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Nguyen GH, Oh S, Schneider C, Teoh JY, Engstrom M, Santana-Gonzalez C, Porter D, Quevedo K. Neurofeedback and Affect Regulation Circuitry in Depressed and Healthy Adolescents. BIOLOGY 2023; 12:1399. [PMID: 37997998 PMCID: PMC10669603 DOI: 10.3390/biology12111399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023]
Abstract
Neurodevelopmental psychopathology seeks to understand higher-order emotion regulation circuitry to develop new therapies for adolescents with depression. Depressed (N = 34) and healthy youth (N = 19) completed neurofeedback (NF) training and exhibited increased bilateral amygdala and hippocampus activity in the region of interest (ROI) analyses by recalling positive autobiographical memories. We tested factors supportive of the engagement of emotion regulation's neural areas during NF (i.e., parental support, medication, and gender effects upon anterior cingulate cortex (ACC) engagement). Whole-brain analyses yielded effects of NF vs. control condition and effects of diagnosis. Youth showed higher amygdala and hippocampus (AMYHIPPO) activity during the NF vs. control condition, particularly in the left hippocampus. ACC's activity was also higher during NF vs. control. Higher average ACC activity was linked to better parental support, absent depression, female gender, and absent medication. Control youth showed higher average AMYHIPPO and ACC activity throughout the task and a faster decline in activity vs. depressed youths. Whole-brain level analyses showed higher activity in the frontotemporal network during the NF vs. control conditions, suggesting targeting their connectivity in future neurofeedback trials.
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Affiliation(s)
- Giang H. Nguyen
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (G.H.N.); (C.S.); (J.Y.T.); (M.E.); (C.S.-G.); (D.P.)
| | - Sewon Oh
- Department of Psychology, Institute for Mind and Brain, University of South Carolina, Columbia, SC 29208, USA;
| | - Corey Schneider
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (G.H.N.); (C.S.); (J.Y.T.); (M.E.); (C.S.-G.); (D.P.)
| | - Jia Y. Teoh
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (G.H.N.); (C.S.); (J.Y.T.); (M.E.); (C.S.-G.); (D.P.)
| | - Maggie Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (G.H.N.); (C.S.); (J.Y.T.); (M.E.); (C.S.-G.); (D.P.)
| | - Carmen Santana-Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (G.H.N.); (C.S.); (J.Y.T.); (M.E.); (C.S.-G.); (D.P.)
| | - David Porter
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (G.H.N.); (C.S.); (J.Y.T.); (M.E.); (C.S.-G.); (D.P.)
| | - Karina Quevedo
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN 55454, USA; (G.H.N.); (C.S.); (J.Y.T.); (M.E.); (C.S.-G.); (D.P.)
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Saini R, Das RC, Chatterjee K, Srivastava K, Khera A, Agrawal S. Augmenting mental health literacy of troops in a large military station: A novel approach. Ind Psychiatry J 2023; 32:S166-S173. [PMID: 38370959 PMCID: PMC10871393 DOI: 10.4103/ipj.ipj_233_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/14/2023] [Accepted: 08/29/2023] [Indexed: 02/20/2024] Open
Abstract
Background Mental health literacy (MHL) helps in acknowledging the symptoms at an early stage, thus promoting prompt management of negative stress behaviors. Despite the central thrust towards augmentation of MHL of troops, there is a paucity of available literature on the subject matter, especially in the Indian context. Current research explores the efficacy of a standardized Information Education and Communication (IEC) module for the promotion of MHL among troops. Materials and Methods 1200 soldiers posted in a large military station underwent a psycho-educational module about stress and related mental health conditions in an open-label experimental study. Data was collected using a simple demographic tool and a specially constructed Armed Forces Medical College (AFMC) mental health awareness questionnaire. The same sample was studied before the IEC activity, immediately after the IEC activity, and again after six months. Results Community-based psycho-educational module helped in improvement in MHL and the gains were stable at six months. Conclusions Well-standardized and structured module was found to be an effective strategy for improving MHL. The authors consider this study as seminal for bringing objectivity to mental health promotional programs in the Armed Forces.
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Affiliation(s)
- Rajiv Saini
- Department of Psychiatry, Command Hospital (Western Command), Panchkhula, Haryana, India
| | - R. C. Das
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Kaushik Chatterjee
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Kalpana Srivastava
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Anurag Khera
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Sunil Agrawal
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
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Lee H, Lee W. Association between unmet healthcare needs and suicidal behaviors among the Korean population. Gen Hosp Psychiatry 2023; 84:158-164. [PMID: 37499273 DOI: 10.1016/j.genhosppsych.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/06/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Suicide is an important public health concern. In South Korea, suicide rates have steadily risen over the past two decades. Unfortunately, there is a dearth of literature on the effects of unmet healthcare needs on suicide. Therefore, this study aimed to analyze the relationship between unmet healthcare needs and suicidal behaviors (suicidal ideation, plans, and attempts). METHOD This study analyzed data from 27,498 participants assessed by the Korea National Health and Nutrition Examination Survey conducted between 2016 and 2020. Logistic regression was used to evaluate the relationship between unmet healthcare needs and suicidal behaviors, while controlling for age, sex, education, household income, occupation, smoking, obesity, and alcohol consumption. RESULTS Adjusted odds ratios (95% confidence interval) were significantly higher in participants who experienced unmet healthcare needs [suicidal ideation: 2.31 (1.84-2.90); suicidal planning: 2.23 (1.75-2.85); and suicidal attempts: 1.92 (1.27-2.87)]. After stratifying for sex and depression, this trend was maintained in male participants and those without a depression diagnosis. CONCLUSIONS This study analyzed the relationship between unmet healthcare needs and suicidal behavior. Further studies using data sources that include more detailed information on suicide and somatic symptoms are required.
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Affiliation(s)
- Hangyeol Lee
- College of Medicine, Gachon University, Incheon, Republic of Korea
| | - Wanhyung Lee
- Department of Occupational and Environmental Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
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Wingenbach G, Koswatta TJ, Engels J, Freeny J, Haddad S. Outcomes of professional development activities for selected Texas school personnel helping students cope with behavioral and mental health issues. Sci Rep 2023; 13:10346. [PMID: 37365213 DOI: 10.1038/s41598-023-37298-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/19/2023] [Indexed: 06/28/2023] Open
Abstract
School personnel help youth cope with life and school stressors. However, help may depend on each person's confidence or knowledge of such issues. In 2019 and 2020, more than 13,800 Texas educators participated in Emotional Backpack Project (EBP) training to support youth coping with behavioral and mental health issues. Post-intervention results revealed significant gains in self-perceived understanding of students' behavioral and mental health issues, improved confidence in approaching students, parents, or other school staff to discuss students' harmful behaviors, understanding of mindfulness activities, and increased knowledge of trauma informed schools and trauma informed educators. Teachers and other school personnel were less confident in approaching parents or guardians to discuss youth mental health issues than in approaching students, counselors, and other staff. School personnel's knowledge, perceptions, and confidence to help students cope with behavioral and mental health issues was significantly better after EBP interventions. EBP training should be adopted widely and occur more than once annually.
