennessy E. The Components and Characteristics of Safety Management Plans Used to Reduce the Risk of Self Harm: A PRISMA Scoping Review. Arch Suicide Res 2024:1-14. [PMID: 38915220 DOI: 10.1080/13811118.2024.2363226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND The term "safety management planning" can be thought of as having evolved to constitute a number of different intervention types and components used across various clinical settings with various populations. This poses a challenge for effective communication between clinicians and likely variability in the clinical effectiveness of these interventions. AIM This PRISMA Scoping Review aims to review the literature to ascertain which intervention components and characteristics currently fall under this umbrella term as well as in which contexts the plans are delivered and who is involved in the process. METHOD Published research studies in PsycINFO, CINAHL Plus, MEDLINE, Science Direct and Web of Science were reviewed. Grey literature was searched using the databases Base and OpenGrey as well as through the search engine Google. RESULTS 2853 abstracts were initially identified for screening and 74 pieces of literature informed the final review, with 54 derived from the published academic literature and 20 from the grey literature. Results indicated that the safety plans are used with a wide variety of populations and often include components related to identifying warning signs, internal coping strategies, accessing social professional support amongst other components. CONCLUSION Although most safety management plans described appeared to be based on specific interventions, there was a large amount of heterogeneity of components and characteristics observed. This was particularly the case with regards to safety management planning within the grey literature.
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13
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McIntyre RS, Mansur RB, Rosenblat JD, Teopiz KM, Kwan ATH. The association between ketamine and esketamine and suicidality: reports to the Food And Drug Administration Adverse Event Reporting System (FAERS). Expert Opin Drug Saf 2024:1-6. [PMID: 38884147 DOI: 10.1080/14740338.2024.2368827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 06/12/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION Replicated evidence indicates that ketamine and esketamine reduce measures of suicidality in persons with treatment-resistant depression (TRD). It remains uncertain whether individuals experience worsening of preexisting suicidality with either agent. RESEARCH DESIGN AND METHODS The Food and Drug Administration Adverse Event Reporting System (FAERS) database was searched from 1970 and 2019 to 30 September 2023 for reports of suicidal ideation, depression suicidal, suicidal behavior, suicidal attempt, and completed suicide in association with ketamine and esketamine exposure, respectively. We present reporting odds ratios (ROR) significance was determined when the lower limit of the 95% confidence interval (CI) exceeded 1.0. Lithium was used as the control agent. RESULTS Observed a higher ROR for suicidal ideation (ROR 7.58, 95% CI 6.34-9.07) and depression suicidal (ROR 14.19, 95% CI 1.80-112.07) with esketamine. Significantly lower RORs were observed for suicide attempt with ketamine (ROR 0.15, 95% CI 0.11-0.21) and esketamine (ROR 0.57, 95% CI 0.48-0.67). CONCLUSIONS Mixed RORs across aspects of suicidality were observed with ketamine and esketamine. Limitations of the FAERS database prevent any determination of causal effects new onset suicidality to either agent. The lower RORs for suicide attempt with ketamine and esketamine is noted but cannot be interpreted as a direct therapeutic effect.
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Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Rodrigo B Mansur
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Joshua D Rosenblat
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Angela T H Kwan
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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14
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Tandon R. Suicide prevention: A public health imperative Asian Journal of Psychiatry Collection 2018-2024. Asian J Psychiatr 2024; 96:104094. [PMID: 38789362 DOI: 10.1016/j.ajp.2024.104094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Affiliation(s)
- Rajiv Tandon
- Department of Psychiatry, WMU Homer Stryker School of Medicine, Kalamazoo, MI, USA.
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15
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Chitavi SO, Patrianakos J, Williams SC, Schmaltz SP, Ahmedani BK, Roaten K, Boudreaux ED, Brown GK. Evaluating the Prevalence of Four Recommended Practices for Suicide Prevention Following Hospital Discharge. Jt Comm J Qual Patient Saf 2024; 50:393-403. [PMID: 38538500 DOI: 10.1016/j.jcjq.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND The Joint Commission's National Patient Safety Goal (NPSG) for suicide prevention (NPSG.15.01.01) requires that accredited hospitals maintain policies/procedures for follow-up care at discharge for patients identified as at risk for suicide. The proportion of hospitals meeting these requirements through use of recommended discharge practices is unknown. METHODS This cross-sectional observational study explored the prevalence of suicide prevention activities among Joint Commission-accredited hospitals. A questionnaire was sent to 1,148 accredited hospitals. The authors calculated the percentage of hospitals reporting implementation of four recommended discharge practices for suicide prevention. RESULTS Of 1,148 hospitals, 346 (30.1%) responded. The majority (n = 212 [61.3%]) of hospitals had implemented formal safety planning, but few of those (n = 41 [19.3%]) included all key components of safety planning. Approximately a third of hospitals provided a warm handoff to outpatient care (n = 128 [37.0%)] or made follow-up contact with patients (n = 105 [30.3%]), and approximately a quarter (n = 97 [28.0%]) developed a plan for lethal means safety. Very few (n = 14 [4.0%]) hospitals met full criteria for implementing recommended suicide prevention activities at time of discharge. CONCLUSION The study revealed a significant gap in implementation of recommended practices related to prevention of suicide postdischarge. Additional research is needed to identify factors contributing to this implementation gap.
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16
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Xiao Y, Bi K, Yip PSF, Cerel J, Brown TT, Peng Y, Pathak J, Mann JJ. Decoding Suicide Decedent Profiles and Signs of Suicidal Intent Using Latent Class Analysis. JAMA Psychiatry 2024; 81:595-605. [PMID: 38506817 PMCID: PMC10955339 DOI: 10.1001/jamapsychiatry.2024.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/07/2024] [Indexed: 03/21/2024]
Abstract
Importance Suicide rates in the US increased by 35.6% from 2001 to 2021. Given that most individuals die on their first attempt, earlier detection and intervention are crucial. Understanding modifiable risk factors is key to effective prevention strategies. Objective To identify distinct suicide profiles or classes, associated signs of suicidal intent, and patterns of modifiable risks for targeted prevention efforts. Design, Setting, and Participants This cross-sectional study used data from the 2003-2020 National Violent Death Reporting System Restricted Access Database for 306 800 suicide decedents. Statistical analysis was performed from July 2022 to June 2023. Exposures Suicide decedent profiles were determined using latent class analyses of available data on suicide circumstances, toxicology, and methods. Main Outcomes and Measures Disclosure of recent intent, suicide note presence, and known psychotropic usage. Results Among 306 800 suicide decedents (mean [SD] age, 46.3 [18.4] years; 239 627 males [78.1%] and 67 108 females [21.9%]), 5 profiles or classes were identified. The largest class, class 4 (97 175 [31.7%]), predominantly faced physical health challenges, followed by polysubstance problems in class 5 (58 803 [19.2%]), and crisis, alcohol-related, and intimate partner problems in class 3 (55 367 [18.0%]), mental health problems (class 2, 53 928 [17.6%]), and comorbid mental health and substance use disorders (class 1, 41 527 [13.5%]). Class 4 had the lowest rates of disclosing suicidal intent (13 952 [14.4%]) and leaving a suicide note (24 351 [25.1%]). Adjusting for covariates, compared with class 1, class 4 had the highest odds of not disclosing suicide intent (odds ratio [OR], 2.58; 95% CI, 2.51-2.66) and not leaving a suicide note (OR, 1.45; 95% CI, 1.41-1.49). Class 4 also had the lowest rates of all known psychiatric illnesses and psychotropic medications among all suicide profiles. Class 4 had more older adults (23 794 were aged 55-70 years [24.5%]; 20 100 aged ≥71 years [20.7%]), veterans (22 220 [22.9%]), widows (8633 [8.9%]), individuals with less than high school education (15 690 [16.1%]), and rural residents (23 966 [24.7%]). Conclusions and Relevance This study identified 5 distinct suicide profiles, highlighting a need for tailored prevention strategies. Improving the detection and treatment of coexisting mental health conditions, substance and alcohol use disorders, and physical illnesses is paramount. The implementation of means restriction strategies plays a vital role in reducing suicide risks across most of the profiles, reinforcing the need for a multifaceted approach to suicide prevention.
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Affiliation(s)
- Yunyu Xiao
- Department of Population Health Sciences, Weill Cornell Medicine/NewYork-Presbyterian, New York
| | - Kaiwen Bi
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Paul Siu-Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong
| | - Julie Cerel
- College of Social Work, University of Kentucky, Lexington
| | | | - Yifan Peng
- Department of Population Health Sciences, Weill Cornell Medicine/NewYork-Presbyterian, New York
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medicine/NewYork-Presbyterian, New York
| | - J. John Mann
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, New York
- Department of Radiology, Columbia University Irving Medical Center, Columbia University, New York, New York
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York
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17
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Gill VS, Sullivan G, Stearns H, Tummala SV, Haglin JM, Economopoulos KJ, Marks L, Chauhan M. Mental Health in Elite Athletes: A Systematic Review of Suicidal Behaviour as Compared to the General Population. Sports Med 2024; 54:1-18. [PMID: 38407749 DOI: 10.1007/s40279-024-01998-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND OBJECTIVE Previous systematic reviews on mental health in athletes have found athletes to be at a potentially increased risk for mental health diagnoses compared to the public. Multiple cross-sectional studies have examined suicide behaviour within different athlete populations, but there is a need for a comprehensive review to synthesize and identify risk factors and epidemiology regarding suicide behaviour in the elite athlete population, especially as it compares to the general population. METHODS A systematic literature search was performed in MEDLINE, EMBASE, Scopus, and Web of Science from 1990 to January 2023. Inclusion criteria included original peer-reviewed research articles examining suicidal ideation, suicide attempt, or suicide completion within elite athlete populations. Exclusion criteria included athletes participating in high-school or Paralympic level sports, studies that did not report results regarding elite athletes and non-athletes separately, and non-peer reviewed work. All studies were screened for inclusion by two independent reviewers. The primary outcome variables extracted from included studies included rates, risk factors, and protective factors for suicide behaviour. The study quality and risk of bias was evaluated for each study using the Joanna-Briggs Institute (JBI) critical appraisal tools. RESULTS Of the 875 unique studies identified, 22 studies, all of which were cross-sectional in nature, met the inclusion criteria. Seven studies evaluated previous athletes, 13 studies evaluated current athletes, and two studies included a combination of previous and current athletes. Seven studies involved varsity college athletes, nine involved professional athletes of various sports, and six focused on international or Olympic level athletes. The rate of suicidal ideation in professional athletes ranged from 6.9 to 18% across four studies, while the rate in collegiate athletes ranged from 3.7 to 6.5% across three studies. Ten studies compared athletes to the general population, the majority of which found athletes to be at reduced risk of suicidal ideation, suicide attempt, and suicide completion. Only one study found athletes to have increased rates of suicide compared to matched non-athletes. Risk factors for suicide behaviour identified across multiple studies included male sex, non-white race, older age, and depression. Player position, athletic level, sport played, and injuries showed trends of having limited effect on suicide behaviour risk. CONCLUSION This review suggests that elite athletes generally demonstrate reduced risk of suicidal ideation, suicide attempt, and suicide completion compared to the general population. Coaches should remain aware of specific factors, such as male sex, non-white race, and higher athletic level, in order to better identify at-risk athletes. Limitations of this review include the heterogeneity in the methodology and athlete populations across the included studies. Therefore, future targeted research is essential to compare suicide behaviour between sports and identify sport-specific suicide risk factors. TRIAL REGISTRATION PROSPERO Registration: CRD42023395990.
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Affiliation(s)
- Vikram S Gill
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA.
- Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA.
| | | | - Hunter Stearns
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | | | - Jack M Haglin
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | | | - Lisa Marks
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Mohit Chauhan
- Department of Psychiatry, Mayo Clinic, Jacksonville, FL, USA
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Schwerthöffer D, Förstl H. [Insomniac symptoms and suicidality-link and management]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2024; 38:53-61. [PMID: 37171521 PMCID: PMC11143018 DOI: 10.1007/s40211-023-00466-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/01/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND A link between insomniac symptoms and suicidality has long been suspected and deserves specific attention. OBJECTIVE We examine the current evidence for this relationship from epidemiology and neurobiology in order to propose a targeted management. MATERIAL AND METHOD Clinical example and selective Medline-literature research for insomnia symptoms and suicidality. RESULTS Epidemiological data and statistical analysis show that symptoms of insomnia are independent risk factors for suicidality. Neurobiological factors associated with combined insomnia symptoms and suicidality are: serotonergic dysfunction and circadian rhythm disorder leading to hypofrontality with reduced problem solving capacity and impaired emotional and impulse-control. Social isolation, recurrent rumination, comorbid psychiatric disorders, access to potentially lethal drugs or weapons need urgent evaluation in patients with a combination of suicidality and symptoms of insomnia. CONCLUSION patients with insomnia and further risk factors for suicide need to be treated resolutely and at an early stage. Modern sleep-promoting antidepressants with low toxicity and antipsychotics must be preferred in the treatment of patients with insomniac sleep disorders and suicidality. Multimodal anti-insomnia and anti-depressive therapy adapted to the circadian rhythm can exert a favorable influence both on depressive-suicidal and insomnia symptoms and their inherent risks.
