National Trends of Mental Health Care Among US Adults Who Attempted Suicide in the Past 12 Months

National Trends in Emergency Department Visits for Suicide Attempts and Intentional Self-Harm

OBJECTIVE

This study estimated national annual trends and characteristics of emergency department visits for suicide attempts and intentional self-harm in the United States from 2011 to 2020.

METHODS

Data were from the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national sample survey of emergency departments. Visits for suicide attempts and intentional self-harm were identified using discharge diagnosis codes (ICD-9-CM for 2011-2015; ICD-10-CM for 2016-2020) or reason-for-visit codes. The annual proportion of emergency department visits for suicide attempts and intentional self-harm was estimated.

RESULTS

The weighted number of emergency department visits for suicide attempts and intentional self-harm increased from 1.43 million, or 0.6% of total emergency department visits, in 2011-2012 to 5.37 million, or 2.1% of total emergency department visits in 2019-2020 (average annual percent change, 19.5%, 95% CI=16.9, 22.2). Visits per capita increased from 261 to 871 visits per 100,000 persons (average annual percent change, 18.8%, 95% CI=17.6, 20.0). The increase in visits was widely distributed across sociodemographic groups. While suicide attempt and intentional self-harm visits were most common among adolescents, adults age 65 or older demonstrated the largest increase (average annual percent change, 30.2%, 95% CI=28.5, 32.0). Drug-related diagnoses were the most common co-occurring diagnosis among suicide attempt and intentional self-harm visits. Despite the rise in emergency department visits for suicide attempts and intentional self-harm, less than 16% included an evaluation by a mental health professional.

CONCLUSIONS

A significant national increase in emergency department visits for suicide attempts and intentional self-harm occurred from 2011 to 2020, as a proportion of total emergency department visits and as visits per capita. These trends underscore an urgent need to improve the continuum of mental health care for individuals with suicidal symptoms.

National trends and correlates of treatment resistance in major depressive episode and associated suicidal ideation and behaviors among adults in the United States

OBJECTIVE

To examine recent 12-year trends in prevalence of suicidal ideation and behaviors (SIBs) among US adults experiencing a past-year treatment-resistant depression (TRD).

METHODS

Using data from the National Survey of Drug Use and Health, we estimated the annual percentage of individuals aged ≥18 with TRD who reported past-year SIBs, and estimated linear trends adjusting for potentially confounding factors from 2009 to 2020.

RESULTS

Of estimated 237.5 million US adults, 7.1 % met diagnostic criteria for a past-year major depressive episode (MDE) between 2009 and 2020. Of these, 9.7 % met criteria for TRD. The proportion reporting past-year suicidal ideation in TRD ranged from 39.5 % (95 % confidence interval [CI], 32.1-47.3 %) in 2009-2010 to 43.4 % (95 % CI, 36.7-503 %) in 2019-2020, with an average annual percent change (AAPC) of 1.3 % (95 % CI, -0.7 % to 3.3 %). The prevalence of past-year suicide attempts in TRD was 7.3 % across the study period (AAPC, 0.1 %; 95 % CI, -4.3 % to 4.7 %). Past-year SIBs were significantly associated with an increased likelihood of meeting criteria for TRD among adults with MDE (adjusted odds ratio [AOR], 1.53; 95 % CI, 1.35-1.75 for suicidal ideation; AOR, 2.17; 95 % CI, 1.79-2.62 for suicide attempts). No significant differences were observed between 2019 and 2020, reflecting the COVID-19 pandemic.

CONCLUSION

Among individuals with TRD, proportions of SIBs are high. These findings underscore an urgent need for suicide prevention efforts in this high-risk population, including preventive services across diverse settings and accessibility to evidence-based pharmacological and non-pharmacological interventions.

Perceived discrimination, mental health help-seeking attitudes, and suicide ideation, planning, and attempts among black young adults

BACKGROUND

Developing an understanding of the negative impact of discrimination is critical when examining the suicidality of Black young adults in the US. Suicide rates among Black young adults have increased at alarming rates. One of the reasons for this increase is the disparities related to access to mental health services, which has long-term health consequences. This study addresses a significant gap in the literature by examining associations between experiences of everyday discrimination, attitudes towards mental health help-seeking attitudes, on the outcomes suicide ideation, planning to die by suicide, and suicide attempts.

METHODS

The data came from a national study of the experiences of Black young adults regarding mental, physical, and sexual health. Participants were recruited from across the Midwestern region of the United States through Qualtrics Panels, an online survey delivery service used to recruit study participants. The total sample for this study was N = 362, and the average age of the sample was 21 (SD: 1.96). We used a logistic regression analysis to examine the role of everyday discrimination, mental health support-seeking attitudes, and covariates on the outcomes: suicide ideation, planning to die by committing suicide, and suicide attempts.

RESULTS

Black young adults with positive mental health help-seeking attitudes were 34% less likely to attempt suicide (OR = 0.66; 95% CI: 0.46, 0.96) and 35% less likely to experience suicide ideation (OR = 0.65; 95% CI: 0.47, 0.89). However, those young adults who experienced discrimination daily were more likely to report having attempted suicide (OR = 1.70; 95% CI: 1.34, 2.15).

CONCLUSIONS

Our findings offer valuable insights into the complex interplay between experiences of discrimination, attitudes toward seeking mental health support, and suicidal behaviors. However, our research also underscores how experiences of discrimination can significantly exacerbate feelings of isolation, hopelessness, and inadequacy, further contributing to suicidal behaviors in this population. By promoting positive mental health help-seeking behaviors, actively addressing discrimination, and applying an intersectional approach to suicide prevention efforts, we can take significant strides towards building a more supportive and inclusive society. This approach aims to empower individuals to seek help, reduce the risk of suicidal behaviors, and create a more welcoming environment for all members of our community.

Change in suicidal ideation, depression, and anxiety following collaborative care in the community

BACKGROUND

The Collaborative Care Model (CoCM) increases access to mental health treatment and improves outcomes among patients with mild to moderate psychopathology; however, it is unclear how effective CoCM is for patients with elevated suicide risk.

METHODS

We examined data from the Penn Integrated Care program, a CoCM program including an intake and referral management center plus traditional CoCM services implemented in primary care clinics within a large, diverse academic medical system. In this community setting, we examined: (1) characteristics of patients with and without suicidal ideation who initiated CoCM, (2) changes in suicidal ideation (Patient Health Questionnaire-9 [PHQ-9] item 9), depression (PHQ-9 total scores), and anxiety (Generalized Anxiety Disorder Scale-7 scores) from the first to last CoCM visit overall and across demographic subgroups, and (3) the relationship between amount of CoCM services provided and degree of symptom reduction.

