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Melzer L, Forkmann T, Teismann T. Suicide Crisis Syndrome: A systematic review. Suicide Life Threat Behav 2024; 54:556-574. [PMID: 38411273 DOI: 10.1111/sltb.13065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 01/15/2024] [Accepted: 02/07/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND The objective of this systematic review is to describe the scientific evidence for the Suicide Crisis Syndrome (SCS), a presuicidal cognitive and affective state consisting of five symptomatic dimensions: entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal. The aim of this article is to summarize the emerging literature on the SCS and to assess the extent to which a uniform syndrome can be assumed. METHODS A systematic literature search was conducted in three different databases (PubMed, PsycInfo, and Google Scholar) using the search terms "Suicide Crisis Inventory," "Suicide Crisis Syndrome," "Narrative Crisis Model of Suicide," and "Suicide Trigger State." RESULTS In total, 37 articles from 2010 to 2022 were identified by search criteria. Twenty-one articles published between 2017 and 2022 were included in the systematic review. All but three studies were conducted in the United States and examined clinical samples of adult high-risk psychiatric in- and outpatients. Sample sizes ranged from N = 170 to 4846. The findings confirm the unidimensional structure of the proposed disorder and support the predictive validity for short-term suicidal behavior above and beyond suicidal ideation. CONCLUSION Despite the promising predictive validity of the SCS, a precise prediction of future suicidal behavior remains difficult.
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Affiliation(s)
- Laura Melzer
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Thomas Forkmann
- Department of Clinical Psychology, University of Duisburg-Essen, Essen, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
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2
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Nemesure MD, Streltzov N, Schommer LM, Lekkas D, Jacobson NC, Bujarski KA. Predictive modeling of suicidal ideation in patients with epilepsy. Epilepsia 2022; 63:2269-2278. [PMID: 35689808 PMCID: PMC10129274 DOI: 10.1111/epi.17324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The prevalence of suicide in the United States has seen an increasing trend and is responsible for 1.6% of all mortality nationwide. Although suicide has the potential to broadly impact the entire population, it has a substantially increased prevalence in persons with epilepsy (PWE), despite many of these individuals consistently seeing a health care provider. The goal of this work is to predict the development of suicidal ideation (SI) in PWE using machine learning methodology such that providers can be better prepared to address suicidality at visits where it is likely to be prominent. METHODS The current study leverages data collected at an epilepsy clinic during patient visits to predict whether an individual will exhibit SI at their next visit. The data used for prediction consisted of patient responses to questions about the severity of their epilepsy, issues with memory/concentration, somatic problems, markers for mental health, and demographic information. A machine learning approach was then applied to predict whether an individual would display SI at their following visit using only data collected at the prior visit. RESULTS The modeling approach allowed for the successful prediction of an individual's passive and active SI severity at the following visit (r = .42, r = .39) as well as the presence of SI regardless of severity (area under the curve [AUC] = .82, AUC = .8). This shows that the model was successfully able to synthesize the unique combination of an individual's responses to important questions during a clinical visit and utilize that information to indicate whether that individual will exhibit SI at their next visit. SIGNIFICANCE The results of this modeling approach allow the health care team to be prepared, in advance of a clinical visit, for the potential reporting of SI. By allowing the necessary support to be prepared ahead of time, it can be better integrated at the point of care, where patients are most likely to follow up on potential referrals or treatment.
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Affiliation(s)
- Matthew D Nemesure
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA.,Quantitative Biomedical Sciences Program, Dartmouth College, Lebanon, New Hampshire, USA
| | - Nicholas Streltzov
- Dartmouth-Hitchcock Medical Center Epilepsy Clinic, Lebanon, New Hampshire, USA
| | - Lindsay M Schommer
- Dartmouth-Hitchcock Medical Center Epilepsy Clinic, Lebanon, New Hampshire, USA
| | - Damien Lekkas
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA.,Quantitative Biomedical Sciences Program, Dartmouth College, Lebanon, New Hampshire, USA
| | - Nicholas C Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA.,Quantitative Biomedical Sciences Program, Dartmouth College, Lebanon, New Hampshire, USA.,Department of Biomedical Data Science, Geisel School of Medicine, Lebanon, New Hampshire, USA
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3
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Phalen P, Grossmann J, Bruder T, Jeong JY, Calmes C, McGrath K, Malouf E, James A, Romero E, Bennett M. Description of a Dialectical Behavior Therapy program in a Veterans Affairs Health Care System. EVALUATION AND PROGRAM PLANNING 2022; 92:102098. [PMID: 35525095 DOI: 10.1016/j.evalprogplan.2022.102098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/30/2021] [Accepted: 04/17/2022] [Indexed: 06/14/2023]
Abstract
A comprehensive Dialectical Behavior Therapy (DBT) program was created within a VA Health Care System for patients with recent psychiatric hospitalization, suicidality and/or significant emotion dysregulation. The program was notable for being one of a relatively small number of comprehensive DBT programs in the VA system, and for including patients with psychosis and psychotic disorder, with a majority of patients (58%) having a documented history of psychosis or endorsing psychotic symptoms in assessments. We describe the process of creating this program at a VA medical center and present preliminary program evaluation data. All patients completed assessments of suicidality (C-SSRS), emotion dysregulation (DERS), skills use and dysfunctional coping (DBT-WCCL), borderline symptomatology (BSL-23), and depression (PHQ-9) at program entry and subsequently every 6-8 weeks through program completion. Suicide attempts and hospitalizations were also tracked. Twelve patients completed multiple (up to six) assessment timepoints, allowing for evaluation of change during treatment. Patients demonstrated improvements on most measures and no hospitalizations or suicide attempts during active treatment, and the subsample with psychosis showed average improvements on every outcome measure. Eleven of 12 patients completed a full six-month rotation.
