1
|
Abbott-Smith S, Dougall N, Ring N. Suicide prevention: Introducing the Lothian Safekeeping Plan © for parents as a clinical innovation for use alongside safety plans for children and young people. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2024; 37:e12455. [PMID: 38368534 DOI: 10.1111/jcap.12455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/19/2024]
Abstract
TOPIC Internationally, preventing suicide in children and young people is a priority and there are a range of preventative approaches available for health professionals to use, including brief interventions. Safety planning is one such brief intervention. Safety plans have long been recommended for use with young people who are suicidal but, these were initially developed for adults. A recent scoping review revealed safety plans need to be tailored to children and young people. This review also identified an important practice gap, that parents also require plans supporting them to keep their child safe. PURPOSE This paper highlights how a Scottish clinical child and adolescent mental health setting in the UK's National Health Service developed and implemented evidence-based safety plans for suicidality-the Lothian Safety Plan for young people and the Lothian Safekeeping Plan for parents. This paper outlines both plans and gives recommendations for their use by healthcare professionals. The parental Lothian Safekeeping Plan is discussed in more depth as this is a novel intervention. CONCLUSION The Lothian Safekeeping Plan is a clinically led evidence-based practice innovation. It is a specific suicide prevention plan for use by parents as an additional, complementary, and enhanced resource to the Lothian Safety Plan for young people. It is recommended that healthcare professionals also use a parental safety plan when supporting young people presenting with suicidal crisis. Further research is needed to evaluate the impact of these plans.
Collapse
Affiliation(s)
- Susan Abbott-Smith
- Child and Adolescent Mental Health Services, NHS Lothian Royal Hospital for Children and Young People, Edinburgh, UK
| | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Nicola Ring
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| |
Collapse
|
2
|
Choi NG, Marti CN, Choi BY. Firearm use risk factors and access restriction among suicide decedents age 75 and older who disclosed their suicidal intent. Front Public Health 2023; 11:1255519. [PMID: 38026395 PMCID: PMC10654963 DOI: 10.3389/fpubh.2023.1255519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background and aims A majority of older adult suicide decedents used firearms. In this study, we focused on suicide decedents age 75+ who disclosed their suicidal intent within a month of their injury/death to examine demographic and clinical characteristics associated with firearm use and firearm access restriction attempts by their family members. Methods The 2017-2019 U.S. National Violent Death Reporting System provided data (N = 1,734 suicidal intent disclosers; 1,476 males and 258 females; 21.4% of decedents age 75+). Generalized linear model (GLM) for a Poisson distribution with a log link was used to examine firearm use risk factors. Firearm access restriction attempts by decedents' family members were examined based on coroner/medical examiner and law enforcement (CME/LE) reports. Results Nearly three quarters of disclosers disclosed their intent to family members, and 82.9% of males and 27.5% of females used firearms. GLM results showed males, non-Hispanic white people, and residents in the South and West regions had higher likelihood of firearm use. CME/LE reports of 140 out of 1,294 firearm decedents included narratives related to firearm restriction attempts or lack thereof. Firearm access restrictions were not attempted in 65 cases because family members did not take suicidal intent disclosure seriously or because decedents promised no self-harm. Partial or complete removal of firearms in 75 cases were not effective as decedents had hidden a firearm or purchased a new one. Others used different lethal methods. Implications The findings indicate a need for: (a) training family members of older adults who are at risk of suicide in effective means safety/access restriction and strategies to prevent means substitution; (b) more comprehensive legislative reforms reducing access to firearms by those at risk of suicide; and (c) more comfort and palliative care and counseling for psychosocial risk factors.