RESULTS

From 2018 to 2022, 3,487 patients were referred to CoCM, initiated treatment for at least 15 days, and had completed symptom measures at the first and last visit. Patients were 74% female, 45% Black/African American, and 45% White. The percentage of patients reporting suicidal ideation declined 11%-7% from the first to last visit. Suicidal ideation severity typically improved, and very rarely worsened, during CoCM. Depression and anxiety declined significantly among patients with and without suicidal ideation and across demographic subgroups; however, the magnitude of these declines differed across race, ethnicity, and age. Patients with suicidal ideation at the start of CoCM had higher depression scores than patients without suicidal ideation at the start and end of treatment. Longer CoCM episodes were associated with greater reductions in depression severity.

CONCLUSIONS

Suicidal ideation, depression, and anxiety declined following CoCM among individuals with suicidal ideation in a community setting. Findings are consistent with emerging evidence from clinical trials suggesting CoCM's potential for increasing access to mental healthcare and improving outcomes among patients at risk for suicide.

Prenatal opioid use as a predictor of postpartum suicide attempts among reproductive-age women enrolled in Oregon Medicaid

BACKGROUND

The rates of suicide and opioid use disorder (OUD) among pregnant and postpartum women continue to increase. This research characterized OUD and suicide attempts among Medicaid-enrolled perinatal women and examined prenatal OUD diagnosis as a marker for postpartum suicide attempts.

METHODS

Data from Oregon birth certificates, Medicaid eligibility and claims files, and hospital discharge records were linked and analyzed. The sample included Oregon Medicaid women aged 15-44 who became pregnant and gave live births between January 2008 and January 2016 (N = 61,481). Key measures included indicators of suicide attempts (separately for any means and opioid poisoning) and OUD diagnosis, separately assessed during pregnancy and the one-year postpartum period. Probit regression was used to examine the overall relationship between prenatal OUD diagnosis and postpartum suicide attempts. A simultaneous equations model was employed to explore the link between prenatal OUD diagnosis and postpartum suicide attempts, mediated by postpartum OUD diagnosis.

RESULTS

Thirty-three prenatal suicide attempts by any means were identified. Postpartum suicide attempts were more frequent with 58 attempts, corresponding to a rate of 94.3 attempts per 100,000. Of these attempts, 79% (46 attempts) involved opioid poisoning. A total of 1,799 unique women (4.6% of the sample) were diagnosed with OUD either during pregnancy or one-year postpartum with 53% receiving the diagnosis postpartum. Postpartum suicide attempts by opioid poisoning increased from 55.5 per 100,000 in 2009 to 105.1 per 100,000 in 2016. The rate of prenatal OUD also almost doubled over the same period. Prenatal OUD diagnosis was associated with a 0.15%-point increase in the probability of suicide attempts by opioid poisoning within the first year postpartum. This increase reflects a three-fold increase compared to the rate for women without a prenatal OUD diagnosis. A prenatal OUD diagnosis was significantly associated with an elevated risk of postpartum suicide attempts by opioid poisoning via a postpartum OUD diagnosis.

CONCLUSIONS

The risk of suicide attempt by opioid poisoning is elevated for Medicaid-enrolled reproductive-age women during pregnancy and postpartum. Women diagnosed with prenatal OUD may face an increased risk of postpartum suicides attempts involving opioid poisoning.

Evaluating the clinical utility of an easily applicable prediction model of suicide attempts, newly developed and validated with a general community sample of adults

BACKGROUND

A suicide attempt (SA) is a clinically serious action. Researchers have argued that reducing long-term SA risk may be possible, provided that at-risk individuals are identified and receive adequate treatment. Algorithms may accurately identify at-risk individuals. However, the clinical utility of algorithmically estimated long-term SA risk has never been the predominant focus of any study.

METHODS

The data of this report stem from CoLaus|PsyCoLaus, a prospective longitudinal study of general community adults from Lausanne, Switzerland. Participants (N = 4,097; Mage = 54 years, range: 36-86; 54% female) were assessed up to four times, starting in 2003, approximately every 4-5 years. Long-term individual SA risk was prospectively predicted, using logistic regression. This algorithm's clinical utility was assessed by net benefit (NB). Clinical utility expresses a tool's benefit after having taken this tool's potential harm into account. Net benefit is obtained, first, by weighing the false positives, e.g., 400 individuals, at the risk threshold, e.g., 1%, using its odds (odds of 1% yields 1/(100-1) = 1/99), then by subtracting the result (400*1/99 = 4.04) from the true positives, e.g., 5 individuals (5-4.04), and by dividing the result (0.96) by the sample size, e.g., 800 (0.96/800). All results are based on 100 internal cross-validations. The predictors used in this study were: lifetime SA, any lifetime mental disorder, sex, and age.

RESULTS

SA at any of the three follow-up study assessments was reported by 1.2%. For a range of seven a priori selected threshold probabilities, ranging between 0.5% and 2%, logistic regression showed highest overall NB in 97.4% of all 700 internal cross-validations (100 for each selected threshold probability).

CONCLUSION

Despite the strong class imbalance of the outcome (98.8% no, 1.2% yes) and only four predictors, clinical utility was observed. That is, using the logistic regression model for clinical decision making provided the most true positives, without an increase of false positives, compared to all competing decision strategies. Clinical utility is one among several important prerequisites of implementing an algorithm in routine practice, and may possibly guide a clinicians' treatment decision making to reduce long-term individual SA risk. The novel metric NB may become a standard performance measure, because the a priori invested clinical considerations enable clinicians to interpret the results directly.

Association between insurance type and suicide-related behavior among US adults: The impact of the Affordable Care Act

This study examined the association between insurance type and suicidal ideation and attempts among adults in the United States, incorporating a comparative analysis of the pre- and post-Affordable Care Act (ACA) periods. We used a nationally representative, cross-sectional, population-based survey of individuals aged 18 years and older from the 2010-2019 National Survey on Drug Use and Health. The higher rates of suicidal ideation and attempts among Medicaid and uninsured groups compared with those with private insurance. After implementation of the ACA policy, the difference-in-differences analysis showed a significantly reduced risk of suicide in the Medicare group compared with the privately insured group, with no significant differences observed in the other groups. These findings highlight the importance of improving access to mental health services, particularly for those with lower levels of insurance coverage, such as Medicaid and Medicare.