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Affiliation(s)
- Peter Phalen
- VA Maryland Health Care System, United States; University of Maryland School of Medicine, United States.
| | | | | | - Jae Yeon Jeong
- VA Maryland Health Care System, United States; University of Maryland School of Medicine, United States
| | | | | | | | | | - Erin Romero
- VA Maryland Health Care System, United States; University of Maryland School of Medicine, United States
| | - Melanie Bennett
- VA Maryland Health Care System, United States; University of Maryland School of Medicine, United States
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4
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Kim EJ, Kim Y, Lee G, Choi JH, Yook V, Shin MH, Jeon HJ. Comparing warning signs of suicide between suicide decedents with depression and those non-diagnosed psychiatric disorders. Suicide Life Threat Behav 2022; 52:178-189. [PMID: 33638573 DOI: 10.1111/sltb.12739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/15/2020] [Accepted: 12/14/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Early recognition of a high-risk group impending suicide is important. We aimed to compare warning signs depending on the nature of the psychiatric disorder and whether it was a documented diagnosis. METHODS Data of suicide decedents were collected from police records from 2013 to 2017. We evaluate psychiatric symptoms and warning signs in three aspects (language, behavior, and affect) using the Korea-Psychological Autopsy Checklist for Police Records (K-PAC-PR). RESULTS A total of 13,265 suicide decedents were recruited for this study. Of them, 66.9% of females and 46.7% of males diagnosed psychiatric disorders, with depressive disorder being the most common one. Warning signs were observed in 93.0% of suicide decedents. They were observed more in those who were diagnosed with psychiatric disorders, especially in those with a depressive disorder. "Talking about dying or suicide" was the most common warning sign in all groups, and "apathetic behavior" was the most related warning sign for depressive disorder. Especially for "talking about dying or suicide," the proportion of observed "within a week" was high, making it valuable as a warning sign. CONCLUSION Warning signs were commonly found in suicide decedents regardless of gender. They were more common among the decedents diagnosed with psychiatric disorders, especially among those with a depressive disorder.
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Affiliation(s)
- Eun Ji Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Korea Psychological Autopsy Center (KPAC), Seoul, South Korea
| | - Yuwon Kim
- Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Gusang Lee
- Korea Psychological Autopsy Center (KPAC), Seoul, South Korea
| | - Jin Hwa Choi
- Korea Psychological Autopsy Center (KPAC), Seoul, South Korea
| | - Vidal Yook
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Korea Psychological Autopsy Center (KPAC), Seoul, South Korea
| | - Myung-Hee Shin
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Korea Psychological Autopsy Center (KPAC), Seoul, South Korea.,Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
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5
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Capron DW, Bauer BW, Bryan CJ. When people die by suicide: Introducing unacceptable loss thresholds as a potential missing link between suicide readiness states and actively suicidal clinical states. Suicide Life Threat Behav 2022; 52:280-288. [PMID: 34854497 DOI: 10.1111/sltb.12820] [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] [Received: 08/11/2020] [Revised: 08/27/2021] [Accepted: 09/13/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Contemporary models of suicide have largely overlooked why a person at high risk for suicide attempts suicide at a specific time. We propose the construct of unacceptable loss thresholds (i.e., a person's tolerance limit for a negative life event, which if violated results in an increase in suicide risk), which addresses many paradoxes in the literature related to suicide triggers. The aim of this paper is to provide preliminary proof of concept and to stimulate replication and further empirical study. METHODS We recruited an online community sample of individuals with a suicide attempt history (n = 144). These individuals answered questions about the time leading up to their most recent suicide attempt. RESULTS The majority (70.8% yes; 18.1% cannot remember; 11.1% no) reported creating a threshold of unacceptable loss, and that relatively small events were enough to trigger feelings that life was not worth living (63.9% yes; 30.6% maybe; 5.6% no). Further, the majority (57.6% yes; 21.5% yes, but only if asked; 20.8% - no) reported they would be willing to tell their therapist/doctor about their thresholds of unacceptable loss. CONCLUSION The construct of unacceptable loss deserves further empirical inquiry. Individuals contemplating suicide set them and if the loss occurs, it may trigger suicidal action in suicide ready individuals. Thresholds could provide risk assessment and safety planning data currently being overlooked.
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Affiliation(s)
- Daniel W Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Brian W Bauer
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Craig J Bryan
- Department of Psychiatry & Behavioral Health, The Ohio State University, Columbus, Ohio, USA
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6
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Heisel MJ, Flett GL. Screening for suicide risk among older adults: assessing preliminary psychometric properties of the Brief Geriatric Suicide Ideation Scale (BGSIS) and the GSIS-Screen. Aging Ment Health 2022; 26:392-406. [PMID: 33327729 DOI: 10.1080/13607863.2020.1857690] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To initially assess psychometric properties of two abbreviated versions of the Geriatric Suicide Ideation Scale (GSIS): a 10-item Brief Geriatric Suicide Ideation Scale (BGSIS), and a 5-item Geriatric Suicide Ideation Scale-Screen (GSIS-Screen). METHODS A series of psychometric analyses was conducted, assessing the internal consistency, test-retest reliability, construct and predictive validity of the abbreviated GSIS scales. This was done by selecting-out GSIS items from a combined dataset of studies on suicide ideation in older adults: 1) The GSIS scale development study (n = 107); 2) A clinical trial of Interpersonal Psychotherapy (IPT) modified for suicidal older adults(n = 25); 3) A longitudinal study of risk and resiliency to suicide ideation in community-residing older adults (n = 173). RESULTS Overall findings demonstrated strong internal consistency, test-retest reliability, concurrent and predictive validity for the BGSIS and GSIS-Screen with older adults across community, clinical, and residential settings. CONCLUSION Study findings support the use of the abbreviated GSIS scales when conducting research on suicide risk identification among older adults. Future research is recommended testing these scales prospectively in public health, residential, and clinical settings, in research and healthcare delivery contexts.