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Affiliation(s)
- Gary Wingenbach
- Texas A&M University, 2116 TAMU, College Station, TX, 77843-2116, USA.
| | - Taniya J Koswatta
- Texas A&M University, 2116 TAMU, College Station, TX, 77843-2116, USA
| | - Josephine Engels
- Center for School, Behavioral Health at Mental Health America of Greater Houston, Houston, USA
| | - Jamie Freeny
- Center for School, Behavioral Health at Mental Health America of Greater Houston, Houston, USA
| | - Sana Haddad
- Center for School, Behavioral Health at Mental Health America of Greater Houston, Houston, USA
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de Araújo RMF, Zanotto M, da Rosa LR, Mazzochi L, Lara DR. Sensitivity is the dimension of temperament most associated with the progression from ideation to suicide attempts. J Affect Disord 2021; 294:695-700. [PMID: 34343927 DOI: 10.1016/j.jad.2021.07.038] [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: 02/09/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND To analyze the association between temperament (emotional and affective) and scrutinize the progression from suicide ideation to attempt, by using data from a large internet-based sample. METHODS It is a cross-sectional study, based on the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). Temperament was assessed by the Affective and Emotional Composite Temperament Scale (AFECTS), and life-long suicidal behavior was determined by the adapted Suicidal Behaviors Questionnaire (SBQ-17). Odds ratios were obtained through multivariate logistic regression and a multiple linear regression were used in the analysis. According to the "ideation-to-action framework", we performed analyzes using two different reference groups: no suicidal ideation and suicidal ideation. RESULTS The affective temperaments that showed the greatest association with suicide attempts were depressive, cyclothymic, and volatile. The temperaments that reflected higher associations for progression from ideation to suicide attempt were cyclothymic, depressive, and euphoric. Sensitivity was manifested as the emotional temperament with the strongest positive association with the severity of suicidal behavior, followed by desire and control. Stability was estimated as the emotional trait with the strongest negative association with the severity of suicidal behavior. LIMITATIONS It is not a population based sample. BRAINSTEP is a self-selected sample whose participants are mostly women, who are highly educated and young. CONCLUSIONS Our results suggest that temperament assessment using AFECT model may be relevant to assess the risk for the progression from ideation to suicide attempts. These results strengthen the "ideation-to-action" framework that risk factors to suicide ideators can differ from suicide attempters.
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Affiliation(s)
- Rafael M F de Araújo
- Universidade do Vale do Taquari, Lajeado, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | | | | | - Leonardo Mazzochi
- Universidade do Vale do Taquari, Lajeado, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Diogo R Lara
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Morton M, Wang S, Tse K, Chung C, Bergmans Y, Ceniti A, Flam S, Johannes R, Schade K, Terah F, Rizvi S. Gatekeeper training for friends and family of individuals at risk of suicide: A systematic review. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:1838-1871. [PMID: 34125969 DOI: 10.1002/jcop.22624] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 06/12/2023]
Abstract
AIMS Gatekeeper training (GKT) is an important suicide prevention strategy. Studies have evaluated the effectiveness of GKT in different populations, often neglecting family and friends who play a vital role in caring for people with suicide risk. This review evaluated GKT programs targeting family and friends to determine their effectiveness in this specific population. METHODS Academic databases were searched for studies on GKT programs. Programs involving family and friends caring for people with suicide risk were assessed for any impact on knowledge, self-efficacy, attitudes, and suicide prevention skills. RESULTS Seventeen studies were reviewed. GKT showed significant gains on outcomes of interest. Three studies targeted family and friends, with one involving them in program creation and conduction and another adjusting the program after their input. CONCLUSIONS GKT programs have potentially positive effects on family and friends caring for people with suicide risk. Few programs address the specific needs of this group, and programs adapted specifically for them are scarce. Future program development recommendations are discussed.
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Affiliation(s)
- Michael Morton
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, Canada
| | - Shijing Wang
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Kristen Tse
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, Canada
| | - Carolyn Chung
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, Canada
| | - Yvonne Bergmans
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Amanda Ceniti
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Shelley Flam
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, Canada
| | - Robb Johannes
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, Canada
- Health Promotions Program, Fred Victor, Toronto, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Kathryn Schade
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, Canada
| | - Flora Terah
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, Canada
| | - Sakina Rizvi
- Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's Hospital, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Barredo J, Bozzay ML, Primack JM, Schatten HT, Armey MF, Carpenter LL, Philip NS. Translating Interventional Neuroscience to Suicide: It's About Time. Biol Psychiatry 2021; 89:1073-1083. [PMID: 33820628 PMCID: PMC8603185 DOI: 10.1016/j.biopsych.2021.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/26/2022]
Abstract
Despite significant advances in psychiatric and psychological treatment over the last 30 years, suicide deaths have increased. Unfortunately, neuroscience insights have yielded few translational interventions that specifically target suicidal thoughts and behaviors. In our view, this is attributable to two factors. The first factor is our limited integration of neurocircuitry models with contemporary suicide theory. The second challenge is inherent to the variable nature of suicide risk over time. Few interventional neuroscience studies evaluate how temporal fluctuations in risk affect treatment, despite evidence that temporality is a key component distinguishing suicide phenotypes. To wit, individual variability in risk trajectories may provide different treatment targets to engage as a patient moves between suicidal ideation and attempt. Here, we first review contemporary ideation-to-action theories of suicide from a neurobiological perspective, focusing on valence and executive function circuits and the key role of state-induced (e.g., within stressful contexts) functional modulation on longitudinal risk trajectories. We then describe neural correlates of suicide reduction following various interventions, ranging from circuit specific (i.e., transcranial magnetic stimulation) to broader pharmacological (i.e., ketamine, lithium) to psychological (i.e., brief cognitive therapy). We then introduce novel strategies for tracking risk in naturalistic settings and real time using ecological momentary interventions. We provide a critical integration of the literature focusing on the intersection between targets and temporality, and we conclude by proposing novel research designs integrating real-time and biologically based interventions to generate novel strategies for future suicide reduction research.
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Affiliation(s)
- Jennifer Barredo
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; COBRE Center for Neuromodulation and Neuroimaging, Providence, Rhode Island.
| | - Melanie L Bozzay
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jennifer M Primack
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; Psychosocial Research Program, Butler Hospital, Providence, Rhode Island; Providence VA Medical Center, Providence, Rhode Island
| | - Heather T Schatten
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; Psychosocial Research Program, Butler Hospital, Providence, Rhode Island
| | - Michael F Armey
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; Psychosocial Research Program, Butler Hospital, Providence, Rhode Island
| | - Linda L Carpenter
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; COBRE Center for Neuromodulation and Neuroimaging, Providence, Rhode Island
| | - Noah S Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island; COBRE Center for Neuromodulation and Neuroimaging, Providence, Rhode Island
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Hopwood H, Sevalie S, Herman MO, Harris D, Collet K, Bah AJ, Beynon F. The burden of mental disorder in Sierra Leone: a retrospective observational evaluation of programmatic data from the roll out of decentralised nurse-led mental health units. Int J Ment Health Syst 2021; 15:31. [PMID: 33832523 PMCID: PMC8033705 DOI: 10.1186/s13033-021-00455-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/22/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa the treatment gap for mental disorders is high. In 2009, 98.0% of people with mental illness in Sierra Leone were not receiving treatment, partly due to the absence of public psychiatric facilities outside the capital. In response, the Ministry of Health and Sanitation rolled out nurse-led mental health units (MHU) to every district. This study aims to retrospectively evaluate the uptake of these services by examining the pathways to care, diagnosis, management, and treatment gap, to provide insight into the functioning of these units and the potential burden of mental health disorders in Sierra Leone. METHODS We evaluated the roll out of MHU using summary data from all units between 1 st January 2015 and 1 st January 2017, to establish the burden of diagnoses among service users, pathways to care, treatments provided, and treatment gaps. Negative binomial regressions examine bivariate relationships between diagnoses, treatments, and medication inaccessibility with demographics (age and sex), location (Freetown vs the rest and Ebola endemic regions vs the rest) and year. RESULTS We collected data from 15 MHU covering 13 districts in 24 months. There were 2401 referrals. The largest age category was 25-34 (23.4%). The prominent diagnoses were epilepsy (43.5%, associated with children) and psychosis (17.5%, associated with males). Reported depression (8.6%) and suicide attempts (33 patients) were low. Ebola endemic regions reported higher rates of grief, trauma, and medically unexplained symptoms. In 24.7% of cases where medication was required, it was not accessible. CONCLUSIONS Nurse-led MHU can have a modest effect on the treatment gap in resource constrained environments such as Sierra Leone, particularly in epilepsy and psychosis.