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Affiliation(s)
- Dirk Schwerthöffer
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU-München, Ismaningerstraße 22, 81675, München, Deutschland.
| | - Hans Förstl
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU-München, Ismaningerstraße 22, 81675, München, Deutschland
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Savarino JR, Rubin E, Masiakos PT, McLellan R, Rolle ML, Nanda P, Stapleton CJ, Sacks CA. The Experience of Survivors of Firearm Suicide Attempts: A Retrospective Case Series. ANNALS OF SURGERY OPEN 2024; 5:e418. [PMID: 38911645 PMCID: PMC11191906 DOI: 10.1097/as9.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/11/2024] [Indexed: 06/25/2024] Open
Abstract
Objective We sought to identify people who survived firearm suicide attempts to describe the acute stressors, substance use, and mental health conditions related to the attempt. Background Most firearm deaths in the United States are the result of suicide. Because firearm suicide attempts have a case fatality rate of approximately 90%, little is known about the precipitating factors that lead to firearm suicide attempts. Methods We conducted a retrospective case series of patients admitted to a large hospital system between 2000 and 2019 who survived intentional, self-inflicted gunshot wounds to the head. Through the electronic medical record, we collected information about acute stressors, substance use, and mental health diagnoses before or at the time of the suicide attempt. Results Thirty-four patients were included in the study cohort. Patients were predominantly White (74%) and male (88%), with a mean age of 44 (range, 14-82). Nineteen (56%) patients were acutely intoxicated with alcohol upon hospitalization and 17 (50%) patients had a positive urine drug screen. Acute stressors involving interpersonal relationships (53%), work/school (32%), and legal disputes (18%), among others, were documented in 82% of patients. Most patients (65%) had been diagnosed with depression before their index hospitalization. Most patients were discharged to an acute rehabilitation center (41%) or an inpatient psychiatric facility (41%). Conclusions Acute stress and alcohol intoxication were common in this cohort of patients who attempted suicide using firearms. These data offer an ability to learn from the experience of survivors of firearm suicide attempts, a rare population.
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Affiliation(s)
| | - Emily Rubin
- Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Peter T. Masiakos
- Pediatric Trauma Service, Department of Surgery, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Rachel McLellan
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Myron L. Rolle
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Pranav Nanda
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Christopher J. Stapleton
- Harvard Medical School, Boston, MA
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Chana A. Sacks
- Harvard Medical School, Boston, MA
- Division of General Internal Medicine and Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA
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Oquendo MA, Wall M, Wang S, Olfson M, Blanco C. Lifetime Suicide Attempts in Otherwise Psychiatrically Healthy Individuals. JAMA Psychiatry 2024; 81:572-578. [PMID: 38381442 PMCID: PMC10882500 DOI: 10.1001/jamapsychiatry.2023.5672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/17/2023] [Indexed: 02/22/2024]
Abstract
Importance Not all people who die by suicide have a psychiatric diagnosis; yet, little is known about the percentage and demographics of individuals with lifetime suicide attempts who are apparently psychiatrically healthy. If such suicide attempts are common, there are implications for suicide risk screening, research, policy, and nosology. Objective To estimate the percentage of people with lifetime suicide attempts whose first attempt occurred prior to onset of any psychiatric disorder. Design, Setting, and Participants This cross-sectional study used data from the US National Epidemiologic Study of Addictions and Related Conditions III (NESARC-III), a cross-sectional face-to-face survey conducted with a nationally representative sample of the US civilian noninstitutionalized population, and included persons with lifetime suicide attempts who were aged 20 to 65 years at survey administration (April 2012 to June 2013). Data from the NESARC, Wave 2 survey from August 2004 to September 2005 were used for replication. Analyses were performed from April to August 2023. Exposure Lifetime suicide attempts. Main Outcomes and Measures The main outcome was presence or absence of a psychiatric disorder before the first lifetime suicide attempt. Among persons with lifetime suicide attempts, the percentage and 95% CI of those whose first suicide attempt occurred before the onset of any apparent psychiatric disorders was calculated, weighted by NESARC sampling and nonresponse weights. Separate analyses were performed for males, females, and 3 age groups (20 to <35, 35-50, and >50 to 65 years). Results In the total sample of 36 309 respondents, 1948 persons had lifetime suicide attempts; 66.8% (95% CI, 64.1%-69.4%) were female, and 6.2% (95% CI, 4.9%-7.4%) had no apparent lifetime psychiatric diagnoses when surveyed. In addition, 13.4% (95% CI, 11.6%-15.2%) made their first suicide attempt prior to psychiatric disorder onset. Thus, an estimated 19.6% of respondents first attempted suicide without an antecedent psychiatric disorder. No significant age or sex differences were detected in the percentage of those with lifetime suicide attempts absent psychiatric disorders, although females were more likely than males to attempt suicide in the year of psychiatric disorder onset (14.9% [95% CI, 12.5%-17.3%] vs 8.6% [95% CI, 6.0%-11.2%]; P < .001), and attempts were less frequent among those older than 50 to 65 years (3.9% [95% CI, 3.5%-4.4%] vs 6.1% [95% CI, 5.4%-6.8%] for 35-50 years and 6.2% [95% CI, 5.6%-6.9%] for 20 to <35 years; P < .001). Conclusions and Relevance In this study, an estimated 19.6% of individuals who attempted suicide did so despite not meeting criteria for an antecedent psychiatric disorder. This finding challenges clinical notions of who is at risk for suicidal behavior and raises questions about the safety of limiting suicide risk screening to psychiatric populations.
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Affiliation(s)
- Maria A. Oquendo
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Melanie Wall
- Department of Psychiatry, Columbia University, New York, New York
| | - Shuai Wang
- National Institute on Drug Abuse, Rockville, Maryland
| | - Mark Olfson
- Department of Psychiatry, Columbia University, New York, New York
| | - Carlos Blanco
- National Institute on Drug Abuse, Rockville, Maryland
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21
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DeBeer B, Mignogna J, Talbot M, Villarreal E, Mohatt N, Borah E, Russell PD, Bryan CJ, Monteith LL, Bongiovanni K, Hoffmire C, Peterson AL, Heise J, Baack S, Weinberg K, Polk M, Benzer JK. Suicide Prevention Programming: Comparing Four Prominent Frameworks. Psychiatr Serv 2024:appips20230173. [PMID: 38807579 DOI: 10.1176/appi.ps.20230173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
OBJECTIVE Suicide is a significant public health concern. About 48,000 individuals died by suicide in 2021 in the United States, and approximately one in 100 deaths globally are due to suicide. Continuing efforts in program development and evaluation are vital to preventing suicide. Multiple frameworks have been developed to reduce suicide rates, but they have not been compared to assess their comprehensiveness, nor have their components been classified. METHODS In 2019, the authors conducted a narrative review of the literature and identified four major frameworks for suicide prevention: the U.S. Department of Veterans Affairs (VA) Suicide Prevention Program, the Defense Suicide Prevention Program of the U.S. Department of Defense, Zero Suicide in Health and Behavioral Health Care, and the technical package developed by the Centers for Disease Control and Prevention. Program components for these frameworks were identified and classified by using two prevention strategy classification systems: the National Academy of Medicine's (NAM's) continuum-of-care model and the Substance Abuse and Mental Health Services Administration's (SAMHSA's) prevention model. RESULTS The cross-program comparison revealed that no single program included all components of suicide prevention programs. However, the VA program was the most comprehensive in terms of the number of components and their spread across prevention strategy classifications. The programs used few components categorized under NAM's promotion or selective prevention strategy classifications. The SAMHSA prevention strategy classifications of information dissemination, community-based processes, and positive alternatives were also used infrequently. CONCLUSIONS Organizations, health care systems, and policy makers may use these findings as they develop, improve, and implement suicide prevention programs.
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Affiliation(s)
- Bryann DeBeer
- Rocky Mountain Mental Illness, Research, Education and Clinical Center for Suicide Prevention, Eastern Colorado Veterans Affairs (VA) Health Care System, Aurora (DeBeer, Mignogna, Talbot, Russell, Monteith, Hoffmire); Department of Physical Medicine and Rehabilitation (DeBeer, Mignogna, Russell, Hoffmire) and Department of Psychiatry (Monteith), University of Colorado Anschutz Medical Campus, Aurora; Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs (Talbot); Office of Mental Health and Suicide Prevention, VA Central Office, Washington, D.C. (Villarreal); Division of Prevention and Community Research, Yale School of Medicine, New Haven (Mohatt); Booz Allen Hamilton, Arlington, Virginia (Mohatt); Steve Hicks School of Social Work and Dell Medical School (Borah) and Department of Psychiatry (Benzer), University of Texas at Austin, Austin; College of Medicine, Ohio State University, Columbus, and VA Veterans Integrated Services Network (VISN) 2 Center of Excellence, New York City (Bryan); VA VISN 17 Clinical Resource Hub, VA Texas Valley Coastal Bend Healthcare System, Harlingen (Bongiovanni); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson); Suicide Prevention Center of New York, Albany, and Zero Suicide Institute, Education Development Center, Waltham, Massachusetts (Heise); Michael E. DeBakey VA Medical Center, Houston (Baack); Central Texas VA Health Care System, Temple (Weinberg); VA Portland Healthcare System, Portland, Oregon (Polk); VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas (Benzer)
| | - Joseph Mignogna
- Rocky Mountain Mental Illness, Research, Education and Clinical Center for Suicide Prevention, Eastern Colorado Veterans Affairs (VA) Health Care System, Aurora (DeBeer, Mignogna, Talbot, Russell, Monteith, Hoffmire); Department of Physical Medicine and Rehabilitation (DeBeer, Mignogna, Russell, Hoffmire) and Department of Psychiatry (Monteith), University of Colorado Anschutz Medical Campus, Aurora; Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs (Talbot); Office of Mental Health and Suicide Prevention, VA Central Office, Washington, D.C. (Villarreal); Division of Prevention and Community Research, Yale School of Medicine, New Haven (Mohatt); Booz Allen Hamilton, Arlington, Virginia (Mohatt); Steve Hicks School of Social Work and Dell Medical School (Borah) and Department of Psychiatry (Benzer), University of Texas at Austin, Austin; College of Medicine, Ohio State University, Columbus, and VA Veterans Integrated Services Network (VISN) 2 Center of Excellence, New York City (Bryan); VA VISN 17 Clinical Resource Hub, VA Texas Valley Coastal Bend Healthcare System, Harlingen (Bongiovanni); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson); Suicide Prevention Center of New York, Albany, and Zero Suicide Institute, Education Development Center, Waltham, Massachusetts (Heise); Michael E. DeBakey VA Medical Center, Houston (Baack); Central Texas VA Health Care System, Temple (Weinberg); VA Portland Healthcare System, Portland, Oregon (Polk); VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas (Benzer)
| | - Margaret Talbot
- Rocky Mountain Mental Illness, Research, Education and Clinical Center for Suicide Prevention, Eastern Colorado Veterans Affairs (VA) Health Care System, Aurora (DeBeer, Mignogna, Talbot, Russell, Monteith, Hoffmire); Department of Physical Medicine and Rehabilitation (DeBeer, Mignogna, Russell, Hoffmire) and Department of Psychiatry (Monteith), University of Colorado Anschutz Medical Campus, Aurora; Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs (Talbot); Office of Mental Health and Suicide Prevention, VA Central Office, Washington, D.C. (Villarreal); Division of Prevention and Community Research, Yale School of Medicine, New Haven (Mohatt); Booz Allen Hamilton, Arlington, Virginia (Mohatt); Steve Hicks School of Social Work and Dell Medical School (Borah) and Department of Psychiatry (Benzer), University of Texas at Austin, Austin; College of Medicine, Ohio State University, Columbus, and VA Veterans Integrated Services Network (VISN) 2 Center of Excellence, New York City (Bryan); VA VISN 17 Clinical Resource Hub, VA Texas Valley Coastal Bend Healthcare System, Harlingen (Bongiovanni); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson); Suicide Prevention Center of New York, Albany, and Zero Suicide Institute, Education Development Center, Waltham, Massachusetts (Heise); Michael E. DeBakey VA Medical Center, Houston (Baack); Central Texas VA Health Care System, Temple (Weinberg); VA Portland Healthcare System, Portland, Oregon (Polk); VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas (Benzer)
| | - Edgar Villarreal
- Rocky Mountain Mental Illness, Research, Education and Clinical Center for Suicide Prevention, Eastern Colorado Veterans Affairs (VA) Health Care System, Aurora (DeBeer, Mignogna, Talbot, Russell, Monteith, Hoffmire); Department of Physical Medicine and Rehabilitation (DeBeer, Mignogna, Russell, Hoffmire) and Department of Psychiatry (Monteith), University of Colorado Anschutz Medical Campus, Aurora; Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs (Talbot); Office of Mental Health and Suicide Prevention, VA Central Office, Washington, D.C. (Villarreal); Division of Prevention and Community Research, Yale School of Medicine, New Haven (Mohatt); Booz Allen Hamilton, Arlington, Virginia (Mohatt); Steve Hicks School of Social Work and Dell Medical School (Borah) and Department of Psychiatry (Benzer), University of Texas at Austin, Austin; College of Medicine, Ohio State University, Columbus, and VA Veterans Integrated Services Network (VISN) 2 Center of Excellence, New York City (Bryan); VA VISN 17 Clinical Resource Hub, VA Texas Valley Coastal Bend Healthcare System, Harlingen (Bongiovanni); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson); Suicide Prevention Center of New York, Albany, and Zero Suicide Institute, Education Development Center, Waltham, Massachusetts (Heise); Michael E. DeBakey VA Medical Center, Houston (Baack); Central Texas VA Health Care System, Temple (Weinberg); VA Portland Healthcare System, Portland, Oregon (Polk); VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas (Benzer)
| | - Nathaniel Mohatt
