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Dani A, Balachandran S, McGill K, Whyte I, Carter G. Prevalence of Depression and Predictors of Discharge to a Psychiatric Hospital in Young People with Hospital-Treated Deliberate Self-Poisoning at an Australian Sentinel Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15753. [PMID: 36497828 PMCID: PMC9737120 DOI: 10.3390/ijerph192315753] [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: 10/29/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Hospital treated deliberate self-poisoning is common in young people. Internationally, estimates of rates of depression in this population are very wide (14.6% to 88%). The aims of this study were to determine the prevalence of depression and the independent predictors of referral for psychiatric hospitalisation in young people (aged 16 to 25 years) following an index episode of hospital treated deliberate self-poisoning. METHOD A retrospective cohort study design (n = 1410), with data drawn from a population-based clinical case register. Unadjusted and adjusted estimates of predictors of referral for psychiatric admission (after-care) used logistic regression models. RESULTS Prevalence of any depression diagnosis was 35.5% (n = 500); and 25.4% (n = 358) were referred for a psychiatric admission. The adjusted estimates for predictors of psychiatric inpatient referral were: high suicidal level (OR 118.21: CI 95% 63.23-220.99), low/moderate suicidal level (14.27: 9.38-21.72), any depression (2.88: 1.97-4.22), any psychosis (4.06; 1.15-14.36), older age (1.12: 1.04-1.21), and number of support people (0.88: 0.78-0.98). CONCLUSION Depression was diagnosed in more than a third and was an independent predictor of psychiatric inpatient referral, so service providers need to account for this level of need in the provision of assessment and after-care services. Evidence-based guidelines for psychiatric inpatient after-care for deliberate self-poisoning and/or depression in young people are limited. Our explanatory model included suicidal level, depression, psychosis, older age, and available support persons, suggesting that the treating clinicians were making these discharge decisions for admission in keeping with those limited guidelines, although the balance of benefits and harms of psychiatric hospitalisation are not established. Future research examining patient experiences, effectiveness of psychiatric hospitalisation, and alternatives to hospitalisation is warranted.
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Affiliation(s)
- Anitha Dani
- Child and Adolescent Mental Health Service, Hunter New England Mental Health Service, Newcastle, NSW 2302, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Srilaxmi Balachandran
- Child and Adolescent Mental Health Service, Hunter New England Mental Health Service, Newcastle, NSW 2302, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Katie McGill
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Research Evaluation and Dissemination (MH-READ), Hunter New England Mental Health Service, Newcastle, NSW 2298, Australia
| | - Ian Whyte
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
| | - Greg Carter
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
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Tate AE, Akingbuwa WA, Karlsson R, Hottenga JJ, Pool R, Boman M, Larsson H, Lundström S, Lichtenstein P, Middeldorp CM, Bartels M, Kuja-Halkola R. A genetically informed prediction model for suicidal and aggressive behaviour in teens. Transl Psychiatry 2022; 12:488. [PMID: 36411277 PMCID: PMC9678913 DOI: 10.1038/s41398-022-02245-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/22/2022] Open
Abstract
Suicidal and aggressive behaviours cause significant personal and societal burden. As risk factors associated with these behaviours frequently overlap, combined approaches in predicting the behaviours may be useful in identifying those at risk for either. The current study aimed to create a model that predicted if individuals will exhibit suicidal behaviour, aggressive behaviour, both, or neither in late adolescence. A sample of 5,974 twins from the Child and Adolescent Twin Study in Sweden (CATSS) was broken down into a training (80%), tune (10%) and test (10%) set. The Netherlands Twin Register (NTR; N = 2702) was used for external validation. Our longitudinal data featured genetic, environmental, and psychosocial predictors derived from parental and self-report data. A stacked ensemble model was created which contained a gradient boosted machine, random forest, elastic net, and neural network. Model performance was transferable between CATSS and NTR (macro area under the receiver operating characteristic curve (AUC) [95% CI] AUCCATSS(test set) = 0.709 (0.671-0.747); AUCNTR = 0.685 (0.656-0.715), suggesting model generalisability across Northern Europe. The notable exception is suicidal behaviours in the NTR, which was no better than chance. The 25 highest scoring variable importance scores for the gradient boosted machines and random forest models included self-reported psychiatric symptoms in mid-adolescence, sex, and polygenic scores for psychiatric traits. The model's performance is comparable to current prediction models that use clinical interviews and is not yet suitable for clinical use. Moreover, genetic variables may have a role to play in predictive models of adolescent psychopathology.
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Affiliation(s)
- Ashley E. Tate
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Wonuola A. Akingbuwa
- grid.12380.380000 0004 1754 9227Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Robert Karlsson
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Jouke-Jan Hottenga
- grid.12380.380000 0004 1754 9227Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - René Pool
- grid.12380.380000 0004 1754 9227Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Magnus Boman
- grid.5037.10000000121581746Division of Software and Computer Systems, School of Electrical Engineering and Computer Science KTH, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Solna, Sweden
| | - Henrik Larsson
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden ,grid.15895.300000 0001 0738 8966School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Sebastian Lundström
- grid.8761.80000 0000 9919 9582Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Paul Lichtenstein
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Christel M. Middeldorp
- grid.12380.380000 0004 1754 9227Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands ,grid.1003.20000 0000 9320 7537Child Health Research Centre, the University of Queensland, Brisbane, QLD Australia ,grid.512914.a0000 0004 0642 3960Child and Youth Mental Health Service, Children’s Health Queensland Hospital and Health Services, Brisbane, QLD Australia
| | - Meike Bartels
- grid.12380.380000 0004 1754 9227Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ralf Kuja-Halkola
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
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Turner K, Pisani AR, Sveticic J, O’Connor N, Woerway-Mehta S, Burke K, Stapelberg NJC. The Paradox of Suicide Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192214983. [PMID: 36429717 PMCID: PMC9690149 DOI: 10.3390/ijerph192214983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/11/2022] [Accepted: 11/12/2022] [Indexed: 05/11/2023]
Abstract
The recognition that we cannot use risk stratification (high, medium, low) to predict suicide or to allocate resources has led to a paradigm shift in suicide prevention efforts. There are challenges in adapting to these new paradigms, including reluctance of clinicians and services to move away from traditional risk categorisations; and conversely, the risk of a pendulum swing in which the focus of care swings from one approach to determining service priority and focus (e.g., diagnosis, formulation, risk and clinical care) to a new focus (e.g., suicide specific and non-clinical care), potentially supplanting the previous approach. This paper argues that the Prevention Paradox provides a useful mental model to support a shift in paradigm, whilst maintaining a balanced approach that incorporates new paradigms within the effective aspects of existing ones. The Prevention Paradox highlights the seemingly paradoxical situation where the greatest burden of disease or death is caused by those at low to moderate risk due their larger numbers. Current planning frameworks and resources do not support successful or sustainable adoption of these new approaches, leading to missed opportunities to prevent suicidal behaviours in healthcare. Adopting systems approaches to suicide prevention, such as the Zero Suicide Framework, implemented in a large mental health service in Australia and presented in this paper as a case study, can support a balanced approach of population- and individual-based suicide prevention efforts. Results demonstrate significant reductions in re-presentations with suicide attempts for consumers receiving this model of care; however, the increasing numbers of placements compromise the capacity of clinical teams to complete all components of standardised pathway of care. This highlights the need for review of resource planning frameworks and ongoing evaluations of the critical aspects of the interventions.
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Affiliation(s)
- Kathryn Turner
- Metro North Mental Health, Metro North Health, Brisbane, QLD 4029, Australia
- Correspondence:
| | - Anthony R. Pisani
- Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, NY 14642, USA
| | | | - Nick O’Connor
- Clinical Excellence Commission, Sydney, NSW 2065, Australia
| | - Sabine Woerway-Mehta
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4215, Australia
| | - Kylie Burke
- Metro North Mental Health, Metro North Health, Brisbane, QLD 4029, Australia
- School of Psychology, The University of Queensland, Brisbane, QLD 4072, Australia
- Australian Research Council’s Centre of Excellence for Children and Families over the Life Course, Brisbane, QLD 4068, Australia
| | - Nicolas J. C. Stapelberg
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4215, Australia
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Tamworth M, Killaspy H, Billings J, Gibbons R. Psychiatrists' Experience of a Peer Support Group for Reflecting on Patient Suicide and Homicide: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114507. [PMID: 36361387 PMCID: PMC9654625 DOI: 10.3390/ijerph192114507] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 05/13/2023]
Abstract
There is a lack of support for mental health professionals who experience a patient suicide or homicide. This is despite a high likelihood of such an occurrence and the heavy professional and personal toll the experience can take. We conducted 15 interviews with members of a facilitated peer support group run for consultant psychiatrists who have experienced a patient homicide or suicide. Our interviews explored the trauma of the experience as well as the effectiveness of the group in helping the clinician heal. Our results echoed previous research that the experience can be profoundly traumatic. A professionally facilitated, consultant-only peer group specifically dedicated to suicide and homicide were the key components helping participants to process their grief. Mental health trusts should consider setting up facilitated peer support groups for clinicians who experience patient suicide or homicide.
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Affiliation(s)
- Millie Tamworth
- Division of Psychiatry, University College London, London W1T 7NF, UK
- Correspondence:
| | - Helen Killaspy
- Division of Psychiatry, University College London, London W1T 7NF, UK
- Camden & Islington NHS Foundation Trust, London NW1 0PE, UK
| | - Jo Billings
- Division of Psychiatry, University College London, London W1T 7NF, UK
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Robison M, Rogers ML, Robertson L, Duffy ME, Manwaring J, Riddle M, Rienecke RD, Le Grange D, Duffy A, Plotkin M, Blalock DV, Mehler PS, Joiner TE. Avoidant restrictive food intake disorder and suicidal ideation. Psychiatry Res 2022; 317:114925. [PMID: 37732866 DOI: 10.1016/j.psychres.2022.114925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/14/2022] [Accepted: 10/22/2022] [Indexed: 11/28/2022]
Abstract
Most DSM-5 eating disorder diagnoses are associated with elevated suicide risk; however, little is known about the relationship between Avoidant/Restrictive Food Intake Disorder (ARFID) and suicidal ideation. The aim of the current study was to examine suicidal ideation within an adult ARFID sample. Patients with eating disorders (N = 936), some of whom met criteria for a current DSM-5 diagnosis of ARFID (n = 79), completed the Beck Depression Inventory II Item 9, regarding suicidal ideation. The study was conducted within an eating disorder treatment facility that offers inpatient, residential, partial hospitalization program, and intensive outpatient levels of care. Findings suggest no significant pairwise differences in suicidal ideation prevalence between participants with ARFID and those with any other ED diagnosis. Thorough screening for suicidal thoughts and risk among those with ARFID is warranted at all levels of care. We suggest that future research expand upon this work in a larger adult ARFID sample.
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Affiliation(s)
- Morgan Robison
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA.
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Lee Robertson
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA
| | - Mary E Duffy
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA
| | - Jamie Manwaring
- ACUTE at Denver Health, Denver, CO, USA; Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA
| | - Megan Riddle
- ACUTE at Denver Health, Denver, CO, USA; University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, WA
| | - Renee D Rienecke
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA; Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL (Emeritus), USA
| | - Alan Duffy
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA
| | - Millie Plotkin
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Philip S Mehler
- ACUTE at Denver Health, Denver, CO, USA; Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA; Department of Internal Medicine, University of Colorado School of Medicine, Denver, CO, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA
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Hawton K, Lascelles K, Pitman A, Gilbert S, Silverman M. Assessment of suicide risk in mental health practice: shifting from prediction to therapeutic assessment, formulation, and risk management. Lancet Psychiatry 2022; 9:922-928. [PMID: 35952701 DOI: 10.1016/s2215-0366(22)00232-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 12/20/2022]
Abstract
Suicide prevention in psychiatric practice has been dominated by efforts to predict risk of suicide in individual patients. However, traditional risk prediction measures have been shown repeatedly in studies from high income countries to be ineffective. Several factors might contribute to clinicians' preoccupation with risk prediction, which can have negative effects on patient care and also on clinicians where prediction is seen as failing. The model of therapeutic risk assessment, formulation, and management we outline in this article regards all patients with mental health problems as potentially at increased risk of suicide. It is aimed at reducing risk through use of a person-centred approach. We describe how a move towards therapeutic risk assessment, formulation, and risk management, including collaborative safety planning, could help clinicians develop a more tailored approach to managing risk for all patients, incorporating potentially therapeutic effects as well as helping to identify other risk reduction interventions. Such an approach could lead to enhanced patient safety and quality of care, which is more acceptable to patients.