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Affiliation(s)
- Marnin J Heisel
- Departments of Psychiatry and of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Department of Psychiatry, Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, USA
| | - Gordon L Flett
- Department of Psychology, York University, Toronto, Ontario, Canada
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7
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Li XY, Tabarak S, Su XR, Qin Z, Chai Y, Zhang S, Wang KQ, Guan HY, Lu SL, Chen YN, Chen HM, Zhao L, Lu YX, Li SX, Zhang XY. Identifying clinical risk factors correlate with suicide attempts in patients with first episode major depressive disorder. J Affect Disord 2021; 295:264-270. [PMID: 34482058 DOI: 10.1016/j.jad.2021.08.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/07/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is the most common mental disorder associated with suicide attempts. When a patient first visits the clinic, clinicians are often expected to make concrete diagnose about acute suicidal risk. However, the timeliness of suicide attempts correlates with patients with MDD has not been tested. METHODS We divided 1718 first-episode and untreated MDD outpatients into those who did not have suicide attempts (non-attempts), recent suicide attempters (≤14 days before assessment) and long - dated suicide attempters (> 30 days before assessment). Positive Symptom Scale of Positive and Negative Syndrome Scale (PANSS), the 17-item Hamilton Depression Scale, 14 - item Hamilton Anxiety Scale, and clinical global impression of severity scale (CGI-S) was assessed. Body mass index, some glycolipid metabolism and thyroid hormone parameters were measured. A gradient-boosted decision trees statistical model was used to generate equally weighted classification for distinguishing recent and long - dated suicide attempters from non-attempts. RESULTS The classifier identified higher excitement, hostility, anxiety, depression symptoms and higher free thyroxine (FT4) as risk factors for recent suicide attempters with an estimated accuracy of 87% (sensitivity, 59.1%; specificity, 61.2 %). For long - dated suicide attempters' risk factors, single status, higher anxiety and hostility symptoms, higher LDLC and lower BMI, the estimated accuracy was 88% (sensitivity, 52.8%; specificity, 49.6%). CONCLUSIONS Risk factors for suicide attempt among patients with MDD can be identified by integrating demographic, clinical, and biological variables as early as possible during the first time see a doctor.
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Affiliation(s)
- Xiao-Yan Li
- Rong Jun Hospital, Baoding 071000, Hebei Province, China
| | - Serik Tabarak
- Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Beijing Key laboratory of Drug Dependence, National Institute on Drug Dependence, Peking University, Beijing, China
| | - Xiu-Ru Su
- Rong Jun Hospital, Baoding 071000, Hebei Province, China
| | - Zengchang Qin
- Intelligent Computing and Machine Learning Lab, School of Automation Science and Electrical Engineering, Beihang University, Beijing 100191, China
| | - Yuan Chai
- Intelligent Computing and Machine Learning Lab, School of Automation Science and Electrical Engineering, Beihang University, Beijing 100191, China
| | - Shunyu Zhang
- Intelligent Computing and Machine Learning Lab, School of Automation Science and Electrical Engineering, Beihang University, Beijing 100191, China
| | - Ke-Qiang Wang
- Rong Jun Hospital, Baoding 071000, Hebei Province, China
| | - Heng-Yong Guan
- Rong Jun Hospital, Baoding 071000, Hebei Province, China
| | - Shu-Lan Lu
- Rong Jun Hospital, Baoding 071000, Hebei Province, China
| | - Ying-Nan Chen
- Rong Jun Hospital, Baoding 071000, Hebei Province, China
| | - Hong-Mei Chen
- Rong Jun Hospital, Baoding 071000, Hebei Province, China
| | - Long Zhao
- Rong Jun Hospital, Baoding 071000, Hebei Province, China
| | - Yan-Xin Lu
- Rong Jun Hospital, Baoding 071000, Hebei Province, China
| | - Su-Xia Li
- Beijing Key laboratory of Drug Dependence, National Institute on Drug Dependence, Peking University, Beijing, China; Department of Pharmacology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China.