- Rocky Mountain Mental Illness, Research, Education and Clinical Center for Suicide Prevention, Eastern Colorado Veterans Affairs (VA) Health Care System, Aurora (DeBeer, Mignogna, Talbot, Russell, Monteith, Hoffmire); Department of Physical Medicine and Rehabilitation (DeBeer, Mignogna, Russell, Hoffmire) and Department of Psychiatry (Monteith), University of Colorado Anschutz Medical Campus, Aurora; Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs (Talbot); Office of Mental Health and Suicide Prevention, VA Central Office, Washington, D.C. (Villarreal); Division of Prevention and Community Research, Yale School of Medicine, New Haven (Mohatt); Booz Allen Hamilton, Arlington, Virginia (Mohatt); Steve Hicks School of Social Work and Dell Medical School (Borah) and Department of Psychiatry (Benzer), University of Texas at Austin, Austin; College of Medicine, Ohio State University, Columbus, and VA Veterans Integrated Services Network (VISN) 2 Center of Excellence, New York City (Bryan); VA VISN 17 Clinical Resource Hub, VA Texas Valley Coastal Bend Healthcare System, Harlingen (Bongiovanni); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson); Suicide Prevention Center of New York, Albany, and Zero Suicide Institute, Education Development Center, Waltham, Massachusetts (Heise); Michael E. DeBakey VA Medical Center, Houston (Baack); Central Texas VA Health Care System, Temple (Weinberg); VA Portland Healthcare System, Portland, Oregon (Polk); VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas (Benzer)
| | - Elisa Borah
- Rocky Mountain Mental Illness, Research, Education and Clinical Center for Suicide Prevention, Eastern Colorado Veterans Affairs (VA) Health Care System, Aurora (DeBeer, Mignogna, Talbot, Russell, Monteith, Hoffmire); Department of Physical Medicine and Rehabilitation (DeBeer, Mignogna, Russell, Hoffmire) and Department of Psychiatry (Monteith), University of Colorado Anschutz Medical Campus, Aurora; Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs (Talbot); Office of Mental Health and Suicide Prevention, VA Central Office, Washington, D.C. (Villarreal); Division of Prevention and Community Research, Yale School of Medicine, New Haven (Mohatt); Booz Allen Hamilton, Arlington, Virginia (Mohatt); Steve Hicks School of Social Work and Dell Medical School (Borah) and Department of Psychiatry (Benzer), University of Texas at Austin, Austin; College of Medicine, Ohio State University, Columbus, and VA Veterans Integrated Services Network (VISN) 2 Center of Excellence, New York City (Bryan); VA VISN 17 Clinical Resource Hub, VA Texas Valley Coastal Bend Healthcare System, Harlingen (Bongiovanni); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson); Suicide Prevention Center of New York, Albany, and Zero Suicide Institute, Education Development Center, Waltham, Massachusetts (Heise); Michael E. DeBakey VA Medical Center, Houston (Baack); Central Texas VA Health Care System, Temple (Weinberg); VA Portland Healthcare System, Portland, Oregon (Polk); VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas (Benzer)
| | - Patricia D Russell
- Rocky Mountain Mental Illness, Research, Education and Clinical Center for Suicide Prevention, Eastern Colorado Veterans Affairs (VA) Health Care System, Aurora (DeBeer, Mignogna, Talbot, Russell, Monteith, Hoffmire); Department of Physical Medicine and Rehabilitation (DeBeer, Mignogna, Russell, Hoffmire) and Department of Psychiatry (Monteith), University of Colorado Anschutz Medical Campus, Aurora; Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs (Talbot); Office of Mental Health and Suicide Prevention, VA Central Office, Washington, D.C. (Villarreal); Division of Prevention and Community Research, Yale School of Medicine, New Haven (Mohatt); Booz Allen Hamilton, Arlington, Virginia (Mohatt); Steve Hicks School of Social Work and Dell Medical School (Borah) and Department of Psychiatry (Benzer), University of Texas at Austin, Austin; College of Medicine, Ohio State University, Columbus, and VA Veterans Integrated Services Network (VISN) 2 Center of Excellence, New York City (Bryan); VA VISN 17 Clinical Resource Hub, VA Texas Valley Coastal Bend Healthcare System, Harlingen (Bongiovanni); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson); Suicide Prevention Center of New York, Albany, and Zero Suicide Institute, Education Development Center, Waltham, Massachusetts (Heise); Michael E. DeBakey VA Medical Center, Houston (Baack); Central Texas VA Health Care System, Temple (Weinberg); VA Portland Healthcare System, Portland, Oregon (Polk); VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas (Benzer)
| | - Craig J Bryan
- Rocky Mountain Mental Illness, Research, Education and Clinical Center for Suicide Prevention, Eastern Colorado Veterans Affairs (VA) Health Care System, Aurora (DeBeer, Mignogna, Talbot, Russell, Monteith, Hoffmire); Department of Physical Medicine and Rehabilitation (DeBeer, Mignogna, Russell, Hoffmire) and Department of Psychiatry (Monteith), University of Colorado Anschutz Medical Campus, Aurora; Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs (Talbot); Office of Mental Health and Suicide Prevention, VA Central Office, Washington, D.C. (Villarreal); Division of Prevention and Community Research, Yale School of Medicine, New Haven (Mohatt); Booz Allen Hamilton, Arlington, Virginia (Mohatt); Steve Hicks School of Social Work and Dell Medical School (Borah) and Department of Psychiatry (Benzer), University of Texas at Austin, Austin; College of Medicine, Ohio State University, Columbus, and VA Veterans Integrated Services Network (VISN) 2 Center of Excellence, New York City (Bryan); VA VISN 17 Clinical Resource Hub, VA Texas Valley Coastal Bend Healthcare System, Harlingen (Bongiovanni); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson); Suicide Prevention Center of New York, Albany, and Zero Suicide Institute, Education Development Center, Waltham, Massachusetts (Heise); Michael E. DeBakey VA Medical Center, Houston (Baack); Central Texas VA Health Care System, Temple (Weinberg); VA Portland Healthcare System, Portland, Oregon (Polk); VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas (Benzer)
| | - Lindsey L Monteith
- Rocky Mountain Mental Illness, Research, Education and Clinical Center for Suicide Prevention, Eastern Colorado Veterans Affairs (VA) Health Care System, Aurora (DeBeer, Mignogna, Talbot, Russell, Monteith, Hoffmire); Department of Physical Medicine and Rehabilitation (DeBeer, Mignogna, Russell, Hoffmire) and Department of Psychiatry (Monteith), University of Colorado Anschutz Medical Campus, Aurora; Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs (Talbot); Office of Mental Health and Suicide Prevention, VA Central Office, Washington, D.C. (Villarreal); Division of Prevention and Community Research, Yale School of Medicine, New Haven (Mohatt); Booz Allen Hamilton, Arlington, Virginia (Mohatt); Steve Hicks School of Social Work and Dell Medical School (Borah) and Department of Psychiatry (Benzer), University of Texas at Austin, Austin; College of Medicine, Ohio State University, Columbus, and VA Veterans Integrated Services Network (VISN) 2 Center of Excellence, New York City (Bryan); VA VISN 17 Clinical Resource Hub, VA Texas Valley Coastal Bend Healthcare System, Harlingen (Bongiovanni); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson); Suicide Prevention Center of New York, Albany, and Zero Suicide Institute, Education Development Center, Waltham, Massachusetts (Heise); Michael E. DeBakey VA Medical Center, Houston (Baack); Central Texas VA Health Care System, Temple (Weinberg); VA Portland Healthcare System, Portland, Oregon (Polk); VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas (Benzer)
| | - Kathryn Bongiovanni
- Rocky Mountain Mental Illness, Research, Education and Clinical Center for Suicide Prevention, Eastern Colorado Veterans Affairs (VA) Health Care System, Aurora (DeBeer, Mignogna, Talbot, Russell, Monteith, Hoffmire); Department of Physical Medicine and Rehabilitation (DeBeer, Mignogna, Russell, Hoffmire) and Department of Psychiatry (Monteith), University of Colorado Anschutz Medical Campus, Aurora; Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs (Talbot); Office of Mental Health and Suicide Prevention, VA Central Office, Washington, D.C. (Villarreal); Division of Prevention and Community Research, Yale School of Medicine, New Haven (Mohatt); Booz Allen Hamilton, Arlington, Virginia (Mohatt); Steve Hicks School of Social Work and Dell Medical School (Borah) and Department of Psychiatry (Benzer), University of Texas at Austin, Austin; College of Medicine, Ohio State University, Columbus, and VA Veterans Integrated Services Network (VISN) 2 Center of Excellence, New York City (Bryan); VA VISN 17 Clinical Resource Hub, VA Texas Valley Coastal Bend Healthcare System, Harlingen (Bongiovanni); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson); Suicide Prevention Center of New York, Albany, and Zero Suicide Institute, Education Development Center, Waltham, Massachusetts (Heise); Michael E. DeBakey VA Medical Center, Houston (Baack); Central Texas VA Health Care System, Temple (Weinberg); VA Portland Healthcare System, Portland, Oregon (Polk); VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas (Benzer)
| | - Claire Hoffmire
- Rocky Mountain Mental Illness, Research, Education and Clinical Center for Suicide Prevention, Eastern Colorado Veterans Affairs (VA) Health Care System, Aurora (DeBeer, Mignogna, Talbot, Russell, Monteith, Hoffmire); Department of Physical Medicine and Rehabilitation (DeBeer, Mignogna, Russell, Hoffmire) and Department of Psychiatry (Monteith), University of Colorado Anschutz Medical Campus, Aurora; Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs (Talbot); Office of Mental Health and Suicide Prevention, VA Central Office, Washington, D.C. (Villarreal); Division of Prevention and Community Research, Yale School of Medicine, New Haven (Mohatt); Booz Allen Hamilton, Arlington, Virginia (Mohatt); Steve Hicks School of Social Work and Dell Medical School (Borah) and Department of Psychiatry (Benzer), University of Texas at Austin, Austin; College of Medicine, Ohio State University, Columbus, and VA Veterans Integrated Services Network (VISN) 2 Center of Excellence, New York City (Bryan); VA VISN 17 Clinical Resource Hub, VA Texas Valley Coastal Bend Healthcare System, Harlingen (Bongiovanni); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson); Suicide Prevention Center of New York, Albany, and Zero Suicide Institute, Education Development Center, Waltham, Massachusetts (Heise); Michael E. DeBakey VA Medical Center, Houston (Baack); Central Texas VA Health Care System, Temple (Weinberg); VA Portland Healthcare System, Portland, Oregon (Polk); VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas (Benzer)
| | - Alan L Peterson
- Rocky Mountain Mental Illness, Research, Education and Clinical Center for Suicide Prevention, Eastern Colorado Veterans Affairs (VA) Health Care System, Aurora (DeBeer, Mignogna, Talbot, Russell, Monteith, Hoffmire); Department of Physical Medicine and Rehabilitation (DeBeer, Mignogna, Russell, Hoffmire) and Department of Psychiatry (Monteith), University of Colorado Anschutz Medical Campus, Aurora; Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs (Talbot); Office of Mental Health and Suicide Prevention, VA Central Office, Washington, D.C. (Villarreal); Division of Prevention and Community Research, Yale School of Medicine, New Haven (Mohatt); Booz Allen Hamilton, Arlington, Virginia (Mohatt); Steve Hicks School of Social Work and Dell Medical School (Borah) and Department of Psychiatry (Benzer), University of Texas at Austin, Austin; College of Medicine, Ohio State University, Columbus, and VA Veterans Integrated Services Network (VISN) 2 Center of Excellence, New York City (Bryan); VA VISN 17 Clinical Resource Hub, VA Texas Valley Coastal Bend Healthcare System, Harlingen (Bongiovanni); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson); Suicide Prevention Center of New York, Albany, and Zero Suicide Institute, Education Development Center, Waltham, Massachusetts (Heise); Michael E. DeBakey VA Medical Center, Houston (Baack); Central Texas VA Health Care System, Temple (Weinberg); VA Portland Healthcare System, Portland, Oregon (Polk); VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas (Benzer)
| | - Jenna Heise
- Rocky Mountain Mental Illness, Research, Education and Clinical Center for Suicide Prevention, Eastern Colorado Veterans Affairs (VA) Health Care System, Aurora (DeBeer, Mignogna, Talbot, Russell, Monteith, Hoffmire); Department of Physical Medicine and Rehabilitation (DeBeer, Mignogna, Russell, Hoffmire) and Department of Psychiatry (Monteith), University of Colorado Anschutz Medical Campus, Aurora; Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs (Talbot); Office of Mental Health and Suicide Prevention, VA Central Office, Washington, D.C. (Villarreal); Division of Prevention and Community Research, Yale School of Medicine, New Haven (Mohatt); Booz Allen Hamilton, Arlington, Virginia (Mohatt); Steve Hicks School of Social Work and Dell Medical School (Borah) and Department of Psychiatry (Benzer), University of Texas at Austin, Austin; College of Medicine, Ohio State University, Columbus, and VA Veterans Integrated Services Network (VISN) 2 Center of Excellence, New York City (Bryan); VA VISN 17 Clinical Resource Hub, VA Texas Valley Coastal Bend Healthcare System, Harlingen (Bongiovanni); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson); Suicide Prevention Center of New York, Albany, and Zero Suicide Institute, Education Development Center, Waltham, Massachusetts (Heise); Michael E. DeBakey VA Medical Center, Houston (Baack); Central Texas VA Health Care System, Temple (Weinberg); VA Portland Healthcare System, Portland, Oregon (Polk); VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas (Benzer)
| | - Sylvia Baack
- Rocky Mountain Mental Illness, Research, Education and Clinical Center for Suicide Prevention, Eastern Colorado Veterans Affairs (VA) Health Care System, Aurora (DeBeer, Mignogna, Talbot, Russell, Monteith, Hoffmire); Department of Physical Medicine and Rehabilitation (DeBeer, Mignogna, Russell, Hoffmire) and Department of Psychiatry (Monteith), University of Colorado Anschutz Medical Campus, Aurora; Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs (Talbot); Office of Mental Health and Suicide Prevention, VA Central Office, Washington, D.C. (Villarreal); Division of Prevention and Community Research, Yale School of Medicine, New Haven (Mohatt); Booz Allen Hamilton, Arlington, Virginia (Mohatt); Steve Hicks School of Social Work and Dell Medical School (Borah) and Department of Psychiatry (Benzer), University of Texas at Austin, Austin; College of Medicine, Ohio State University, Columbus, and VA Veterans Integrated Services Network (VISN) 2 Center of Excellence, New York City (Bryan); VA VISN 17 Clinical Resource Hub, VA Texas Valley Coastal Bend Healthcare System, Harlingen (Bongiovanni); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson); Suicide Prevention Center of New York, Albany, and Zero Suicide Institute, Education Development Center, Waltham, Massachusetts (Heise); Michael E. DeBakey VA Medical Center, Houston (Baack); Central Texas VA Health Care System, Temple (Weinberg); VA Portland Healthcare System, Portland, Oregon (Polk); VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas (Benzer)
| | - Kimberly Weinberg