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Affiliation(s)
- Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | | | - Alexandra Pitman
- UCL Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | | | - Morton Silverman
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Hedley D, Batterham PJ, Bury SM, Clapperton A, Denney K, Dissanayake C, Fox P, Frazier TW, Gallagher E, Hayward SM, Robinson J, Sahin E, Trollor J, Uljarević M, Stokes MA. The Suicidal Ideation Attributes Scale-Modified (SIDAS-M): Development and preliminary validation of a new scale for the measurement of suicidal ideation in autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:1115-1131. [PMID: 36237153 DOI: 10.1177/13623613221131234] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Autistic people may be at higher risk of suicidal behavior than people in the general population. Suicidal behavior may include thinking about suicide or attempting to end one's own life by suicide. It is important to identify autistic people who may be thinking about suicide. People who are at risk of suicidal behavior can be identified by asking questions about whether they have been thinking about suicide. A specially designed questionnaire, or screening instrument, can help someone ask the best questions to find out if someone has been thinking about suicide. This information can help to identify supports to be put in place to prevent suicidal behavior, such as a suicide attempt. However, autistic people may interpret questions differently than non-autistic people. It is important to use screening tools that have been designed with, and for autistic people. In this study, we examined the Suicidal Ideation Attributes Scale (SIDAS). The SIDAS is an existing tool that was developed to screen for suicidal thinking in the general population. We modified SIDAS for use with autistic adults. We involved autistic people in the process of modifying SIDAS. We called the modified instrument the SIDAS-M. The results of our study showed SIDAS-M may be useful for screening for suicidal thinking in autistic adults who do not have an intellectual disability.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jo Robinson
- The University of Melbourne, Australia.,Orygen, Australia
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Ranning A, Uddin MJ, Sørensen HJ, Laursen TM, Thorup AAE, Madsen T, Nordentoft M, Erlangsen A. Intergenerational transmission of suicide attempt in a cohort of 4.4 million children. Psychol Med 2022; 52:3202-3209. [PMID: 33827720 DOI: 10.1017/s0033291720005310] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The association between suicide attempts (SAs) in parents and children is unclear, and risk indicators for intergenerational transmission remain undocumented. We aimed to assess this association, considering the child's developmental period at the time of parents' attempted suicide, and the parental relation. METHODS Using a prospective cohort design, nationwide population data were linked to the Psychiatric Central Register and National Patient Register for all individuals aged 10 years or older living in Denmark between 1980 and 2016. We assessed incidence rate ratios (IRRs) and cumulative hazards for children's first SA. RESULTS In a cohort of 4 419 651 children, 163 056 (3.7%) had experienced a parental SA. An SA was recorded among 6996 (4.3%) of the exposed children as opposed to 70112 (1.6%) in unexposed individuals. Higher rates were noted when a parental SA occurred during early childhood (0 ⩽ age < 2) [IRR, 4.7; 95% confidence interval (CI) 4.2-5.4] v. late childhood (6 ⩽ age < 13) (IRR, 3.6; 95% CI 3.4-3.8) when compared to those unexposed. Children exposed prior to age 2 had the highest rates of all sub-groups when reaching age 13-17 (IRR, 6.5; 95% CI 6.0-7.1) and 18-25 years (IRR, 6.8; 95% CI 6.2-7.4). Maternal SA (IRR, 3.4; 95% CI 3.2-3.5) was associated with higher rates than paternal (IRR, 2.8; 95% CI 2.7-2.9). CONCLUSION Parental SA was associated with children's own SA. Exposure during early developmental stages was associated with the highest rates. Early preventive efforts are warranted as is monitoring of suicide risk in the children from age 13.
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Affiliation(s)
- Anne Ranning
- Copenhagen Research Center for Mental Health, Copenhagen, Denmark
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Md Jamal Uddin
- Copenhagen Research Center for Mental Health, Copenhagen, Denmark
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | | | - Thomas Munk Laursen
- National Center for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Anne A E Thorup
- Child and Adolescent Mental Health Center, Capital Region of Denmark, Denmark
| | - Trine Madsen
- Copenhagen Research Center for Mental Health, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health, Copenhagen, Denmark
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center of Mental Health Research, Australian National University, Canberra, Australia
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Improving ascertainment of suicidal ideation and suicide attempt with natural language processing. Sci Rep 2022; 12:15146. [PMID: 36071081 PMCID: PMC9452591 DOI: 10.1038/s41598-022-19358-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/29/2022] [Indexed: 12/03/2022] Open
Abstract
Methods relying on diagnostic codes to identify suicidal ideation and suicide attempt in Electronic Health Records (EHRs) at scale are suboptimal because suicide-related outcomes are heavily under-coded. We propose to improve the ascertainment of suicidal outcomes using natural language processing (NLP). We developed information retrieval methodologies to search over 200 million notes from the Vanderbilt EHR. Suicide query terms were extracted using word2vec. A weakly supervised approach was designed to label cases of suicidal outcomes. The NLP validation of the top 200 retrieved patients showed high performance for suicidal ideation (area under the receiver operator curve [AUROC]: 98.6, 95% confidence interval [CI] 97.1–99.5) and suicide attempt (AUROC: 97.3, 95% CI 95.2–98.7). Case extraction produced the best performance when combining NLP and diagnostic codes and when accounting for negated suicide expressions in notes. Overall, we demonstrated that scalable and accurate NLP methods can be developed to identify suicidal behavior in EHRs to enhance prevention efforts, predictive models, and precision medicine.
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Moller CI, Badcock PB, Hetrick SE, Rice S, Berk M, Dean OM, Chanen AM, Gao C, Davey CG, Cotton SM. Assessing Suicidal Ideation in Young People With Depression: Factor Structure of the Suicidal Ideation Questionnaire. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221124388. [PMID: 36067753 DOI: 10.1177/00302228221124388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Evaluating suicidal ideation in young people seeking mental health treatment is an important component of clinical assessment and treatment planning. To reduce the burden of youth suicide, we need to improve our understanding of suicidal ideation, its underlying constructs, and how ideation translates into suicidal behaviour. Using exploratory factor analysis, we investigated the dimensionality of the Suicidal Ideation Questionnaire (SIQ) among 273 participants aged 15-25 with Major Depressive Disorder. Area under the receiver operating characteristic curve (AUROC) analysis was used to explore associations between latent factors and actual suicidal behaviour. Findings suggested that the SIQ assesses multiple factors underlying suicidal ideation. AUROC analyses demonstrated that latent factors relating to both active and passive suicidal ideation predicted past-month suicidal behaviour and suicide attempt. These findings contribute to an improved understanding of the complexities of suicidal ideation and relationships with suicidal behaviour in young people with depression.
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Affiliation(s)
- Carl I Moller
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Paul B Badcock
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Sarah E Hetrick
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Simon Rice
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Michael Berk
- School of Medicine, Barwon Health, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia
- Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Olivia M Dean
- School of Medicine, Barwon Health, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Australia
- Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrew M Chanen
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Caroline Gao
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Christopher G Davey
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Sue M Cotton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
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Smith M. Suicide Risk Assessments: A Scientific and Ethical Critique. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:481-493. [PMID: 35606610 PMCID: PMC9463356 DOI: 10.1007/s11673-022-10189-5] [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: 08/25/2021] [Accepted: 03/02/2022] [Indexed: 06/15/2023]
Abstract
There are widely held premises that suicide is almost exclusively the result of mental illness and there is "strong evidence for successfully detecting and managing suicidality in healthcare" (Hogan and Grumet, 2016). In this context, 'zero-suicide' policies have emerged, and suicide risk assessment tools have become a normative component of psychiatric practice. This essay discusses how suicide evolved from a moral to a medical problem and how, in an effort to reduce suicide, a paternalistic healthcare response emerged to predict those at high risk. The evidence for the premises is critiqued and shown to be problematic; and it is found that strong paternalistic interventions are being used more often than acknowledged. Using a Principles approach, the ethics of overriding autonomy in suicide prevention is considered. Ethical concerns are identified with the current approach which are potentially amplified by the use of these risk assessments. Furthermore, it is identified that the widespread use of risk assessments in health settings is equivalent to screening without regard to the ethical principles of screening. The essay concludes that this is unethical; that we should abandon the use of standardized suicide risk assessments and 'zero-suicide' policy; and that this may improve outcomes.
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Affiliation(s)
- Mike Smith
- Bioethics Centre, University of Otago, Dunedin, New Zealand.
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Predicting suicide and suicide attempts in adults in acute hospitals: A systematic review of diagnostic accuracy evaluating risk scales. Int J Nurs Stud 2022; 136:104361. [DOI: 10.1016/j.ijnurstu.2022.104361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/19/2022] [Accepted: 09/07/2022] [Indexed: 11/19/2022]
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Hopkins D, Rickwood DJ, Hallford DJ, Watsford C. Structured data vs. unstructured data in machine learning prediction models for suicidal behaviors: A systematic review and meta-analysis. Front Digit Health 2022; 4:945006. [PMID: 35983407 PMCID: PMC9378826 DOI: 10.3389/fdgth.2022.945006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
Suicide remains a leading cause of preventable death worldwide, despite advances in research and decreases in mental health stigma through government health campaigns. Machine learning (ML), a type of artificial intelligence (AI), is the use of algorithms to simulate and imitate human cognition. Given the lack of improvement in clinician-based suicide prediction over time, advancements in technology have allowed for novel approaches to predicting suicide risk. This systematic review and meta-analysis aimed to synthesize current research regarding data sources in ML prediction of suicide risk, incorporating and comparing outcomes between structured data (human interpretable such as psychometric instruments) and unstructured data (only machine interpretable such as electronic health records). Online databases and gray literature were searched for studies relating to ML and suicide risk prediction. There were 31 eligible studies. The outcome for all studies combined was AUC = 0.860, structured data showed AUC = 0.873, and unstructured data was calculated at AUC = 0.866. There was substantial heterogeneity between the studies, the sources of which were unable to be defined. The studies showed good accuracy levels in the prediction of suicide risk behavior overall. Structured data and unstructured data also showed similar outcome accuracy according to meta-analysis, despite different volumes and types of input data.