Comorbidity profiles in older patients last seen by mental health prior to suicide attempt

OBJECTIVES

Suicide in late life is a public health concern. Determining profiles of psychiatric/medical comorbidity in those who attempt while engaged in mental health services may assist with prevention. We identified comorbidity profiles and their association with utilization, means, and fatality in a national sample who attempted suicide.

METHODS

Using latent class analysis, all patients aged ≥ 65 from the Department of Veterans Affairs (VA) healthcare services (2012-2018) last seen in mental health prior to suicide attempt were included. Diagnoses and attempt data were obtained from VA and Center for Medicare & Medicaid Services, VA Suicide Prevention Applications Network, and VA National Mortality Data Repository.

RESULTS

2,269 patients were clustered into three profiles, all with high probability of depression. Profiles included minimal comorbidity (50.4%), high medical comorbidity (28.6%), and high (psychiatric/medical) comorbidity (21.0%). Over half (61.7%) attempted suicide within one week of their visit. The class with highest comorbidity had lowest proportion of fatal attempts, while minimal comorbidity class had highest proportion.

CONCLUSIONS

Older patients last seen in mental health prior to suicide attempt were characterized by depression and varying additional comorbidity and attempt-related factors. Findings have implications for risk assessment and intervention in mental health settings, beyond depression.

Suicide Methods and Trends Across Race/Ethnicity, Age, and Sex Groups in Chicago, Illinois, 2015-2021

Objectives. To measure differences in suicide rates across race/ethnicity, age, and sex groups in Chicago, Illinois, from 2015 to 2021. Methods. We calculated the incidence rate and annual percentage change in suicides among Asian, Black, Latino/a, and White persons in Chicago. We also analyzed patterns in suicide method across race/ethnicity, age, and sex groups. Results. Suicides increased significantly among Black males (incidence rate ratio [IRR] = 1.10; 95% confidence interval [CI] = 1.01, 1.20), Black females (IRR = 1.18; 95% CI = 1.04, 1.33), and Latino males (IRR = 1.23; 95% CI = 1.11, 1.38) between 2015 and 2021. Suicides decreased overall among White Chicagoans during this period. A significantly greater proportion of Black males than Black females died by suicide using a firearm (55.79% vs 24.05%; P < .001). Similar results were detected for Latino males and females (32.99% vs 9.09%; P = .001) and White males and females (30.10% vs 11.73%; P < .001). Conclusions. Black persons in Chicago were the only group to experience significant increases in suicide among both males and females from 2015 to 2021, although specific methods used varied by race/ethnicity and sex group. (Am J Public Health. 2024;114(3):319-328. https://doi.org/10.2105/AJPH.2023.307511).

Treating individuals with suicidal ideation in primary care: Patient-level characteristics associated with follow-up in the Collaborative Care Model

INTRODUCTION

The Collaborative Care Model (CoCM) is an evidence-based approach which embeds behavioral health providers (BHPs) into primary care. Whether patients with suicidal ideation (SI) are willing to engage in CoCM is unclear.

METHODS

Using Patient Health Questionnaire-9 (PHQ-9) administrative data from primary care practices within an urban academic health system, we identified patients with and without SI who were referred to a CoCM BHP. We compared engagement, defined as attendance at ≥1 CoCM visit, across groups.

RESULTS

Between 2018 and 2022, 7391 primary care patients were referred to a CoCM BHP. Eight hundred and ninety-two of these patients reported SI on the PHQ-9 (754 on "several days" during the previous 2 weeks and 138 on "more than half or most days"). Across groups, most patients engaged in CoCM. Patients reporting SI on several days engaged at a lower rate (61.4%) than those reporting SI on more than half or most days (65.9%). Both SI groups engaged at a lower rate than the 6499 patients who did not report SI (67.5%).

CONCLUSION

Most patients referred to a CoCM BHP engaged in ≥1 visit. Rates were lower for patients with SI, with the lowest rate among those reporting SI on several days.

Racial-Ethnic Differences in Receipt of Past-Year Health Care Services Among Suicide Decedents: A Case-Control Study

OBJECTIVE

Suicide remains an urgent public health crisis. Although some sociodemographic characteristics are associated with greater suicide risk in the general population, it is unclear whether individuals utilizing health care in the United States have similar suicide incidence patterns. The authors examined whether race-ethnicity is associated with suicide death among patients seeking health care and investigated health care utilization patterns.

METHODS

Data were collected from electronic health records and government mortality records for patients seeking health care across nine health care systems in the United States. Patients who died by suicide (N=1,935) were matched with patients in a control group (N=19,350) within each health care system.

RESULTS

Patients who died by suicide were significantly more likely to be White, older, male, living in low-education areas, living in rural areas, or diagnosed as having mental health conditions or were significantly less likely to have commercial insurance (p<0.05). Among most racial-ethnic groups, those who died by suicide had a higher number of past-year mental health, primary care, and total health care visits; for American Indian/Alaska Native patients, the number of health care visits tended to be lower among suicide decedents.

CONCLUSIONS

These findings suggest that higher past-year health care utilization was associated with increased likelihood of suicide death across several racial-ethnic groups. This observation underscores the need for identifying and managing suicide risk in health care settings, including outside of mental health visits, among most racial-ethnic groups.

Reasons for Suicide in Black Young Adults: A Latent Class Analysis

BACKGROUND

Suicides have increased among Black youth in the US, though it remains unclear if these trends persist into young adulthood. Further, even less is known about the reasons why individuals begin to consider suicide as a viable option. The current study aims to redress these gaps by identifying specific reasons for suicide among a sample of 264 Black young adults who reported experiencing suicidal thoughts within the past 2 weeks.

METHODS

Participants were recruited from an online panel. Reasons for suicide were measured using eight individual items/indicators. Latent class analysis was used to detect underlying patterns in Black young adults' reasons for considering suicide.

RESULTS

The most commonly reported reason for considering suicide among the entire sample was feeling hopeless about the future. Black women were more likely to report considering suicide because they could not live up to other's expectations and because they felt lonely and sad. Findings for the 3-class model were retained. The first class is described as the "Somewhat hopeless and other reasons" class (n = 85; 32%). The second class is "Accomplished but extremely lonely and sad" (n = 24; 9%). The third class is described as "Pronounced feelings of failure, hopelessness, being overwhelmed, and lack of accomplishment" and includes 59% of the sample (n = 155).