Collapse
Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, United States
| | - C. Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, United States
| | - Bryan Y. Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DE, United States
| |
Collapse
|
3
|
Abstract
Suicide rates continue to rise, and clinicians and mental health staff play a critical role in keeping suicidal clients safe. Safety planning, including means safety, may help to decrease suicide risk. Unfortunately, availability and evaluation of safety planning training for these providers are scarce. The goal of the present study was to evaluate a safety planning training, LINC to LIFE Safety Planning (L2L SP). L2L SP is a 150-minute, face-to-face training program that teaches providers to engage clients in collaborative safety planning and means safety efforts, facilitate diverse client coping strategies, problem-solve, and involve close others, among other skills. These objectives are achieved through interactive content delivery, role-play, and corrective feedback. L2L SP was administered to 95 participants. Key determinants of behavioral change (e.g., knowledge, attitudes, perceived behavioral control [PBC]) were measured at pre, post, and six-month follow-up. Additionally, participants' behaviors and emotions in working with suicidal clients were measured at pretest and six-month follow-up. Paired sample t-tests, repeated measures MANOVA, and univariate ANOVAs with post-hoc testing using Bonferroni correction were conducted. Results supported significant improvements in knowledge, PBC, and intentions at post-test, and attitudes, PBC, and effective emotional responses at follow-up. Exploratory analyses suggested significant improvements in behaviors among clinicians and mental health staff who saw clients reporting suicidal ideation. The present study provides promising results regarding brief safety planning training. Declines in knowledge and PBC following the training highlight the potential need for booster sessions or more intensive initial training in these areas.HighlightsThe present study evaluated a comprehensive, interactive safety planning training.Knowledge, PBC, and intentions were significantly improved at post-test.Attitudes, PBC, and emotions were significantly improved at follow-up.
Collapse
|
4
|
Massey AE, Borghesani P, Stuber J, Ratzliff A, Rivara FP, Rowhani-Rahbar A. Lethal Means Assessment in Psychiatric Emergency Services: Frequency and Characteristics of Assessment. Arch Suicide Res 2022; 26:112-126. [PMID: 32585123 DOI: 10.1080/13811118.2020.1783411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Lethal means safety is an effective suicide prevention strategy with demonstrated results at the population level, yet individual-level uptake is less well understood. METHODS Using automated data extraction methods, we conducted an investigation of electronic health records from psychiatric emergency service (PES) patients from January 1, 2012 to December 31, 2017 at a busy urban medical center in the Pacific Northwest. At each PES mental health evaluation, every patient received a Suicide Risk Assessment during which providers used an electronic template with standardized fields to record lethal means access and other suicide risk factors. RESULTS We assessed 32,658 records belonging to 15,652 patients. Among all visits, 69.9% (n = 22,824) had some documentation of lethal means assessment. However, 54.1% (n = 17,674) of all visits lacked some or all potential documentation detail. Additionally, among 59.6% of visits in which a patient had documented access to lethal means, the specific means available were not indicated. Across the twenty risk and demographic factors we assessed, the prevalence of documentation did not vary by any given risk factor and only varied minimally by age and race. For example, when comparing visits which indicated family history of suicide to those which indicated no family history of suicide, the prevalence ratio was 0.99 (95% CI: 0.95, 1.03). CONCLUSION Despite the high-risk patient population, mental health focus of the facility, and the presence of a standardized tool, lethal means documentation was suboptimal. In alignment with recent recommendations, our findings indicate that additional focus on implementation is needed to improve documentation of lethal means assessment.HighlightsFifteen times larger than prior comparable studiesFindings demonstrate persistent under-documentation patterns in new setting and regionStandardized methods likely needed to improve documentation detail and frequency.
Collapse
|
5
|
Joiner TE, Jeon ME, Lieberman A, Janakiraman R, Duffy ME, Gai AR, Dougherty SP. On prediction, refutation, and explanatory reach: A consideration of the Interpersonal Theory of Suicidal Behavior. Prev Med 2021; 152:106453. [PMID: 34538380 DOI: 10.1016/j.ypmed.2021.106453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/04/2021] [Accepted: 02/06/2021] [Indexed: 10/20/2022]
Abstract
Theory proposition, empirical evaluation, and resulting support or refutation are core pieces of the scientific process. These steps of theory-testing, however, can be complicated by relative rigidity and dogmatism, in combination with the logistical challenges inherent in conducting comprehensive, real-world tests of theories explicating complex scientific phenomena, especially rare ones. It may be argued that suicide is one such phenomenon, and one for which the field of psychology has struggled to develop satisfactory understanding. One leading theory of suicide, the Interpersonal Theory of Suicide, has garnered attention and, to a considerable degree, has weathered substantial scrutiny. Still, it is arguable that the theory has yet to be tested in full-that is, in accordance with all propositions originally put forth. In this effort, we sought to evaluate the current state of knowledge regarding the Interpersonal Theory of Suicide, as well as to suggest potential directions via which future work may proceed. We draw from the fields of philosophy, psychology, physics, and engineering in the hopes of engendering curiosity and critical thought about the assumptions researchers (ourselves included) bring to their work. We direct particular attention to the role of refutation in theory-testing; the supposed dichotomy of explanatory vs. algorithmic approaches; and the categorization of research programs as progressive vs. degenerative. In doing so, we hope not only to promote these ideas in the study of suicidal behavior but also to empiricists of all creeds and foci. We also include implications for suicide prevention efforts.