- Rocky Mountain Mental Illness, Research, Education and Clinical Center for Suicide Prevention, Eastern Colorado Veterans Affairs (VA) Health Care System, Aurora (DeBeer, Mignogna, Talbot, Russell, Monteith, Hoffmire); Department of Physical Medicine and Rehabilitation (DeBeer, Mignogna, Russell, Hoffmire) and Department of Psychiatry (Monteith), University of Colorado Anschutz Medical Campus, Aurora; Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs (Talbot); Office of Mental Health and Suicide Prevention, VA Central Office, Washington, D.C. (Villarreal); Division of Prevention and Community Research, Yale School of Medicine, New Haven (Mohatt); Booz Allen Hamilton, Arlington, Virginia (Mohatt); Steve Hicks School of Social Work and Dell Medical School (Borah) and Department of Psychiatry (Benzer), University of Texas at Austin, Austin; College of Medicine, Ohio State University, Columbus, and VA Veterans Integrated Services Network (VISN) 2 Center of Excellence, New York City (Bryan); VA VISN 17 Clinical Resource Hub, VA Texas Valley Coastal Bend Healthcare System, Harlingen (Bongiovanni); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson); Suicide Prevention Center of New York, Albany, and Zero Suicide Institute, Education Development Center, Waltham, Massachusetts (Heise); Michael E. DeBakey VA Medical Center, Houston (Baack); Central Texas VA Health Care System, Temple (Weinberg); VA Portland Healthcare System, Portland, Oregon (Polk); VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas (Benzer)
| | - Marcy Polk
- Rocky Mountain Mental Illness, Research, Education and Clinical Center for Suicide Prevention, Eastern Colorado Veterans Affairs (VA) Health Care System, Aurora (DeBeer, Mignogna, Talbot, Russell, Monteith, Hoffmire); Department of Physical Medicine and Rehabilitation (DeBeer, Mignogna, Russell, Hoffmire) and Department of Psychiatry (Monteith), University of Colorado Anschutz Medical Campus, Aurora; Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs (Talbot); Office of Mental Health and Suicide Prevention, VA Central Office, Washington, D.C. (Villarreal); Division of Prevention and Community Research, Yale School of Medicine, New Haven (Mohatt); Booz Allen Hamilton, Arlington, Virginia (Mohatt); Steve Hicks School of Social Work and Dell Medical School (Borah) and Department of Psychiatry (Benzer), University of Texas at Austin, Austin; College of Medicine, Ohio State University, Columbus, and VA Veterans Integrated Services Network (VISN) 2 Center of Excellence, New York City (Bryan); VA VISN 17 Clinical Resource Hub, VA Texas Valley Coastal Bend Healthcare System, Harlingen (Bongiovanni); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson); Suicide Prevention Center of New York, Albany, and Zero Suicide Institute, Education Development Center, Waltham, Massachusetts (Heise); Michael E. DeBakey VA Medical Center, Houston (Baack); Central Texas VA Health Care System, Temple (Weinberg); VA Portland Healthcare System, Portland, Oregon (Polk); VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas (Benzer)
| | - Justin K Benzer
- Rocky Mountain Mental Illness, Research, Education and Clinical Center for Suicide Prevention, Eastern Colorado Veterans Affairs (VA) Health Care System, Aurora (DeBeer, Mignogna, Talbot, Russell, Monteith, Hoffmire); Department of Physical Medicine and Rehabilitation (DeBeer, Mignogna, Russell, Hoffmire) and Department of Psychiatry (Monteith), University of Colorado Anschutz Medical Campus, Aurora; Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs (Talbot); Office of Mental Health and Suicide Prevention, VA Central Office, Washington, D.C. (Villarreal); Division of Prevention and Community Research, Yale School of Medicine, New Haven (Mohatt); Booz Allen Hamilton, Arlington, Virginia (Mohatt); Steve Hicks School of Social Work and Dell Medical School (Borah) and Department of Psychiatry (Benzer), University of Texas at Austin, Austin; College of Medicine, Ohio State University, Columbus, and VA Veterans Integrated Services Network (VISN) 2 Center of Excellence, New York City (Bryan); VA VISN 17 Clinical Resource Hub, VA Texas Valley Coastal Bend Healthcare System, Harlingen (Bongiovanni); Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, and Research and Development Service, South Texas Veterans Health Care System, San Antonio (Peterson); Suicide Prevention Center of New York, Albany, and Zero Suicide Institute, Education Development Center, Waltham, Massachusetts (Heise); Michael E. DeBakey VA Medical Center, Houston (Baack); Central Texas VA Health Care System, Temple (Weinberg); VA Portland Healthcare System, Portland, Oregon (Polk); VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas (Benzer)
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22
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Saini P, Hunt A, Blaney P, Murray A. Recognising and Responding to Suicide-Risk Factors in Primary Care: A Scoping Review. JOURNAL OF PREVENTION (2022) 2024:10.1007/s10935-024-00783-1. [PMID: 38801507 DOI: 10.1007/s10935-024-00783-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
The cost of one suicide is estimated to be £1.67 million (2 million euros) to the UK economy. Most people who die by suicide have seen a primary care practitioner (PCP) in the year prior to death. PCPs could aim to intervene before suicidal behaviours arise by addressing suicide-risk factors noted in primary care consultations, thereby preventing suicide and promoting health and wellbeing. This study aimed to conduct a rapid, systematic scoping review to explore how PCPs can effectively recognise and respond to suicide-risk factors. MedLine, CINAHL, PsycINFO, Web of Science and Cochrane Library databases were searched for three key concepts: suicide prevention, mental health and primary care. Two reviewers screened titles, abstracts and full papers independently against the eligibility criteria. Data synthesis was achieved by extracting and analysing study characteristics and findings. Forty-two studies met the eligibility criteria and were cited in this scoping review. Studies were published between 1990 and 2020 and were of good methodological quality. Six themes regarding suicide risk assessment in primary care were identified: Primary care consultations prior to suicide; Reasons for non-disclosure of suicidal behaviour; Screening for suicide risk; Training for primary care staff; Use of language by primary care staff; and, Difference in referral pathways from general practitioners or primary care practitioners. This review focused on better recognition and response to specific suicide-risk factors more widely such as poor mental health, substance misuse and long-term physical health conditions. Primary care is well placed to address the range of suicide-risk factors including biological, physical-health, psychological and socio-economic factors and therefore these findings could inform the development of person-centred approaches to be used in primary care.
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Affiliation(s)
- Pooja Saini
- School of Psychology, Faculty of Health, Suicide and Self-Harm Prevention, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK.
| | - Anna Hunt
- School of Psychology, Faculty of Health, Suicide and Self-Harm Prevention, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Peter Blaney
- School of Psychology, Faculty of Health, Suicide and Self-Harm Prevention, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF, UK
| | - Annie Murray
- Department of Health and Social Care, Office for Health Improvement and Disparities, Piccadilly Place 3, Manchester, M1 3BN, UK
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23
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Almanzar S. Advancing Global Health Through Primary Care Physician Education on Suicide Prevention. Ann Glob Health 2024; 90:32. [PMID: 38800707 PMCID: PMC11122702 DOI: 10.5334/aogh.4410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024] Open
Abstract
The rising global suicide rate presents a major public health concern, resulting in the loss of over 700,000 lives annually. Discrepancies in the impact of suicide among diverse populations underscore the necessity for targeted prevention strategies. Primary care providers (PCPs) play a crucial role in identifying and managing suicide risk, particularly in underserved areas with limited access to mental health care. Educating PCPs about evidence-based interventions and suicide prevention strategies has demonstrated effectiveness in reducing suicide rates. Landmark initiatives in Australia, Sweden, and Hungary have successfully lowered suicide rates by implementing educational programs for PCPs focused on suicide prevention. Denmark, previously afflicted by some of the highest rates globally in the 1980s, has significantly reduced its figures and now ranks among countries with the lowest rates in high-income nations. Collaborative programs involving PCPs and health workers in low-resource regions have also shown promising outcomes in suicide prevention efforts. Enhancing the expertise of PCPs in suicide prevention can fortify healthcare systems, prioritize mental health, and ultimately save lives, contributing to global health endeavors aimed at addressing the pervasive issue of suicide.
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24
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Gabilondo A, Gonzalez-Pinto A, Garcia J, Del Valle D, Morentin B, Iruin A. Analysis of health services use and clinical profiles in the year prior to suicide between 2010 and 2018: An opportunity to improve its prevention. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2024:S2950-2853(24)00031-0. [PMID: 38768759 DOI: 10.1016/j.sjpmh.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 05/07/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Suicide is the first cause of external death in Spain. International studies show frequent and varied health contacts in the months prior to suicide. There are hardly any studies on that phenomenon in this country. OBJECTIVE To analyze health care use in the year prior to suicide between 2010 and 2018 in the Basque Country, as well as pharmacological prescriptions and psychiatric diagnoses received. METHODS Retrospective descriptive study with all suicides registered by the Basque Institute of Legal Medicine (BILM) between 2010 and 2018. The records of the BILM and the Basque Health Service (Osakidetza) were cross-checked. RESULTS 1526 suicides were analyzed. 74% had health contacts in the previous year. The use was higher in women (p<0.05) and in older ages (p<0001). Primary care was the most used specialty (58.8% the previous year and 7.1% the previous week), followed by Hospital Emergencies (50.3% and 10.2%) and Outpatient Medical Specialties (49% and 11.6%), especially Radiology. Outpatient psychiatry only contacted 29.6% that year, although it had the highest average number of visits (15.1 SD22.6). The most frequent diagnostic category among psychiatric patients was F30-39 (26.7%), with differences between sexes and ages. 49.7% received psychotropic drugs. CONCLUSIONS The results are aligned with international evidence, which they also extend, and reinforce the need to extend prevention beyond psychiatric services. It seems advisable to increase proactivity in the search for risk by sensitizing and training different professional profiles, but also to work from non-health settings to improve assistance to highly vulnerable profiles (young men) with low health links.
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Affiliation(s)
- Andrea Gabilondo
- Outpatient Mental Health Network of Gipuzkoa, Basque Health System (Osakidetza), San Sebastián, Spain; Biodonostia Health Research Institute, Basque Health System (Osakidetza), San Sebastián, Spain; CiberSam, Network Centre for Biomedical Research in Mental Health, Spain.
| | - Ana Gonzalez-Pinto
- CiberSam, Network Centre for Biomedical Research in Mental Health, Spain; University Hospital of Araba, Basque Health System (Osakidetza), Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Basque Health System (Osakidetza), Vitoria-Gasteiz, Spain
| | - Jon Garcia
- Outpatient Mental Health Network of Bizkaia, Basque Health System (Osakidetza), Bilbao, Spain; Biocruces Health Research Institute, Basque Health System (Osakidetza), Bilbao, Spain
| | - David Del Valle
- Basque Institute of Legal Medicine, San Sebastián, Bilbao, Vitoria-Gasteiz, Spain
| | - Benito Morentin
- Basque Institute of Legal Medicine, San Sebastián, Bilbao, Vitoria-Gasteiz, Spain
| | - Alvaro Iruin
- Outpatient Mental Health Network of Gipuzkoa, Basque Health System (Osakidetza), San Sebastián, Spain; Biodonostia Health Research Institute, Basque Health System (Osakidetza), San Sebastián, Spain
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25
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Kim H, Son Y, Lee H, Kang J, Hammoodi A, Choi Y, Kim HJ, Lee H, Fond G, Boyer L, Kwon R, Woo S, Yon DK. Machine Learning-Based Prediction of Suicidal Thinking in Adolescents by Derivation and Validation in 3 Independent Worldwide Cohorts: Algorithm Development and Validation Study. J Med Internet Res 2024; 26:e55913. [PMID: 38758578 PMCID: PMC11143390 DOI: 10.2196/55913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Suicide is the second-leading cause of death among adolescents and is associated with clusters of suicides. Despite numerous studies on this preventable cause of death, the focus has primarily been on single nations and traditional statistical methods. OBJECTIVE This study aims to develop a predictive model for adolescent suicidal thinking using multinational data sets and machine learning (ML). METHODS We used data from the Korea Youth Risk Behavior Web-based Survey with 566,875 adolescents aged between 13 and 18 years and conducted external validation using the Youth Risk Behavior Survey with 103,874 adolescents and Norway's University National General Survey with 19,574 adolescents. Several tree-based ML models were developed, and feature importance and Shapley additive explanations values were analyzed to identify risk factors for adolescent suicidal thinking. RESULTS When trained on the Korea Youth Risk Behavior Web-based Survey data from South Korea with a 95% CI, the XGBoost model reported an area under the receiver operating characteristic (AUROC) curve of 90.06% (95% CI 89.97-90.16), displaying superior performance compared to other models. For external validation using the Youth Risk Behavior Survey data from the United States and the University National General Survey from Norway, the XGBoost model achieved AUROCs of 83.09% and 81.27%, respectively. Across all data sets, XGBoost consistently outperformed the other models with the highest AUROC score, and was selected as the optimal model. In terms of predictors of suicidal thinking, feelings of sadness and despair were the most influential, accounting for 57.4% of the impact, followed by stress status at 19.8%. This was followed by age (5.7%), household income (4%), academic achievement (3.4%), sex (2.1%), and others, which contributed less than 2% each. CONCLUSIONS This study used ML by integrating diverse data sets from 3 countries to address adolescent suicide. The findings highlight the important role of emotional health indicators in predicting suicidal thinking among adolescents. Specifically, sadness and despair were identified as the most significant predictors, followed by stressful conditions and age. These findings emphasize the critical need for early diagnosis and prevention of mental health issues during adolescence.