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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8
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A sex-stratified analysis of suicidal ideation correlates among deployed post-9/11 veterans: Results from the survey of experiences of returning veterans. J Affect Disord 2021; 294:824-830. [PMID: 34375209 DOI: 10.1016/j.jad.2021.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 06/18/2021] [Accepted: 07/11/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Suicide rates are higher among veterans than non-veterans; this difference is particularly salient for females. Knowledge is sparse regarding correlates of suicidal ideation (SI) among female veterans, particularly in non-VHA samples. As such, and given that SI confers a strong risk for subsequent suicidal behavior, this study aimed to: (1) compare prevalence of recent SI by sex; and (2) determine whether deployment stressors, mental health symptoms, and recent psychosocial stressors are associated with recent SI, by sex, among post-9/11 veterans. METHODS A sex-stratified analysis of cross-sectional data from 809 post-9/11, deployed veterans was conducted using the Survey of Experiences of Returning Veterans (SERV); statistical interactions between sex and correlates of interest were assessed. RESULTS Self-reported prevalence of recent SI did not differ by sex. A statistically significant interaction between sex and combat was observed; greater combat experience was associated with increased SI for females only. While significant interactions were not observed for other correlates, differences in significant predictors and predictor effect sizes were noted across sex-stratified models. Recent housing and financial concerns were only associated with increased SI prevalence among females, whereas concern about other recent stressful life events was associated with increased SI prevalence only among males. LIMITATIONS This is a cross-sectional analysis of a national survey with limited power to detect statistical sex interactions. CONCLUSIONS While correlates of SI are relatively consistent for males and females notable differences suggest that tailored assessment and intervention based on sex may hold merit in mitigating SI among post-9/11 era Veterans.
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9
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Decker SE, Ramsey CM, Ronzitti S, Kerns RD, Driscoll MA, Dziura J, Skanderson M, Bathulapalli H, Brandt CA, Haskell SG, Goulet JL. Military sexual trauma and suicidal ideation in VHA-care-seeking OEF/OIF/OND veterans without mental health diagnosis or treatment. Psychiatry Res 2021; 303:114089. [PMID: 34247061 DOI: 10.1016/j.psychres.2021.114089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 11/19/2022]
Abstract
Sexual trauma is a suicide risk factor. While military sexual trauma (MST) is frequently associated with suicidal ideation (SI) in women and men veterans who served in recent conflicts, less is known about MST's relationship to SI in veterans who have no documented mental health concerns. Of the 1.1 million post-9/11 veterans enrolled in the Veterans Healthcare Administration (VHA) we examined 41,658 (12.3% women, 87.7% men) without evidence of mental health diagnosis or treatment and who were screened for MST and SI using the standard VHA clinical reminders between 2008 and 2013. Relative risk estimates were generated using separate models for women and men. MST was reported by 27.9% of women and 2.9% of men; SI by 14.7% and 16.5%, respectively. The adjusted relative risk of MST on SI was 1.65 (95% CI 1.35, 2.00) in women, and 1.49 (95% CI 1.26, 1.75) in men. In this sample of veterans without evidence of mental health diagnosis or treatment, MST was associated with a high risk of SI in both genders. Positive MST screening should prompt SI screening and risk management if indicated, and further study of barriers to mental healthcare among MST survivors at risk for suicide is warranted.
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Affiliation(s)
- Suzanne E Decker
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States; Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States.
| | - Christine M Ramsey
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States; Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States
| | - Silvia Ronzitti
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States; Yale School of Medicine, New Haven, Connecticut, United States
| | - Robert D Kerns
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States; Department of Neurology, Yale School of Medicine, New Haven, Connecticut, United States; Department of Psychology, Yale University, New Haven, Connecticut, United States
| | - Mary A Driscoll
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States
| | - James Dziura
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States
| | - Melissa Skanderson
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States
| | - Harini Bathulapalli
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States
| | - Cynthia A Brandt
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States
| | - Sally G Haskell
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States
| | - Joseph L Goulet
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut, United States; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States
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Which PHQ-9 Items Can Effectively Screen for Suicide? Machine Learning Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073339. [PMID: 33804879 PMCID: PMC8036742 DOI: 10.3390/ijerph18073339] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 12/21/2022]
Abstract
(1) Background: The Patient Health Questionnaire-9 (PHQ-9) is a tool that screens patients for depression in primary care settings. In this study, we evaluated the efficacy of PHQ-9 in evaluating suicidal ideation (2) Methods: A total of 8760 completed questionnaires collected from college students were analyzed. The PHQ-9 was scored in combination with and evaluated against four categories (PHQ-2, PHQ-8, PHQ-9, and PHQ-10). Suicidal ideations were evaluated using the Mini-International Neuropsychiatric Interview suicidality module. Analyses used suicide ideation as the dependent variable, and machine learning (ML) algorithms, k-nearest neighbors, linear discriminant analysis (LDA), and random forest. (3) Results: Random forest application using the nine items of the PHQ-9 revealed an excellent area under the curve with a value of 0.841, with 94.3% accuracy. The positive and negative predictive values were 84.95% (95% CI = 76.03–91.52) and 95.54% (95% CI = 94.42–96.48), respectively. (4) Conclusion: This study confirmed that ML algorithms using PHQ-9 in the primary care field are reliably accurate in screening individuals with suicidal ideation.
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Ilgen MA, Stewart HJ, Lhermitte SL, Pfeiffer PN, Britton PC, Pope EB. Developing and testing Crisis Line Facilitation (CLF) to encourage help-seeking in adults receiving inpatient treatment for a suicidal crisis. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28. [PMID: 33679121 DOI: 10.1016/j.cbpra.2020.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Military Veterans are at overall greater risk of suicide than non-Veterans and have experienced increases in rates of suicide that are on par with or exceed those of the general population. The Department of Veterans Affairs has undertaken several initiatives to reduce suicide among Veterans, including the development and expansion of the Veterans Crisis Line (VCL). The VCL has the potential to reduce suicidal behaviors, but it is likely underutilized by high-risk Veterans. This paper describes the development of Crisis Line Facilitation (CLF) a brief intervention, designed to increase use of the VCL in this high-risk population. In a single session, CLF presents psychoeducational information about the VCL, discusses the participant's perceived barriers and facilitators to future use of the VCL, and culminates in the Veteran calling the VCL with the therapist to provide firsthand experiences that may counter negative impressions of the line. The intervention development process, intervention and control condition, and self-reported change indices are presented. Preliminary results (N = 301) suggest Veterans receiving CLF may experience a significant increase in comfort with, and confidence in, using the VCL during future crises compared to those in the control condition.