CONCLUSIONS

Culturally grounded clinical treatments and interventions are needed to meet the specific mental health needs of Black young adults. A particular focus on identifying factors that drive feelings of hopelessness and failure is warranted.

Association of opioid or other substance use disorders with health care use among patients with suicidal symptoms

INTRODUCTION

Prior literature establishes noteworthy relationships between suicidal symptoms and substance use disorders (SUDs), particularly opioid use disorder (OUD). However, engagement with health care services among this vulnerable population remains underinvestigated. This study sought to examine patterns of health care use, identify risk factors in seeking treatment, and assess associations between outpatient service use and emergency department (ED) visits.

METHODS

Using electronic health records (EHRs) derived from five health systems across New York City, the study selected 7881 adults with suicidal symptoms (including suicidal ideation, suicide attempt, or self-harm) and SUDs between 2010 and 2019. To examine the association between SUDs (including OUD) and all-cause service use (outpatient, inpatient, and ED), we performed quasi-Poisson regressions adjusted for age, gender, and chronic disease burden, and we estimated the relative risks (RR) of associated factors. Next, the study evaluated cause-specific utilization within each resource category (SUD-related, suicide-related, and other-psychiatric) and compared them using Mann-Whitney U tests. Finally, we used adjusted quasi-Poisson regression models to analyze the association between outpatient and ED utilization among different risk groups.

RESULTS

Among patients with suicidal symptoms and SUD diagnoses, relative to other SUDs, a diagnosis of OUD was associated with higher all-cause outpatient visits (RR: 1.22), ED visits (RR: 1.54), and inpatient hospitalizations (RR: 1.67) (ps < 0.001). Men had a lower risk of having outpatient visits (RR: 0.80) and inpatient hospitalizations (RR: 0.90), and older age protected against ED visits (RR range: 0.59-0.69) (ps < 0.001). OUD was associated with increased SUD-related encounters across all settings, and increased suicide-related ED visits and inpatient hospitalizations (p < 0.001). Individuals with more mental health outpatient visits were less likely to have suicide-related ED visits (RR: 0.86, p < 0.01), however this association was not found among younger and male patients with OUD. Although few OUD patients received medications for OUD (MOUD) treatment (9.9 %), methadone composed the majority of MOUD prescriptions (77.7 %), of which over 70 % were prescribed during an ED encounter.

CONCLUSIONS

This study reinforces the importance of tailoring SUD and suicide risk interventions to different age groups and types of SUDs, and highlights missed opportunities for deploying screening and prevention resources among the male and OUD populations. Redressing underutilization of MOUD remains a priority to reduce acute health outcomes among younger patients with OUD.

Identifying features of risk periods for suicide attempts using document frequency and language use in electronic health records

Background

Individualising mental healthcare at times when a patient is most at risk of suicide involves shifting research emphasis from static risk factors to those that may be modifiable with interventions. Currently, risk assessment is based on a range of extensively reported stable risk factors, but critical to dynamic suicide risk assessment is an understanding of each individual patient's health trajectory over time. The use of electronic health records (EHRs) and analysis using machine learning has the potential to accelerate progress in developing early warning indicators.

Setting

EHR data from the South London and Maudsley NHS Foundation Trust (SLaM) which provides secondary mental healthcare for 1.8 million people living in four South London boroughs.

Objectives

To determine whether the time window proximal to a hospitalised suicide attempt can be discriminated from a distal period of lower risk by analysing the documentation and mental health clinical free text data from EHRs and (i) investigate whether the rate at which EHR documents are recorded per patient is associated with a suicide attempt; (ii) compare document-level word usage between documents proximal and distal to a suicide attempt; and (iii) compare n-gram frequency related to third-person pronoun use proximal and distal to a suicide attempt using machine learning.

Methods

The Clinical Record Interactive Search (CRIS) system allowed access to de-identified information from the EHRs. CRIS has been linked with Hospital Episode Statistics (HES) data for Admitted Patient Care. We analysed document and event data for patients who had at some point between 1 April 2006 and 31 March 2013 been hospitalised with a HES ICD-10 code related to attempted suicide (X60-X84; Y10-Y34; Y87.0/Y87.2).

Findings

n = 8,247 patients were identified to have made a hospitalised suicide attempt. Of these, n = 3,167 (39.8%) of patients had at least one document available in their EHR prior to their first suicide attempt. N = 1,424 (45.0%) of these patients had been "monitored" by mental healthcare services in the past 30 days. From 60 days prior to a first suicide attempt, there was a rapid increase in the monitoring level (document recording of the past 30 days) increasing from 35.1 to 45.0%. Documents containing words related to prescribed medications/drugs/overdose/poisoning/addiction had the highest odds of being a risk indicator used proximal to a suicide attempt (OR 1.88; precision 0.91 and recall 0.93), and documents with words citing a care plan were associated with the lowest risk for a suicide attempt (OR 0.22; precision 1.00 and recall 1.00). Function words, word sequence, and pronouns were most common in all three representations (uni-, bi-, and tri-gram).

Conclusion

EHR documentation frequency and language use can be used to distinguish periods distal from and proximal to a suicide attempt. However, in our study 55.0% of patients with documentation, prior to their first suicide attempt, did not have a record in the preceding 30 days, meaning that there are a high number who are not seen by services at their most vulnerable point.

Systematic analysis of nonfatal suicide attempts and further diagnostic of secondary injury in strangulation survivors: A retrospective cross-sectional study

Background and Aims

Data on nonfatal suicide attempts in Germany are sparse. The study aimed to analyze data on nonfatal suicide attempts and consecutive diagnostic steps to identify secondary injuries after strangulation.

Methods

All admissions after nonfatal suicide attempt in a large Bavarian psychiatric hospital between 2014 and 2018 were reviewed and the methods were analyzed.

Results

A total of 2125 verified cases out of 2801 registered cases of nonfatal suicide attempts were included in further analysis. The most common methods were intoxication (n = 1101, 51.8%), cutting (n = 461, 21.7%), and strangulation (n = 183, 8.6%). Among survivors of strangulation with external neck compression (n = 99, 54.1%), no diagnostic steps were performed in 36 (36.4%) patients and insufficient imaging in 13 (20.6%) patients. Carotid artery dissection was detected in two (4.0%) of 50 patients with adequate neuroimaging.