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Affiliation(s)
- Hyejun Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Applied Information Engineering, Yonsei University, Seoul, Republic of Korea
| | - Yejun Son
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Hojae Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, Republic of Korea
| | - Jiseung Kang
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Ahmed Hammoodi
- Department of Business Administration, Kyung Hee University School of Management, Seoul, Republic of Korea
| | - Yujin Choi
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Korean Medicine, Kyung Hee University College of Korean Medicine, Seoul, Republic of Korea
| | - Hyeon Jin Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, Republic of Korea
| | - Hayeon Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Guillaume Fond
- Assistance Publique-Hôpitaux de Marseille (APHM), CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Laurent Boyer
- Assistance Publique-Hôpitaux de Marseille (APHM), CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - Rosie Kwon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Selin Woo
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, Republic of Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
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26
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Ku BS, Barrera Flores FJ, Congdon P, Yuan Q, Druss BG. The association between county-level mental health provider shortage areas and suicide rates in the United States during the COVID-19 pandemic. Gen Hosp Psychiatry 2024; 88:48-50. [PMID: 38492445 PMCID: PMC10999330 DOI: 10.1016/j.genhosppsych.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Prior literature has shown that mental health provider Health Professional Shortage Areas (MHPSAs) experienced a greater increase in suicide rates compared to non-shortage areas from 2010 to 2018. Although suicide rates have been on the rise, rates have slightly decreased during the COVID-19 pandemic. This study sought to characterize the differences in suicide rate trends during the pandemic by MHPSA status. METHOD We used generalized estimating equation regression to test the associations between MHPSA status and suicide rates from 2018 to 2021. Suicide deaths were obtained from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research. RESULTS MHPSA status was associated with higher suicide rates (adjusted IRR:1.088 [95% CI, 1.024-1.156]). Furthermore, there was a significant interaction between MHPSA status and year (adjusted IRR:1.056 [95% CI, 1.022-1.091]), such that suicide rates did not significantly change among MHPSAs but slightly decreased among non-MHPSAs from 2018 to 2021. CONCLUSIONS During the COVID-19 pandemic, there was a slight decrease in suicide rates among non-MHPSAs, while those with shortages experienced no significant changes in suicide rates. It will be important to closely monitor MHPSAs as continued at-risk regions for suicide as trendlines return to their pre-pandemic patterns.
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Affiliation(s)
- Benson S Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | | | - Peter Congdon
- School of Geography, Queen Mary University of London, London E1 4NS, UK
| | - Qingyue Yuan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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27
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Aharon G, Aisenberg-Shafran D, Levi-Belz Y. Adherence to Masculinity Norms and Depression Symptoms Among Israeli Men: The Moderating Role of Psychological Flexibility. Am J Mens Health 2024; 18:15579883241253820. [PMID: 38794957 PMCID: PMC11128175 DOI: 10.1177/15579883241253820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/27/2024] Open
Abstract
Being a man has been recognized as a salient risk factor for suicide. Adopting uncompromised masculine perceptions (i.e., conforming to the masculine gender role norms) may restrict emotional expressiveness in men, which, in turn, may contribute to depression and somatization symptoms. We examined the moderating role of psychological flexibility and alexithymia in the relationship of masculinity with depression and somatization symptoms. A sample of 119 men completed measures of masculinity, alexithymia (difficulty identifying and delivering subjective feelings), psychological flexibility, depression, and somatization symptoms in a cross-sectional design study. Psychological flexibility levels moderated the relationship between masculinity and depression symptoms: Masculinity contributed as positively associated with depression symptoms when psychological flexibility was low, but no such association was found at moderate or high levels of psychological flexibility. As a cognitive factor promoting adaptive emotional regulation, psychological flexibility might reduce depression symptoms among inflexible masculine men. Clinical implications relate to diagnosing at-risk subgroups and their treatment.
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Affiliation(s)
- Gal Aharon
- Ruppin Academic Center, Emek Hefer, Israel
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28
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Tsindos G, Scurrah K, Benakovic R, Reynolds KA, King K. Exploring the Association Between Help-Seeking Intentions and Suicidal Ideation in Australian Adult Men. CRISIS 2024; 45:234-241. [PMID: 38441130 DOI: 10.1027/0227-5910/a000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Background: Men account for three-quarters of suicide deaths in Australia. Self-reliant masculine norms may act as barriers to men's help-seeking and contribute to suicidal ideation. Men who seek help may be less likely to experience suicidal ideation. Aim: We evaluated the association between help-seeking intentions and suicidal ideation in Australian adult men using data from Wave 2 of the Australian Longitudinal Study on Male Health (Ten to Men). Method: Using scores on the General Help-Seeking Questionnaire, we explored the association between informal help-seeking intentions (e.g., friend, family), formal help-seeking intentions (e.g., psychologist), overall help-seeking intentions (all sources), and new-onset suicidal ideation. We conducted logistic regression analyses using a sample of 7,828 men aged 18-60 years. Results: Increased overall help-seeking intentions and informal help-seeking intentions were significantly associated with lower odds of new-onset suicidal ideation, whereas formal help-seeking intentions were not significantly associated. Limitations: The cross-sectional design limits inferences about causality. Conclusion: Men who have greater informal help-seeking intentions may be less likely to experience a new onset of suicidal ideation; however, more longitudinal research is needed.
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Affiliation(s)
- Georgia Tsindos
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Katrina Scurrah
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
- Data and Lifecourse Studies, Australian Institute of Family Studies, Melbourne, VIC, Australia
| | - Ruben Benakovic
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Kate A Reynolds
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Kylie King
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
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29
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Xu L, Liu C, Liu Q, Wang X, Yang Z, Liang M, Liu Z. A special type of homicide-suicide: A retrospective study of the characteristics of extended suicide. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 94:101987. [PMID: 38663173 DOI: 10.1016/j.ijlp.2024.101987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/09/2024] [Accepted: 04/17/2024] [Indexed: 06/15/2024]
Abstract
Extended suicide, a specific type of homicide-suicide event, has severe social consequences yet remains lacking systematic research. This retrospective study investigated 51 cases of extended suicide involving mental disorders in central China with aim of better understanding risk factors for such events and guiding prevention strategies. Over an 8-year period from 2015 to 2022, cases were collected from forensic institutions, and demographic characteristics, case details, and psychiatric data were recorded. The 51 incidents involved 51 perpetrators and 79 victims, with more female perpetrators (58.8%) and more female victims (54.4%). The average age of the perpetrators was 36.1, and most were married (88.2%). Almost all of the victims were family members of the perpetrator, like the most numerous children (64.6%), followed by spouses (24.1%). The most common homicide mode of death was mechanical asphyxia (38.0%), followed by sharp devices (36.7%) and drug poisoning (16.5%). Depressive disorders (76.5%) were the most common diagnosis of mental disorder for perpetrators. The study analyzed the unique characteristics of extended suicide to enrich such data. These findings help strengthen the screening and identification of potential perpetrators and victims to prevent such cases from occurring.
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Affiliation(s)
- Luyao Xu
- Department of Forensic Medicine, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Cong Liu
- Department of Forensic Medicine, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Quan Liu
- Hubei Key Laboratory of the Forensic Science (Hubei University of Police), Wuhan 430035, China
| | - Xuemei Wang
- Department of Forensic Medicine, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ziqian Yang
- Department of Forensic Medicine, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Man Liang
- Department of Forensic Medicine, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Zilong Liu
- Department of Forensic Medicine, Huazhong University of Science and Technology, Wuhan 430030, China.
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Sattler A, Dunn J, Albarran M, Berger C, Calugar A, Carper J, Chirravuri L, Jawad N, Zein M, McGovern M. Asynchronous Versus Synchronous Screening for Depression and Suicidality in a Primary Health Care System: Quality Improvement Study. JMIR Ment Health 2024; 11:e50192. [PMID: 38712997 PMCID: PMC11082433 DOI: 10.2196/50192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 02/10/2024] [Accepted: 02/27/2024] [Indexed: 05/08/2024] Open
Abstract
Background Despite being a debilitating, costly, and potentially life-threatening condition, depression is often underdiagnosed and undertreated. Previsit Patient Health Questionnaire-9 (PHQ-9) may help primary care health systems identify symptoms of severe depression and prevent suicide through early intervention. Little is known about the impact of previsit web-based PHQ-9 on patient care and safety. Objective We aimed to investigate differences among patient characteristics and provider clinical responses for patients who complete a web-based (asynchronous) versus in-clinic (synchronous) PHQ-9. Methods This quality improvement study was conducted at 33 clinic sites across 2 health systems in Northern California from November 1, 2020, to May 31, 2021, and evaluated 1683 (0.9% of total PHQs completed) records of patients endorsing thoughts that they would be better off dead or of self-harm (question 9 in the PHQ-9) following the implementation of a depression screening program that included automated electronic previsit PHQ-9 distribution. Patient demographics and providers' clinical response (suicide risk assessment, triage nurse connection, medication management, electronic consultation with psychiatrist, and referral to social worker or psychiatrist) were compared for patients with asynchronous versus synchronous PHQ-9 completion. Results Of the 1683 patients (female: n=1071, 63.7%; non-Hispanic: n=1293, 76.8%; White: n=831, 49.4%), Hispanic and Latino patients were 40% less likely to complete a PHQ-9 asynchronously (odds ratio [OR] 0.6, 95% CI 0.45-0.8; P<.001). Patients with Medicare insurance were 36% (OR 0.64, 95% CI 0.51-0.79) less likely to complete a PHQ-9 asynchronously than patients with private insurance. Those with moderate to severe depression were 1.61 times more likely (95% CI 1.21-2.15; P=.001) to complete a PHQ-9 asynchronously than those with no or mild symptoms. Patients who completed a PHQ-9 asynchronously were twice as likely to complete a Columbia-Suicide Severity Rating Scale (OR 2.41, 95% CI 1.89-3.06; P<.001) and 77% less likely to receive a referral to psychiatry (OR 0.23, 95% CI 0.16-0.34; P<.001). Those who endorsed question 9 "more than half the days" (OR 1.62, 95% CI 1.06-2.48) and "nearly every day" (OR 2.38, 95% CI 1.38-4.12) were more likely to receive a referral to psychiatry than those who endorsed question 9 "several days" (P=.002). Conclusions Shifting depression screening from in-clinic to previsit led to a dramatic increase in PHQ-9 completion without sacrificing patient safety. Asynchronous PHQ-9 can decrease workload on frontline clinical team members, increase patient self-reporting, and elicit more intentional clinical responses from providers. Observed disparities will inform future improvement efforts.
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Affiliation(s)
- Amelia Sattler
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Julia Dunn
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Marleni Albarran
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Charlotte Berger
- Technology and Digital Solutions, Stanford Health Care, Palo Alto, CA, United States
| | - Ana Calugar
- Department of Quality, Stanford Health Care, Stanford, CA, United States
| | - John Carper
- University Healthcare Alliance, Stanford, CA, United States
| | | | - Nadine Jawad
- Stanford University School of Medicine, Palo Alto, CA, United States
| | - Mira Zein
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Mark McGovern
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
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McIntyre RS. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and suicidality: what do we know and future vistas. Expert Opin Drug Saf 2024; 23:539-542. [PMID: 38520274 DOI: 10.1080/14740338.2024.2335215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Ontario Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario Canada
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
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Britton PC, Karras E, Stecker T, Klein J, Crasta D, Brenner LA, Pigeon WR. The Veterans Crisis Line: Relations among immediate call outcomes and treatment contact and utilization following the call. Suicide Life Threat Behav 2024. [PMID: 38687175 DOI: 10.1111/sltb.13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Crisis line callers experience reductions in distress and suicidal ideation and utilize more health care following calls. The purpose of this study was to determine whether changes in distress and suicidal ideation during a call are associated with later healthcare contact and utilization. METHOD Veterans Crisis Line calls from 599 veterans were extracted with call dates between 12/1/2018 and 11/30/2019. Calls were coded for changes in distress and suicidal ideation and linked with VA medical records to obtain healthcare data. Generalized Linear Mixed Modeling was used to examine the associations of changes in distress and suicidal ideation with healthcare contact (yes/no) and utilization (days of treatment) in the month (30 days) following the call. RESULTS Reductions in distress were associated with behavioral (i.e., mental and substance use) healthcare utilization, F(1, 596) = 4.52, p = 0.03, and reductions in suicidal ideation were associated with any healthcare utilization, F(1, 596) = 6.45, p = 0.01. Changes in distress and suicidal ideation were not associated with healthcare contact. CONCLUSION Responders need to help resolve distress and suicidal ideation and link callers with treatment. Unresolved distress and suicidal thoughts may signify later problems with treatment utilization. Research is needed to determine causality.