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Affiliation(s)
- Danielle Hopkins
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
- *Correspondence: Danielle Hopkins
| | | | | | - Clare Watsford
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
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Hill NTM, Woolard A, Perry Y, Lin A. The role of health professionals in suicide prevention in young people. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:513-515. [PMID: 35597244 DOI: 10.1016/s2352-4642(22)00156-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/04/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Nicole T M Hill
- Telethon Kids Institute, Centre for Child Health Research, University of Western Australia, Nedlands, WA 6005, Australia.
| | - Alix Woolard
- Telethon Kids Institute, Centre for Child Health Research, University of Western Australia, Nedlands, WA 6005, Australia
| | - Yael Perry
- Telethon Kids Institute, Centre for Child Health Research, University of Western Australia, Nedlands, WA 6005, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, Centre for Child Health Research, University of Western Australia, Nedlands, WA 6005, Australia
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Fanshawe TR, Fazel S. The 'double whammy' of low prevalence in clinical risk prediction. BMJ Evid Based Med 2022; 27:191-194. [PMID: 34389609 DOI: 10.1136/bmjebm-2021-111683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
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Berg SH, Rørtveit K, Walby FA, Aase K. Shared understanding of resilient practices in the context of inpatient suicide prevention: a narrative synthesis. BMC Health Serv Res 2022; 22:967. [PMID: 35906685 PMCID: PMC9336074 DOI: 10.1186/s12913-022-08282-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 07/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background The prevailing patient safety strategies in suicide prevention are suicide risk assessments and retrospective reviews, with emphasis on minimising risk and preventing adverse events. Resilient healthcare focuses on how everyday clinical practice succeeds and emphasises learning from practice, not from adverse events. Yet, little is known about resilient practices for suicidal inpatients. The aim of the study is to draw upon the perspectives of patients and healthcare professionals to inform the conceptual development of resilient practices in inpatient suicide prevention. Methods A narrative synthesis was conducted of findings across patients and healthcare professionals derived from a qualitative case study based on interviews with patients and healthcare professionals in addition to a systematic literature review. Results Three sub-themes categorise resilient practices for healthcare professionals and for patients hospitalised with suicidal behaviour: 1) interactions capturing non-verbal cues; 2) protection through dignity and watchfulness; and 3) personalised approaches to alleviate emotional pressure. The main theme, the establishment of relationships of trust in resilient practices for patients in suicidal crisis, is the foundation of their communication and caring. Conclusion Clinical practice for patients hospitalised with suicidal behaviour has characteristics of complex adaptive systems in terms of dynamic interactions, decision-making under uncertainty, tensions between goals solved through trade-offs, and adaptations to patient variability and interpersonal needs. To improve the safety of patients hospitalised with suicidal behaviour, variability in clinical practice should be embraced. Trial registration https://doi.org/10.1136/bmjopen-2016-012874
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Affiliation(s)
- Siv Hilde Berg
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, N-4036, Stavanger, Norway. .,Clinics of Adult Mental Health Care, Stavanger University Hospital, P.O. Box 8100, N-4068, Stavanger, Norway.
| | - Kristine Rørtveit
- Milieu Therapy and Mental Health Nursing Research Group, Clinics of Adult Mental Health Care, Stavanger University Hospital, P.O. Box 8100, N-4068, Stavanger, Norway.,Life Phenomena and Caring Research Group, Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Fredrik A Walby
- National Centre for Suicide Research and Prevention, Faculty of Medicine, University of Oslo, Sognsvannsveien 21, Building 12, N-0320, Oslo, Norway
| | - Karina Aase
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, N-4036, Stavanger, Norway
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Meinhardt I, Cuthbert S, Gibson K, Fortune S, Hetrick SE. Young people and adult stakeholders' reflections on how school staff should support students who self-harm: A qualitative study. J Adolesc 2022; 94:969-980. [PMID: 35880459 DOI: 10.1002/jad.12078] [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: 02/06/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Self-harm is a significant public health issue affecting school communities, students, and families. The school is an ideal environment for early intervention and prevention. This study aimed to explore the views of young people and stakeholders on how school staff should support students who self-harm in the context of developing accessible and acceptable guidelines. METHODS The study was nested within a larger Delphi study conducted in New Zealand. Two panels were asked to provide reflection in open text boxes in two questionnaires on how school staff can support students who self-harm. The youth panel included 22 participants between 16 and 25 years, and 81.8% identified as female and 18.3% as male. The stakeholder panel (e.g., school staff) included 27 participants over 25 years, and 63.0% identified as female, and 37.0% as male. The data were analyzed using thematic analysis to identify key themes. RESULTS Eight themes were identified; (1) an approach that prioritizes trust, (2) an approach that recognizes students' agency, (3) an individually tailored approach, (4) a whole-school approach, (5) an approach that recognizes role boundaries, (6) an approach that prioritizes safety, (7) a nonpunitive approach, and (8) an appropriately-resourced approach. CONCLUSION The eight themes identified highlighted ineffective practices in response to self-harm in schools. The eight themes provide solutions to these practices. Our findings highlighted four recommendations that address ineffective management approaches in response to students who self-harm. These recommendations included using a student-centered approach, a whole-school approach, avoiding punitive approaches, and providing adequate resourcing to schools.
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Affiliation(s)
- Inge Meinhardt
- School of Psychology, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Sasha Cuthbert
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kerry Gibson
- School of Psychology, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Sarah Fortune
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychological Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Sarah Elisabeth Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,A Better Start, E Tipu E Rea (Grant Number 15-02688), National Science Challenge, Auckland, New Zealand.,Centre of Excellence in Youth Mental Health, The Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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68
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Schafer KM, Kennedy G, Joiner T. Hopelessness, Interpersonal, and Emotion Dysregulation Perspectives on Suicidal Ideation: Tests in a Clinical Sample. Arch Suicide Res 2022; 26:1159-1172. [PMID: 33336628 DOI: 10.1080/13811118.2020.1859031] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The present study directly compared three perspectives of suicidality: Interpersonal Theory of Suicide (IPTS), Hopelessness Theory, and a perspective emphasizing emotion dysregulation. METHOD 219 adults seeking outpatient psychological services completed questionnaires during intake between November 2015 and February 2019. Patients were included if they completed surveys related to thwarted belongingness (TB), perceived burdensomeness (PB), hopelessness, depressive symptoms, negative affect, and Borderline Personality Disorder (BPD) symptoms. Analyses tested the ability of TB, PB, depressive symptoms, hopelessness, and emotion dysregulation to relate to total scores on Beck Scale for Suicide Ideation. We employed Pearson's correlations and linear regressions to investigate these relations. RESULTS Constructs related to emotion dysregulation-negative affect (r = 0.161, p < .05) and Borderline Personality Disorder symptoms (r = 0.284, p < .01)-were significantly correlated with suicidal ideation, as were those relevant to Hopelessness Theory-depressive symptoms (r = 0.46, p < .01) and hopelessness (r = 0.45, p < .01)- and IPTS-TB (r = 0.36, p < .01) and PB (r = 0.43, p < .01). Notably the combinations of constructs as proposed by theories were significantly associated with suicidal ideation, but did not improve upon single constructs. This indicated that theoretically relevant constructs alone were strongly associated with suicidal ideation, but were not bested by interactions. CONCLUSIONS This project compared constructs relevant to three theories of suicidality among a sample of treatment seeking outpatients. Findings indicated that suicidal ideation assessment was similarly informed by Hopelessness Theory and IPTS, and to a lesser degree emotion dysregulation. The cross sectional nature of the data and the reliance upon self-report measures limit the inferences that can be made.
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69
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Jacobsen AL, Madsen T, Ranning A, Nielsen AS, Nordentoft M, Erlangsen A. Level of Suicidal Ideation Among Callers to the Danish Suicide Prevention Helpline. Arch Suicide Res 2022:1-16. [PMID: 35703206 DOI: 10.1080/13811118.2022.2084005] [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: 11/02/2022]
Abstract
OBJECTIVE The aim of this study was to: (1) determine the proportion of callers to a national helpline for suicide prevention who were evaluated to be at risk of suicide; (2) identify characteristics associated with being at risk; (3) determine the level of suicidal ideation among callers, as measured by a clinical scale, and compared to the general population. METHOD Data on all calls answered at the Danish helpline for suicide prevention during 2018-2019 were analyzed. These consisted of socio-demographic covariates and items related to suicidality, including the Suicidal Ideation Attribute Scale (SIDAS). Data on SIDAS for the general population derived from a survey. Being at risk of suicide, as evaluated by the counselors, was examined as outcome in adjusted logistic regressions. RESULTS Among 42,393 answered calls, 24,933 (59%) related to personal concerns. Of these, 47% and 14% of callers, respectively, had suicidal thoughts and concrete suicidal plans, while 53% were evaluated to be at risk. Higher risks were found when issues related to self-harm, mental health problems, eating disorders, incest, physical health problems, substance abuse, or sexual assault were mentioned. In all 37% of callers who were administered the SIDAS scale were evaluated to be at high risk of suicide compared to 1.5% in the general population. CONCLUSIONS A substantial share of callers to a national helpline for suicide prevention were evaluated to be at risk of suicide, also when using a clinical scale. This emphasizes the potential for counselors to prevent suicidal behavior.HighlightsMore than half of callers reaching out to the helpline were evaluated to be at risk of suicide, and 37% were identified as being at high risk using SIDAS, a clinical scale.Being woman, of younger age, having a history of previous suicide attempt as well as experiencing problems related to self-harm, mental disorders, sexual assault, substance abuse, and physical health problems was associated with risk of suicide, as evaluated by counselors.This seemingly is the first study to compare clinical scores of helpline callers to those of the general population and significantly higher levels of suicidal ideation were found among helpline callers.
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70
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Harris LM, Broshek CE, Ribeiro JD. Does Body Mass Index Confer Risk for Future Suicidal Thoughts and Behaviors? A Meta-analysis of Longitudinal Studies. Curr Obes Rep 2022; 11:45-54. [PMID: 35174455 DOI: 10.1007/s13679-022-00468-y] [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] [Accepted: 08/23/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Body mass index (BMI) outside of the "normal" range is commonly cited as a predictor of adverse health outcomes and has been identified as a potential risk factor for suicidal thoughts and behaviors (STBs). This meta-analysis provides a descriptive and quantitative summary of the literature evaluating the longitudinal relationship between BMI/weight status and STBs. RECENT FINDINGS The longitudinal literature examining the relationship between BMI/weight status and STBs is small and methodologically constrained. Within the existing literature, BMI and weight status are generally weak or nonsignificant risk factors for STBs. It is possible that body weight has a complex relationship with physical and mental health, including STBs, which may not be possible to accurately capture with a singular metric such as BMI. BMI and weight status do not appear to robustly predict STBs, at least within the methodological constraints of the existing literature.
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71
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Podlogar MC, Gutierrez PM, Osman A. Optimizing the Beck Scale for Suicide Ideation: An Item Response Theory Approach Among U.S. Military Personnel. Assessment 2022; 30:1321-1333. [PMID: 35575070 DOI: 10.1177/10731911221092420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Beck Scale for Suicide Ideation (BSS) is one of the most used and empirically supported suicide risk assessment measures for behavioral health clinicians and researchers. However, the 19-item BSS is a relatively long measure and can take 5 to 10 minutes to administer. This study used Item Response Theory (IRT) techniques across two samples of mostly U.S. military service members to first identify (n1 = 1,899) and then validate (n2 = 757) an optimized set of the most informative BSS items. Results indicated that Items 1, 2, 4, 6, and 15 provided a similar-shaped test information curve across the same range of the latent trait as the full-length BSS and showed reliable item functioning across participant characteristics. The sum score of these five items showed a linear score linkage with the full-scale score, ρ > 0.87, and was equally as sensitive as the full scale for prospectively predicting near-term suicidal behavior at 74% with a cut score ≥1 (equivalent to full-scale score ≥6). Results are consistent with those from civilian samples. In time- or length-limited assessments, using these five BSS items may improve administration efficiency over the full BSS, while maintaining classification sensitivity.This study suggests that summing Items 1, 2, 4, 6, and 15 of the Beck Scale for Suicide Ideation (BSS) is an acceptable approach for shortening the full-length measure.