Collapse
Affiliation(s)
- Thomas E Joiner
- Department of Psychology, Florida State University, United States of America.
| | - Min Eun Jeon
- Department of Psychology, Florida State University, United States of America
| | - Amy Lieberman
- Department of Psychology, Florida State University, United States of America
| | - Roshni Janakiraman
- Department of Psychology, Florida State University, United States of America
| | - Mary E Duffy
- Department of Psychology, Florida State University, United States of America
| | - Anna R Gai
- Department of Psychology, Florida State University, United States of America
| | - Sean P Dougherty
- Department of Psychology, Florida State University, United States of America
| |
Collapse
|
6
|
Hoyt T, Holliday R, Simonetti JA, Monteith LL. Firearm Lethal Means Safety with Military Personnel and Veterans: Overcoming Barriers using a Collaborative Approach. ACTA ACUST UNITED AC 2021; 52:387-395. [PMID: 34421193 DOI: 10.1037/pro0000372] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Suicides by firearm have increased over the past decade among United States service members and veterans. As firearm access is a suicide risk factor, firearm-related lethal means safety is critical to suicide prevention. However, identity, occupational, and cultural barriers may deter efforts to promote lethal means safety with service members and veterans. The current manuscript describes a collaborative framework to guide mental health providers' in conducting firearm-related lethal means safety with service members and veterans, including within the context of Safety Planning. In approaching firearm lethal means safety conversations with patients, clinicians must work to overcome their own reticence, address patient concerns directly, and remain culturally sensitive to the values of the military and veteran communities. This approach is illustrated using case vignettes that encompass addressing firearm-related lethal means safety with service members and veterans.
Collapse
Affiliation(s)
- Tim Hoyt
- Psychological Health Center of Excellence, Defense Health Agency
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention.,Department of Psychiatry, University of Colorado Anschutz Medical Campus
| | - Joseph A Simonetti
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention.,Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration.,Hospital Medicine Group, Rocky Mountain Regional VA Medical Center
| | - Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention.,Department of Psychiatry, University of Colorado Anschutz Medical Campus
| |
Collapse
|
7
|
Wilks CR, Chu C, Sim D, Lovell J, Gutierrez P, Joiner T, Kessler RC, Nock MK. User Engagement and Usability of Suicide Prevention Apps: Systematic Search in App Stores and Content Analysis. JMIR Form Res 2021; 5:e27018. [PMID: 34259163 PMCID: PMC8319780 DOI: 10.2196/27018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/15/2021] [Accepted: 04/29/2021] [Indexed: 01/27/2023] Open
Abstract
Background People with suicidal thoughts are more inclined to seek technology-delivered interventions than in-person forms of treatment, making mobile apps for suicide prevention an ideal platform for treatment delivery. This review examines apps designed for suicide prevention, with a specific focus on user engagement. Objective This study aims to update the literature and broadly evaluate the landscape of mobile health apps for suicide prevention; examine apps with key features and primary approaches to suicide prevention; and systematically evaluate the engagement, functionality, aesthetics, and information of the apps. Methods All apps related to suicidal thoughts and behaviors were identified in the Google Play and iOS app stores and were systematically reviewed for their content and quality. The mobile app rating scale (MARS) was used to evaluate app usability and engagement. Results Of the 66 apps identified, 42 (64%) were specifically designed for people with suicidal ideation, and 59 (89%) had at least one best practice feature for suicide risk reduction. The mean overall MARS score of all apps was 3.5 (range 2.1-4.5), with 83% (55/66) of apps having a minimum acceptability score of 3. The total MARS score was not associated with the user app rating (r=−0.001; P=.99) or the number of features (r=0.24; P=.09). Conclusions This study identified many usable and engaging apps in app stores designed for suicide prevention. However, there are only limited apps for clinicians. Thus, mobile apps for suicide prevention should be carefully developed and clinically evaluated.