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Affiliation(s)
- Helen Hopwood
- King's Sierra Leone Partnership, King's Global Health Partnerships, King's Centre for Global Health and Health Partnerships, School of Population and Environmental Sciences, King's College London, Freetown, Sierra Leone.
| | | | - Moshi Optat Herman
- Kings College London Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Dawn Harris
- King's Sierra Leone Partnership, King's Global Health Partnerships, King's Centre for Global Health and Health Partnerships, School of Population and Environmental Sciences, King's College London, Freetown, Sierra Leone
| | | | | | - Fenella Beynon
- King's Sierra Leone Partnership, King's Global Health Partnerships, King's Centre for Global Health and Health Partnerships, School of Population and Environmental Sciences, King's College London, Freetown, Sierra Leone
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Holmes G, Clacy A, Hermens DF, Lagopoulos J. The Long-Term Efficacy of Suicide Prevention Gatekeeper Training: A Systematic Review. Arch Suicide Res 2021; 25:177-207. [PMID: 31809659 DOI: 10.1080/13811118.2019.1690608] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The practice of educating individuals (known as 'gatekeepers' [GK]) at the informal social level with the knowledge, skills, and confidence to identify an at-risk individual and provide support has been shown as an effective suicide prevention method. Despite the efficacy of gatekeeper training (GKT) in the short-term, there are concerns over the long-term efficacy of these outcomes. The objective of this review was to identify the empirical GKT studies in the literature that included evaluations at pre, post, and follow-up. Additionally, this review aimed to evaluate the long-term effect of training on GK behavior. PubMed, Cochrane Library, and PsycNET databases were searched using the terms 'gatekeeper' and 'suicid*' present in the title and/or the abstract, with the terms 'follow-up', 'pre-post', or 'long-term' present in any text. Studies must have involved a suicide prevention program intervention provided to general members of the community. Knowledge and self-efficacy were shown to exhibit the strongest endurance of training effect, although some decay was present for knowledge over time (M follow-up delay 6.1 months). Gatekeeper attitude at follow-up (M follow-up delay 4.4 months) had returned to baseline levels in 57% (4/7) of the identified studies that evaluated this construct. Behavioral intention and behavior both indicate a weak training effect with poor translation of training into intervention behavior. Findings indicate the ideological and socio-cultural aspects of individual GKs should also be addressed to facilitate the improved potential for long-term attitudinal change. Future research directions are discussed.
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Tripp DA, Jones K, Mihajlovic V, Westcott S, MacQueen G. Childhood trauma, depression, resilience and suicide risk in individuals with inflammatory bowel disease. J Health Psychol 2021; 27:1626-1634. [PMID: 33719635 PMCID: PMC9092906 DOI: 10.1177/1359105321999085] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Despite the prevalence of suicide risk in inflammatory bowel disease populations,
research has yet to examine associations between childhood trauma, resilience,
depression and suicide risk. In the present online study, 172 participants
responded to measures of childhood trauma, resilience, depression and suicide
risk. A moderated mediation revealed that resilience does not moderate the
associations between childhood trauma, depressive symptoms and suicide risk.
However, a serial mediation revealed that childhood trauma is associated with
decreased resilience, which is related to higher depressive symptoms, and
ultimately higher suicide risk, thus suggesting resilience and depression as
significant intervention targets.
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Bertuccio RF, Frank JL, Hall CM. Patterns of Warning Signs Among Adolescents Who Contemplate Suicide: A Latent Profile Analysis. SCHOOL PSYCHOLOGY REVIEW 2021. [DOI: 10.1080/2372966x.2020.1836519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nwangwu H, de Peralta SS, Birman S, Hicks RW. Implementation of the standardized, evidence-based three-stage suicide risk screening: Experience of a large Veterans Affairs medical center. J Am Assoc Nurse Pract 2021; 33:838-846. [PMID: 33534288 DOI: 10.1097/jxx.0000000000000540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022]
Abstract
ABSTRACT Suicide is a global public health concern and may be preventable with early identification. The suicide rate among US veterans is increasing. In response to the increase, Veterans Health Administration recommended a new standardized three-step, evidence-based suicide risk screening process across all Veterans Health Administration sites. The purpose of this project was to implement the new three-step suicide screening method and evaluate the rate of provider adherence. The implementation occurred in seven clinical sites in the Veterans Affairs Greater Los Angeles Health care System. Following initial implementation, two Plan-Do-Study-Act (PDSA) evaluated provider adherence to the screening processes. Staff members at each site received suicide prevention education. Staff members had the option of using an embedded template in the course of normal patient care workflow. Plan-Do-Study-Act 1 measured the early results. Staff members achieved a performance adherence rate of 18%, indicating that staff were less likely to proactively screen for risk of suicide. In PDSA-2, the mandatory use of screening replaced the optional use. Staff members achieved a 95% adherence rate after 3 months. Changing the workflow within the electronic health record from optional to mandatory utilization brought forth improvements in suicide prevention screening.
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Affiliation(s)
- Helen Nwangwu
- VA Long Beach Healthcare System, Long Beach, California
- School of Nursing, Azusa Pacific University, Azusa, California
| | - Shelly S de Peralta
- VA Greater Los Angeles Healthcare System, Los Angeles, California
- College of Graduate Nursing, Western University of Health Sciences, Pomona, California
| | - Sharon Birman
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Rodney W Hicks
- College of Graduate Nursing, Western University of Health Sciences, Pomona, California
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Madadin M, Menezes RG, Alassaf MA, Almulhim AM, Abumadini MS, Alnemer FA, Alrasheed FR, Alramadhan AK. Suicidal Ideation Among Medical Students in Dammam, Saudi Arabia. CRISIS 2020; 42:278-283. [PMID: 33034518 DOI: 10.1027/0227-5910/a000720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: Medical students are at high risk of suicidal ideation. Aim: We aimed to obtain information on suicidal ideation among medical students in Dammam located in the Eastern Province of Saudi Arabia. Method: This cross-sectional study was conducted at the College of Medicine affiliated with Imam Abdulrahman Bin Faisal University in the Eastern Province of Saudi Arabia. Suicidal ideation in the past 12 months was assessed based on responses to four questions in the depression subscale of the General Health Questionnaire 28 (GHQ-28). In addition, data were collected to examine the association of suicidal ideation with various factors. Results: We found that 1 in 3 medical students in the study had suicidal ideation in the past 12 months, while around 40% had lifetime suicidal ideation. Suicidal ideation was associated with feelings of parental neglect, history of physical abuse, and dissatisfaction with academic performance. Limitations: The cross-sectional nature of this study limits its ability to determine causality regarding suicidal ideation. Conclusion: These rates are considerably high when compared with rates from studies in other countries around the world. This study provides a reference in the field of suicidology for this region of Saudi Arabia.