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Affiliation(s)
- Matthew C Podlogar
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, USA
- University of Colorado School of Medicine, Aurora, USA
| | - Peter M Gutierrez
- Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Aurora, USA
- University of Colorado School of Medicine, Aurora, USA
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Bryan CJ, Bryan AO, Wastler HM, Khazem LR, Ammendola E, Baker JC, Szeto E, Tabares J, Bauder CR. Assessment of Latent Subgroups With Suicidal Ideation and Suicidal Behavior Among Gun Owners and Non-Gun Owners in the US. JAMA Netw Open 2022; 5:e2211510. [PMID: 35544138 PMCID: PMC9096594 DOI: 10.1001/jamanetworkopen.2022.11510] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Firearm ownership is associated with increased risk for suicide. OBJECTIVE To examine patterns of associations among suicidal thoughts and behaviors among gun owners and non-gun owners in the US. DESIGN, SETTING, AND PARTICIPANTS In this survey study, cross-sectional online survey data were collected from March to April 2020 from US adults recruited via Qualtrics Panels. Quota sampling was used to approximate US census demographics. MAIN OUTCOMES AND MEASURES The primary outcomes were past-year passive suicidal ideation, active suicidal ideation, suicidal planning, suicidal behaviors, and nonsuicidal self-injury as measured by items from the Self-Injurious Thoughts and Behaviors Interview-Revised (SITBI-R). Simple latent class analysis (LCA) was used to assign participants to separate classes based on posterior probabilities, and multigroup LCA was used to assess whether the same construct was measured in specified groups. RESULTS Of 65 079 adults invited to participate, 10 625 (16.3%) completed the survey; 9153 responded "yes" or "no" to the firearm ownership item and were included in the analysis. Of these 9153 respondents (4695 [51.3%] male; mean [SD] age, 46.7 [16.8] years), 2773 (30.3%) reported owning a gun and 6380 (69.7%) reported not owning a gun. Compared with non-gun owners, gun owners were more likely to be male (1779 [64.2%] vs 2916 [45.7%]; χ21, 263.3; P < .001) and White (2090 [75.4%] vs 3945 [61.8%]; χ25, 232.9; P < .001) and to have served in the military (772 [27.8%] vs 609 [9.5%]; χ21, 571.4; P < .001). Five distinct patterns of SITBI-R item endorsement were extracted using simple LCA. Multigroup LCA indicated that the probability of SITBI-R item endorsement differed between gun owners and non-gun owners across subgroups. Among gun owners, the probability of past-month nonfatal suicide attempts was highest in class 4 (ranging from 16.8% for reaching out for help to 27.2% for starting, then changing one's mind). Gun owners in class 4 were characterized by high probabilities of endorsing thoughts about specific ways or methods to attempt suicide (100%) and preparatory behavior (100%). Among non-gun owners, the probability of nonfatal suicide attempts was highest in class 5 (ranging from 14.9% for reaching out for help to 29.7% for starting, then changing one's mind). Non-gun owners in class 5 were characterized by high probabilities of endorsing passive suicidal ideation (84.0%-100%), active suicidal ideation (86.7%-95.0%), and thoughts about specific ways or methods to attempt suicide (97.4%) and a specific place (92.1%) to attempt suicide. CONCLUSIONS AND RELEVANCE In this study, in subgroups with lower probabilities of suicide attempt, gun owners and non-gun owners showed similar patterns of suicide risk item endorsement, but when the probability of a suicide attempt increased, gun owners were less likely than non-gun owners to endorse passive and active suicidal ideation. These findings suggest that assessing a broader range of suicide risk indicators may improve risk detection.
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Affiliation(s)
- Craig J. Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
| | - AnnaBelle O. Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
| | - Heather M. Wastler
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
| | - Lauren R. Khazem
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
| | - Ennio Ammendola
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
| | - Justin C. Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
| | - Edwin Szeto
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
| | - Jeffrey Tabares
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
| | - Christina R. Bauder
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus
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van Velzen LS, Toenders YJ, Avila-Parcet A, Dinga R, Rabinowitz JA, Campos AI, Jahanshad N, Rentería ME, Schmaal L. Classification of suicidal thoughts and behaviour in children: results from penalised logistic regression analyses in the Adolescent Brain Cognitive Development study. Br J Psychiatry 2022; 220:210-218. [PMID: 35135639 DOI: 10.1192/bjp.2022.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite efforts to predict suicide risk in children, the ability to reliably identify who will engage in suicide thoughts or behaviours has remained unsuccessful. AIMS We apply a novel machine-learning approach and examine whether children with suicide thoughts or behaviours could be differentiated from children without suicide thoughts or behaviours based on a combination of traditional (sociodemographic, physical health, social-environmental, clinical psychiatric) risk factors, but also more novel risk factors (cognitive, neuroimaging and genetic characteristics). METHOD The study included 5885 unrelated children (50% female, 67% White, 9-11 years of age) from the Adolescent Brain Cognitive Development (ABCD) study. We performed penalised logistic regression analysis to distinguish between: (a) children with current or past suicide thoughts or behaviours; (b) children with a mental illness but no suicide thoughts or behaviours (clinical controls); and (c) healthy control children (no suicide thoughts or behaviours and no history of mental illness). The model was subsequently validated with data from seven independent sites involved in the ABCD study (n = 1712). RESULTS Our results showed that we were able to distinguish the suicide thoughts or behaviours group from healthy controls (area under the receiver operating characteristics curve: 0.80 child-report, 0.81 for parent-report) and clinical controls (0.71 child-report and 0.76-0.77 parent-report). However, we could not distinguish children with suicidal ideation from those who attempted suicide (AUROC: 0.55-0.58 child-report; 0.49-0.53 parent-report). The factors that differentiated the suicide thoughts or behaviours group from the clinical control group included family conflict, prodromal psychosis symptoms, impulsivity, depression severity and history of mental health treatment. CONCLUSIONS This work highlights that mostly clinical psychiatric factors were able to distinguish children with suicide thoughts or behaviours from children without suicide thoughts or behaviours. Future research is needed to determine if these variables prospectively predict subsequent suicidal behaviour.
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Affiliation(s)
- Laura S van Velzen
- Orygen, Australia; and Centre for Youth Mental Health, University of Melbourne, Australia
| | - Yara J Toenders
- Orygen, Australia; and Centre for Youth Mental Health, University of Melbourne, Australia
| | - Aina Avila-Parcet
- Department of Psychiatry, Hospital de la Santa Creu I Sant Pau, Spain
| | - Richard Dinga
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, the Netherlands
| | - Jill A Rabinowitz
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, USA
| | - Adrián I Campos
- Department of Genetics & Computational Biology, QIMR Berghofer Medical Research Institute, Australia; and School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Australia
| | - Neda Jahanshad
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, USA
| | - Miguel E Rentería
- Department of Genetics & Computational Biology, QIMR Berghofer Medical Research Institute, Australia; and School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Australia
| | - Lianne Schmaal
- Orygen, Australia; and Centre for Youth Mental Health, University of Melbourne, Australia
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Bentley KH, Zuromski KL, Fortgang RG, Madsen EM, Kessler D, Lee H, Nock MK, Reis BY, Castro VM, Smoller JW. Implementing Machine Learning Models for Suicide Risk Prediction in Clinical Practice: Focus Group Study With Hospital Providers. JMIR Form Res 2022; 6:e30946. [PMID: 35275075 PMCID: PMC8956996 DOI: 10.2196/30946] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 11/19/2022] Open
Abstract
Background Interest in developing machine learning models that use electronic health record data to predict patients’ risk of suicidal behavior has recently proliferated. However, whether and how such models might be implemented and useful in clinical practice remain unknown. To ultimately make automated suicide risk–prediction models useful in practice, and thus better prevent patient suicides, it is critical to partner with key stakeholders, including the frontline providers who will be using such tools, at each stage of the implementation process. Objective The aim of this focus group study is to inform ongoing and future efforts to deploy suicide risk–prediction models in clinical practice. The specific goals are to better understand hospital providers’ current practices for assessing and managing suicide risk; determine providers’ perspectives on using automated suicide risk–prediction models in practice; and identify barriers, facilitators, recommendations, and factors to consider. Methods We conducted 10 two-hour focus groups with a total of 40 providers from psychiatry, internal medicine and primary care, emergency medicine, and obstetrics and gynecology departments within an urban academic medical center. Audio recordings of open-ended group discussions were transcribed and coded for relevant and recurrent themes by 2 independent study staff members. All coded text was reviewed and discrepancies were resolved in consensus meetings with doctoral-level staff. Results Although most providers reported using standardized suicide risk assessment tools in their clinical practices, existing tools were commonly described as unhelpful and providers indicated dissatisfaction with current suicide risk assessment methods. Overall, providers’ general attitudes toward the practical use of automated suicide risk–prediction models and corresponding clinical decision support tools were positive. Providers were especially interested in the potential to identify high-risk patients who might be missed by traditional screening methods. Some expressed skepticism about the potential usefulness of these models in routine care; specific barriers included concerns about liability, alert fatigue, and increased demand on the health care system. Key facilitators included presenting specific patient-level features contributing to risk scores, emphasizing changes in risk over time, and developing systematic clinical workflows and provider training. Participants also recommended considering risk-prediction windows, timing of alerts, who will have access to model predictions, and variability across treatment settings. Conclusions Providers were dissatisfied with current suicide risk assessment methods and were open to the use of a machine learning–based risk-prediction system to inform clinical decision-making. They also raised multiple concerns about potential barriers to the usefulness of this approach and suggested several possible facilitators. Future efforts in this area will benefit from incorporating systematic qualitative feedback from providers, patients, administrators, and payers on the use of these new approaches in routine care, especially given the complex, sensitive, and unfortunately still stigmatized nature of suicide risk.
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Affiliation(s)
- Kate H Bentley
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychology, Harvard University, Cambridge, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Kelly L Zuromski
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Rebecca G Fortgang
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Emily M Madsen
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Daniel Kessler
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Hyunjoon Lee
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Ben Y Reis
- Harvard Medical School, Boston, MA, United States.,Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States
| | - Victor M Castro
- Research Information Science and Computing, Mass General Brigham, Somerville, MA, United States
| | - Jordan W Smoller
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
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75
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Herrman H, Patel V, Kieling C, Berk M, Buchweitz C, Cuijpers P, Furukawa TA, Kessler RC, Kohrt BA, Maj M, McGorry P, Reynolds CF, Weissman MM, Chibanda D, Dowrick C, Howard LM, Hoven CW, Knapp M, Mayberg HS, Penninx BWJH, Xiao S, Trivedi M, Uher R, Vijayakumar L, Wolpert M. Time for united action on depression: a Lancet-World Psychiatric Association Commission. Lancet 2022; 399:957-1022. [PMID: 35180424 DOI: 10.1016/s0140-6736(21)02141-3] [Citation(s) in RCA: 291] [Impact Index Per Article: 145.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Sangath, Goa, India; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Christian Kieling
- Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Child & Adolescent Psychiatry Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Michael Berk
- Deakin University, IMPACT Institute, Geelong, VIC, Australia
| | - Claudia Buchweitz
- Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Mario Maj
- Department of Psychiatry, University of Campania L Vanvitelli, Naples, Italy
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Myrna M Weissman
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Dixon Chibanda
- Department of Psychiatry, University of Zimbabwe, Harare, Zimbabwe; Centre for Global Mental Health, The London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Louise M Howard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christina W Hoven
- Columbia University Mailman School of Public Health, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Helen S Mayberg
- Departments of Neurology, Neurosurgery, Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Shuiyuan Xiao
- Central South University Xiangya School of Public Health, Changsha, China
| | - Madhukar Trivedi
- Peter O'Donnell Jr Brain Institute and the Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Lakshmi Vijayakumar
- Sneha, Suicide Prevention Centre and Voluntary Health Services, Chennai, India
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76
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Moore FR, Doughty H, Neumann T, McClelland H, Allott C, O'Connor RC. Impulsivity, aggression, and suicidality relationship in adults: A systematic review and meta-analysis. EClinicalMedicine 2022; 45:101307. [PMID: 35243273 PMCID: PMC8860929 DOI: 10.1016/j.eclinm.2022.101307] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The aim of the study was to crystallize the nature of relationships between impulsivity, aggression, and suicidality. We reviewed studies of adults with published, psychometric measures of impulsivity and aggression, and measures of suicidality. METHODS Our primary data source was Web of Science (from inception to 31st December 2021). Quality of articles was assessed using a Joanna Briggs Appraisal Tool and publication bias using Trim and Fill. We synthesised results using random effects meta-analyses and explored moderation by measure of impulsivity, aggression, and suicidality, and population. FINDINGS 77 studies were included in our analysis. We found weak positive relationships between impulsivity (r = 0·19 [95% CI: 0·15-0·22]), aggression (0·23 ([0·17, 0·29]), and impulsive aggression (0·16 [0·1, 0·22]) with suicidality. Heterogeneity was significant and only partially explained by moderators. Limitations included the lack of studies which assess impulsivity or aggression proximal to suicidality. INTERPRETATION Given small effect sizes and significant heterogeneity, the study suggests that additional studies are needed in the field to analyze the relation between impulsivity and aggression with suicidality. FUNDING None.