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Affiliation(s)
- Mark A Ilgen
- VA Center for Clinical Management Research (CCMR)
- Department of Psychiatry, University of Michigan
| | - Haylie J Stewart
- VA Center for Clinical Management Research (CCMR)
- Department of Psychiatry, University of Michigan
| | | | - Paul N Pfeiffer
- VA Center for Clinical Management Research (CCMR)
- Department of Psychiatry, University of Michigan
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12
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Belouali A, Gupta S, Sourirajan V, Yu J, Allen N, Alaoui A, Dutton MA, Reinhard MJ. Acoustic and language analysis of speech for suicidal ideation among US veterans. BioData Min 2021; 14:11. [PMID: 33531048 PMCID: PMC7856815 DOI: 10.1186/s13040-021-00245-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Screening for suicidal ideation in high-risk groups such as U.S. veterans is crucial for early detection and suicide prevention. Currently, screening is based on clinical interviews or self-report measures. Both approaches rely on subjects to disclose their suicidal thoughts. Innovative approaches are necessary to develop objective and clinically applicable assessments. Speech has been investigated as an objective marker to understand various mental states including suicidal ideation. In this work, we developed a machine learning and natural language processing classifier based on speech markers to screen for suicidal ideation in US veterans. METHODOLOGY Veterans submitted 588 narrative audio recordings via a mobile app in a real-life setting. In addition, participants completed self-report psychiatric scales and questionnaires. Recordings were analyzed to extract voice characteristics including prosodic, phonation, and glottal. The audios were also transcribed to extract textual features for linguistic analysis. We evaluated the acoustic and linguistic features using both statistical significance and ensemble feature selection. We also examined the performance of different machine learning algorithms on multiple combinations of features to classify suicidal and non-suicidal audios. RESULTS A combined set of 15 acoustic and linguistic features of speech were identified by the ensemble feature selection. Random Forest classifier, using the selected set of features, correctly identified suicidal ideation in veterans with 86% sensitivity, 70% specificity, and an area under the receiver operating characteristic curve (AUC) of 80%. CONCLUSIONS Speech analysis of audios collected from veterans in everyday life settings using smartphones offers a promising approach for suicidal ideation detection. A machine learning classifier may eventually help clinicians identify and monitor high-risk veterans.
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Affiliation(s)
- Anas Belouali
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington, DC, USA.
| | - Samir Gupta
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington, DC, USA
| | - Vaibhav Sourirajan
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington, DC, USA
| | - Jiawei Yu
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington, DC, USA
| | - Nathaniel Allen
- War Related Illness and Injury Study Center, Veterans Affairs Medical Center, Washington, DC, USA
| | - Adil Alaoui
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington, DC, USA
| | - Mary Ann Dutton
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC, USA
| | - Matthew J Reinhard
- War Related Illness and Injury Study Center, Veterans Affairs Medical Center, Washington, DC, USA
- Department of Psychiatry, Georgetown University Medical Center, Washington, DC, USA
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13
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Cusick M, Adekkanattu P, Campion TR, Sholle ET, Myers A, Banerjee S, Alexopoulos G, Wang Y, Pathak J. Using weak supervision and deep learning to classify clinical notes for identification of current suicidal ideation. J Psychiatr Res 2021; 136:95-102. [PMID: 33581461 DOI: 10.1016/j.jpsychires.2021.01.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/17/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
Mental health concerns, such as suicidal thoughts, are frequently documented by providers in clinical notes, as opposed to structured coded data. In this study, we evaluated weakly supervised methods for detecting "current" suicidal ideation from unstructured clinical notes in electronic health record (EHR) systems. Weakly supervised machine learning methods leverage imperfect labels for training, alleviating the burden of creating a large manually annotated dataset. After identifying a cohort of 600 patients at risk for suicidal ideation, we used a rule-based natural language processing approach (NLP) approach to label the training and validation notes (n = 17,978). Using this large corpus of clinical notes, we trained several statistical machine learning models-logistic classifier, support vector machines (SVM), Naive Bayes classifier-and one deep learning model, namely a text classification convolutional neural network (CNN), to be evaluated on a manually-reviewed test set (n = 837). The CNN model outperformed all other methods, achieving an overall accuracy of 94% and a F1-score of 0.82 on documents with "current" suicidal ideation. This algorithm correctly identified an additional 42 encounters and 9 patients indicative of suicidal ideation but missing a structured diagnosis code. When applied to a random subset of 5,000 clinical notes, the algorithm classified 0.46% (n = 23) for "current" suicidal ideation, of which 87% were truly indicative via manual review. Implementation of this approach for large-scale document screening may play an important role in point-of-care clinical information systems for targeted suicide prevention interventions and improve research on the pathways from ideation to attempt.