Conclusions

This study provides details on nonfatal suicide attempts in Germany. Slightly more than half of the patients with strangulation underwent adequate diagnostic work-up, with 4.0% being diagnosed with dissection. Further studies with systematic screening for dissection after strangulation in psychiatric hospitals are recommended to reduce possible under-reporting.

An exploration of suicidal ideation and attempts, and care use and unmet need among suicide-ideators in a Belgian population study

BACKGROUND

Suicidal ideation, or thinking about death and suicide, is common across all layers of society. The aim of this paper is to add to the understanding of suicidal ideation in the general population, as well as help-seeking behaviors and perceived unmet mental health needs among those who report suicidal thoughts.

METHODS

The research is part of a representative population-based survey study of mental wellbeing in Antwerp (Flanders, Belgium) carried out in 2021. A total of 1202 participants between 15 and 80 years old answered the Ask Suicide-Screening Questions (ASQ), and an additional question about suicide plans. Participation was by invitation only and possible online or via a postal paper questionnaire. Univariate and multivariate logistic regression analyses were used to explore the association between both current suicidal ideation and self-reported lifetime suicide attempt with the sociodemographic factors age, gender, educational level, origin and financial distress. Moreover, formal care use for mental health was examined among those experiencing suicidal ideation, and logistic regression analyses were used to assess associated sociodemographic factors. Finally, perceived unmet mental health needs were assessed among suicide ideators.

RESULTS

The point-prevalence of suicidal ideation was 8.6% and was higher among younger age groups and individuals reporting financial distress. The lifetime-prevalence of suicide attempts is 6.5% and was higher in younger people and individuals with a primary educational level and with financial distress. About half (45.6%) of those with suicidal ideation consulted a professional for mental health problems in the past twelve months. Men and those with a primary educational level were less likely to seek help. Half of suicide ideators without care use perceived some need for mental health care, and a third of suicide ideators who used care perceived the obtained help as insufficient, resulting in a population prevalence of 3.6% suicide ideators with a fully or partially perceived unmet need.

CONCLUSIONS

The prevalence of suicide attempts, suicidal ideation and unmet needs among suicide-ideators is high in this Belgian sample. Mental health care need perception in suicide ideators needs further investigation.

Increasing Use of Cannabis for Medical Purposes Among U.S. Residents, 2013-2020

INTRODUCTION

Cannabis use for medical purposes is legalized across 39 states and the District of Columbia in the U.S. The objective of this study was to evaluate temporal trends and correlates of cannabis use for medical purposes in the U.S.

METHODS

Data from the 2013-2020 National Survey on Drug Use and Health were used. Since 2013, medical cannabis use has been assessed using a dichotomous question asking whether any medical cannabis use was recommended by a doctor among those who used cannabis in the past 12 months. A modified Poisson model was used to estimate the average annual percentage change in medical cannabis use from 2013 to 2020. The analyses were repeated for key sociodemographic and clinical subgroups. Data were analyzed from September to November 2022.

RESULTS

The prevalence of U.S. residents using cannabis for medical purposes increased significantly from 1.2% in 2013-2014 to 2.5% in 2019-2020, with an average annual percentage change of 12.9% (95% CI=10.4, 15.5), and many of sociodemographic and clinical subgroups showed similar significant increases in cannabis use for medical purposes. In the multivariable-adjusted model, living in a state that legalized medical cannabis remained significantly associated with medical cannabis use (AOR=4.10; 95% CI=3.68, 4.56).

CONCLUSIONS

The study documents a continued nationwide increase in the use of cannabis for diverse medical purposes between 2013 and 2020, two decades after the first state passed legalizing legislation.

Modeling the Future of Prevention in Primary Mental Health Care: A Narrative Literature Review

Introduction

Adults in the U.S. have had poor and worsening mental health for years. Poor mental health exacts a high human and economic cost.

Methods

Using PubMed, we conducted a focused narrative literature review on mental well-being and its role in mental and physical health care.

Results

Mental well-being is essential for mental and physical health. High mental well-being is associated with a lower incidence of psychiatric disorder diagnosis and better function for those who do carry a formal diagnosis. High mental well-being also improves health outcomes for several physical diseases. Cultivating mental well-being is both a primary and secondary prevention strategy for mental and physical illness. There is a growing number of low-cost and accessible interventions to promote mental well-being, rooted in the research of positive psychology. These interventions improve mental well-being in multiple populations from different cultural backgrounds. There have been some efforts to incorporate these interventions to improve mental well-being in the clinical setting.

Conclusions

Our mental healthcare system would substantially improve its ability to protect against mental illness and promote positive function if mental well-being was routinely measured in the clinical setting, and interventions to improve mental well-being were routinely incorporated into standard primary and specialty care.

Racial and ethnic differences in suicidal behavior and mental health service use among US adults, 2009-2020

BACKGROUND

While suicide rates have recently declined for White individuals, rates among Black and Hispanic individuals have increased. Yet, little is known about racial/ethnic differences in precursors to suicide, including suicidal ideation (SI) and suicide attempts (SA).

METHODS

Data from 2009-2020 National Survey of Drug Use and Health (NSDUH) consisted of non-institutionalized US civilians aged ⩾18 (n = 426 008). We compared proportions of White, Black, and Hispanics among adults reporting no past-year suicidal thoughts/behavior, SI, and SA. Multivariable-adjusted analyses were used to evaluate the independence of observed racial/ethnic differences in past-year SI, SA, and mental health service use.

RESULTS

In the entire sample, 20 791 (4.9%) reported past-year SI only and 3661 (0.9%) reported a SA. Compared to White individuals, Black and Hispanic individuals were significantly less likely to report past-year SI [OR 0.73 (95% CI 0.69-0.77); OR 0.75 (95% CI 0.71-0.79), respectively], but more likely to report a past-year SA [OR 1.45 (95% CI 1.28-1.64); OR 1.19 (95% CI 1.04-1.37), respectively] even after multivariable adjustment. Black and Hispanic individuals were significantly less likely to use mental health services, but the lack of significant interactions between race/ethnicity and SI/SA in association with service use suggests differences in service use do not account for differences in SI or SA.

CONCLUSIONS

Black and Hispanic individuals are significantly less likely than White individuals to report SI but more likely to report SAs, suggesting differences in suicidal behavior across race/ethnicity that may be impacted by socio-culturally acceptable expressions of distress and structural racism in the healthcare system.