Collapse
Affiliation(s)
- Chelsey R Wilks
- Department of Psychological Sciences, University of Missouri-St. Louis, St Louis, MO, United States
| | - Carol Chu
- Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
| | - DongGun Sim
- School of Theology, Boston University, Boston, MA, United States
| | - Josh Lovell
- Department of Psychology, Hofstra University, Hempstead, NY, United States
| | - Peter Gutierrez
- Rocky Mountain Regional VA Medical Center, Denver, CO, United States.,University of Colorado Anschutz Medical Campus, Denver, CO, United States
| | - Thomas Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, United States
| |
Collapse
|
8
|
Brown LA, Boudreaux ED, Arias SA, Miller IW, May AM, Camargo CA, Bryan CJ, Armey MF. C-SSRS performance in emergency department patients at high risk for suicide. Suicide Life Threat Behav 2020; 50:1097-1104. [PMID: 32706437 PMCID: PMC7746629 DOI: 10.1111/sltb.12657] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 11/12/2019] [Accepted: 11/24/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the psychometric and predictive performance of the Columbia-Suicide Severity Rating Scale (C-SSRS) in emergency department (ED) patients with suicidal ideation or attempts (SI/SA). METHODS Participants (n = 1,376, mean age 36.8, 55% female, 76.8% white) completed the C-SSRS during the ED visit and were followed for one year. Reliability analyses, exploratory structural equation modeling, and prediction of future SA were explored. RESULTS Reliability of the Suicidal Ideation subscale was adequate, but was poor for the Intensity of Ideation and Suicidal Behavior subscales. Three empirically derived factors characterized the C-SSRS. Only Factor 1 (Suicidal Ideation and Attempts) was a reliable predictor of subsequent SA, though odds ratios were small (ORs: 1.09-1.10, CI95% : 1.04, 1.15). The original C-SSRS Suicidal Ideation and Suicidal Behavior subscales and the C-SSRS ED screen predicted subsequent SA, again with small odds ratios (ORs: 1.07-1.19, CI95% : 1.01, 1.29). In participants without a SA history, no C-SSRS subscale predicted subsequent SA. History of any SA (OR: 1.98, CI95% : 1.43, 2.75) was the strongest predictor of subsequent SA. CONCLUSIONS The psychometric evidence for the C-SSRS was mixed. History of a prior SA, as measured by the C-SSRS, provided the most parsimonious and powerful assessment for predicting future SA.
Collapse
Affiliation(s)
- Lily A. Brown
- Department of Psychosocial Research, Butler Hospital and Warren Alpert Medical School of Brown University
| | - Edwin D. Boudreaux
- Department of Emergency Medicine, University of Massachusetts Medical School
| | - Sarah A. Arias
- Department of Psychosocial Research, Butler Hospital and Warren Alpert Medical School of Brown University
| | - Ivan W. Miller
- Department of Psychosocial Research, Butler Hospital and Warren Alpert Medical School of Brown University
| | - Alexis M. May
- Department of Psychosocial Research, Butler Hospital and Warren Alpert Medical School of Brown University
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School
| | | | - Michael F. Armey
- Department of Psychosocial Research, Butler Hospital and Warren Alpert Medical School of Brown University
| |
Collapse
|
9
|
Blosnich JR, Clark KA, Mays VM, Cochran SD. Sexual and Gender Minority Status and Firearms in the Household: Findings From the 2017 Behavioral Risk Factor Surveillance System Surveys, California and Texas. Public Health Rep 2020; 135:778-784. [PMID: 33026962 DOI: 10.1177/0033354920954789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Although lesbian, gay, bisexual, and transgender (LGBT) people have a higher prevalence of reporting a lifetime suicide attempt than non-LGBT people, suicide prevention research on access to lethal means (eg, firearms) among LGBT people is limited. Our study examined (1) the presence of firearms in the home and (2) among respondents with firearms in the home, the storage of firearms as stored unloaded, stored as loaded and locked, or stored as loaded and unlocked. METHODS We used data from the 2017 Behavioral Risk Factor Surveillance System surveys from California and Texas (N = 11 694), which were the only states to include items about both sexual orientation and gender identity and the status of firearms in the home. We used logistic regression analysis to assess the association of sexual orientation and gender identity with having firearms in the home while accounting for sociodemographic characteristics and survey state. All analyses were weighted to account for the complex sampling design. RESULTS Approximately 4.2% of the sample identified as lesbian, gay, and bisexual (LGB). About 18.2% of LGB people reported firearms in the home compared with 29.9% of their heterosexual peers. After adjusting for sex, age, race/ethnicity, educational attainment, and military veteran status, LGB respondents had significantly lower odds of reporting firearms in the home than their heterosexual peers (adjusted odds ratio = 0.47; 95% CI, 0.27-0.84). Among respondents with firearms in the home, firearm storage did not differ by sexual orientation. CONCLUSIONS Further research is needed to examine whether lower odds of firearms in the home are protective against suicide deaths among LGB populations.