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Affiliation(s)
- Peter C Britton
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Elizabeth Karras
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Tracy Stecker
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John Klein
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
| | - Dev Crasta
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Lisa A Brenner
- Rocky Mountain MIRECC for Suicide Prevention, VA Eastern Colorado Health Care System, Denver, Colorado, USA
- Department of Psychiatry, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Wilfred R Pigeon
- Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, Canandaigua VA Medical Center, Canandaigua, New York, USA
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
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Stas P, Hoorelbeke K, De Jaegere E, Pauwels K, Portzky G. Suicide risk, related factors and the impact of COVID-19 amongst suicide prevention helpline callers: A network analysis. J Affect Disord 2024; 351:372-380. [PMID: 38302063 DOI: 10.1016/j.jad.2024.01.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The COVID-19 pandemic brought along many known risk factors for suicide. It is important to map out contributing and protective factors for suicide risk and examine possible changes in these associations during pandemics such as COVID-19. The current study aimed to examine how information on risk and protective factors obtained through a suicide prevention helpline is linked to the assessed suicide risk and the possible impact of the COVID-19 pandemic. METHODS Data on 9474 calls registered by operators of the suicide prevention helpline of Flanders (i.e., part of Belgium) were analysed using network analysis. Using network analyses allowed for a data-driven examination of direct and indirect pathways through which risk and protective factors are associated to perceived suicide risk. The network before and during COVID-19 were compared to examine the possible impact of the pandemic. RESULTS Our findings suggest that different vulnerability and protective factors contribute to perceived suicide risk. Experiencing a break-up, abuse, previous attempt(s), experienced difficulties with the healthcare system and availability of resources were directly and uniquely associated with perceived suicide risk before and during COVID-19. LIMITATIONS Main limitations of this study are the possible bias of operator assessment accuracy, absence of several important psychological risk factors and the use of cross-sectional data. CONCLUSIONS The current study provides insight in the effect of COVID-19 on suicidality and its risk and protective factors amongst suicide prevention helpline users, a population with high risk of suicide. Implications for suicide prevention helplines are discussed.
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Affiliation(s)
- Pauline Stas
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium.
| | - Kristof Hoorelbeke
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Eva De Jaegere
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Kirsten Pauwels
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium; Suicide Prevention Centre, Brussels, Belgium
| | - Gwendolyn Portzky
- Flemish Centre of Expertise in Suicide Prevention, Department of Head and Skin, Ghent University, Ghent, Belgium
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Jeong H, Yim HW, Lee SY, Park M, Ko W. The effectiveness of a suicide prevention program in primary care clinics supported by community public health resources: A difference-in-differences analysis. Psychiatry Res 2024; 334:115803. [PMID: 38412714 DOI: 10.1016/j.psychres.2024.115803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 02/29/2024]
Abstract
The importance of appropriate and intensive follow-up management for individuals identified with suicide risk through screening is highlighted. The Link between Primary Care Clinic and Public Health Resources Intervention(LinkPC-PH), a suicide prevention program in primary care clinics supported by community public health resources, was implemented at the district level in 2017. The purpose of the present study is to evaluate the effectiveness of the LinkPC-PH intervention by comparing suicide rates before(2014-2016) and after(2017-2019) implementation of the intervention using a difference-in-differences design. The LinkPC-PH comprises several dimensions of intervention including screening, risk assessment of suicidality, and referral in primary care clinics and crisis contact within 24 hours, case management, and safety planning led by public health professionals. After adjustment for district-level confounders, an intervention-implemented district had 2.87 fewer suicide deaths per 100,000 people in a population sample at post-intervention than would have been expected from the same trend in suicide rates as non-implemented intervention districts. In other words, the suicide rate in the intervention area decreased by 25% following the intervention. These results empirically substantiate suicide prevention programs in primary care clinics by community public health resources for reduced suicide rates to support effective community-based suicide prevention interventions.
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Affiliation(s)
- Hyunsuk Jeong
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Rep. of Korea
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Rep. of Korea.
| | - Seung-Yup Lee
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Rep of Korea
| | - Misun Park
- Department of Biostatistics, Clinical Research Coordinating Center, The Catholic University of Korea, Seoul, Rep of Korea
| | - Woolim Ko
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Rep. of Korea
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Carson NJ, Yang X, Mullin B, Stettenbauer E, Waddington M, Zhang A, Williams P, Rios Perez GE, Cook BL. Predicting adolescent suicidal behavior following inpatient discharge using structured and unstructured data. J Affect Disord 2024; 350:382-387. [PMID: 38158050 PMCID: PMC10923087 DOI: 10.1016/j.jad.2023.12.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/30/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The objective was to develop and assess performance of an algorithm predicting suicide-related ICD codes within three months of psychiatric discharge. METHODS This prognostic study used a retrospective cohort of EHR data from 2789 youth (12 to 20 years old) hospitalized in a safety net institution in the Northeastern United States. The dataset combined structured data with unstructured data obtained through natural language processing of clinical notes. Machine learning approaches compared gradient boosting to random forest analyses. RESULTS Area under the ROC and precision-recall curve were 0.88 and 0.17, respectively, for the final Gradient Boosting model. The cutoff point of the model-generated predicted probabilities of suicide that optimally classified the individual as high risk or not was 0.009. When applying the chosen cutoff (0.009) to the hold-out testing set, the model correctly identified 8 positive cases out of 10, and 418 negative cases out 548. The corresponding performance metrics showed 80 % sensitivity, 76 % specificity, 6 % PPV, 99 % NPV, F-1 score of 0.11, and an accuracy of 76 %. LIMITATIONS The data in this study comes from a single health system, possibly introducing bias in the model's algorithm. Thus, the model may have underestimated the incidence of suicidal behavior in the study population. Further research should include multiple system EHRs. CONCLUSIONS These performance metrics suggest a benefit to including both unstructured and structured data in design of predictive algorithms for suicidal behavior, which can be integrated into psychiatric services to help assess risk.
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Affiliation(s)
- Nicholas J Carson
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02139, USA.
| | - Xinyu Yang
- Parexel, 275 Grove St., Suite 101C, Newton, MA 02466, USA
| | - Brian Mullin
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02139, USA
| | | | - Marin Waddington
- Division of Gastroenterology at Brigham and Women's Hospital, Resnek Family Center for PSC Research, 75 Francis Street, Boston, MA 02115, USA
| | - Alice Zhang
- Department of Psychology, New York University, 6 Washington Place, New York, NY 10003, USA
| | - Peyton Williams
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02139, USA
| | - Gabriel E Rios Perez
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02139, USA
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02139, USA
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Zerach G, Levinstein Y, Levi-Belz Y. Longitudinal associations between exposure to potentially morally injurious events and suicidal ideation among recently discharged veterans - The mediating roles of depression and loneliness. J Affect Disord 2024; 350:689-697. [PMID: 38224741 DOI: 10.1016/j.jad.2024.01.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Exposure to potentially morally injurious events (PMIEs) during military service is associated with heightened suicidal ideation (SI). However, no longitudinal study has established temporal associations between these variables and examined the possible mediating roles of depression and loneliness in this effect. METHODS Participants were 374 active-duty Israeli combatants who participated in a five-year longitudinal study with four measurement points: T1- one year before enlistment, T2- one month before discharge from army service, and then again six months and twelve months following their discharge (T3 and T4, respectively). Data were assessed through semi-structured interviews and validated self-report questionnaires. RESULTS Above and beyond pre-enlistment personal characteristics (T1) and combat exposure (T2), PMIEs-'betrayal' (T2) predicted more frequent SI over the past twelve months (T4) through the mediation of depression. Moreover, both PMIEs-'betrayal' and 'self' (T2) predicted more frequent SI over the past twelve months (T4) through the mediation of loneliness. LIMITATIONS We used self-report measures to assess PMIEs and SI, which may suffer from various biases. CONCLUSIONS Our findings are the first to provide evidence of longitudinal, temporal associations between exposure to PMIEs and SI. Notably, potential interventions might consider addressing the loneliness experienced following exposure to PMIEs during military service, among recently discharged traumatized veterans.
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Affiliation(s)
- Gadi Zerach
- Dept. of Psychology, Ariel University, Ariel, Israel.
| | - Yoav Levinstein
- Dept. of Health and Well-being, Medical Corps, IDF, School of Social Work, Bar-Ilan University, Ramat-Gan, Israel
| | - Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
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Daglas Z, Lu S, Gresham D, Tatnell R, Stanley BH, Melvin GA. Classifying coping strategies from suicide prevention safety plans. Suicide Life Threat Behav 2024; 54:275-285. [PMID: 38300145 DOI: 10.1111/sltb.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 08/18/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Understanding the specific strategies individuals use to cope with their suicidal thoughts may have implications for suicide prevention. This study developed a classification system of coping strategies and applied this system to individual coping behaviors documented in a safety planning intervention smartphone application called Beyond Now. METHOD 725 Beyond Now safety planning app users, aged 16 to over 55 years, entered coping strategies that were used to develop a classification system through content analysis. Entries were either user generated or selected from a list of suggested coping strategies, and 2960 entries were classified using the system. RESULTS Our classification system featured 11 distinct descriptive categories, with media consumption being the most popular coping strategy among Beyond Now users, followed by relaxation and self-care activities, exercise and creative activities. More than half (57%) of the entries were suggested coping strategies with the remainder being user-generated entries (43%). CONCLUSION A wide range of coping strategies were entered into safety plans, with activities that aim to either distract or provide reductions in emotional arousal common. Future research is needed to evaluate the efficacy of the coping strategies listed in safety plans.
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Affiliation(s)
- Zoe Daglas
- School of Psychology, SEED Lifespan, Deakin University, Geelong, Victoria, Australia
| | - Sinh Lu
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Daniel Gresham
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Ruth Tatnell
- School of Psychology, SEED Lifespan, Deakin University, Geelong, Victoria, Australia
| | - Barbara H Stanley
- Department of Psychiatry, Columbia University, New York, New York, USA
| | - Glenn A Melvin
- School of Psychology, SEED Lifespan, Deakin University, Geelong, Victoria, Australia
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McMahon EM, Cully G, Corcoran P, Arensman E, Griffin E. Advancing early detection of suicide? A national study examining socio-demographic factors, antecedent stressors and long-term history of self-harm. J Affect Disord 2024; 350:372-378. [PMID: 38232777 DOI: 10.1016/j.jad.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 12/04/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND A range of factors including mental disorders, adverse events and history of self-harm are associated with suicide risk. Further examination is needed of the characteristics of suicides which occur without established risk factors, using national surveillance systems. METHODS Data on all suicides in Ireland from 2015 to 2017 were drawn from the Irish Probable Suicide Deaths Study (IPSDS). Variables examined included socio-demographics, psychiatric history and precipitant stressors. Suicide data were linked with data on prior self-harm from the National Self-Harm Registry Ireland (NSHRI). Latent Class Analysis (LCA) was used to identify sub-groups of suicide cases. RESULTS Of the 1809 individuals who died by suicide, 401 (22.2 %) had a history of hospital-treated self-harm. Four distinct profiles of suicides were identified. One group was marked by high levels of prior self-harm and mental health conditions. Two of the groups included few individuals with a history of self-harm but had notably high levels of mental health conditions. These two groups had relatively high levels of reported chronic pain or illness but differed in terms of socio-demographics. The final group, predominantly male, had markedly low levels of mental health conditions or self-harm but high levels of personal stressors and substance use. LIMITATIONS The use of coronial data may be limited by bias in the collecting of information from the deceased's family members. CONCLUSIONS A sub-group of suicide cases exists without any psychiatric or self-harm history but with salient occupational or health-related proximal stressors. Suicide prevention interventions should include occupational settings and should promote mental health literacy.
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Affiliation(s)
- E M McMahon
- School of Public Health, University College Cork, Cork, Ireland; National Suicide Research Foundation, Cork, Ireland.
| | - G Cully
- School of Public Health, University College Cork, Cork, Ireland; National Suicide Research Foundation, Cork, Ireland
| | - P Corcoran
- School of Public Health, University College Cork, Cork, Ireland; National Suicide Research Foundation, Cork, Ireland
| | - E Arensman
- School of Public Health, University College Cork, Cork, Ireland; National Suicide Research Foundation, Cork, Ireland; Australian Institute for Suicide Research and Prevention, School of Applied Psychology, Griffith University, Brisbane, Australia
| | - E Griffin
- School of Public Health, University College Cork, Cork, Ireland; National Suicide Research Foundation, Cork, Ireland
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Zisook S, Moutier CY, Rush AJ, Johnson GR, Tal I, Chen PJ, Davis LL, Hicks PB, Wilcox J, Planeta B, Lauro KW, Scrymgeour AA, Kasckow J, Mohamed S. Effect of next-step antidepressant treatment on suicidal ideation: findings from the VAST-D trial. Psychol Med 2024; 54:1172-1183. [PMID: 37859623 DOI: 10.1017/s0033291723003008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) contributes to suicide risk. Treating MDD effectively is considered a key suicide prevention intervention. Yet many patients with MDD do not respond to their initial medication and require a 'next-step'. The relationship between next-step treatments and suicidal thoughts and behaviors is uncharted. METHOD The VA Augmentation and Switching Treatments for Depression trial randomized 1522 participants to one of three next-step treatments: Switching to Bupropion, combining with Bupropion, and augmenting with Aripiprazole. In this secondary analysis, features associated with lifetime suicidal ideation (SI) and attempts (SA) at baseline and current SI during treatment were explored. RESULTS Compared to those with SI only, those with lifetime SI + SA were more likely to be female, divorced, or separated, unemployed; and to have experienced more childhood adversity. They had a more severe depressive episode and were more likely to respond to 'next-step' treatment. The prevalence of SI decreased from 46.5% (694/1492) at baseline to 21.1% (315/1492) at end-of-treatment. SI during treatment was associated with baseline SI; low positive mental health, more anxiety, greater severity and longer duration of current MDD episode; being male and White; and treatment with S-BUP or C-BUP as compared to A-ARI. CONCLUSION SI declines for most patients during next-step medication treatments. But about 1 in 5 experienced emergent or worsening SI during treatment, so vigilance for suicide risk through the entire 12-week acute treatment period is necessary. Treatment selection may affect the risk of SI.