Acceptability and feasibility of ecological momentary assessment with augmentation of passive sensor data in young adults at high risk for suicide

Ecological Momentary Assessment (EMA) and wearable sensor data have the potential to enhance prediction of suicide risk in real-world conditions. However, the feasibility of this methodology with high-risk populations, including over extended periods, warrants closer attention. This study examined the feasibility and acceptability of concurrent EMA and wearable sensor monitoring in young adults after emergency department (ED) care for suicide risk-related concerns. For 2 months after ED discharge, 106 participants (ages 18-25; 81.1% female) took part in EMA surveys (4x per day) and passive sensor (Fitbit) monitoring and completed an end-of-study phone interview. Overall adherence to EMA (62.1%) and wearable sensor (53.6%) was moderate and comparable to briefer protocols. Relative to EMAs (81%), fewer participants completed the full 8 weeks of Fitbit (63%). While lower initial hopelessness was linked to reduced EMA adherence, previous-day suicidal ideation predicted lower Fitbit adherence on the next day. Self-endorsed barriers to EMA and wearable sensor adherence were also examined. Participants tended to report positive experience with the protocol, with majority indicating EMAs were minimally burdensome, reporting that the Fitbit was generally comfortable, and expressing interest in participating in a similar study again. Findings provide support for the feasibility and acceptability of concurrent intensive self-report and wearable sensor data during a high-risk period. Implications and future directions are discussed.

Unequal Treatment? Confronting Racial, Ethnic, and Socioeconomic Disparity in Management of Survivors of Violent Suicide Attempt

BACKGROUND

Psychiatric inpatient hospitalization is nearly always indicated for patients with recent suicidal behavior. We aimed to assess the factors associated with receiving mental health services during hospitalization or on discharge among survivors of suicide attempts in trauma centers.

STUDY DESIGN

A 3-year analysis of the 2017 to 2019 American College of Surgeons TQIP. Adults (≥18 years) presenting after suicide attempts were included. Patients who died, those with emergency department discharge disposition, those with superficial lacerations, and those who were transferred to nonpsychiatric care facilities were excluded. Backward stepwise regression analyses were performed to identify predictors of receiving mental health services (inpatient psychiatric consultation/psychotherapy, discharge/transfer to a psychiatric hospital, or admission to a distinct psychiatric unit of a hospital).

RESULTS

We identified 18,701 patients, and 56% received mental health services. The mean age was 40 ± 15 years, 72% were males, 73% were White, 57% had a preinjury psychiatric comorbidity, and 18% were uninsured. Of these 18,701 patients, 43% had moderate to severe injuries (Injury Severity Score > 8), and the most common injury was cut/stab (62%), followed by blunt mechanisms (falls, lying in front of a moving object, and intentional motor vehicle collisions) (18%) and firearm injuries (16%). On regression analyses, Black race, Hispanic ethnicity, male sex, younger age, and positive admission alcohol screen were associated with lower odds of receiving mental health services (p < 0.05). Increasing injury severity, being insured, having preinjury psychiatric diagnosis, and positive admission illicit drug screen were associated with higher odds of receiving mental health services (p < 0.05).

CONCLUSIONS

Significant disparities exist in the management of survivors of suicide attempts. There is a desperate need for improved access to mental health services. Further studies should focus on delineating the cause of these disparities, identifying the barriers, and finding solutions.

Rising Rates of Suicidal Behaviors and Large Unmet Treatment Needs Among US Adults With a Major Depressive Episode, 2009 to 2020

OBJECTIVE

To examine recent 12-year trends in the incidence of suicidal ideation (SI) and suicide attempts (SAs) and receipt of mental health treatment among individuals experiencing a past-year major depressive episode (MDE).

PATIENTS AND METHODS

Using data from the National Survey of Drug Use and Health, we estimated the annual percentage of individuals with MDE who reported past-year SI or SAs and their use of mental health services from 2009 to 2020 and calculated odds ratios (ORs) for longitudinal change adjusting for potentially confounding factors.

RESULTS

During our study period, the weighted unadjusted proportion of patients with a past-year MDE who reported SI increased from 26.2% (668,690 of 2,550,641) to 32.5% (1,068,504 of 3,285,986; OR, 1.38; 95% CI, 1.25 to 1.51) and remained significant in the multivariable-adjusted analysis (P<.001). The greatest increase in SI was seen among Hispanic patients, young adults, and individuals with alcohol use disorder. Similar trends were seen for past-year SAs, increasing from 2.7% (69,548 of 2,550,641) to 3.3% (108,135 of 3,285,986; OR, 1.29; 95% CI, 1.04 to 1.61), especially among Black individuals, patients with incomes greater than $75,000, and those with substance use disorders. In multivariable-adjusted analyses, the temporal trend of increasing SI and SAs remained significant (P<.001 and P=0.04, respectively). Among individuals with past-year SI or SAs, there was no notable change in the mental health service use, and over 50% of individuals with MDE and SI (2,472,401 of 4,861,298) reported unmet treatment needs. No notable differences were observed between 2019 and 2020, reflecting the coronavirus disease 2019 pandemic.

CONCLUSION

Among individuals with MDE, rates of SI and SAs have increased, especially among racial minorities and individuals with substance use disorders, without a corresponding change in mental health service use.

National Trends in Mental Health-Related Emergency Department Visits Among Youth, 2011-2020

Importance

There has been increasing concern about the burden of mental health problems among youth, especially since the COVID-19 pandemic. Trends in mental health-related emergency department (ED) visits are an important indicator of unmet outpatient mental health needs.

Objective

To estimate annual trends in mental health-related ED visits among US children, adolescents, and young adults between 2011 and 2020.

Design, Setting, and Participants

Data from 2011 to 2020 in the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national probability sample survey of EDs, was used to examine mental health-related visits for youths aged 6 to 24 years (unweighted = 49 515).

Main Outcomes and Measures

Mental health-related ED visits included visits associated with psychiatric or substance use disorders and were identified by International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM; 2011-2015) and ICD-10-CM (2016-2020) discharge diagnosis codes or by reason-for-visit (RFV) codes. We estimated the annual proportion of mental health-related pediatric ED visits from 2011 to 2020. Subgroup analyses were performed by demographics and broad psychiatric diagnoses. Multivariable-adjusted logistic regression analyses estimated factors independently associated with mental health-related ED visits controlling for period effects.