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Affiliation(s)
- Fhionna R. Moore
- NHS Highland's Child and Adolescent Mental Health Services, Phoenix Centre, Raigmore Hospital, Inverness, Scotland IV2 3UJ United Kingdom
- Suicidal Behavior Research Laboratory, Institute of Health and Wellbeing, College of Medicine, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Northern Ireland G12 8QQ United Kingdom
- Corresponding author at: NHS Highland's Child and Adolescent Mental Health Services, Phoenix Centre, Raigmore Hospital, Inverness, Scotland IV2 3UJ United Kingdom.
| | - Heather Doughty
- School of Social and Health Science, University of Dundee, Dundee, Northern Ireland DD1 4HN United Kingdom
| | - Tabea Neumann
- School of Social and Health Science, University of Dundee, Dundee, Northern Ireland DD1 4HN United Kingdom
| | - Heather McClelland
- Suicidal Behavior Research Laboratory, Institute of Health and Wellbeing, College of Medicine, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Northern Ireland G12 8QQ United Kingdom
| | - Claire Allott
- NHS Highland's Child and Adolescent Mental Health Services, Phoenix Centre, Raigmore Hospital, Inverness, Scotland IV2 3UJ United Kingdom
| | - Rory C. O'Connor
- Suicidal Behavior Research Laboratory, Institute of Health and Wellbeing, College of Medicine, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Northern Ireland G12 8QQ United Kingdom
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77
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Hospital-Based Suicides: Challenging Existing Myths. Psychiatr Q 2022; 93:1-13. [PMID: 33169312 DOI: 10.1007/s11126-020-09856-w] [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] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
Myths are widely held and often based on false beliefs. To improve patient safety and speed the translation of research to clinical practice, we highlight and then debunk 10 common myths regarding the assessment, treatment, and management of hospitalized patients at risk for suicide. Myths regarding hospital-based suicides are examined and empirical evidence that counters each myth is offered. Ten common myths regarding hospital-based suicides are found to be untrue or unsupported based on existing empirical evidence. Rethinking common beliefs and practices that lack empirical support and seeking alternatives based on research evidence is consistent with an emphasis on evidence-based practices leading to improved patient care and protection.
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78
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Rahman M, Leckman-Westin E, Stanley B, Kammer J, Layman D, Labouliere CD, Cummings A, Vasan P, Vega K, Green KL, Brown GK, Finnerty M, Galfalvy H. Predictors of Intentional Self -Harm Among Medicaid Mental Health Clinic Clients In New York. J Affect Disord 2022; 299:698-706. [PMID: 34813869 PMCID: PMC8808564 DOI: 10.1016/j.jad.2021.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 10/15/2021] [Accepted: 11/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Behavioral health outpatients are at risk for self-harm. Identifying individuals or combination of risk factors could discriminate those at elevated risk for self-harm. METHODS The study population (N = 248,491) included New York State Medicaid-enrolled individuals aged 10 to 64 with mental health clinic services between November 1, 2015 to November 1, 2016. Self-harm episodes were defined using ICD-10 codes from emergency department and inpatient visits. Multi-predictor logistic regression models were fit on a subsample of the data and compared to a testing sample based on discrimination performance (Area Under the Curve or AUC). RESULTS Of N = 248,491 patients, 4,224 (1.70%) had an episode of intentional self-harm. Factors associated with increased self-harm risk were age 17-25, being female and having recent diagnoses of depression (AOR=4.3, 95%CI: 3.6-5.0), personality disorder (AOR=4.2, 95%CI: 2.9-6.1), or substance use disorder (AOR=3.4, 95%CI: 2.7-4.3) within the last month. A multi-predictor logistic regression model including demographics and new psychiatric diagnoses within 90 days prior to index date had good discrimination and outperformed competitor models on a testing sample (AUC=0.86, 95%CI:0.85-0.87). LIMITATIONS New York State Medicaid data may not be generalizable to the entire U.S population. ICD-10 codes do not allow distinction between self-harm with and without intent to die. CONCLUSIONS Our results highlight the usefulness of recency of new psychiatric diagnoses, in predicting the magnitude and timing of intentional self-harm risk. An algorithm based on this finding could enhance clinical assessments support screening, intervention and outreach programs that are at the heart of a Zero Suicide prevention model.
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Affiliation(s)
| | - Emily Leckman-Westin
- New York State Office of Mental Health, NY; Department of Epidemiology and Biostatistics, University at Albany-SUNY, School of Public Health
| | - Barbara Stanley
- New York State Psychiatric Institute, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, NY
| | | | | | - Christa D Labouliere
- New York State Psychiatric Institute, NY; Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, NY
| | | | | | | | - Kelly L Green
- Department of Psychiatry Perelman School of Medicine University of Pennsylvania, PA
| | - Gregory K Brown
- Department of Psychiatry Perelman School of Medicine University of Pennsylvania, PA
| | - Molly Finnerty
- New York State Office of Mental Health, NY; Department of Child and Adolescent Psychiatry, New York University Langone Health, NY
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, NY; Department of Biostatistics Columbia University Mailman School of Public Health, NY
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79
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Du L, Shi HY, Qian Y, Jin XH, Yu HR, Fu XL, Wu H, Chen HL. Development and validation of a model for predicting the risk of suicide in patients with cancer. Arch Suicide Res 2022; 27:644-659. [PMID: 35129100 DOI: 10.1080/13811118.2022.2035289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The objective of this study was to establish a nomogram model to predict SI in patients with cancer and further evaluate its performance. METHOD This study was performed among 390 patients in oncology departments of Affiliated Hospital of Nantong University from April 2020 to January 2021. Of these, eligible patients who were diagnosed with cancer were split into training and validation cohorts according the ratio of 2:1 randomly. In the training cohort, multivariate regression was performed to determine the independent variables related to SI. A nomogram was built incorporating these variables. The model performance was evaluated by an independent validation cohort. RESULTS The prevalence of SI in patients with cancer was 22.31% and 19.23% in training and validation cohorts, respectively. The nomogram model suggested independent variables for SI, including depression, emotional function, time after diagnosis, family function and educational status. The area under the curve (AUC) was 0.93 (95%CI, 0.90-0.97) and 0.82 (95%CI, 0.74-0.90) in training and validation cohorts respectively, which indicated good discrimination of the nomogram in predicting SI in cancer patients. The p-value of the goodness of fit (GOF) test was 0.197 and 0.974 in training and validation cohorts respectively, suggesting our nomogram model has acceptable calibration power, and the calibration curves further indicated good calibration power. CONCLUSION In conclusion, the nomogram model for predicting individualized probability of SI could help clinical caregivers estimate the risk of SI in patients with cancer and provide appropriate management.
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80
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Chen X, Mo Q, Yu B, Bai X, Jia C, Zhou L, Ma Z. Hierarchical and nested associations of suicide with marriage, social support, quality of life, and depression among the elderly in rural China: Machine learning of psychological autopsy data. Front Psychiatry 2022; 13:1000026. [PMID: 36226103 PMCID: PMC9548573 DOI: 10.3389/fpsyt.2022.1000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To identify mechanisms underpinning the complex relationships between influential factors and suicide risk with psychological autopsy data and machine learning method. DESIGN A case-control study with suicide deaths selected using two-stage stratified cluster sampling method; and 1:1 age-and-gender matched live controls in the same geographic area. SETTING Disproportionately high risk of suicide among rural elderly in China. PARTICIPANTS A total of 242 subjects died from suicide and 242 matched live controls, 60 years of age and older. MEASUREMENTS Suicide death was determined based on the ICD-10 codes. Influential factors were measured using validated instruments and commonly accepted variables. RESULTS Of the total sample, 270 (55.8%) were male with mean age = 74.2 (SD = 8.2) years old. Four CART models were used to select influential factors using the criteria: areas under the curve (AUC) ≥ 0.8, sensitivity ≥ 0.8, and specificity ≥ 0.8. Each model included a lead predictor plus 8-10 hierarchically nested factors. Depression was the first to be selected in Model 1 as the lead predictor; After depression was excluded, quality of life (QOL) was selected in Model 2; After depression and QOL were excluded, social support was selected in Model 3. Finally, after all 3 lead factors were excluded, marital status was selected in Model 4. In addition, CART demonstrated the significance of several influential factors that would not be associated with suicide if the data were analyzed using the conventional logistic regression. CONCLUSION Associations between the key factors and suicide death for Chinese rural elderly are not linear and parallel but hierarchically nested that could not be effectively detected using conventional statistical methods. Findings of this study provide new and compelling evidence supporting tailored suicide prevention interventions at the familial, clinical and community levels.
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Affiliation(s)
- Xinguang Chen
- Global Health Institute, Xi'an Jiaotong University, Xi'an, China
| | - Qiqing Mo
- Department of Social Medicine, School of Public Health, Guangxi Medical University, Nanning, China.,Guilin People's Hospital, Guilin, China.,Department of Epidemiology, Universtiy of Florida, Gaineville, FL, United States
| | - Bin Yu
- Department of Biostatistics and Epidemiology, School of Public Health, Wuhan University, Wuhan, China
| | - Xinyu Bai
- Department of Social Medicine, School of Public Health, Guangxi Medical University, Nanning, China.,People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Cunxian Jia
- Department of Epidemiology, School of Public Health, Cheeloo Medical College, Shandong University, Jinan, China
| | - Liang Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhenyu Ma
- Department of Social Medicine, School of Public Health, Guangxi Medical University, Nanning, China
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81
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A virtual, pilot randomized trial of a brief intervention to prevent suicide in an integrated healthcare setting. Gen Hosp Psychiatry 2022; 75:68-74. [PMID: 35202942 PMCID: PMC8955571 DOI: 10.1016/j.genhosppsych.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Patients who die by suicide are often seen in primary care settings in the weeks leading to their death. There has been little study of brief interventions to prevent suicide in these settings. METHOD We conducted a virtual, pilot, randomized controlled trial of a brief suicide prevention strategy called Veterans Affairs Brief Intervention and Contact Program (VA BIC) in patients who presented to a primary care mental health walk-in clinic for a new mental health intake appointment and were at risk for suicide. Our primary aim was to assess feasibility. We measured our ability to recruit 20 patients. We measured the proportion of enrolled patients who completed all study assessments. We assessed adherence among patients assigned to VA BIC. RESULTS Twenty patients were enrolled and 95% (N = 19) completed all study assessments. Among the 10 patients assigned to VA BIC, 90% (N = 9) of patients completed all required intervention visits, and 100% (N = 10) completed ≥70% of the required interventions visits. CONCLUSION It is feasible to conduct a virtual trial of VA BIC in an integrated care setting. Future research should clarify the role of VA BIC as a suicide prevention strategy in integrated care settings using an adequately powered design. CLINICAL TRIAL REGISTRATION NCT04054947.