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Affiliation(s)
- Marika Cusick
- Department of Information and Technology Services, Weill Cornell Medicine, New York, USA; Department Population Health Sciences, Weill Cornell Medicine, New York, USA.
| | - Prakash Adekkanattu
- Department of Information and Technology Services, Weill Cornell Medicine, New York, USA.
| | - Thomas R Campion
- Department of Information and Technology Services, Weill Cornell Medicine, New York, USA; Department Population Health Sciences, Weill Cornell Medicine, New York, USA.
| | - Evan T Sholle
- Department of Information and Technology Services, Weill Cornell Medicine, New York, USA.
| | - Annie Myers
- Department Population Health Sciences, Weill Cornell Medicine, New York, USA.
| | - Samprit Banerjee
- Department Population Health Sciences, Weill Cornell Medicine, New York, USA.
| | | | - Yanshan Wang
- Division of Digital Health Sciences, Mayo Clinic, MN, USA; Department of Health Sciences Research, Mayo Clinic, MN, USA.
| | - Jyotishman Pathak
- Department Population Health Sciences, Weill Cornell Medicine, New York, USA; Department of Psychiatry, Weill Cornell Medicine, New York, USA.
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14
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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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15
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Elucidating the chronic, complex nature of suicidal ideation: A national qualitative study of veterans with a recent suicide attempt. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2020. [DOI: 10.1016/j.jadr.2020.100030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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16
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Abou El-Magd RM, Urichuk L, Surood S, Li D, Greenshaw A, Grunau M, MacNeil L, Challborn I, Grauwiler D, Olson R, Agyapong VIO. Family Members' Perspectives on Family and Social Support Available to Suicidal Patients, and Health Systems' Interactions and Responses to Suicide Cases in Alberta: Protocol for a Quantitative Research Study. JMIR Res Protoc 2020; 9:e19112. [PMID: 33231553 PMCID: PMC7723743 DOI: 10.2196/19112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/02/2020] [Accepted: 08/18/2020] [Indexed: 11/15/2022] Open
Abstract
Background Suicide is a major cause of preventable death globally and a leading cause of death by injury in Canada. To support people who experience suicidal thoughts and behaviors and to ultimately prevent people from dying by suicide, it is important to understand individual and familial experiences with the health care system. Objective We present the protocol for a study, the objective of which is to explore how people who died by suicide, and their family members, interacted with the health care system. Methods This is a quantitative research study. Data will be collected through a self-administered paper-based or online survey of the family member of patients who died by suicide. The sample size was calculated to be 385 (margin of error ±3%). Results Data collection will start in October 2020 and results will be available by March 2021. We expect the results to shed light on the experiences of individuals who died by suicide and their family members with the health care system. The study has received ethical clearance from the Health Ethics Research Board of the University of Alberta (Pro00096342). Conclusions Our study may inform practice, policy, and future research. The findings may shape how members of the health care system respond to people who are at risk of suicide and their families. International Registered Report Identifier (IRRID) PRR1-10.2196/19112
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Affiliation(s)
- Rabab M Abou El-Magd
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Liana Urichuk
- Addiction & Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Shireen Surood
- Addiction & Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Daniel Li
- Addiction & Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Andrew Greenshaw
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mara Grunau
- Centre for Suicide Prevention, Calgary, AB, Canada
| | | | - Ione Challborn
- Canadian Mental Health Association, Edmonton, AB, Canada
| | | | - Robert Olson
- Centre for Suicide Prevention, Calgary, AB, Canada
| | - Vincent Israel Opoku Agyapong
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada.,Addiction & Mental Health, Alberta Health Services, Edmonton, AB, Canada
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17
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Schriver E, Lieblich S, AlRabiah R, Mowery DL, Brown LA. Identifying risk factors for suicidal ideation across a large community healthcare system. J Affect Disord 2020; 276:1038-1045. [PMID: 32763588 DOI: 10.1016/j.jad.2020.07.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 05/14/2020] [Accepted: 07/05/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Suicide is the tenth leading cause of death in the United States. Several studies have leveraged electronic health record (EHR) data to predict suicide risk in veteran and military samples; however, few studies have investigated suicide risk factors in a large-scale community health population. METHODS Clinical data was queried for 9,811 patients from the Penn Medicine Health System who had completed a Patient Health Questionnaire-9 (PHQ-9) documented in the EHR between January 2017 and June 2019. Patient demographics, PHQ-9 scores, and psychiatric comorbidities were extracted from the EHR. Univariate and multivariable logistic regressions were applied to determine significant risk factors associated with suicide ideation responses from the PHQ-9. RESULTS One-quarter (25.8%% of patients endorsed suicide ideation. Univariate analysis found 22 risk factors of suicide ideation. Multivariable logistic regression found significant positive associations (Odds Ratio, (95% Confidence Interval)) with the following: younger ages less than 18 years: 2.1, (1.69, 2.60) and 19-24 years: 1.55, (1.29, 1.87)), single marital status (1.22, (1.08, 1.38)), African American (1.22, (1.08, 1.38)), non-commercial insurance (1.16, (1.03, 1.31)), multiple comorbidities (1 comorbidity (1.65, (1.32, 2.07); 2 comorbidities (2.07, (1.61, 2.64)), 3+ comorbidities (2.49, (1.87, 3.33))), bipolar disorders (Type I: 1.38, (1.14, 1.67) and Type II: 1.94, (1.52, 2.49)), depressive disorders (1.70, (1.49, 1.94)), obsessive compulsive disorder (OCD) (1.43, (1.08, 1.90)), and stress disorders (1.53, (1.33, 1.76)). CONCLUSION Community EHR information can be used to predict suicidal ideation. This information can be used to design tools for identifying patients at risk for suicide in real-time.