Results

From 2011 to 2020, the weighted number of pediatric mental health-related visits increased from 4.8 million (7.7% of all pediatric ED visits) to 7.5 million (13.1% of all ED visits) with an average annual percent change of 8.0% (95% CI, 6.1%-10.1%; P < .001). Significant linearly increasing trends were seen among children, adolescents, and young adults, with the greatest increase among adolescents and across sex and race and ethnicity. While all types of mental health-related visits significantly increased, suicide-related visits demonstrated the greatest increase from 0.9% to 4.2% of all pediatric ED visits (average annual percent change, 23.1% [95% CI, 19.0%-27.5%]; P < .001).

Conclusions and Relevance

Over the last 10 years, the proportion of pediatric ED visits for mental health reasons has approximately doubled, including a 5-fold increase in suicide-related visits. These findings underscore an urgent need to improve crisis and emergency mental health service capacity for young people, especially for children experiencing suicidal symptoms.

Deliberate Self-Poisoning: Real-Time Characterization of Suicidal Habits and Toxidromes in the Food and Drug Administration Adverse Event Reporting System

INTRODUCTION

Deliberate self-poisoning (DSP) using drugs is the preferred method of suicide at a global level. Its investigation is hampered by limited sample sizes and data reliability. We investigate the role of the US FDA Adverse Event Reporting System (FAERS), a consolidated pharmacovigilance database, in outlining DSP habits and toxidromes.

METHODS

We retrieved cases of 'intentional overdose' and 'poisoning deliberate' from the FAERS (January 2004-December 2021). Using descriptive and disproportionality analyses, we estimated temporal trends, potential risk factors, toxidromes, case-fatality rates and lethal doses (LDs) for the most frequently reported drugs.

RESULTS

We retrieved 42,103 DSP cases (17% fatal). Most cases were submitted in winter. Reports of DSP involved younger people, psychiatric conditions, and alcohol use, compared with non-DSP, and fatality was higher in men and older patients. Suspected drugs were mainly antidepressants, analgesics, and antipsychotics. Multiple drug intake was recorded in more than 50% of the reports, especially analgesics, psychotropics, and cardiovascular agents. The most frequently reported drugs were paracetamol, promethazine, amlodipine, quetiapine, and metformin. We estimated LD25 for paracetamol (150 g).

CONCLUSION

Worldwide coverage of the FAERS complements existing knowledge about DSP and may drive tailored prevention measures to timely address the DSP phenomenon and prevent intentional suicides.

[What is the contribution of smoking to the increased risk of suicide in young smokers? A systematic review]

OBJECTIVES

The correlation between smoking and suicide is well documented in the general population: there is an increased risk of suicide among tobacco smokers. However, the association between smoking and suicidal behaviors (ideations, plans, attempts) in youth is poorly elucidated. This is a systematic review of the literature examined data on the relationship between active and passive smoking and suicidal ideation (SI), suicide planning (SP), and suicide attempts (SA) among youth in the general population.

METHOD

Medline searches were performed for the period 1980-2020. Cross-sectional, case-control, prospective population-based studies of young people (age less than 18 years) were included in this review; studies of specific populations (patients with an identified pathology of any kind) were excluded.

RESULTS

This review included 43 studies: 23 studies on the association between active smoking and SI, SI and/or PS, TS; three studies on the association between passive smoking and suicidal behavior, three studies on the association between smoking and suicidal behavior in young people in psychiatric hospital settings, and five studies comparing the suicidal behavior of girls and boys. Analysis of the data collected lead to the conclusion that active or passive smoking is associated with suicidal behavior in young people. Smoking appears to contribute to psychopathological disorders, including depression, the use of other psychoactive substances, or psychosocial suffering which are often associated with an increased risk of suicide in young people. The correlations between smoking and the presence of mental disorders have been highlighted; tobacco use may contribute to the development of depression, anxiety and stress. Further studies are needed to verify the existence of a causal link between smoking and suicide.

CONCLUSION

Smoking is associated with the risk of suicidal behavior in young people; it should be included among the criteria for assessing suicidal risk in youth. Smoking cessation, which improves psychological well-being, should be further integrated into the prevention of suicidal behavior.

Mental Health Service Use Among Lesbian, Gay, and Bisexual Adults Who Report Having Attempted Suicide

OBJECTIVE

This study estimated mental health service use among lesbian, gay, and bisexual (LGB) adults in the United States who reported having made a suicide attempt.

METHODS

Data came from the pooled 2015-2019 National Surveys on Drug Use and Health. Of the 191,954 adult respondents, 1,946 reported a past-year suicide attempt. Survey-weighted descriptive and regression analyses were conducted to compare mental health service use among LGB and heterosexual adults.

RESULTS

Three percent of LGB adults (N=598) reported having attempted suicide in the past year, compared with 0.5% of heterosexual adults (N=1,348). Mental health treatment use was significantly higher among LGB adults than among heterosexual adults (64% versus 56%) before analyses were adjusted for sociodemographic characteristics.

CONCLUSIONS

Because suicide attempts and mental health use are elevated among LGB adults, clinicians must provide evidence-based approaches for identifying and managing suicide risk to LGB adults in an affirming manner.

National trends of suicidal ideation and mental health services use among US adults with opioid use disorder, 2009-2020

BACKGROUND

The substantial increase in deaths by overdose and potential underlying suicidal intent in such deaths suggest the importance of understanding trends of suicidal ideation in individuals with opioid use disorder (OUD). This study aimed to examine the trends and correlates of past-year suicidal ideation (SI) and mental health service use among US adults with past-year OUD from 2009 to 2020.

METHODS

We used data from the National Survey on Drug Use and Health. Participants included non-institutionalized US civilians aged ≥18 with past-year OUD (n=5386). SI was measured by self-reported thoughts of killing oneself. Mental health service utilization was assessed with questions concerning receipt of any past-year outpatient or inpatient mental health services or prescription medications. We examined the prevalence and correlates of SI and adjusted odds ratios (aORs) for changes over time adjusting for potentially confounding sociodemographic and clinical characteristics. Further, trends in utilization of mental health services were explored.

FINDINGS

From 2009 to 2020, the prevalence of SI increased from 22.8% to 29.8% (average annual percent change, 3.64% [95% CI, 1.01-2.10%]) in adults with OUD. Subgroups including individuals aged 18-25 (aOR, 1.72 [95% CI, 1.09-2.71]; P=0.020), residing in non-metropolitan areas (aOR, 1.43 [95% CI, 1.04-1.97]; P = 0.029), with co-occurring past-year major depressive episode (aOR, 5.28 [95% CI, 4.27-6.53]; P < 0.001) and alcohol (aOR, 1.55 [95% CI, 1.23-1.97]; P < 0.001), cocaine (aOR, 1.42 [95% CI, 1.03-1.97]; P = 0.034), and sedative use disorders (aOR, 1.48 [95% CI, 1.11-1.98]; P = 0.008) were associated with SI after adjusting for covariates. No significant change in mental health service use was observed. Individuals with SI were 2.5 times more likely to report an unmet need for treatment compared to individuals without SI (53.6% vs 21.4%; P < 0.001).