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Affiliation(s)
- Mohammed Madadin
- Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ritesh G Menezes
- Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Maha A Alassaf
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulaziz M Almulhim
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mahdi S Abumadini
- Department of Psychiatry, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Chen L, Ngoubene-Atioky AJ, Zanardelli G, Yuanping D, Yu L. Childhood Abuse and Suicidal Behaviors Among Chinese Migrant Workers: The Mediating Role of Alexithymia and Social Support. Arch Suicide Res 2020; 24:633-647. [PMID: 31502515 DOI: 10.1080/13811118.2019.1658142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study aims to investigate the lifetime prevalence of suicidal behaviors in a sample of Chinese migrant workers. It also examined the mediating role of alexithymia and social support in the link between childhood abuse and suicidal behaviors. A total of 1,563 migrant workers were surveyed by using cluster sampling. Results showed that the estimated lifetime prevalence of suicide ideation, plan, and attempt among Chinese migrant workers was 12.8%, 8.1%, and 4.6%, respectively. Structural equation modeling analyses revealed a significant positive association between childhood abuse and suicidal behaviors; this association was partially mediated by social support. A significant path from childhood abuse through alexithymia and social support to suicidal behaviors was also established. Findings of this study emphasize the importance of social support and alexithymia in understanding the possible mechanisms underlying the relationship between childhood abuse and suicidal behaviors and suggest possible avenues for suicide interventions.
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Bruen AJ, Wall A, Haines-Delmont A, Perkins E. Exploring Suicidal Ideation Using an Innovative Mobile App-Strength Within Me: The Usability and Acceptability of Setting up a Trial Involving Mobile Technology and Mental Health Service Users. JMIR Ment Health 2020; 7:e18407. [PMID: 32985995 PMCID: PMC7551108 DOI: 10.2196/18407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/07/2020] [Accepted: 07/21/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Suicide is a growing global public health problem that has resulted in an increase in the demand for psychological services to address mental health issues. It is expected that 1 in 6 people on a waiting list for mental health services will attempt suicide. Although suicidal ideation has been shown to be linked to a higher risk of death by suicide, not everybody openly discloses their suicidal thoughts or plans to friends and family or seeks professional help before suicide. Therefore, new methods are needed to track suicide risk in real time together with a better understanding of the ways in which people communicate or express their suicidality. Considering the dynamic nature and challenges in understanding suicide ideation and suicide risk, mobile apps could be better suited to prevent suicide as they have the ability to collect real-time data. OBJECTIVE This study aims to report the practicalities and acceptability of setting up and trialing digital technologies within an inpatient mental health setting in the United Kingdom and highlight their implications for future studies. METHODS Service users were recruited from 6 inpatient wards in the north west of England. Service users who were eligible to participate and provided consent were given an iPhone and Fitbit for 7 days and were asked to interact with a novel phone app, Strength Within Me (SWiM). Interaction with the app involved journaling (recording daily activities, how this made them feel, and rating their mood) and the option to create safety plans for emotions causing difficulties (identifying strategies that helped with these emotions). Participants also had the option to allow the study to access their personal Facebook account to monitor their social media use and activity. In addition, clinical data (ie, assessments conducted by trained researchers targeting suicidality, depression, and sleep) were also collected. RESULTS Overall, 43.0% (80/186 response rate) of eligible participants were recruited for the study. Of the total sample, 67 participants engaged in journaling, with the average number of entries per user being 8.2 (SD 8.7). Overall, only 24 participants created safety plans and the most common difficult emotion to be selected was feeling sad (n=21). This study reports on the engagement with the SWiM app, the technical difficulties the research team faced, the importance of building key relationships, and the implications of using Facebook as a source to detect suicidality. CONCLUSIONS To develop interventions that can be delivered in a timely manner, prediction of suicidality must be given priority. This paper has raised important issues and highlighted lessons learned from implementing a novel mobile app to detect the risk of suicidality for service users in an inpatient setting.
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Affiliation(s)
- Ashley Jane Bruen
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Abbie Wall
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Alina Haines-Delmont
- Department of Nursing, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, United Kingdom
| | - Elizabeth Perkins
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
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16
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Ernst M, Reiner I, Fieß A, Tibubos AN, Schulz A, Burghardt J, Klein EM, Brähler E, Wild PS, Münzel T, König J, Lackner KJ, Pfeiffer N, Michal M, Wiltink J, Beutel ME. Sex-dependent associations of low birth weight and suicidal ideation in adulthood: a community-based cohort study. Sci Rep 2020; 10:12969. [PMID: 32737388 PMCID: PMC7395149 DOI: 10.1038/s41598-020-69961-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022] Open
Abstract
Low birth weight (LBW; < 2,500 g) has been identified as a risk factor for adverse mental health outcomes over the life span. However, little is known about the association of LBW and suicidal ideation in middle and late adulthood. We investigated N = 8,278 participants of a representative community cohort: 3,849 men (46.5%) and 4,429 women (53.5%) (35-74 years of age). We assessed standardized measures of mental distress, sociodemographics, health behavior, and somatic factors (based on an extensive medical assessment). Controlling for these confounders, we examined the relationship of birth weight and suicidal ideation in logistic regression models. As men and women differ with regard to their susceptibility to suicidal ideation and behavior, we tested sex-dependent effects. LBW was reported by 458 participants (5.5%). In men, LBW was associated with a higher likelihood of reporting suicidal ideation (OR 2.92, 95% CI 1.58-5.12). In women, there was no such relationship. The findings underscore the interrelatedness of the physical and psychological domain, the role of early adversity in suicidal ideation, and they identify a vulnerable group whose numbers are expected to grow. They also indicate other risk factors for suicidal ideation in the community (mental distress, lack of social support, and health risk behavior).
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Affiliation(s)
- Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany.
| | - Iris Reiner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Achim Fieß
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Ana N Tibubos
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine - Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Juliane Burghardt
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Eva M Klein
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine - Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Thomas Münzel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckstr. 1, 55131, Mainz, Germany
- Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Obere Zahlbacher Str. 69, 55131, Mainz, Germany
| | - Karl J Lackner
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckstr. 1, 55131, Mainz, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
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Quevedo K, Yuan Teoh J, Engstrom M, Wedan R, Santana-Gonzalez C, Zewde B, Porter D, Cohen Kadosh K. Amygdala Circuitry During Neurofeedback Training and Symptoms' Change in Adolescents With Varying Depression. Front Behav Neurosci 2020; 14:110. [PMID: 32774244 PMCID: PMC7388863 DOI: 10.3389/fnbeh.2020.00110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 06/04/2020] [Indexed: 12/28/2022] Open
Abstract
Typical adolescents have increased limbic engagement unchecked by regulatory medial prefrontal cortex (PFC) activity as well as heightened self-focus. The resulting emotion dysregulation and self-focused rumination make adolescents more susceptible to depression and suicide attempts. Heightened self-focus converges with mental illness among depressed adolescents, who deploy exaggerated attention to negative self-relevant stimuli and neglect positive ones as part of depression's phenomenology. This results in rigid negative self-representations during an identity formative period with potential lifetime repercussions. Current empirically supported treatments fail to allay recurrent depression. Evidence-based interventions for illnesses linked to suicide ideation and attempts (e.g., depression) underperform across the lifespan. This could be because current treatments are not successful in altering pervasive negative self-representations and affect dysregulation, which is known to be a risk factor of chronic depression. This study departs from the premise that increasing positive self-processing might be protective against chronic depression particularly during adolescence. The present research is a novel investigation of neurofeedback as a potential treatment alternative for adolescent depression. To enhance positive self-processing, we used the happy self-face as a cue to initiate neurofeedback from the bilateral amygdala and hippocampus and adolescents attempted to upregulate that limbic activity through the recall of positive autobiographical memories. We identified limbic functional circuitry engaged during neurofeedback and links to short-term symptoms' change in depression and rumination. We found that depressed youth showed greater right amygdala to right frontocortical connectivity and lower left amygdala to right frontocortical connectivity compared to healthy controls during neurofeedback vs. control conditions. Depressed youth also showed significant symptom reduction. Connectivity between the right amygdala and frontocortical regions was positively correlated with rumination and depression change, but connectivity between frontocortical regions and the left amygdala was negatively correlated with depression change. The results suggest that depressed youth might engage implicit emotion regulation circuitry while healthy youth recruit explicit emotion regulation circuits during neurofeedback. Our findings support a compensatory approach (i.e., target the right amygdala) during future neurofeedback interventions in depressed youth. Future work ought to include a placebo condition or group.