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Affiliation(s)
- Emily Schriver
- Data Analytics Center, Penn Medicine; Institute for Biomedical Informatics, University of Pennsylvania
| | | | - Reem AlRabiah
- Department of Psychiatry, University of Pennsylvania
| | - Danielle L Mowery
- Institute for Biomedical Informatics, University of Pennsylvania; Department of Biostatistics, Epidemiology, & Informatics, University of Pennsylvania
| | - Lily A Brown
- Department of Psychiatry, University of Pennsylvania.
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18
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The association between nocturnal panic attacks and suicidal ideation, plans, and attempts. Psychiatry Res 2020; 291:113280. [PMID: 32763542 DOI: 10.1016/j.psychres.2020.113280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/03/2020] [Accepted: 07/03/2020] [Indexed: 01/15/2023]
Abstract
Panic and sleep disturbances are established risk factors for suicide. Nocturnal panic attacks, which occur out of sleep, represent an intersection of these risk factors. Only one study to date has examined this relationship, but measured suicidality as a unitary construct. This represents a significant gap in the literature, considering most individuals who think about suicide do not make a plan and most who make a plan never make an attempt. We sought to expand upon existing research by examining how nocturnal panic relates to suicidal ideation, plans, and attempts separately. We predicted nocturnal panic would be associated with more suicidal ideation, plan, and attempt history than daytime only panic and no panic. Participants recruited from an online community sample were thoroughly screened for nocturnal and daytime panic history and completed questionnaires about past suicidal ideation, plans, and attempts. Nocturnal and daytime panic groups did not differ in past suicidal ideation or plans, but both groups exceeded the non-panic group. The nocturnal panic group reported more suicide attempts than the daytime and non-panic groups and judged themselves as more likely to make an attempt in the future. These results indicate a promising avenue for future research and suicide prevention efforts.
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19
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Harris LM, Huang X, Linthicum KP, Bryen CP, Ribeiro JD. Sleep disturbances as risk factors for suicidal thoughts and behaviours: a meta-analysis of longitudinal studies. Sci Rep 2020; 10:13888. [PMID: 32807889 PMCID: PMC7431543 DOI: 10.1038/s41598-020-70866-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022] Open
Abstract
In recent years, there has been a growing interest in understanding the relationship between sleep and suicide. Although sleep disturbances are commonly cited as critical risk factors for suicidal thoughts and behaviours, it is unclear to what degree sleep disturbances confer risk for suicide. The aim of this meta-analysis was to clarify the extent to which sleep disturbances serve as risk factors (i.e., longitudinal correlates) for suicidal thoughts and behaviours. Our analyses included 156 total effects drawn from 42 studies published between 1982 and 2019. We used a random effects model to analyse the overall effects of sleep disturbances on suicidal ideation, attempts, and death. We additionally explored potential moderators of these associations. Our results indicated that sleep disturbances are statistically significant, yet weak, risk factors for suicidal thoughts and behaviours. The strongest associations were found for insomnia, which significantly predicted suicide ideation (OR 2.10 [95% CI 1.83-2.41]), and nightmares, which significantly predicted suicide attempt (OR 1.81 [95% CI 1.12-2.92]). Given the low base rate of suicidal behaviours, our findings raise questions about the practicality of relying on sleep disturbances as warning signs for imminent suicide risk. Future research is necessary to uncover the causal mechanisms underlying the relationship between sleep disturbances and suicide.
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Affiliation(s)
- Lauren M Harris
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306-4301, USA.
| | - Xieyining Huang
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306-4301, USA
| | - Kathryn P Linthicum
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306-4301, USA
| | - Chloe P Bryen
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306-4301, USA
| | - Jessica D Ribeiro
- Department of Psychology, Florida State University, 1107 W. Call St., Tallahassee, FL, 32306-4301, USA
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20
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Martin JS, Novak LA, Perera K, Olsen CH, Kindt MT, LaCroix JM, Bennion L, Lee-Tauler SY, Ghahramanlou-Holloway M. Suicide Typologies in the United States Air Force: A Hierarchical Cluster Analysis. Suicide Life Threat Behav 2019; 49:1707-1720. [PMID: 31034653 DOI: 10.1111/sltb.12553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/04/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study describes characteristics of United States Air Force (USAF) suicide decedents and determines subgroups. METHOD Retrospective review of demographic, psychiatric, event-related, and psychosocial variables for USAF suicide decedents in the Suicide Event Surveillance System database was conducted between February 1999 and July 2009 (N = 376). Hierarchical cluster analysis was used to determine initial clusters and cluster centroids. RESULTS Analyses identified three clusters. Cluster 1 (n = 149) individuals were mostly single or divorced, E-1-E-6 rank, living alone, and less likely to have psychiatric disorder diagnoses or engage with most helping resources. Cluster 2 (n = 126) decedents were mostly married, living with a partner, higher ranking, and least likely to communicate suicide intent. Cluster 3 (n = 101) individuals were mostly E-4-E-6 rank, with the highest rates of most psychiatric diagnoses, previous suicide-related events, engagement with multiple helping resources, communication of intent, and psychosocial precipitants. Clusters differed significantly in marital status, rank, psychiatric diagnoses, precipitants, service utilization, previous suicide-related events, risk factors, communication of intent, location and method of death, and residential status. CONCLUSIONS This study identifies empirically based suicide typologies within a military decedent sample. While further research and replications of findings are needed, these typologies have clinical and policy implications for military suicide prevention.