INTERPRETATION

The prevalence of SI in adults with OUD increased substantially without a corresponding change in mental health service use. These results underscore the potential benefit of routine screening for suicidality and improved access to care for individuals with OUD, especially those with co-occurring depression and/or polysubstance use.

FUNDING

None reported.

Digital cognitive-behavioural therapy to reduce suicidal ideation and behaviours: a systematic review and meta-analysis of individual participant data

QUESTION

Digital interventions based on cognitive-behavioural therapy (iCBT) is associated with reductions in suicidal ideation. However, fine-grained analyses of effects and potential effect-moderating variables are missing. This study aimed to investigate the effectiveness of iCBT on suicidal ideation, effect moderators, effects on suicide attempts and predictors of adherence.

STUDY SELECTION AND ANALYSIS

We systematically searched CENTRAL, PsycINFO, Embase and PubMed for randomised controlled trials that investigated iCBT for suicidal ideation or behaviours. Participants reporting baseline suicidal ideation were eligible. We conducted a one-stage individual participant data (IPD) meta-analysis. Suicidal ideation was the primary outcome, analysed as three indices: severity of suicidal ideation, reliable changes and treatment response.

FINDINGS

We included IPD from nine out of ten eligible trials (2037 participants). iCBT showed significant reductions of suicidal ideation compared with control conditions across all indices (severity: b=-0.247, 95% CI -0.322 to -0.173; reliable changes: b=0.633, 95% CI 0.408 to 0.859; treatment response: b=0.606, 95% CI 0.410 to 0.801). In iCBT, the rate of reliable improvement was 40.5% (controls: 27.3%); the deterioration rate was 2.8% (controls: 5.1%). No participant-level moderator effects were identified. The effects on treatment response were higher for trials with waitlist-controls compared with active controls. There were insufficient data on suicide attempts. Human support and female gender predicted treatment adherence. The main source of potential bias was missing outcome data.

CONCLUSIONS

The current evidence indicates that iCBT is effective in reducing suicidal ideation irrespective of age, gender and previous suicide attempts. Future studies should rigorously assess suicidal behaviour and drop-out reasons.

Investigation of the Relationship between Psychiatry Visit and Suicide after Deliberate Self-Harm: A Longitudinal National Cohort Study (Preprint)

BACKGROUND

Deliberate self-harm (DSH) along with old age, physical disability, and low socioeconomic status are well-known contributors to suicide-related deaths. In recent years, South Korea has the highest suicide death rate among all Organization for Economic Co-operation and Development countries. Owing to the difficulty of accessing data of individuals with DSH behavior who died by suicide, the factors associated with suicide death in these high-risk individuals have not been sufficiently explored. There have been conflicting findings with regard to the relationship between previous psychiatric visits and suicidal death.

OBJECTIVE

We aimed to address the following 3 questions: Are there considerable differences in demographics, socioeconomic status, and clinical features in individuals who received psychiatric diagnosis (either before DSH or after DSH event) and those who did not? Does receiving a psychiatric diagnosis from the Department of Psychiatry, as opposed to other departments, affect survival? and Which factors related to DSH contribute to deaths by suicide?

METHODS

We used the Korean National Health Insurance Service Database to design a cohort of 5640 individuals (3067/5640, 54.38% women) who visited the hospital for DSH (International Classification of Diseases codes X60-X84) between 2002 and 2020. We analyzed whether there were significant differences among subgroups of individuals with DSH behavior based on psychiatric diagnosis status (whether they had received a psychiatric diagnosis, either before or after the DSH event) and the department from which they had received the psychiatric diagnosis. Another main outcome of the study was death by suicide. Cox regression models yielded hazard ratios (HRs) for suicide risk. Patterns were plotted using Kaplan-Meier survival curves.

RESULTS

There were significant differences in all factors including demographic, health-related, socioeconomic, and survival variables among the groups that were classified according to psychiatric diagnosis status (P<.001). The group that did not receive a psychiatric diagnosis had the lowest survival rate (867/1064, 81.48%). Analysis drawn using different departments from where the individual had received a psychiatric diagnosis showed statistically significant differences in all features of interest (P<.001). The group that had received psychiatric diagnoses from the Department of Psychiatry had the highest survival rate (888/951, 93.4%). These findings were confirmed using the Kaplan-Meier survival curves (P<.001). The severity of DSH (HR 4.31, 95% CI 3.55-5.26) was the most significant contributor to suicide death, followed by psychiatric diagnosis status (HR 1.84, 95% CI 1.47-2.30).

CONCLUSIONS

Receiving psychiatric assessment from a health care professional, especially a psychiatrist, reduces suicide death in individuals who had deliberately harmed themselves before. The key characteristics of individuals with DSH behavior who die by suicide are male sex, middle age, comorbid physical disabilities, and higher socioeconomic status.

Suicide resilience: A concept analysis

OBJECTIVE

Suicide resilience is gaining increasing attention from researchers because of its potential role in preventing suicide. However, it has not been clearly analyzed, and there are various meanings and terms regarding this issue. The purpose of this analysis, therefore, was to conceptualize the concept of suicide resilience.

METHODS

Walker and Avant's method of concept analysis was used to identify the antecedents, attributes, and consequences of suicide resilience. The literature was searched using PubMed, PsychINFO, Embase, Web of Science, CINAHL, CNKI, and WanFang databases with no limitation on publication date. The search included peer-reviewed journal articles and dissertations related to suicide resilience published in English or Chinese.

RESULTS

52 articles were identified to provide information for this concept analysis. Five defining attributes of suicide resilience were identified: social support, coping strategies, psychological capital, meaning in life, and sense of responsibility. Antecedents of suicide resilience were high suicide risk events, and consequences of suicide resilience were keeping vulnerable individuals stay away from or overcoming suicidality.

CONCLUSIONS

The result of the analysis provided a more clear definition of suicide resilience. The identified defining attributes, antecedents, and consequences can be further tested and used to develop potential interventions. Future research is needed and will help to advance our understanding of the scope.