Collapse
Affiliation(s)
- John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA.,98139 Center for Health Equity Research & Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Kirsty A Clark
- 8783 Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Vickie M Mays
- Department of Psychology, University of California, Los Angeles, CA, USA.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA.,Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, University of California, Los Angeles, CA, USA
| | - Susan D Cochran
- 8783 Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA.,Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, University of California, Los Angeles, CA, USA.,Department of Statistics, University of California, Los Angeles, CA, USA
| |
Collapse
|
10
|
|
11
|
DeCou CR, Huppert T, Kume K, Veras P, Comtois KA, Rea T. Prehospital Patient Care Protocols for Suicidality in Washington State. PREHOSP EMERG CARE 2020; 25:432-437. [PMID: 32420776 DOI: 10.1080/10903127.2020.1771489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with suicidal thoughts and behavior represent a growing proportion of patients who present for Emergency Department care. Many of these patients arrive via ambulance. Several brief suicide- or self-harm-specific interventions have been developed for implementation in the Emergency Department setting. However, there is a dearth of training resources, patient care guidelines, and policy guidance to assist prehospital care providers in the treatment of EMS patients who are suicidal. We evaluated prehospital patient care protocols in Washington State to assess for the presence-absence of any suicide and/or self-harm specific protocols, as well as the inclusion of procedures above and beyond conventional approaches to scene safety and transport to the Emergency Department. METHODS Prehospital patient care protocols were obtained for all counties in Washington State. Researchers rated protocols across seven domains, including the mention of any suicide- or self-harm-specific procedures. RESULTS Approximately one-third of counties had any suicide- or self-harm-specific content in prehospital patient care protocols. There was no association between county-level rurality-urbanicity and the presence-absence of suicide- or self-harm-specific care. CONCLUSION These findings demonstrated that little guidance exists for EMS providers in Washington State with regard to the screening or treatment of suicidal patients, above and beyond scene safety and transportation to hospital-based care. Development of guidelines for prehospital suicide care, as well as enhanced screening, assessment, and collaboration with on-call crisis resources has the potential to expand the scope of prehospital treatment for suicidal patients, and reduce burdens on patients, EMS providers, and Emergency Departments.
Collapse
|
12
|
Adhia A, DeCou CR, Huppert T, Ayyagari R. Murder-Suicides Perpetrated by Adolescents: Findings from the National Violent Death Reporting System. Suicide Life Threat Behav 2020; 50:534-544. [PMID: 31773800 PMCID: PMC7148167 DOI: 10.1111/sltb.12607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 09/23/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Murder-suicide is a rare and especially tragic form of violence. Nascent literature has characterized murder-suicide perpetrated by adults, but no study has focused on adolescents who perpetrated murder-suicide. METHOD This study evaluated all cases of murder-suicide perpetrated by persons under age 21 who were included in the National Violent Death Reporting System, and categorized each incident using Joiner's perversion of virtue framework of murder-suicide. RESULTS Forty-seven incidents of murder-suicide perpetrated by adolescents were identified, representing 56 victims. Most cases did not have sufficient information to be categorized within a particular perversion of virtue. Among the 20 cases who did have sufficient detail to be categorized, incidents were identified as perversions of self-control (n = 11), justice (n = 8), and mercy (n = 1). Most perpetrators were male, and the majority of victims were female. Additional victim, perpetrator, and incident characteristics are described. CONCLUSIONS Our findings extend previous work by employing a coding system based on a theoretically derived framework for categorizing "genuine" murder-suicide and related behavior among adolescents. This study also characterized the nature of this complex and tragic sequence of behavior among adolescents, who are at elevated risk of suicide, and who may benefit from prevention efforts that effectively address means safety, suicidality, and intimate partner violence.