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82
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Fawcett E, O'Reilly G. Hospital presenting suicidal ideation: A systematic review. Clin Psychol Psychother 2022; 29:1530-1541. [PMID: 35716391 PMCID: PMC9796242 DOI: 10.1002/cpp.2761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Research indicates that the emergency department is the primary setting for people to present with suicidal ideation. Attempting to provide interventions for this population depends greatly on understanding their needs and life circumstances at the time of presentation to services, therefore enabling more appropriate treatment pathways and services to be provided. AIM This review aims to collate, evaluate and synthesize the empirical research focused on the population of people presenting to hospital settings with suicidal ideation. METHOD A systematic literature search was performed. Articles that met a specified set of inclusion criteria including participants being over 18, not being admitted to hospital and presenting to an emergency department setting underwent a quality assessment and data analysis. The quality assessment used was the EPHPP Quality Assessment Tool for Quantitative Studies (Thomas et al., 2004). RESULTS Twenty-seven articles were included in the review. Studies were quantitative and of reasonable methodological quality (Thomas et al., 2004). The literature was characterized by demographic information, mental health factors associated with the presentation to hospital and treatment pathways or outcomes reported. The reviewed research showed that people presenting to emergency departments with suicidal ideation were varying in age, gender, ethnic background and socio-economic status (SES). Large proportions of studies reported psychosocial factors alongside interpersonal struggles as the main presenting reason. The review highlights large variability across these factors. Mental health diagnosis was common, previous suicide attempt was a risk factor, and treatment pathways were unclear. The review identifies the outstanding gaps and weaknesses in this literature as well as areas in need of future research. CONCLUSIONS In conclusion, the review highlights the prevalence of people reporting interpersonal factors as the reason for suicidal ideation and not mental health disorders or diagnosis. Despite this, no mention of trauma or life stories was made in any study assessing this population. Despite a large variation across studies making synthesis difficult, data proves clinically relevant and informative for future practice and guidance on areas needing further research.
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Affiliation(s)
- Emma Fawcett
- Department of PsychologyUniversity College DublinDublinIreland
| | - Gary O'Reilly
- Department of PsychologyUniversity College DublinDublinIreland
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83
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Chan EC, Wallace K, Yang EH, Roper L, Aryal G, Lodhi RJ, Isenberg R, Carnes P, Baskys A, Green B, Aitchison KJ. The feasibility and acceptability of mobile application-based assessment of suicidality using self-report components of a novel tool, the Suicide Ideation and Behavior Assessment Tool (SIBAT). Psychiatry Res 2022; 307:114316. [PMID: 34896843 DOI: 10.1016/j.psychres.2021.114316] [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: 03/17/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 11/17/2022]
Abstract
The aim of this study was to assess the validity of a mobile application-based self-report questionnaire in the assessment of suicidality. We developed a program for the administration of self-report components of the Suicide Ideation and Behavior Assessment Tool (SIBAT). We invited university students and trainees enrolled in a study of addictions to complete this component of the SIBAT using the program on their mobile devices or personal computer. 196 participants completed all required modules of the SIBAT, with 97 using their mobile device and 99 using their personal computer. Rates of completed questionnaires between the two groups were compared, as were the responses to the items and the total scores. There was a significant difference between proportions of scale completion in both groups, with a greater number of participants who used a personal computer to complete the scale not responding to all questions compared to participants who used a mobile device to complete the scale. Data collected via mobile device showed good concurrent validity with data collected via personal computer. A trend toward greater disclosure of suicidality was observed in the mobile device group however, replication of these findings using larger sample sizes is needed.
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Affiliation(s)
- Eric C Chan
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
| | - Keanna Wallace
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Esther H Yang
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Leslie Roper
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Garima Aryal
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Rohit J Lodhi
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Richard Isenberg
- American Foundation for Addiction Research, Psychological Counseling Services, Scottsdale, Arizona, USA
| | - Patrick Carnes
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrius Baskys
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Graduate College of Biomedical Sciences and University Medical Center, Western University of Health Sciences, Pomona, California, USA; Memory Disorders and Genomic Medicine Clinic, Riverside, California, USA
| | - Bradley Green
- Department of Psychology, University of Texas at Tyler, Tyler, USA
| | - Katherine J Aitchison
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
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84
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Ho TC, Gifuni AJ, Gotlib IH. Psychobiological risk factors for suicidal thoughts and behaviors in adolescence: a consideration of the role of puberty. Mol Psychiatry 2022; 27:606-623. [PMID: 34117365 PMCID: PMC8960417 DOI: 10.1038/s41380-021-01171-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/03/2021] [Accepted: 05/11/2021] [Indexed: 02/05/2023]
Abstract
Suicide is the second leading cause of death among adolescents. While clinicians and researchers have begun to recognize the importance of considering multidimensional factors in understanding risk for suicidal thoughts and behaviors (STBs) during this developmental period, the role of puberty has been largely ignored. In this review, we contend that the hormonal events that occur during puberty have significant effects on the organization and development of brain systems implicated in the regulation of social stressors, including amygdala, hippocampus, striatum, medial prefrontal cortex, orbitofrontal cortex, and anterior cingulate cortex. Guided by previous experimental work in adults, we also propose that the influence of pubertal hormones and social stressors on neural systems related to risk for STBs is especially critical to consider in adolescents with a neurobiological sensitivity to hormonal changes. Furthermore, facets of the pubertal transition, such as pubertal timing, warrant deeper investigation and may help us gain a more comprehensive understanding of sex differences in the neurobiological and psychosocial mechanisms underlying adolescent STBs. Ultimately, advancing our understanding of the pubertal processes that contribute to suicide risk will improve early detection and facilitate the development of more effective, sex-specific, psychiatric interventions for adolescents.
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Affiliation(s)
- Tiffany C. Ho
- grid.168010.e0000000419368956Department of Psychology, Stanford University, Stanford, CA USA ,grid.266102.10000 0001 2297 6811Department of Psychiatry and Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA USA
| | - Anthony J. Gifuni
- grid.168010.e0000000419368956Department of Psychology, Stanford University, Stanford, CA USA ,grid.14709.3b0000 0004 1936 8649Psychiatry Department and Douglas Mental Health University Institute, McGill University, Montréal, QC Canada
| | - Ian H. Gotlib
- grid.168010.e0000000419368956Department of Psychology, Stanford University, Stanford, CA USA
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85
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Airey ND, Iqbal Z. Are Clinicians Confident in the Risk Assessment of Suicide?: A Systematic Literature Review. Arch Suicide Res 2022; 26:1-13. [PMID: 32669055 DOI: 10.1080/13811118.2020.1792019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Suicide reduction is recognized as a vital focus for mental health clinicians. Clinician confidence to undertake suicide risk assessment, though poorly understood, appears related to job performance, though overconfidence has also been evident in clinical practice. A systematic literature search was undertaken on PSYCinfo and MEDLINE using the terms: suicide risk assessment, confidence, clinician. Of 192 papers identified, 10 articles were deemed pertinent. These for the most part suggested clinician confidence above the 50% chance level though statistical evidence was lacking for all but two. The literature fails to provide sufficient and objective evidence of the impact of clinician confidence in practice. Recommendations are provided for future research.
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86
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Harris K, Haddock G, Peters S, Gooding P. Psychometric properties of the Suicidal Ideation Attributes Scale (SIDAS) in a longitudinal sample of people experiencing non-affective psychosis. BMC Psychiatry 2021; 21:628. [PMID: 34915870 PMCID: PMC8675490 DOI: 10.1186/s12888-021-03639-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicidal ideation is a key precursor for suicide attempts and suicide deaths. Performing routine screening of suicide precursors can help identify people who are at high risk of death by suicide. This is, arguably, an important suicide prevention effort. The aim of this study was to assess the validity, reliability, and factor structure of the Suicidal Ideation Attributes Scale (SIDAS) in a three-month longitudinal study with people with a diagnosis of schizophrenia or non-affective psychosis and experiences of suicidal ideation and/or behaviours. It was predicted that the SIDAS would have high internal consistency, test-retest reliability, convergent, discriminant and construct validity. METHODS Ninety-nine participants experiencing psychosis completed the SIDAS at baseline and 89 participants completed it 3 months later. Additionally, participants completed a demographic questionnaire, the Beck Scale for Suicide Ideation, the Beck Hopelessness Scale, and the Defeat and Entrapment Scales. The internal consistency, test-retest reliability, convergent validity, and discriminant validity of the SIDAS were investigated in comparison to other constructs. Factor analysis was performed to examine the factor structure of the scale. RESULTS Principal component analysis yielded a theoretically coherent one-dimensional factor structure of SIDAS, suggesting good construct validity (PCA = .71). The SIDAS had high internal consistency (α = .89) and good test-retest reliability (α = .73). It was highly correlated with other self-report measures, including the Beck Scale for Suicide Ideation, Beck Hopelessness Scale, Defeat and Entrapment scales, indicating excellent construct validity. CONCLUSION The SIDAS is a valid and reliable self-report instrument for assessing the severity of suicidal ideation in a population of people with a diagnosis of schizophrenia or non-affective psychosis. Further research should test the psychometric properties of the scale in individuals experiencing different mental health problems in cross-cultural settings, in order to establish its broader validity, reliability, and clinical utility.
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Affiliation(s)
- Kamelia Harris
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
| | - Gillian Haddock
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Manchester Academic Health Science Centre, MAHSC, Manchester, UK
| | - Sarah Peters
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Patricia Gooding
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Manchester Academic Health Science Centre, MAHSC, Manchester, UK
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87
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First responder, clinician, and non‐clinical support staff knowledge, attitudes, and behaviours towards people presenting for emergency care following self‐harm: a mixed evidence synthesis. Cochrane Database Syst Rev 2021; 2021:CD014939. [PMCID: PMC8668017 DOI: 10.1002/14651858.cd014939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: The objectives of this review are threefold, as follows. Firstly, to assess the content of knowledge, attitudes, and behaviours of first responders, clinicians, and non‐clinical support staff towards service users with SH presentations. Secondly, to understand how service user and staff characteristics (e.g. age, gender, sociodemographic background), type of SH presentation (e.g. method, repetition), and contextual factors (e.g. hospital environment, presence of bystanders) affect the knowledge, attitudes, and behaviours of first responders, clinicians, and non‐clinical support staff in providing acute care. Thirdly, to assess whether clinicians' knowledge, attitudes, and behaviours have evolved over time.
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88
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Comparing machine learning to a rule-based approach for predicting suicidal behavior among adolescents: Results from a longitudinal population-based survey. J Affect Disord 2021; 295:1415-1420. [PMID: 34620490 DOI: 10.1016/j.jad.2021.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/22/2021] [Accepted: 09/12/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Suicidal thoughts and suicide attempts are one of the most prominent public health concerns in adolescents and therefore early detection is important to initiate preventive interventions and closer monitoring. METHOD We examined whether the Machine Learning models Random Forest and Lasso Regression better predict future suicidal behavior than a simple decision rule that classifies every adolescent with history of suicide ideation at baseline as at risk (current practice). We used data from a general population of students in second and fourth year of secondary education in Amsterdam, the Netherlands. RESULTS Both the Random Forest and the Lasso Regression resulted in slightly better prediction. The AUC of the Random Forest (0.79) and Lasso regression (0.76) were both higher than the AUC of the decision rule (0.64). The Random Forest achieved slightly (but non-significantly) higher sensitivity than the decision rule (0.37 versus 0.34), with the same specificity (0.94). With Lasso Regression the sensitivity increased significantly (0.52), but at the expense of the specificity (0.85). LIMITATIONS The loss of cases after merging the data, the use of self-reported data, confidential data collection and the use of only four questions to measure suicidal behavior. CONCLUSIONS This is the first study applying Machine Learning techniques to predict future suicidal behavior on survey data collected in a general population of adolescents. Our study showed that integrating machine learning techniques in screening practice will result in a small improvement in the ability to predict suicide. The models need to be further optimized to improve accuracy.