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Affiliation(s)
- Sidney Zisook
- University of California San Diego, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | | | - A John Rush
- Duke Medical School, Durham, NC, USA
- Duke-National University of Singapore, Singapore
| | - Gary R Johnson
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ilanit Tal
- VA San Diego Healthcare System, San Diego, CA, USA
| | - P J Chen
- Department of Psychiatry, VA Northeast Ohio Healthcare System, and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lori L Davis
- Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA
| | - Paul B Hicks
- Department of Psychiatry, Texas A&M College of Medicine, Temple, TX, USA
| | - James Wilcox
- Department of Veterans Affairs, Phoenix, AZ, USA
| | - Beata Planeta
- Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | | | - Alexandra A Scrymgeour
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM, USA
| | - John Kasckow
- University of Pittsburgh Physicians, Pittsburgh, PA, USA
| | - Somaia Mohamed
- Veterans Affairs (VA) New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, CT, USA
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Mortier P, Amigo F, Bhargav M, Conde S, Ferrer M, Flygare O, Kizilaslan B, Latorre Moreno L, Leis A, Mayer MA, Pérez-Sola V, Portillo-Van Diest A, Ramírez-Anguita JM, Sanz F, Vilagut G, Alonso J, Mehlum L, Arensman E, Bjureberg J, Pastor M, Qin P. Developing a clinical decision support system software prototype that assists in the management of patients with self-harm in the emergency department: protocol of the PERMANENS project. BMC Psychiatry 2024; 24:220. [PMID: 38509500 PMCID: PMC10956300 DOI: 10.1186/s12888-024-05659-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Self-harm presents a significant public health challenge. Emergency departments (EDs) are crucial healthcare settings in managing self-harm, but clinician uncertainty in risk assessment may contribute to ineffective care. Clinical Decision Support Systems (CDSSs) show promise in enhancing care processes, but their effective implementation in self-harm management remains unexplored. METHODS PERMANENS comprises a combination of methodologies and study designs aimed at developing a CDSS prototype that assists clinicians in the personalized assessment and management of ED patients presenting with self-harm. Ensemble prediction models will be constructed by applying machine learning techniques on electronic registry data from four sites, i.e., Catalonia (Spain), Ireland, Norway, and Sweden. These models will predict key adverse outcomes including self-harm repetition, suicide, premature death, and lack of post-discharge care. Available registry data include routinely collected electronic health record data, mortality data, and administrative data, and will be harmonized using the OMOP Common Data Model, ensuring consistency in terminologies, vocabularies and coding schemes. A clinical knowledge base of effective suicide prevention interventions will be developed rooted in a systematic review of clinical practice guidelines, including quality assessment of guidelines using the AGREE II tool. The CDSS software prototype will include a backend that integrates the prediction models and the clinical knowledge base to enable accurate patient risk stratification and subsequent intervention allocation. The CDSS frontend will enable personalized risk assessment and will provide tailored treatment plans, following a tiered evidence-based approach. Implementation research will ensure the CDSS' practical functionality and feasibility, and will include periodic meetings with user-advisory groups, mixed-methods research to identify currently unmet needs in self-harm risk assessment, and small-scale usability testing of the CDSS prototype software. DISCUSSION Through the development of the proposed CDSS software prototype, PERMANENS aims to standardize care, enhance clinician confidence, improve patient satisfaction, and increase treatment compliance. The routine integration of CDSS for self-harm risk assessment within healthcare systems holds significant potential in effectively reducing suicide mortality rates by facilitating personalized and timely delivery of effective interventions on a large scale for individuals at risk of suicide.
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Grants
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- AC22/00006; AC22/00045 Instituto de Salud Carlos III (ISCIII) and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia
- ESF+; CP21/00078 ISCIII-FSE Miguel Servet co-funded by the European Social Fund Plus
- PI22/00107 ISCIII and co-funded by the European Union
- PI22/00107 ISCIII and co-funded by the European Union
- PI22/00107 ISCIII and co-funded by the European Union
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- 202220-30-31 Fundación la Marató de TV3
- FI23/00004 PFIS ISCIII
- FI23/00004 PFIS ISCIII
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- SGR 00624 the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- CIBERESP; CB06/02/0046 CIBER of Epidemiology & Public Health
- ERAPERMED2022 the Health Research Board Ireland
- ERAPERMED2022 the Health Research Board Ireland
- no. 2022-00549 the Swedish Innovation Agency
- no. 2022-00549 the Swedish Innovation Agency
- project no. 342386 the Research Council of Norway
- project no. 342386 the Research Council of Norway
- project no. 342386 the Research Council of Norway
- the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement of the Generalitat de Catalunya AGAUR 2021
- CIBER of Epidemiology & Public Health
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Affiliation(s)
- Philippe Mortier
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain.
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain.
| | - Franco Amigo
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
| | - Madhav Bhargav
- School of Public Health & National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Susana Conde
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
| | - Montse Ferrer
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Oskar Flygare
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Busenur Kizilaslan
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Laura Latorre Moreno
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
| | - Angela Leis
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Miguel Angel Mayer
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Víctor Pérez-Sola
- Neuropsychiatry and Drug Addiction Institute, Barcelona MAR Health Park Consortium PSMAR, Barcelona, Spain
- CIBER of Mental Health and Carlos III Health Institute (CIBERSAM, ISCIII), Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public Health Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ana Portillo-Van Diest
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
| | - Juan Manuel Ramírez-Anguita
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ferran Sanz
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- National Bioinformatics Institute - ELIXIR-ES (IMPaCT-Data-ISCIII), Barcelona, Spain
| | - Gemma Vilagut
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
| | - Jordi Alonso
- Hospital del Mar Research Institute, Barcelona Biomedical Research Park (PRBB), Carrer Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Carlos III Health Institute (CIBERESP, ISCIII), Madrid, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ella Arensman
- School of Public Health & National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Manuel Pastor
- Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Wexler L, Ginn J, White L, Schmidt T, Rataj S, Wells CC, Schultz K, Kapoulea EA, McEachern D, Habecker P, Laws H. Considering the importance of 'Communities of Practice' and Health Promotion Constructs for Upstream Suicide Prevention. RESEARCH SQUARE 2024:rs.3.rs-3976483. [PMID: 38559170 PMCID: PMC10980165 DOI: 10.21203/rs.3.rs-3976483/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Suicide is a serious and growing health inequity for Alaska Native (AN) youth (ages 15-24), who experience suicide rates significantly higher than the general U.S. youth population. In low-resourced, remote communities, building on the local and cultural resources found in remote AN communities to increase uptake of prevention behaviors like lethal means reduction, interpersonal support, and postvention can be more effective at preventing suicide than a risk-referral process. This study expands the variables we hypothesize as important for reducing suicide risk and supporting wellbeing. These variables are: 1) perceived suicide prevention self-efficacy, 2) perceived wellness self-efficacy, and 3) developing a 'community of practice' (CoP) for prevention/wellness work. Method With a convenience sample (N = 398) of participants (ages 15+) in five remote Alaska Native communities, this study characterizes respondents' social roles: institutional role if they have a job that includes suicide prevention (e.g. teachers, community health workers) and community role if their primary role is based on family or community positioning (e.g. Elder, parent). The cross-sectional analysis then explores the relationship between respondents' wellness and prevention self-efficacy and CoP as predictors of their self-reported suicide prevention and wellness promotion behaviors: (1) working together with others (e.g. community initiatives), (2) offering interpersonal support to someone, (3) reducing access to lethal means, and (4) reducing suicide risk for others after a suicide death in the community. Results Community and institutional roles are vital, and analyses detected distinct patterns linking our dependent variables to different preventative behaviors. Findings associated wellness self-efficacy and CoP (but not prevention self-efficacy) with 'working together' behaviors, wellness and prevention self-efficacy (but not CoP) with interpersonal supportive behaviors; both prevention self-efficacy and CoP with higher postvention behaviors. Only prevention self-efficacy was associated with lethal means reduction. Conclusions The study widens the scope of suicide prevention. Promising approaches to suicide prevention in rural low-resourced communities include: (1) engaging people in community and institutional roles, (2) developing communities of practice for suicide prevention among different sectors of a community, and (3) broadening the scope of suicide prevention to include wellness promotion as well as suicide prevention.
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Fletcher CME, Woolford D, Gladigau J, Gunn KM. A 'Vocal Locals' social network campaign is associated with increased frequency of conversations about mental health and improved engagement in wellbeing-promoting activities in an Australian farming community. BMC Public Health 2024; 24:673. [PMID: 38431599 PMCID: PMC10909292 DOI: 10.1186/s12889-024-18193-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/23/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Farmers face numerous barriers to accessing professional mental health services and instead report a preference for informal support systems, such as lay or peer networks. Farmers also experience barriers to investing time in maintaining or improving their wellbeing, stemming from sociocultural norms and attitudes that are widespread in agricultural communities. The Vocal Locals social network campaign is an ifarmwell initiative that aims to promote conversations about wellbeing and challenge attitudes and behaviours that contribute to farmers' poor mental health. METHODS The Vocal Locals campaign was underpinned by the socio-ecological model which explains human behaviour as stemming from interactions between the individual, their closest social circle, the community, and broader society. The campaign ran in Loxton, South Australia, from June to August 2022. Ten community members (8/10 farmers) became 'Vocal Locals' and were supported to share 'calls-to-action' to encourage people in their social networks to engage in wellbeing-promoting activities. A broader communications campaign reinforced key messages and amplified Vocal Locals' activities in the community. The intrapersonal and community-level impacts of the campaign were evaluated via pre- and post-campaign surveys of Vocal Locals and community members respectively. RESULTS Vocal Locals reported significantly lower psychological distress (p = .014), and higher positive mental wellbeing (p = .011), levels of general mental health knowledge (p = .022), and confidence helping someone with poor mental health (p = .004) following the intervention. However, changes in stigmatising beliefs about mental illness, confidence recognising poor mental health, and confidence and comfort speaking to others about mental health were non-significant. Community members who were familiar with the campaign reported having significantly more wellbeing-related conversations post-campaign compared to before (p = .015). Respondents also reported being more comfortable speaking to others about mental health or wellbeing (p = .001) and engaging more in activities to maintain or improve their wellbeing (p = .012) following the campaign. CONCLUSIONS The Vocal Locals social network campaign is an example of how science and community can be brought together to achieve meaningful outcomes. The campaign may serve as a model for others who wish to challenge attitudinal or knowledge-related barriers to help-seeking and improve engagement in wellbeing-promoting activities in difficult-to-reach communities.
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Affiliation(s)
- Chloe M E Fletcher
- IIMPACT in Health, Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, 5000, Australia
| | - Dale Woolford
- IIMPACT in Health, Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, 5000, Australia
| | - John Gladigau
- Gladigau Enterprises Pty Ltd, Loxton, SA, 5333, Australia
| | - Kate M Gunn
- IIMPACT in Health, Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, 5000, Australia.
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Krysinska K, Andriessen K, Bandara P, Reifels L, Flego A, Page A, Schlichthorst M, Pirkis J, Mihalopoulos C, Khanh-Dao Le L. The Cost-Effectiveness of Psychosocial Interventions Following Self-Harm in Australia. CRISIS 2024; 45:118-127. [PMID: 37904498 DOI: 10.1027/0227-5910/a000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Background: Psychosocial interventions following self-harm in adults, in particular cognitive behavioral therapy (CBT), can be effective in lowering the risk of repeated self-harm. Aims: To evaluate the cost-effectiveness of CBT for reducing repeated self-harm in the Australian context. Method: The current study adopted the accessing cost-effectiveness (ACE) approach using return-on-investment (ROI) analysis. Uncertainty and sensitivity analyses (Sas) tested the robustness of the model outputs to changes in three assumptions: general practitioner referral pathway (SA1), private setting intervention delivery (SA2), and training costs (SA3). Results: The intervention produced cost savings of A$ 46M (95% UI -223.7 to 73.3) and A$ 18.3M (95% UI -86.2 to 24.6), subject to the effect of intervention lasting 2- or 1-year follow-up. The ROI ratio reduced to 5.22 in SA1 (95% UI -10.1 to 27.9), 2.5 in SA2 (95% UI -4.8 to 13.3), and 5.1 in SA3 (95% UI -9.8 to 27.8). Limitations: We assumed that the effectiveness would reduce 50% within 5 years in the base case, and we used Australian data and a partial social perspective. Conclusions: The current study demonstrated cost-effectiveness of CBT for adults who have self-harmed with the return-on-investment ratio of A$ 2.3 to $6.0 for every A$ 1 invested.