Collapse
Affiliation(s)
- Avanti Adhia
- Department of Pediatrics Harborview Injury Prevention and Research Center University of Washington School of Medicine Seattle WA USA
| | - Christopher R. DeCou
- Department of Psychiatry and Behavioral Sciences Harborview Injury Prevention and Research Center University of Washington School of Medicine Seattle WA USA
| | - Tierney Huppert
- Department of Psychiatry and Behavioral Sciences Harborview Injury Prevention and Research Center University of Washington School of Medicine Seattle WA USA
| | - Rajiv Ayyagari
- Department of Public Health Johns Hopkins University Baltimore MD USA
| |
Collapse
|
13
|
Brief measures of physical and psychological distance to suicide methods as correlates and predictors of suicide risk: A multi-study prospective investigation. Behav Res Ther 2019; 120:103330. [DOI: 10.1016/j.brat.2018.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/13/2018] [Accepted: 11/05/2018] [Indexed: 12/16/2022]
|
14
|
Anestis MD, Houtsma C. What I have is what I am: Differences in demographics, suicidal thoughts and behaviors, and firearm behavior and beliefs between firearm owners who do and do not primarily identify as firearm owners. J Psychiatr Res 2019; 116:157-165. [PMID: 31247359 DOI: 10.1016/j.jpsychires.2019.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/27/2019] [Accepted: 06/18/2019] [Indexed: 01/21/2023]
Abstract
Non-legislative forms of means safety (i.e., safe firearm storage practices) have been promoted as a way to reduce elevated suicide risk found among firearm owners. However, evidence suggests that some firearm owners are less willing than others to engage in these practices. The current study aimed to understand factors that differentiate firearm owners' beliefs and behaviors that are relevant to suicide risk by examining differences between individuals for whom firearm ownership represents a central aspect of identity (i.e., primary firearm owners) versus firearm owners who primarily identify with some other demographic or occupational characteristic. Results of main analyses revealed that primary firearm owners were more likely to be male, were less likely to have experienced suicidal ideation, were less likely to store their firearms safely across a number of storage methods, and were less open to means safety across all storage methods. These findings highlight demographically which firearm owners may be more likely to view firearm ownership as central to their identity and also suggest that this identification may be associated with beliefs and behaviors that increase suicide risk. Future firearm suicide prevention efforts should focus on culturally competent discussions and messaging to find common ground with firearm owners and to increase the salience of suicide among firearm owners.
Collapse
|
15
|
Bulger EM, Kuhls DA, Campbell BT, Bonne S, Cunningham RM, Betz M, Dicker R, Ranney ML, Barsotti C, Hargarten S, Sakran JV, Rivara FP, James T, Lamis D, Timmerman G, Rogers SO, Choucair B, Stewart RM. Proceedings from the Medical Summit on Firearm Injury Prevention: A Public Health Approach to Reduce Death and Disability in the US. J Am Coll Surg 2019; 229:415-430.e12. [PMID: 31108194 DOI: 10.1016/j.jamcollsurg.2019.05.018] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Eileen M Bulger
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Washington, Seattle, WA.