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Affiliation(s)
- Karina Quevedo
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Jia Yuan Teoh
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Maggie Engstrom
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Riley Wedan
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Carmen Santana-Gonzalez
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Betanya Zewde
- Department of Psychiatry, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - David Porter
- Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN, United States
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18
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Almaliah-Rauscher S, Ettinger N, Levi-Belz Y, Gvion Y. "Will you treat me? I'm suicidal!" The effect of patient gender, suicidal severity, and therapist characteristics on the therapist's likelihood to treat a hypothetical suicidal patient. Clin Psychol Psychother 2020; 27:278-287. [PMID: 31989723 DOI: 10.1002/cpp.2426] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 01/18/2023]
Abstract
The purpose of our study was to broaden the understanding regarding mental health professionals' willingness to treat and likeliness to refer suicidal patients to other professionals. More specifically, our aim was to examine the effect of the patient's gender and suicidal severity, as well as the mental health professionals' personal and professional characteristics, on the willingness to treat and likeliness to refer. A total of 331 mental health professionals were randomly exposed to one of four case descriptions of a hypothetical patient in a crisis. The cases shared a common background story; however, they differed in terms of the patient's gender and suicidal condition (high vs. low). The exposure was followed by questionnaires aimed to reflect the subject's evaluation of the patient's suicidal severity, the subject's sense of competence and responsibility, willingness to treat or likeliness to refer, emotional contagion, and depression. The results indicate a lower willingness to treat and higher likelihood to refer suicidal patients compared with depressed patients. In addition, subjects exposed to the high suicidality cases showed a greater willingness to treat and refer female patients compared with male patients. A sense of competence was found as the strongest predictor of mental health professionals' willingness to treat and likelihood to refer, and emotional contagion was found as a predictor of likelihood to refer. It is important that mental health professionals be aware of the low tendency to treat suicidal patients especially if they are male. Further research should explore suitable training programmes and their application in the mental health curriculum.
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Affiliation(s)
| | - Noa Ettinger
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yafo, Israel
| | - Yossi Levi-Belz
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | - Yari Gvion
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yafo, Israel.,Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
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19
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Kar N, Prasad T. Suicide by psychiatric patients: Nature of risk, risk categorisation and preventability. MEDICINE, SCIENCE, AND THE LAW 2019; 59:255-264. [PMID: 31378145 DOI: 10.1177/0025802419867507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study considers risk factors associated with suicide by psychiatric patients, the perceived risk at last contact and risk categorisation and reflects upon the potential for prevention. Information regarding 63 consecutive suicides known to mental health services in Wolverhampton, UK, over a 15-year period was collected as part of an audit using a semi-structured questionnaire covering sociodemographic and clinical risk factors, along with information about preventability. A complex mixture of historical, enduring and current risk factors was observed. In addition to common risk factors, a considerable proportion had histories of multiple co-morbid psychiatric (52.5%) and physical diagnoses (27.6%) and psychiatric admission (70.5%). Common suicide methods included hanging (36.5%) and poisoning (36.5%). Most suicides occurred in the post-discharge months up to around two years (75.8%). Although a range of psychopathologies and suicidal cognitions were observed at the last clinical contact, the immediate suicide risk was considered low (46.2%) or not present (38.5%) in the majority of cases. Clinicians suggested various factors that could have made suicides less likely. Clinical assessment can identify risk factors, but categorisation may not be indicative of the outcome. A focus on modifiable factors, with support for psychosocial and clinical issues, may assist with prevention.
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Affiliation(s)
- Nilamadhab Kar
- Department of Psychiatry, Black Country Partnership NHS Foundation Trust, Steps to Health, UK
| | - Tulika Prasad
- Department of Psychiatry, Black Country Partnership NHS Foundation Trust, Penn Hospital, UK
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20
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Ng J, Sjöstrand M, Eyal N. Adding Lithium to Drinking Water for Suicide Prevention—The Ethics. Public Health Ethics 2019. [DOI: 10.1093/phe/phz002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Recent observations associate naturally occurring trace levels of Lithium in ground water with significantly lower suicide rates. It has been suggested that adding trace Lithium to drinking water could be a safe and effective way to reduce suicide. This article discusses the many ethical implications of such population-wide Lithium medication. It compares this policy to more targeted solutions that introduce trace amounts of Lithium to groups at higher risk of suicide or lower risk of adverse effects. The question of mass treatment with Lithium recalls other choices in public health between population-wide and more targeted interventions. The framework we propose could be relevant to some of these other dilemmas.
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Affiliation(s)
- Jared Ng
- Department of Developmental Psychiatry, Institute of Mental Health
| | - Manne Sjöstrand
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet
| | - Nir Eyal
- Department of Global Health and Population, Harvard TH Chan School of Public Health
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21
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Bajaj S, Raikes AC, Smith R, Vanuk JR, Killgore WDS. The Role of Prefrontal Cortical Surface Area and Volume in Preclinical Suicidal Ideation in a Non-Clinical Sample. Front Psychiatry 2019; 10:445. [PMID: 31312146 PMCID: PMC6613495 DOI: 10.3389/fpsyt.2019.00445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 06/05/2019] [Indexed: 01/08/2023] Open
Abstract
Suicidal ideation (SUI) can occur in the absence of concomitant psychiatric diagnoses, and even normal levels can be problematic among individuals experiencing excess stress or lack of social support. The objective of this study was to investigate the neuroanatomical basis of SUI in non-clinical human populations who are within the normal limits of SUI, after accounting for elevated stress and perceived lack of social support. Neuroanatomical data were collected from 55 healthy individuals (mean age 30.9 ± 8.1 years, 27 females) whose depression severity levels were below the Diagnostic and Statistical Manual of Mental Disorders criteria. Measures of SUI, aggression, stress, non-support, and treatment rejection were collected from the treatment-consideration scales (TCS) of the Personality Assessment Inventory (PAI). Correlations between standardized SUI scores and three brain morphometry measures, including vertex wise cortical thickness (CT), cortical surface area (CSA), and cortical volume (CV), were estimated for each participant, controlling for age, sex, intracranial volume, and the remaining TCS measures. We observed a significant negative association between scores on SUI and both CSA and CV (cluster-forming threshold of p < 0.005, clusterwise threshold of p < 0.05, FDR corrected for multiple comparisons) within the left rostral middle frontal gyrus. Our findings suggest that greater CSA and CV within the dorsolateral prefrontal cortex are associated with reduced SUI in a non-clinical population with mild levels of stress and perceived lack of social support. Because the dorsolateral prefrontal cortex has been broadly linked to cognitive reappraisal, self-critical thoughts, and emotional regulation, greater CSA and CV within these regions may lead to better mental health by protecting healthy individuals from engaging in SUI during periods of stress and perceived insufficient social support. As our data consisted of only healthy individuals with non-clinical levels of SUI, further investigation will be necessary to explore the neural basis of SUI in populations who may be at greater risk of future suicidal behavior.