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Affiliation(s)
- Karolina Krysinska
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Karl Andriessen
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Piumee Bandara
- Translational Health Research Institute, Western Sydney University, NSW, Australia
| | - Lennart Reifels
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Anna Flego
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, NSW, Australia
| | - Marisa Schlichthorst
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Health Economics Division, Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Long Khanh-Dao Le
- Health Economics Division, Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Newell S, Rynerson A, Gade P, Bahraini NH, Denneson LM, Dobscha SK. What Now?: Experiences of VHA patients following disclosure of suicidal ideation in primary care and mental health settings. Gen Hosp Psychiatry 2024; 87:7-12. [PMID: 38266442 PMCID: PMC10939769 DOI: 10.1016/j.genhosppsych.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE While screening and treatment options for patients who disclose suicidal ideation in clinical settings have grown in recent decades, little is known about patient experiences following disclosure. We characterize patient perspectives of responses following disclosure of suicidal ideation in Veteran Health Administration (VHA) primary care and mental health settings. METHOD Qualitative thematic analysis using a conventional/directed hybrid approach. RESULTS A national sample comprised of sixty participants who recently screened for suicidal ideation in primary care (n = 28) and mental health (n = 32) settings completed interviews. Many patients described therapeutic experiences following disclosure, including caring staff, timely follow-up care, and offers of multiple treatment options. Other patients, however, reported deficits in staff empathy, long waits for follow-up care, or inadequate treatment options. CONCLUSIONS While many VA clinical settings provided empathic and helpful responses, these experiences were not universal. Our findings reinforce the importance of a patient-centered approach to screening and response to disclosure, including collaboration with patients in treatment planning. Improved follow-up care coordination processes are needed. Following disclosure, contact with the staff who received the disclosure also helps patients feel cared about, and provides opportunity to troubleshoot barriers a patient may experience in accessing care.
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Affiliation(s)
- Summer Newell
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States.
| | - Annabelle Rynerson
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States
| | - Praful Gade
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States
| | - Nazanin H Bahraini
- VA Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, CO, United States of America; Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz School of Medicine, Aurora, CO, United States of America; Department of Psychiatry University of Colorado, Anschutz School of Medicine, Aurora, CO, United States of America
| | - Lauren M Denneson
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States; Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, United States
| | - Steven K Dobscha
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States; Department of Psychiatry, Oregon Health & Sciences University, Portland, OR, United States
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Cho S, Lee K. Association between insurance type and suicide-related behavior among US adults: The impact of the Affordable Care Act. Psychiatry Res 2024; 333:115714. [PMID: 38219348 DOI: 10.1016/j.psychres.2024.115714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/31/2023] [Accepted: 01/02/2024] [Indexed: 01/16/2024]
Abstract
This study examined the association between insurance type and suicidal ideation and attempts among adults in the United States, incorporating a comparative analysis of the pre- and post-Affordable Care Act (ACA) periods. We used a nationally representative, cross-sectional, population-based survey of individuals aged 18 years and older from the 2010-2019 National Survey on Drug Use and Health. The higher rates of suicidal ideation and attempts among Medicaid and uninsured groups compared with those with private insurance. After implementation of the ACA policy, the difference-in-differences analysis showed a significantly reduced risk of suicide in the Medicare group compared with the privately insured group, with no significant differences observed in the other groups. These findings highlight the importance of improving access to mental health services, particularly for those with lower levels of insurance coverage, such as Medicaid and Medicare.
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Affiliation(s)
- Seungwon Cho
- Department of Psychiatry, Hanyang Universtiy Medical Center, Seoul, Republic of Korea; Department of Health Policy and Management, Graduate School of Public Health, Hanyang University, Seoul, Republic of Korea
| | - Kounseok Lee
- Department of Psychiatry, Hanyang Universtiy Medical Center, Seoul, Republic of Korea; Department of Psychiatry, College of Medicine, Hanyang University, Seoul, Republic of Korea.
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Reifels L, Krysinska K, Andriessen K. Suicide prevention during disasters and public health emergencies: a systematic review. Front Public Health 2024; 12:1338099. [PMID: 38379672 PMCID: PMC10876787 DOI: 10.3389/fpubh.2024.1338099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/24/2024] [Indexed: 02/22/2024] Open
Abstract
Background Disasters and public health emergencies increasingly affect populations around the world, posing significant wide-ranging challenges for societies as well as for effective public health and suicide prevention. Intervention research is essential to inform evidence-based responses. Yet, despite evident public concern and growing research interest in heightened suicide risks and impacts, little is known about effective suicide prevention interventions in these contexts. We conducted a systematic review to examine the outcomes of suicide prevention strategies implemented in disasters and public health emergencies. Methods We searched five databases (Medline, Embase, PsycINFO, Web of Science, PTSDpubs) from inception to December 2022 for peer-reviewed quantitative studies that reported relevant intervention outcomes (changes in the frequency of suicide, suicide attempts, self-harm) for populations affected by disasters and public health emergencies. We assessed the quality of eligible studies using the Quality Assessment Tool for Quantitative Studies, and distilled review findings through narrative synthesis. The study protocol was registered with PROSPERO (CRD42021276195). Results Ten eligible and mostly observational studies were included in this review, which examined a range of universal, selective, and indicated interventions. Three of five studies of interventions in public health emergencies indicated the potential effectiveness and buffering effects of generic disaster related mental health support, access to urban parks, as well as the beneficial role of video-enabled tablets in facilitating treatment access and outcomes. Similarly, three of five studies of interventions in disaster contexts provided evidence of the beneficial role of universal economic security measures, national gun laws and buy back schemes, and volunteer-delivered mental health support. Overall, four of six studies with favorable outcomes examined interventions specifically deployed in disaster or public health emergency contexts, whereas two studies examined ongoing existing interventions. Three studies, respectively, of suicide prevention focused interventions or generic interventions reported favorable outcomes. The quality of included studies was variable, with two studies being rated as 'strong', four studies rated as 'moderate', and four studies rated as 'weak'. Conclusion Notwithstanding the limited scope and variable quality of published evidence, our review findings highlight the breadth of interventions that have been applied in such contexts with some success. There is a need for further research on effective interventions and intervention adaptations to inform evidence-based suicide prevention responses to disasters and public health emergencies. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021276195, PROSPERO ID CRD42021276195.
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Affiliation(s)
- Lennart Reifels
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
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Meda N, Miola A, Cattarinussi G, Sambataro F. Whole-brain structural and functional neuroimaging of individuals who attempted suicide and people who did not: A systematic review and exploratory coordinate-based meta-analysis. Eur Neuropsychopharmacol 2024; 79:66-77. [PMID: 38237538 DOI: 10.1016/j.euroneuro.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 02/06/2024]
Abstract
Suicide is the cause of death of approximately 800,000 people a year. Despite the relevance of this behaviour, risk assessment tools rely on clinician experience and subjective ratings. Given that previous suicide attempts are the single strongest predictors of future attempts, we designed a systematic review and coordinate-based meta-analysis to demonstrate whether neuroimaging features can help distinguish individuals who attempted suicide from subjects who did not. Out of 5,659 publications from PubMed, Scopus, and Web of Science, we summarised 102 experiments and meta-analysed 23 of them. A cluster in the right superior temporal gyrus, a region implicated in emotional processing, might be functionally hyperactive in individuals who attempted suicide. No statistically significant differences in brain morphometry were evidenced. Furthermore, we used JuSpace to show that this cluster is enriched in 5-HT1A heteroreceptors in the general population. This exploratory meta-analysis provides a putative neural substrate linked to previous suicide attempts. Heterogeneity in the analytical techniques and weak or absent power analysis of the studies included in this review currently limit the applicability of the findings, the replication of which should be prioritised.
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Affiliation(s)
- Nicola Meda
- Department of Neuroscience, University of Padova, Via Giustiniani, 3, Padua, Italy; Padova University Hospital, Padua, Italy
| | - Alessandro Miola
- Department of Neuroscience, University of Padova, Via Giustiniani, 3, Padua, Italy; Padova Neuroscience Center, University of Padova, Padua, Italy; Casa di Cura Parco dei Tigli, Padova, Italy
| | - Giulia Cattarinussi
- Department of Neuroscience, University of Padova, Via Giustiniani, 3, Padua, Italy; Padova Neuroscience Center, University of Padova, Padua, Italy
| | - Fabio Sambataro
- Department of Neuroscience, University of Padova, Via Giustiniani, 3, Padua, Italy; Padova University Hospital, Padua, Italy; Padova Neuroscience Center, University of Padova, Padua, Italy.
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Hu D, Comben C, Diminic S, Pagliaro C. Review of Australia's funding commitments for suicide prevention from 2021-22 to 2026-27. AUST HEALTH REV 2024; 48:45-51. [PMID: 38105034 DOI: 10.1071/ah23176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
Objective Examine the distribution of funding for suicide prevention in Australia from 2021-22 to 2026-27. Methods Government websites were reviewed to locate budget documents related to suicide prevention funding. Information was extracted on the program/service to be funded, and the funder entity, duration, and year allocation. Extracted data was reviewed to identify commonly targeted sub-populations. Results The majority of suicide prevention-related funding was allocated to aftercare for persons who have attempted suicide, consistent with the effectiveness of these services, followed by programs targeting the general population. Little funding was allocated to other specific sub-populations, such as young people and Aboriginal and Torres Strait Islander peoples. The amount of funding allocated to suicide prevention varied across jurisdictions, which is only partially explained by suicide rates. Conclusions There is a need for greater investment in care for specific sub-populations who are at higher risk of suicide. This study provides a baseline for comparing future investments in suicide prevention in Australia.
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Affiliation(s)
- Di Hu
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia; and Queensland Centre for Mental Health Research, Brisbane, Qld, Australia
| | - Charlotte Comben
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia; and Queensland Centre for Mental Health Research, Brisbane, Qld, Australia
| | - Sandra Diminic
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia; and Queensland Centre for Mental Health Research, Brisbane, Qld, Australia
| | - Claudia Pagliaro
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia; and Queensland Centre for Mental Health Research, Brisbane, Qld, Australia
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Russolillo A, Spidel A, Kealy D. Lack of Identity and Suicidality: The Mediating Role of Emotion Regulation Difficulties. J Nerv Ment Dis 2024; 212:122-128. [PMID: 38290106 DOI: 10.1097/nmd.0000000000001731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
ABSTRACT Identity disturbance has been connected to both psychological distress and suicidality, and associated with emotion dysregulation. However, despite empirical evidence of a relationship between lack of identity and poor psychiatric outcomes, the link between impaired identity and emotion dysregulation in suicide risk remains underexplored, particularly among individuals seeking outpatient mental health services. Using data from a large clinical sample (n = 246), the present study examined the association between lack of identity and suicidality and the role of emotion dysregulation within this process. Findings indicated that the mediation model was significant, with emotion regulation difficulties significantly mediating the association between lack of identity and future suicidal behavior. Furthermore, the indirect effect of lack of identity on anticipated suicidality remained significant beyond general distress and past suicide attempt. Our findings add to the literature examining the complex relationship among lack of identity, emotion regulation, and suicidality.
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Affiliation(s)
| | - Alicia Spidel
- Criminology Department, Kwantlen Polytechnic University, Surrey, British Columbia, Canada
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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Minian N, Gayapersad A, Coroiu A, Dragonetti R, Zawertailo L, Zaheer J, O’Neill B, Lange S, Thomson N, Crawford A, Kennedy SH, Selby P. Prototyping the implementation of a suicide prevention protocol in primary care settings using PDSA cycles: a mixed method study. Front Psychiatry 2024; 15:1286078. [PMID: 38333892 PMCID: PMC10850298 DOI: 10.3389/fpsyt.2024.1286078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/04/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction In Canada, approximately 4,500 individuals die by suicide annually. Approximately 45% of suicide decedents had contact with their primary care provider within the month prior to their death. Current versus never smokers have an 81% increased risk of death by suicide. Those who smoke have additional risks for suicide such as depression, chronic pain, alcohol, and other substance use. They are more likely to experience adverse social determinants of health. Taken together, this suggests that smoking cessation programs in primary care could be facilitators of suicide prevention, but this has not been studied. Study objectives The objectives of the study are to understand barriers/facilitators to implementing a suicide prevention protocol within a smoking cessation program (STOP program), which is deployed by an academic mental health and addiction treatment hospital in primary care clinics and to develop and test implementation strategies to facilitate the uptake of suicide screening and assessment in primary care clinics across Ontario. Methods The study employed a three-phase sequential mixed-method design. Phase 1: Conducted interviews guided by the Consolidated Framework for Implementation Research exploring barriers to implementing a suicide prevention protocol. Phase 2: Performed consensus discussions to map barriers to implementation strategies using the Expert Recommendations for Implementing Change tool and rank barriers by relevance. Phase 3: Evaluated the feasibility and acceptability of implementation strategies using Plan Do Study Act cycles. Results Eleven healthcare providers and four research assistants identified lack of training and the need of better educational materials as implementation barriers. Participants endorsed and tested the top three ranked implementation strategies, namely, a webinar, adding a preamble before depression survey questions, and an infographic. After participating in the webinar and reviewing the educational materials, all participants endorsed the three strategies as acceptable/very acceptable and feasible/very feasible. Conclusion Although there are barriers to implementing a suicide prevention protocol within primary care, it is possible to overcome them with strategies deemed both acceptable and feasible. These results offer promising practice solutions to implement a suicide prevention protocol in smoking cessation programs delivered in primary care settings. Future efforts should track implementation of these strategies and measure outcomes, including provider confidence, self-efficacy, and knowledge, and patient outcomes.
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Affiliation(s)
- Nadia Minian
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Allison Gayapersad
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Adina Coroiu
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rosa Dragonetti
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Laurie Zawertailo
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Juveria Zaheer
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Braden O’Neill
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Shannon Lange
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nicole Thomson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Allison Crawford
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sidney H. Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Arthur Sommer Rotenberg Program in Suicide Studies, Unity Health Toronto, Toronto, ON, Canada
| | - Peter Selby
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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