| | - Deborah A Kuhls
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Nevada, Las Vegas, NV
| | - Brendan T Campbell
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Connecticut, Hartford, CT
| | - Stephanie Bonne
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | | | - Marian Betz
- Department of Emergency Medicine, University of Colorado, Denver, CO
| | - Rochelle Dicker
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of California-Los Angeles, Los Angeles, CA
| | - Megan L Ranney
- Department of Emergency Medicine, Brown University, Alpert Medical School, Providence, RI
| | - Chris Barsotti
- Department of Emergency Medicine, Berkshire Medical Center, Pittsfield, MA
| | - Stephen Hargarten
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Joseph V Sakran
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, Johns Hopkins University, Baltimore, MD
| | | | - Thea James
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA
| | - Dorian Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Gary Timmerman
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of South Dakota Sanford School of Medicine, Sioux Falls, SD
| | - Selwyn O Rogers
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Chicago, Chicago, IL
| | | | - Ronald M Stewart
- American College of Surgeons Committee on Trauma, Chicago, IL; Department of Surgery, University of Texas San Antonio, San Antonio, TX
| |
Collapse
|
16
|
|
17
|
Anestis MD, Houtsma C, Daruwala SE, Butterworth SE. Firearm legislation and statewide suicide rates: The moderating role of household firearm ownership levels. BEHAVIORAL SCIENCES & THE LAW 2019; 37:270-280. [PMID: 31087580 DOI: 10.1002/bsl.2408] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/13/2019] [Accepted: 03/25/2019] [Indexed: 06/09/2023]
Abstract
Firearm legislation is associated with statewide suicide rates; however, prior research has often relied upon older data and categorical legislative grades while also failing to consider the nuanced role of firearm ownership. Therefore, the robust literature base on legislation and suicide has not directly examined regarding the extent to which the value of legislation hinges upon the rate of firearm ownership in a given state. The current study examined 2015 US statewide firearm legislation strength scores from Giffords Law Center to Prevent Gun Violence and 2016 statewide suicide rates from the Centers for Disease Control and Prevention. Firearm legislation strength was inversely associated with statewide overall and firearm suicide rates, but not with non-firearm suicide rates. Firearm ownership rates moderated the association between firearm legislation strength and statewide overall suicide rates. Specifically, firearm legislation strength was inversely associated with statewide overall suicide rates at mean and high levels of firearm ownership. Findings support the potential utility of firearm legislation as part of a national effort to decrease US suicide deaths, particularly in areas with higher firearm ownership rates.
Collapse
Affiliation(s)
- Michael D Anestis
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Claire Houtsma
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Samantha E Daruwala
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Sarah E Butterworth
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| |
Collapse
|
18
|
Bush A, Qeadan F. Social Support and Its Effects on Attempted Suicide Among American Indian/Alaska Native Youth in New Mexico. Arch Suicide Res 2019; 24:337-359. [PMID: 30734650 DOI: 10.1080/13811118.2019.1577779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Abstract
Objective:How social support (SS) affects the odds of suicide attempt among American Indian/Alaska Native (AI/AN) youth in New Mexico and is modified by school location and metropolitan status.Methods:Multiple logistic regression for complex design was used to produce the adjusted odds of suicide attempt by SS using the New Mexico Youth Risk and Resiliency Survey (NM-YRRS) for 2011 (n = 2,730), 2013 (n = 3,171), and 2015 (n = 2,604) while adjusting for age, grade, gender, and maternal education level. Primary outcome: [Formula: see text]one self-reported suicide attempt in the past 12 months. Primary exposure: social support, categorized as low, moderate, and high support. Additional analysis on the 2015 NM-YRRS to understand how SS and the odds of suicide attempt were modified by (a) school location and (b) metropolitan status while adjusting for age, grade, gender, maternal education level, urbanicity, reservation status, unstable housing, forced sexual intercourse, and teen dating violence (n = 1,373).Results:The adjusted odds of suicide attempt among AI/AN students with low support compared to those with high support has declined from 2011 to 2015 (AOR= 5.5, 95% CI 3.3-9.6, in 2011; AOR= 2.2, 95% CI 1.3-3.7, in 2015). Low SS is a significant risk factor for rural/on reservation students. In contrast, low SS was not a risk factor for AI/AN students who attended schools in urban counties.Conclusion:Results address a gap in current research regarding differences in urban/rural AI/AN youth. In addition to SS, this study indicates there are unknown risk factors that drive suicide attempt for AI/AN youth in off reservation/urban schools.