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89
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Lengvenyte A, Olié E, Strumila R, Navickas A, Gonzalez Pinto A, Courtet P. Immediate and short-term efficacy of suicide-targeted interventions in suicidal individuals: A systematic review. World J Biol Psychiatry 2021; 22:670-685. [PMID: 33783294 DOI: 10.1080/15622975.2021.1907712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To address the extreme suicide risk period following a suicidal crisis, we aimed to assess the current evidence for specific healthcare system-based interventions on suicide-related outcomes within one-week or one-month in individuals with current suicidal ideation (SI) or a recent suicide attempt (SA). METHODS We performed a database (Medline, Academic Search Complete, PsycARTICLES, the Cochrane library, PubMed) and manual reference search for randomised controlled trials, published between March 2000 and March 2020. Antisuicidal efficacy was defined as SI, SA, or a closely related concept. Quality was assessed with the Cochrane Risk of Bias 2 tool for randomised trials. RESULTS Out of 34 trials, five reported ketamine or esketamine superiority over placebo in reducing SI in depressed subjects within one week, while five studies had negative findings. Single trials reported positive results for one-month antisuicidal efficacy of buprenorphine, paroxetine, a crisis response plan, and assertive case management. Most trials were underpowered and had moderate-to-high risk of bias. CONCLUSIONS Preliminary mixed evidence suggests the possible utility of several pharmacological (ketamine, esketamine paroxetine, and buprenorphine) and non-pharmacological (a crisis response plan, and assertive case management) interventions. Only the immediate efficacy of ketamine was supported by multiple studies, and replication is needed.
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Affiliation(s)
- Aiste Lengvenyte
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania
| | - Emilie Olié
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,French Association of Biological Psychiatry and Neuropsychopharmacology
| | - Robertas Strumila
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania
| | - Alvydas Navickas
- Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania
| | - Ana Gonzalez Pinto
- CIBERSAM; Bioaraba, Research Group on Severe Mental Illness; Osakidetza, Araba University Hospital, Psychiatry Service; Faculty of Medicine, Department of Neurosciences, University of the Basque Country UPV / EHU, Vitoria-Gasteiz, Spain.,Spanish Society of Biological Psychiatry
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France.,French Association of Biological Psychiatry and Neuropsychopharmacology
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90
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Chan EC, Wallace K, Yang EH, Roper L, Aryal G, Lodhi RJ, Baskys A, Isenberg R, Carnes P, Green B, Aitchison KJ. Internal consistency and concurrent validity of self-report components of a new instrument for the assessment of suicidality, the Suicide Ideation and Behavior Assessment Tool (SIBAT). Psychiatry Res 2021; 304:114128. [PMID: 34343876 DOI: 10.1016/j.psychres.2021.114128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
This study aimed to assess the internal consistency of self-report components of the Suicide Ideation and Behavior Assessment Tool (SIBAT) and validate it with relevant elements of the Mini International Neuropsychiatric Interview (MINI). The SIBAT is a newly developed instrument for the evaluation of suicidality. In this study, we invited university students and trainees participating in a study of addictions to complete the self-report component of the SIBAT as an add-on study. We evaluated the internal consistency of the self-report component of the SIBAT and validated it against the suicidality component of the MINI. Data were analysed using both complete case analysis and multiple imputation. SIBAT data were collected for 394 participants, 314 of whom had also completed the MINI. The internal consistency of modules 2, 3, and 5 of the SIBAT was high. Each item from module 5 had a statistically significant association with the corresponding item from the MINI. The sum of scores from modules 2 and 3 had a moderate correlation with the assessment of suicide risk determined by the MINI, and a strong correlation with the total score of SIBAT module 5. The completion median time of modules 2, 3 and 5 was 14.3 min.
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Affiliation(s)
- Eric C Chan
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
| | - Keanna Wallace
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Esther H Yang
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Leslie Roper
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Garima Aryal
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Rohit J Lodhi
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Andrius Baskys
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Graduate College of Biomedical Sciences and University Medical Center, Western University of Health Sciences, Pomona, California, United States; Memory Disorders and Genomic Medicine Clinic, Riverside, California, United States
| | - Richard Isenberg
- American Foundation for Addiction Research, Psychological Counseling Services, Scottsdale, Arizona, United States
| | - Patrick Carnes
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Bradley Green
- Department of Psychology, University of Texas at Tyler, Tyler, United States
| | - Katherine J Aitchison
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada; Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada.
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91
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Scheunemann J, Jelinek L, Peth J, Runde A, Arlt S, Gallinat J, Kühn S. Do implicit measures improve suicide risk prediction? An 18-month prospective study using different tasks. Suicide Life Threat Behav 2021; 51:993-1004. [PMID: 34196996 DOI: 10.1111/sltb.12785] [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: 08/14/2020] [Revised: 11/12/2020] [Accepted: 04/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is accumulating evidence that implicit measures improve the prediction of suicidality within a 6-month follow-up period in psychiatric populations. Building upon these results, we set out to expand the follow-up period and to investigate various implicit methods. METHODS Seventy-nine inpatients completed the Beck Scale for Suicidal Ideation (BSS) and a range of implicit measures: three implicit association tests (IATs: Death; Self-harm-Me/Others; Self-Harm-Good/Bad) and a subliminal priming task (with separate scores for negative and positive adjectives, each indicating the association between the primes "dying" and "growing"). After 18 months, we reached n = 52 patients and reassessed suicidal ideation, plans, and attempts. RESULTS In a hierarchical regression, the five implicit task indices were entered after the patient's age, gender, and BSS score at baseline. The implicit scores improved prediction of BSS scores after 18 months compared to prediction based on age, gender, and BSS score at baseline alone. However, none of the implicit measures was associated with suicide plans or attempts during the follow-up period. CONCLUSION Results suggest that implicit measures can be a useful assessment tool for the prediction of suicidal ideation, even beyond the BSS. However, long-term prediction of suicide plans or attempts using implicit measures seems limited.
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Affiliation(s)
- Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Peth
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Runde
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sönke Arlt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Lise-Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
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92
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Haroz EE, Grubin F, Goklish N, Pioche S, Cwik M, Barlow A, Waugh E, Usher J, Lenert MC, Walsh CG. Designing a Clinical Decision Support Tool That Leverages Machine Learning for Suicide Risk Prediction: Development Study in Partnership With Native American Care Providers. JMIR Public Health Surveill 2021; 7:e24377. [PMID: 34473065 PMCID: PMC8446841 DOI: 10.2196/24377] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/10/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background Machine learning algorithms for suicide risk prediction have been developed with notable improvements in accuracy. Implementing these algorithms to enhance clinical care and reduce suicide has not been well studied. Objective This study aims to design a clinical decision support tool and appropriate care pathways for community-based suicide surveillance and case management systems operating on Native American reservations. Methods Participants included Native American case managers and supervisors (N=9) who worked on suicide surveillance and case management programs on 2 Native American reservations. We used in-depth interviews to understand how case managers think about and respond to suicide risk. The results from interviews informed a draft clinical decision support tool, which was then reviewed with supervisors and combined with appropriate care pathways. Results Case managers reported acceptance of risk flags based on a predictive algorithm in their surveillance system tools, particularly if the information was available in a timely manner and used in conjunction with their clinical judgment. Implementation of risk flags needed to be programmed on a dichotomous basis, so the algorithm could produce output indicating high versus low risk. To dichotomize the continuous predicted probabilities, we developed a cutoff point that favored specificity, with the understanding that case managers’ clinical judgment would help increase sensitivity. Conclusions Suicide risk prediction algorithms show promise, but implementation to guide clinical care remains relatively elusive. Our study demonstrates the utility of working with partners to develop and guide the operationalization of risk prediction algorithms to enhance clinical care in a community setting.
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Affiliation(s)
- Emily E Haroz
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Fiona Grubin
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Novalene Goklish
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shardai Pioche
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Mary Cwik
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Allison Barlow
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emma Waugh
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jason Usher
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Matthew C Lenert
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Colin G Walsh
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, United States
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93
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Fitzpatrick SJ, Handley T, Powell N, Read D, Inder KJ, Perkins D, Brew BK. Suicide in rural Australia: A retrospective study of mental health problems, health-seeking and service utilisation. PLoS One 2021; 16:e0245271. [PMID: 34288909 PMCID: PMC8294514 DOI: 10.1371/journal.pone.0245271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/02/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Suicide rates are higher in rural Australia than in major cities, although the factors contributing to this are not well understood. This study highlights trends in suicide and examines the prevalence of mental health problems and service utilisation of non-Indigenous Australians by geographic remoteness in rural Australia. METHODS A retrospective study of National Coronial Information System data of intentional self-harm deaths in rural New South Wales, Queensland, South Australia and Tasmania for 2010-2015 from the National Coronial Information System. RESULTS There were 3163 closed cases of intentional self-harm deaths by non-Indigenous Australians for the period 2010-2015. The suicide rate of 12.7 deaths per 100,000 persons was 11% higher than the national Australian rate and increased with remoteness. Among people who died by suicide, up to 56% had a diagnosed mental illness, and a further 24% had undiagnosed symptoms. Reported diagnoses of mental illness decreased with remoteness, as did treatment for mental illness, particularly in men. The most reported diagnoses were mood disorders (70%), psychotic disorders (9%) and anxiety disorders (8%). In the six weeks before suicide, 22% of cases had visited any type of health service at least once, and 6% had visited two or more services. Medication alone accounted for 76% of all cases treated. CONCLUSIONS Higher suicide rates in rural areas, which increase with remoteness, may be attributable to decreasing diagnosis and treatment of mental disorders, particularly in men. Less availability of mental health specialists coupled with socio-demographic factors within more remote areas may contribute to lower mental health diagnoses and treatment. Despite an emphasis on improving health-seeking and service accessibility in rural Australia, research is needed to determine factors related to the under-utilisation of services and treatment by specific groups vulnerable to death by suicide.
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Affiliation(s)
- Scott J. Fitzpatrick
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Tonelle Handley
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Nic Powell
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Donna Read
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Kerry J. Inder
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
| | - David Perkins
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Bronwyn K. Brew
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women and Children’s Health, University of New South Wales, Sydney, Australia
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94
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Teismann T, Forkmann T, Glaesmer H, Juckel G, Cwik JC. Skala Suizidales Erleben und Verhalten (SSEV). DIAGNOSTICA 2021. [DOI: 10.1026/0012-1924/a000269] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Suizidales Erleben und Verhalten ist in klinischen Kontexten sehr verbreitet. Während international diverse Messinstrumente zur Erfassung von Suizidalität entwickelt und validiert wurden, gibt es nur wenige deutsche Messinstrumente. In der vorliegenden Studie wurde die neu entwickelte Skala Suizidales Erleben und Verhalten (SSEV) in fünf Stichproben mit insgesamt N = 1 099 Proband_innen im Hinblick auf ihre psychometrischen Eigenschaften untersucht. Die faktorenanalytische Untersuchung (explorative und konfirmatorische Faktorenanalyse) ergab eine eindimensionale Struktur des Fragebogens. Die interne Konsistenz der SSEV ist hoch und es zeigten sich erwartungsgemäß positive Zusammenhänge zu diversen Maßen aktueller Theoriemodelle suizidalen Erlebens und Verhaltens, sowie zu Depressivität, Angst und Stress. Weitere Analysen zeigten erwartungskonform negative Zusammenhänge mit sozialer Unterstützung und positiver mentaler Gesundheit. Insgesamt verweisen die Ergebnisse darauf, dass es sich beim SSEV um ein reliables und valides Instrument zur Erfassung von akutem suizidalem Erleben und Verhalten handelt, welches in der Forschung und der klinischen Praxis angewendet werden kann.