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Affiliation(s)
- Sahil Bajaj
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Adam C Raikes
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Ryan Smith
- The Laureate Institute for Brain Research (LIBR), Tulsa, OK, United States
| | - John R Vanuk
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - William D S Killgore
- Social, Cognitive and Affective Neuroscience Laboratory (SCAN Lab), Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
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Abstract
Research concerning psychiatric issues relating to opioid drugs currently focuses primarily on their role in reinforcing addictive behaviors, given the recent proliferation of lethal abuse of illicit opiates in the United States and around the world. In contrast, this article will review the mechanism of action of opioids in affective disorders and the available evidence and potential for their use, especially in the treatment of resistant major depression. Buprenorphine is the opioid derivative of special interest; we review this and other opioid derivatives, highlighting the growing role of opioids in treating depressive illnesses and other related psychopathologies.
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Affiliation(s)
- Parnika P Saxena
- Brockton Neighborhood Health Center, 63 Main St, Brockton, MA, 02301, USA.
| | - J Alexander Bodkin
- McLean Hospital, 115 Mill St, North Belknap, Belmont, MA, 02478, USA.,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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23
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Sedative hypnotics overdose: Epidemiology, diagnosis and management. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2018. [DOI: 10.1016/j.injms.2018.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Antidepressant-Like Effects of Gyejibokryeong-hwan in a Mouse Model of Reserpine-Induced Depression. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5845491. [PMID: 30046601 PMCID: PMC6038693 DOI: 10.1155/2018/5845491] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/11/2018] [Accepted: 05/28/2018] [Indexed: 12/16/2022]
Abstract
Treatment with the antihypertensive agent reserpine depletes monoamine levels, resulting in depression. In the present study, we evaluated the antidepressant effects of Gyejibokryeong-hwan (GBH), a traditional Korean medicine, in a mouse model of reserpine-induced depression. Mice were treated with reserpine (0.5 mg·kg−1, i.p.) or phosphate-buffered saline (PBS, i.p., normal) once daily for 10 days. GBH (50, 100, 300, and 500 mg·kg−1), PBS (normal, control), fluoxetine (FXT, 20 mg·kg−1), or amitriptyline (AMT, 30 mg·kg−1) was administered orally 1 h prior to reserpine treatment. Mouse behavior was examined in the forced swim test (FST), tail suspension test (TST), and open-field test (OFT) following completion of the treatment protocol. Administration of GBH reduced immobility time in the FST and TST and significantly increased the total distance traveled in the OFT. Plasma serotonin levels were significantly lower in control mice than in normal mice, although these decreases were significantly attenuated to a similar extent by treatment with GBH, FXT, or AMT. Reserpine-induced increases in plasma corticosterone were also attenuated by GBH treatment. Moreover, GBH attenuated reserpine-induced increases in interleukin- (IL-) 1β, IL-6, and tumor necrosis factor- (TNF-) α mRNA expression in the hippocampus. In addition, GBH mice exhibited increased levels of brain-derived neurotrophic factor (BDNF) and a higher ratio of phosphorylated cAMP response element-binding protein (p-CREB) to CREB (p-CREB/CREB) in the hippocampus. Our results indicated that GBH can ameliorate depressive-like behaviors, affect the concentration of mood-related hormones, and help to regulate immune/endocrine dysfunction in mice with reserpine-induced depression, likely via activation of the BDNF-CREB pathway. Taken together, these findings indicate that GBH may be effective in treating patients with depression.
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Larsson J. Antidepressants and suicide among young women in Sweden 1999-2013. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2018; 29:101-106. [PMID: 28885220 PMCID: PMC5611892 DOI: 10.3233/jrs-170739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To establish whether the young women (15-24 year old) who committed suicide in Sweden (1999-2013) received antidepressant treatment or not, and to what extent, prior to and/or at the time of suicide. To investigate the belief that increased prescription of antidepressants would drastically reduce the number of suicides. METHODS An analysis of data from the Swedish Prescribed Drug Register, the Causes of Death Register, with registers cross checked, and from the National Board of Forensic Medicine. RESULTS This analysis shows a covariance between increased prescription of antidepressants and an increasing trend in the number of suicides among young women. In the period 1999-2003 antidepressants were found in toxicological analyses done in 23% of the young women who committed suicide, and in 39% of cases for 2009-2013. CONCLUSION An increasingly larger proportion of young women who later committed suicide, had in the last few years been treated with antidepressants, prior to and at the time of the suicide. The previous assumptions that treatment with antidepressants would lead to a drastic reduction in suicide rates, are incorrect for the population of young women. On the contrary, it was found that an increasing tendency of completed suicides follow the increased prescription of antidepressants.
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Affiliation(s)
- Jan Larsson
- Reporter/Researcher, Snöbollsgränd 22, 129 45 Hägersten, Sweden. E-mail:
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26
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Testoni I, Ronconi L, Palazzo L, Galgani M, Stizzi A, Kirk K. Psychodrama and Moviemaking in a Death Education Course to Work Through a Case of Suicide Among High School Students in Italy. Front Psychol 2018; 9:441. [PMID: 29692745 PMCID: PMC5902682 DOI: 10.3389/fpsyg.2018.00441] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 03/16/2018] [Indexed: 11/13/2022] Open
Abstract
This study describes the psychological effects of an experience of death education (DE) used to explore a case of suicide in an Italian high school. DE activities included philosophical and religious perspectives of the relationships between death and the meaning of life, a visit to a local hospice, and psychodrama activities, which culminated in the production of short movies. The intervention involved 268 high school students (138 in the experimental group). Pre-test and post-test measures assessed ontological representations of death, death anxiety, alexithymia, and meaning in life. Results confirmed that, in the experimental group, death anxiety was significantly reduced as much as the representation of death as annihilation and alexithymia, while a sense of spirituality and the meaning of life were more enhanced, compared to the No DE group. These improvements in the positive meaning of life and the reduction of anxiety confirmed that it is possible to manage trauma and grief at school with death education interventions that include religious discussion, psychodrama and movie making activities.