Collapse
|
19
|
Master Clinician Review: Saving Holden Caulfield: Suicide Prevention in Children and Adolescents. J Am Acad Child Adolesc Psychiatry 2019; 58:25-35. [PMID: 30577936 DOI: 10.1016/j.jaac.2018.05.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/16/2018] [Accepted: 06/21/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The rate of adolescent suicide and suicidal behavior has risen dramatically in the past decade. The title of this article comes from the classic coming-of-age novel by J.D. Salinger, The Catcher in the Rye. Its protagonist, Holden Caulfield, is a precocious adolescent who, in the face of his inability to cope with his own self-destructives urges, imagines himself saving "little kids playing some game in this big field of rye." He is standing on the edge of a cliff trying to catch "thousands of little kids" before they fall to their demise. This vignette from The Catcher in the Rye provides a useful metaphor for the relationship between mental health professionals and youth at risk for suicide, and suggests more efficient and effective alternative interventions to prevent youth suicide compared to standing by a cliff. METHOD These four alternative approaches are described, namely: (1) leading youth away from the cliff (ie, prevention); (2) going to where youth are (ie, improving access to care); (3) working with others to change the rules in the field (ie, changing the way care is delivered); and (4) putting a fence around the cliff (ie, restriction of access to lethal agents). The evidence to support the utility and cost-effectiveness of each of these approaches is reviewed. CONCLUSION There are extant, empirically supported, cost-effective approaches to the prevention and management of adolescent suicidal behavior that, if implemented widely, are likely to significantly reverse the decade-long rise in adolescent suicide.
Collapse
|
20
|
Van Orden K, Deming C. Late-life suicide prevention strategies: current status and future directions. Curr Opin Psychol 2018; 22:79-83. [PMID: 28938218 PMCID: PMC5843499 DOI: 10.1016/j.copsyc.2017.08.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 08/24/2017] [Accepted: 08/29/2017] [Indexed: 12/16/2022]
Abstract
Late life suicide prevention differs from suicide prevention for other age groups: first, the number of older adults worldwide is on the rise; second, late-life suicide receives much less attention in all societal spheres, from the media, to federal funding agencies, to healthcare initiatives. Recent findings indicate an association between internalized ageist stereotypes and reduced will to live. Recent research also addresses the role of cognitive control as a contributor to risk and as an intervention target (e.g., through psychotherapies such as problem solving therapy) as well as firearm safety as a promising, though a politicized and challenging strategy to implement. Another strategy that may prove feasible is an approach on upstream prevention strategies in healthcare. One strategy we believe holds great promise is the promotion of high quality geriatric medicine. Geriatricians are trained to work with patients to prioritize the promotion of physical and cognitive functioning (rather than solely absence of disease) and to focus on well-being as a goal. Thus, geriatricians routinely target numerous late-life suicide risk factors-physical illness, functioning, pain, and (dis)satisfaction with life. However, efficacious strategies will not prevent suicide deaths if they are not implemented-addressing ageism as a universal prevention strategy is essential.
Collapse
Affiliation(s)
- Kim Van Orden
- University of Rochester School of Medicine and Dentistry, USA.
| | | |
Collapse
|
21
|
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
|
22
|
Ho CSH, Ong YL, Tan GHJ, Yeo SN, Ho RCM. Profile differences between overdose and non-overdose suicide attempts in a multi-ethnic Asian society. BMC Psychiatry 2016; 16:379. [PMID: 27821108 PMCID: PMC5100276 DOI: 10.1186/s12888-016-1105-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 11/01/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study explores differences in characteristics of overdose (OD) and non-overdose (NOD) suicide attempts in Singapore. METHODS Four hundred eighty-five medical records of people who attempted suicide were extracted from a local general hospital patient database and classified into OD and NOD groups. Differences in socio-demographic factors, suicide characteristics and hospital admission types between both groups were examined. RESULTS Indians were more likely than the Chinese and Malays to employ OD method in their attempts. More suicide attempts in the OD group than NOD group were self-reported. The most likely place for suicide attempts for both groups was at home, though more NOD suicide attempts were in public areas as compared to the OD group. Analgesics were the most used substance in the OD group. Those who attempted suicide using OD had a higher number of psychiatric ward admissions than the NOD group. Risk and protective factors varied between both groups. CONCLUSION Differences in socio-demographics, suicide characteristics and admission characteristics between OD and NOD groups were observed. Recommendations for suicide prevention in the community are discussed. Further studies on the mediators and moderators of these trends and characteristics of suicide attempts are necessary to ensure maximal efficacy of prevention and management.
Collapse
Affiliation(s)
- Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Lower Kent Ridge Road, Singapore, 119 228, Singapore.
| | - Y L Ong
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Lower Kent Ridge Road, Singapore, 119 228, Singapore
| | - Gabriel H J Tan
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Lower Kent Ridge Road, Singapore, 119 228, Singapore
| | - S N Yeo
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Lower Kent Ridge Road, Singapore, 119 228, Singapore
| |
Collapse
|