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Affiliation(s)
- Tobias Teismann
- Arbeitseinheit für Klinische Psychologie und Psychotherapie, Ruhr-Universität Bochum
| | - Thomas Forkmann
- Abteilung für Klinische Psychologie, Universität Duisburg-Essen
| | - Heide Glaesmer
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universität Leipzig
| | - Georg Juckel
- Abteilung für Psychiatrie, LWL-Universitätsklinik, Ruhr-Universität Bochum
| | - Jan C. Cwik
- Abteilung für Klinische Psychologie und Psychotherapie, Universität zu Köln
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95
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Hawgood J, Ownsworth T, Mason H, Spence SH, Arensman E, De Leo D. A Pilot Study of Clinicians' Perceptions of Feasibility, Client-Centeredness, and Usability of the Systematic Tailored Assessment for Responding to Suicidality Protocol. CRISIS 2021; 43:523-530. [PMID: 34187175 DOI: 10.1027/0227-5910/a000796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: The Systematic Tailored Assessment for Responding to Suicidality (STARS) is a client-centered, psychosocial needs-based assessment protocol. This semistructured interview obtains client prioritized indicators that contribute to suicidality and informs commensurate care responses for preventing suicide. Aim: To pilot the feasibility, client-centeredness, and usability of the STARS protocol, including clinicians' perceptions of ease of use; content validity; and administration within the community setting. Method: A convenience sample of clinicians who undertook assessment and/or intervention with suicidal persons and had used STARS between mid-2016 and early 2017 completed an online survey assessing feasibility, client-centeredness, and usability of STARS. Results: Of the 51 clinicians who entered the survey, 42 (82.3%; aged 25-74; 69% female) completed it. Overall, perceptions of feasibility and usability of STARS were positive, particularly regarding client-centeredness of the protocol and confidence in information obtained for screening suicidality and informing needs-based priority responses. Limitations: The pilot findings are limited by the use of a small convenience sample and the low completion rate of clinicians with STARS training. Conclusion: STARS was perceived as a feasible and useful psychosocial needs-based assessment protocol. Suggestions for improving STARS, training requirements, and application to diverse populations are outlined.
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Affiliation(s)
- Jacinta Hawgood
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia.,School of Applied Psychology and Menzies Health Institute Queensland; Griffith University, Brisbane, QLD, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and Menzies Health Institute Queensland; Griffith University, Brisbane, QLD, Australia
| | - Helen Mason
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Susan H Spence
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Ella Arensman
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia.,School of Public Health, College of Medicine and Health, University College Cork, Ireland.,National Suicide Research Foundation, Cork, Ireland
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
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96
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Wyder M, Ray MK, Russell S, Kinsella K, Crompton D, van den Akker J. Suicide risk assessment in a large public mental health service: do suicide risk classifications identify those at risk? Australas Psychiatry 2021; 29:322-325. [PMID: 33507816 DOI: 10.1177/1039856220984032] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Risk assessment tools are routinely used to identify patients at high risk. There is increasing evidence that these tools may not be sufficiently accurate to determine the risk of suicide of people, particularly those being treated in community mental health settings. METHODS An outcome analysis for case serials of people who died by suicide between January 2014 and December 2016 and had contact with a public mental health service within 31 days prior to their death. RESULTS Of the 68 people who had contact, 70.5% had a formal risk assessment. Seventy-five per cent were classified as low risk of suicide. None were identified as being at high risk. While individual risk factors were identified, these did not allow to differentiate between patients classified as low or medium. DISCUSSION Risk categorisation contributes little to patient safety. Given the dynamic nature of suicide risk, a risk assessment should focus on modifiable risk factors and safety planning rather than risk prediction. CONCLUSION The prediction value of suicide risk assessment tools is limited. The risk classifications of high, medium or low could become the basis of denying necessary treatment to many and delivering unnecessary treatment to some and should not be used for care allocation.
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Affiliation(s)
- Marianne Wyder
- Metro South Addictions and Mental Health Services, QLD, Australia.,Hopkins Centre, Griffith University, QLD, Australia
| | - Manaan Kar Ray
- Metro South Addictions and Mental Health Services, QLD, Australia
| | - Samara Russell
- Metro South Addictions and Mental Health Services, QLD, Australia
| | - Kieran Kinsella
- Metro South Addictions and Mental Health Services, QLD, Australia
| | - David Crompton
- Metro South Addictions and Mental Health Services, QLD, Australia.,Hopkins Centre, Griffith University, QLD, Australia
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97
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Rozel JS. Broken promise: Challenges in achieving effective universal suicide screening. Acad Emerg Med 2021; 28:705-706. [PMID: 33349999 DOI: 10.1111/acem.14199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 02/06/2023]
Affiliation(s)
- John S. Rozel
- UPMC Western Psychiatric Hospital Pittsburgh Pennsylvania USA
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98
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Examining the Three-Step Theory (3ST) of Suicide in a Prospective Study of Adult Psychiatric Inpatients. Behav Ther 2021; 52:673-685. [PMID: 33990241 DOI: 10.1016/j.beth.2020.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 11/22/2022]
Abstract
This study examined the validity and predictive utility of the three-step theory (3ST) of suicide in psychiatric patients. Participants were 190 consecutively admitted adult psychiatric inpatients (53% female, 60% White, ages 18-73) assessed at three time points: baseline, 4 weeks later (n = 112), and 3 months postdischarge (n = 102). Results were broadly supportive of the 3ST. First, at baseline, an interactive model of pain and hopelessness accounted for substantial variability in suicidal desire, even when controlling for depression and lifetime ideation. This result replicated in different genders and age ranges (i.e., 18-32 and 33-73). Further, pain and hopelessness were robust predictors of suicidal desire weeks and months into the future. Second, among those with pain and hopelessness, lower connectedness, as well as the extent to which pain exceeds connectedness, were robust predictors of higher suicidal desire. Last, a baseline measure of practical capability for suicide predicted suicide attempts both retrospectively and prospectively, even when controlling for lifetime ideation-however, dispositional and acquired contributors to capability were less predictive. Results support the validity and predictive utility of the 3ST, and suggest that the theory may have utility for guiding risk assessment and intervention.
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99
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Bond KS, Cottrill FA, Mackinnon A, Morgan AJ, Kelly CM, Armstrong G, Kitchener BA, Reavley NJ, Jorm AF. Effects of the Mental Health First Aid for the suicidal person course on beliefs about suicide, stigmatising attitudes, confidence to help, and intended and actual helping actions: an evaluation. Int J Ment Health Syst 2021; 15:36. [PMID: 33879197 PMCID: PMC8056520 DOI: 10.1186/s13033-021-00459-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 04/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is a significant concern in Australia and globally. There is a strong argument for training community gatekeepers in how to recognise and support suicidal people in their social network. One such training course is the Mental Health First Aid for the Suicidal Person course. This course was developed using suicide prevention best practice guidelines based on expert opinion (determined using the Delphi Method). METHODS We evaluated the impact of attending the Mental Health First Aid for the Suicidal Person course on suicide literacy and stigma, confidence in and quality of intended and actual helping behaviours towards a person who is suicidal, and course satisfaction. Surveys were administered before and immediately after the course, and at 6-month follow-up. Data were analysed to yield descriptive statistics (percentages, means, standard deviations), with linear mixed models and generalized linear mixed models being used to test the statistical significance of changes over occasions of measurement. RESULTS We recruited 284 participants from workplaces and general community networks. The mean age was 41 years and 74% were female. 85% of people undertook the course as part of professional development, and almost half (44%) did the course because they had contact with a suicidal person. The majority (59%) of participants had previous mental health and suicide prevention training. The majority of participants held knowledge (suicide literacy) before undertaking the course. The major effect of training was to strengthen this knowledge. There was a significant improvement from pre-course (M = 1.79, SD 0.56) to post-course (M = 1.48, SD 0.82, p < 0.0001), which was maintained at follow-up (M = 1.51, SD 0.49, p < 0.0001). Confidence in gatekeeper skills significantly improved after the course and at follow-up (M = 3.15, SD 0.95 before the course to M = 4.02, SD 0.68 afterward and 3.87, SD 0.77 at follow-up, p < 0.0001 and p < 0.0001, respectively). The quality of intended helping behaviours significantly improved from pre-course (intended actions M = 4.28, SD 0.58) and to post-course (M = 4.70, SD 0.50, p < 0.0001) and were maintained at follow-up (M = 4.64, SD 0.41, p < 0.0001). There was significant improvement in some of the actions taken by participants to help a suicidal person from pre-course to post-course (e.g. asking about suicidal thoughts and plan, contacting emergency services). The course was highly acceptable to participants. CONCLUSION These results indicate that this course is an acceptable intervention that delivers a broad spectrum of beneficial outcomes to community and workplace gatekeepers.
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Affiliation(s)
- Kathy S Bond
- Mental Health First Aid Australia, Parkville, VIC, Australia.
| | | | - Andrew Mackinnon
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Amy J Morgan
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Claire M Kelly
- Mental Health First Aid Australia, Parkville, VIC, Australia
| | - Greg Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Nicola J Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Anthony F Jorm
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
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100
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Bjureberg J, Dahlin M, Carlborg A, Edberg H, Haglund A, Runeson B. Columbia-Suicide Severity Rating Scale Screen Version: initial screening for suicide risk in a psychiatric emergency department. Psychol Med 2021; 52:1-9. [PMID: 33766155 PMCID: PMC9811343 DOI: 10.1017/s0033291721000751] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Suicide screening is routine practice in psychiatric emergency (PE) departments, but evidence for screening instruments is sparse. Improved identification of nascent suicide risk is important for suicide prevention. The aim of the current study was to evaluate the association between the novel Colombia Suicide Severity Rating Scale Screen Version (C-SSRS Screen) and subsequent clinical management and suicide within 1 week, 1 month and 1 year from screening. METHODS Consecutive patients (N = 18 684) attending a PE department in Stockholm, Sweden between 1 May 2016 and 31 December 2017 were assessed with the C-SSRS Screen. All patients (52.1% women; mean age = 39.7, s.d. = 16.9) were followed-up in the National Cause of Death Register. Logistic regression and receiver operating characteristic curves analyses were conducted. Optimal cut-offs and accuracy statistics were calculated. RESULTS Both suicidal ideation and behaviour were prevalent at screening. In total, 107 patients died by suicide during follow-up. Both C-SSRS Screen Ideation Severity and Behaviour Scales were associated with death by suicide within 1-week, 1-month and 1-year follow-up. The optimal cut-off for the ideation severity scale was associated with at least four times the odds of dying by suicide within 1 week (adjusted OR 4.7, 95% confidence interval 1.5-14.8). Both scales were also associated with short-term clinical management. CONCLUSIONS The C-SSRS Screen may be feasible to use in the actual management setting as an initial step before the clinical assessment of suicide risk. Future research may investigate the utility of combining the C-SSRS Screen with a more thorough assessment.
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Affiliation(s)
- Johan Bjureberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Psychology, Stanford University, Stanford, California, USA
| | - Marie Dahlin
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stockholms Psykiatri, Stockholm, Sweden
| | - Andreas Carlborg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stockholms Psykiatri, Stockholm, Sweden
| | - Hanna Edberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stockholms Psykiatri, Stockholm, Sweden
| | - Axel Haglund
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & The National Board of Forensic Medicine, Stockholm, Sweden
| | - Bo Runeson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stockholms Psykiatri, Stockholm, Sweden
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