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Affiliation(s)
- Ines Testoni
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), Università degli Studi di Padova, Padova, Italy
| | - Lucia Ronconi
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), Università degli Studi di Padova, Padova, Italy
| | - Lorenza Palazzo
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), Università degli Studi di Padova, Padova, Italy
| | | | | | - Kate Kirk
- Cork Counselling Services, Cork, Ireland
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Lygnugaryte-Griksiene A, Leskauskas D. Assessing suicide management skills of emergency medical services providers before and after suicide intervention/prevention training with Lithuanian version of suicide intervention response inventory. Neuropsychiatr Dis Treat 2018; 14:3405-3412. [PMID: 30587992 PMCID: PMC6298398 DOI: 10.2147/ndt.s186253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Effective suicide management skills of emergency medical services (EMS) providers are crucially important in Lithuania, which has the highest suicide rates in Europe. METHODS Respondents were 268 EMS providers, doctors (n=78) and nurses (n=190), who agreed to participate in suicide prevention/intervention training and completed the survey twice. Study was conducted in five steps: adaptation of Lithuanian version of Suicide Intervention Response Inventory (SIRI-LT); initial assessment of suicide counseling skills of the EMS providers using SIRI-LT; suicide prevention/intervention training; second assessment of suicide counseling skills using SIRI-LT 6 months after training; data analysis evaluating the skills and effectiveness of the training among different groups of EMS providers (doctors vs nurses, age groups). RESULTS SIRI-LT showed good internal consistency: Cronbach's alpha score of 0.85 (pretest) and 0.73 (posttest). The value of Kaiser-Meyer-Olkin measure of sampling adequacy was 0.849. A four-factor solution was forced and accounted for 40.8% of the variance. The SIRI-LT mean total scores before suicide prevention/intervention training were significantly higher for doctors than for nurses (13.01±5.24 vs 11.36±5.14, respectively; P=0.031). Younger respondents with a shorter period of employment and heavier workload were significantly more effective at suicide management than older respondents with a longer period of employment and lower workload. After suicide prevention/intervention training, SIRI-LT mean total scores decreased for doctors (13.0±5.24 vs 11.02±4.76; P=0.031) and significantly increased in older (≥55 age) respondents (11.85±3.82 vs 9.28±4.44; P=0.022). CONCLUSION SIRI-LT has good internal consistency and can be considered a good instrument for assessing suicide management skills of EMS providers. Our results suggest that ability to find appropriate responses to suicide situations may be multidimensional, related to cultural setting and influenced by age, education, motivation, engagement, and emotional distraction. Particular attention should be paid to active listening and empathic communication skills when developing suicide prevention/intervention training for EMS providers.
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Affiliation(s)
| | - Darius Leskauskas
- Department of Psychiatry at Lithuanian University of Health Sciences, Kaunas, Lithuania,
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Abstract
Primary care providers (PCPs) play a crucial role caring for patients with depression, managing antidepressant therapy, and assessing patients for suicide risk. Ten percent of the more than 20 million primary care visits for depression each year involve mental health issues, and account for 62% of the antidepressants prescribed in the United States. Psychiatric disorders appear to be underrecognized and undertreated in primary care. Suicidal ideation is present in a significant percentage of depressed primary care patients but rarely discussed. This article describes the warning signs and risk factors associated with suicide and recommends screening tools that can help PCPs identify patients at risk.
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Understanding and Approaching The Increase in Suicide Rate With a Special Focus on the State Of Delaware. Dela J Public Health 2016; 2:48-53. [PMID: 34466885 PMCID: PMC8389797 DOI: 10.32481/djph.2016.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
Suicide attempters differ in the degree of planning for their suicide attempts. The purpose of this study was to identify differences between individuals who make planned (≥3 hours of planning) and unplanned (<3 hours of planning) suicide attempts. Depressed suicide attempters (n = 110) were compared based on degree of planning of their most recent suicide attempt on demographic and clinical variables. Participants who made planned suicide attempts were more likely to have family history of completed suicide, more severe and frequent suicidal ideation, greater trait impulsivity, and greater suicidal intent and more severe medical consequences for both their most recent and most serious suicide attempts. These results suggest clear clinical differences based on the degree of suicide attempt planning. Severe suicidal ideation, high suicide intent, family history of suicide completion, and high levels of motor impulsivity contribute to a phenotype that is at greater risk of planned, highly lethal suicide attempts.
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Oneib B, Sabir M, Otheman Y, Abda N, Ouanass A. Suicidal ideations, plans and attempts in primary care: cross-sectional study of consultants at primary health care system in Morocco. Pan Afr Med J 2016; 24:274. [PMID: 28154629 PMCID: PMC5267922 DOI: 10.11604/pamj.2016.24.274.9060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 06/21/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction The aim of the study is to estimate the prevalence of suicidal ideation among Moroccan consultants in primary health care system. Methods We conducted a cross sectional survey in three health care centers in two cities of Morocco to estimate the prevalence of suicidal ideation, plan and suicide attempts among 396 consultants in the primary health care system, using the Mini International neuropsychiatric interview. Patients were 18 years and older, without known psychiatric or chronic somatic disease. Statistical analysis was performed by the SPSS 13.0 software. Results The prevalence of suicidal ideation was 5.3%, and 2.7% of the patients planned their suicide and 1.2% tried to commit suicide. The multivariate analysis did not demonstrate significant association. Conclusion Suicidal ideation, plan and suicide attempts are prevalent in primary health care patients, but they are still under diagnosed. An adequate training of physicians and the establishment of education programs is essential to reduce the rate of suicide.
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Affiliation(s)
- Bouchra Oneib
- Department Psychiatry, Faculty of Medicine, University Mohammed I, Oujda Morocco
| | - Maria Sabir
- Department of Psychiatry, Faculty of Medicine, University Mohammed V, Rabat, Morocco
| | - Yassine Otheman
- University Psychiatry Center El Hassan, Faculty of Medicine University Sidi Mohammed Ben Abdellah, Fès, Morocco
| | - Naima Abda
- Laboratory of Epidemiology, Faculty of Medicine University Mohammed I, Oujda, Morocco
| | - Abderrazzak Ouanass
- Department of Psychiatry, Faculty of Medicine, University Mohammed V, Rabat, Morocco
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Riesselman A, Johnson E, Palmer E. Lithium and clozapine in suicidality: shedding some light to get out of the dark. Ment Health Clin 2015. [DOI: 10.9740/mhc.2015.09.237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Suicide is currently on the rise with rates increasing alarmingly during the past decade. There are many risk factors for suicidal behavior, and mental illness is at the top of the list.
Methods
Although a variety of medications have been evaluated in the literature, lithium and clozapine continue to have the most evidence supporting their use in decreasing suicidality.
Results
It is clear that medications are indispensable regarding the reduction of suicidality; however, a holistic approach must be taken when caring for this patient population.
Discussion
This review focuses on the specific role that lithium and clozapine have in the reduction of suicidal behavior.
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Affiliation(s)
- Amber Riesselman
- (Corresponding author) Assistant Professor, Sullivan University College of Pharmacy, Louisville, Kentucky, Clinical Psychiatric Pharmacist, University of Louisville Hospital, Louisville, Kentucky,
| | - Eric Johnson
- Clinical Pharmacist Specialist, Department of Veterans Affairs, Tennessee Valley Healthcare System, Clarksville, Tennessee
| | - Emma Palmer
- Assistant Professor, Sullivan University College of Pharmacy, Louisville, Kentucky, Clinical Psychiatric Pharmacist, Central State Hospital, Louisville, Kentucky
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XXXV International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 26–29 May 2015, St Julian's, Malta. Clin Toxicol (Phila) 2015. [DOI: 10.3109/15563650.2015.1024953] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Schaffer A, Isometsä ET, Tondo L, Moreno D, Turecki G, Reis C, Cassidy F, Sinyor M, Azorin JM, Kessing LV, Ha K, Goldstein T, Weizman A, Beautrais A, Chou YH, Diazgranados N, Levitt AJ, Zarate CA, Rihmer Z, Yatham LN. International Society for Bipolar Disorders Task Force on Suicide: meta-analyses and meta-regression of correlates of suicide attempts and suicide deaths in bipolar disorder. Bipolar Disord 2015; 17:1-16. [PMID: 25329791 PMCID: PMC6296224 DOI: 10.1111/bdi.12271] [Citation(s) in RCA: 213] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/05/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Bipolar disorder is associated with a high risk of suicide attempts and suicide death. The main objective of the present study was to identify and quantify the demographic and clinical correlates of attempted and completed suicide in people with bipolar disorder. METHODS Within the framework of the International Society for Bipolar Disorders Task Force on Suicide, a systematic review of articles published since 1980, characterized by the key terms bipolar disorder and 'suicide attempts' or 'suicide', was conducted, and data extracted for analysis from all eligible articles. Demographic and clinical variables for which ≥ 3 studies with usable data were available were meta-analyzed using fixed or random-effects models for association with suicide attempts and suicide deaths. There was considerable heterogeneity in the methods employed by the included studies. RESULTS Variables significantly associated with suicide attempts were: female gender, younger age at illness onset, depressive polarity of first illness episode, depressive polarity of current or most recent episode, comorbid anxiety disorder, any comorbid substance use disorder, alcohol use disorder, any illicit substance use, comorbid cluster B/borderline personality disorder, and first-degree family history of suicide. Suicide deaths were significantly associated with male gender and first-degree family history of suicide. CONCLUSIONS This paper reports on the presence and magnitude of the correlates of suicide attempts and suicide deaths in bipolar disorder. These findings do not address causation, and the heterogeneity of data sources should limit the direct clinical ranking of correlates. Our results nonetheless support the notion of incorporating diagnosis-specific data in the development of models of understanding suicide in bipolar disorder.
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Affiliation(s)
- Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Erkki T Isometsä
- Institute of Clinical Medicine University of Helsinki, Helsinki, Finland
| | - Leonardo Tondo
- Lucio Bini Center, Cagliari, Italy and Harvard Medical School, McLean Hospital, Boston, MA, USA
| | - Doris Moreno
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Gustavo Turecki
- Departments of Psychiatry, Human Genetics, and Neurology & Neurosurgery, McGill University, Montreal, QC, Canada
| | - Catherine Reis
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Frederick Cassidy
- Department of Psychiatry and Behavioural Sciences, Duke University, Durham, USA
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jean-Michel Azorin
- Department of Psychiatry, University of Aix-Marseille II, Marseille, France
| | - Lars Vedel Kessing
- Faculty of Health Sciences, University of Copenhagen, Psychiatric Center Copenhagen Department, Copenhagen, Denmark
| | - Kyooseob Ha
- Department of Psychiatry, Seoul National University, Bundang Hospital, Seoul, Republic of Korea
| | - Tina Goldstein
- Department of Child and Adolescent Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Abraham Weizman
- Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Annette Beautrais
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Yuan-Hwa Chou
- Department of Psychiatry, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | | | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Zoltán Rihmer
- Department of Clinical and Theoretical Mental Health and Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Budapest, Hungary
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Schaffer A, Sinyor M, Reis C, Goldstein BI, Levitt AJ. Suicide in bipolar disorder: characteristics and subgroups. Bipolar Disord 2014; 16:732-40. [PMID: 24890795 DOI: 10.1111/bdi.12219] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 11/12/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The development of more sophisticated models for understanding suicide among people with bipolar disorder (BD) requires diagnosis-specific data. The present study aimed to elucidate differences between people who die by suicide with and without BD, and to identify subgroups within those with BD. METHODS Data on all suicide deaths in the city of Toronto from 1998 to 2010 were extracted from the Office of the Chief Coroner of Ontario, including demographics, clinical variables, recent stressors, and details of the suicide. Comparisons of person- and suicide-specific variables between suicide deaths among those with BD (n = 170) and those without (n = 2,716) were conducted, and a cluster analysis was performed among the BD suicide group only. RESULTS Those in the BD suicide group were more likely than those in the non-BD suicide group to be female [odds ratio (OR) = 1.75, 95% confidence interval (CI): 1.27-2.42; p = 0.001], to have made a past suicide attempt (OR = 2.01, 95% CI: 1.45-2.80; p < 0.0001), and to have had recent contact with psychiatric or emergency services (OR = 1.59, 95% CI: 1.00-2.52; p = 0.049). Five clusters were identified within the BD group, with differences between clusters in age; sex; marital status; living circumstances; past suicide attempts; substance abuse; interpersonal, employment/financial, and legal/police stressors; and rates of death by fall/jump or self-poisoning. CONCLUSIONS The present findings identified differences between BD and non-BD suicide groups, providing support to the utilization of an illness-specific approach to better understanding suicide in BD. Subgroups of BD suicide deaths, if replicated, should also be incorporated into the design and analysis of future studies of suicide in BD.
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Affiliation(s)
- Ayal Schaffer
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Abstract
BACKGROUND Suicide is a major public health problem, with mental disorders being one of its major risk factors. The high incidence of suicide on the Isle of Wight has motivated this study, the first of its kind on suicide in this small geographic area. Aim The aim of the study was to identify socio-demographic and clinical risk factors for suicide in the population of service users and non-service users, and gender-related characteristics of suicidal behaviour in a limited geographic region. METHOD Data were collected on 68 cases of suicide (ICD-10×60-X84) from residents of the Isle of Wight District between January 2006 and December 2009. All data were statistically analysed using Pearson's χ 2 test and Yates' correction for continuity. RESULTS The mean annual suicide rates over the period were 5.65 per 100 000 for women and 19.28 for men. Significantly (p=0.0006), more men than women (male/female ratio 3:1) died as a result of suicide. Relatively (p=0.07) more women (56.2%) than men (32.7%), and significantly more (p=0.05) service users (45.3%) than non-service users (13.3%) were unemployed. Significantly, more (p=0.0006) service users (64%) than non-service users (20%) had a history of suicide attempts and relatively (p=0.06) more (50.9%) service users than non-service users (20%) had attended the accident and emergency department before their death; 69% had an adverse life event within a year before their suicide. Depression as the most common Axis-I illness was diagnosed in 36% of all; but significantly (p=0.008) more in women (66.6%) than men (17.3%). Relatively (p=0.07) more women (56.2%) than men (32.7%) have contacted services before their death. Suicide by hanging was the most common cause, accounting for the death of 71% of men and 50% of women. CONCLUSIONS The study found that 80% of all suicides occurred in people suffering from mental disorder. Men are at a significant risk of suicide. Depressive disorders in women and stress-related disorders in men were the most common mental disorders. Treating mental disorders and co-morbid conditions seems to be one of the key elements in suicide prevention strategies.
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Crowder MK, Kemmelmeier M. Untreated Depression Predicts Higher Suicide Rates in U.S. Honor Cultures. JOURNAL OF CROSS-CULTURAL PSYCHOLOGY 2014. [DOI: 10.1177/0022022114534915] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Osterman and Brown demonstrated that U.S. honor states had higher rates of suicide than non-honor states and related this phenomenon to the higher incidence of depression and a reduced readiness to seek antidepression treatment in honor states. The present study critiques their research and re-examines the origin of the association between honor culture and suicide using a more expansive multi-year data set and controlling for culturally relevant factors (i.e., climate, gun ownership, population density, collectivism, access to health care, economic deprivation). Replicating some of their findings, higher rates of depression were related to higher levels of suicide in honor states but not non-honor states. In addition, we found state levels of antidepressant drug prescriptions to be related to lower levels of suicide in honor states but not non-honor states. A mediation analysis further revealed that levels of antidepressant drug prescriptions, but not levels of depression, mediated the relationship between honor culture and suicide, consistent with higher suicide rates in honor states being the result of a lack of treatment. The discussion focuses on clinical and cultural implications for suicide prevention in honor states.
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Delaveris GJM, Teige B, Rogde S. Non-natural manners of death among users of illicit drugs: Substance findings. Forensic Sci Int 2014; 238:16-21. [DOI: 10.1016/j.forsciint.2014.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 01/23/2014] [Accepted: 02/10/2014] [Indexed: 10/25/2022]
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