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Affiliation(s)
- Jeffery S Martin
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Laura A Novak
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Kanchana Perera
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Cara H Olsen
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Michael T Kindt
- Air Force Medical Operations Agency, Lackland AFB, San Antonio, TX, USA
| | - Jessica M LaCroix
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Layne Bennion
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Su Yeon Lee-Tauler
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Marjan Ghahramanlou-Holloway
- Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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21
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Guzmán EM, Cha CB, Ribeiro JD, Franklin JC. Suicide risk around the world: a meta-analysis of longitudinal studies. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1459-1470. [PMID: 31485691 DOI: 10.1007/s00127-019-01759-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/20/2019] [Indexed: 01/20/2023]
Abstract
PURPOSE Suicidal thoughts and behaviors (STBs) have been a persistent problem worldwide. Identifying risk factors for STBs across distinct areas of the world may help predict who or where requires the greatest attention. However, risk factors for STBs are infrequently explored cross-nationally. The present study examined whether psychopathology prospectively predicts STBs across different areas of the world, and whether certain country-level factors moderate the degree of risk conferred. METHODS We conducted a meta-analysis of 71 longitudinal studies from 30 different countries that featured psychopathology-related variables predicting STB outcomes. Meta-regression was used to evaluate whether the following country-level factors modified risk: geographic region, income level, and degree of mental health structural stigma. RESULTS Over 90% of studies had been conducted in North America and Europe. When assessed by country income level, it was found that only one longitudinal study on psychopathology and STB was conducted outside of a high-income country. Moreover, less than 10% of studies were conducted in high structural stigma contexts. Meta-regression findings revealed that the variation in risk effect sizes across studies was not explained by models including country-level factors. CONCLUSIONS Our findings show critical underrepresentation of low- and middle-income countries, which account for a large proportion of global suicide deaths. This reveals a need to broaden the scope of longitudinal research on STB risk, such that countries across more regions, income levels, and degrees of structural stigma are fully accounted for. Such lines of research will improve generalizability of findings, and more precisely inform prevention efforts worldwide.
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Affiliation(s)
- E M Guzmán
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 West 120th Street, Box 102, New York, NY, 10027, USA
| | - C B Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 West 120th Street, Box 102, New York, NY, 10027, USA.
| | - J D Ribeiro
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahasee, FL, 32306, USA
| | - J C Franklin
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahasee, FL, 32306, USA
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22
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Bryksa E, Shalaby R, Friesen L, Klingle K, Gaine G, Urichuk L, Surood S, Agyapong V. Family Members' Perspectives of Health Care System Interactions With Suicidal Patients and Responses to Suicides: Protocol for a Qualitative Research Study. JMIR Res Protoc 2019; 8:e13797. [PMID: 31400108 PMCID: PMC6709894 DOI: 10.2196/13797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 12/16/2022] Open
Abstract
Background Suicide is a major cause of preventable death globally and a leading cause of death by injury in Canada. To support people who experience suicidal thoughts and behaviors and ultimately prevent people from dying by suicide, it is important to understand the individual and familial experiences with the health care system. Objective This study aims to explore how suicide victims, and their family members, interacted with the health care system. Methods We will invite family members of 6 to 8 suicide victims to participate in the study by sharing their perspectives on both their relative’s as well as their own interactions with the health care system. Interviews will take place in-person and will be audio recorded, transcribed, and analyzed thematically. Results The results of the study are expected to be available in 12 months. We expect the results to shed light on the experiences of suicide victims and their family members with the health care system. Conclusions Our study results may inform practice, policy, and further research. They may shape how members of the health care system respond to people who are at risk of suicide and their families. International Registered Report Identifier (IRRID) PRR1-10.2196/13797
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Affiliation(s)
- Erin Bryksa
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Laura Friesen
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Kirsten Klingle
- Department of Educational Psychology, Faculty of Education, University of Alberta, Edmonton, AB, Canada
| | - Graham Gaine
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Liana Urichuk
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Shireen Surood
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB, Canada
| | - Vincent Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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23
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Thomas BD, Ford CG, Addicks SH, Williford DN, Manegold EM, Randall CL, Aballay AM, Hajduk GM, Duncan CL. Implementation of a Psychosocial Screener for Adults in an Outpatient Burn Clinic. J Burn Care Res 2019; 40:331-335. [PMID: 30806462 DOI: 10.1093/jbcr/irz020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/05/2019] [Accepted: 02/20/2019] [Indexed: 11/14/2022]
Affiliation(s)
- Ben D Thomas
- Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Cameron G Ford
- Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Sarah H Addicks
- Department of Family Medicine, University of Minnesota School of Medicine, Rochester, Minnesota
| | - Desireé N Williford
- Department of Psychology, West Virginia University, Morgantown, West Virginia
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Ellen M Manegold
- Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Cameron L Randall
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington
| | - Ariel M Aballay
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Gina M Hajduk
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Christina L Duncan
- Department of Psychology, West Virginia University, Morgantown, West Virginia
- West Penn Hospital Burn Center, Allegheny Health Network, Pittsburgh, Pennsylvania
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24
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Holliday R, Smith NB, Monteith LL. An initial investigation of nonsuicidal self-injury among male and female survivors of military sexual trauma. Psychiatry Res 2018; 268:335-339. [PMID: 30096662 DOI: 10.1016/j.psychres.2018.07.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
Nonsuicidal self-injury (NSSI) has been understudied among survivors of military sexual trauma (MST). The aims of the current study were to: (1) describe characteristics of NSSI among survivors of MST and (2) determine if MST survivors who have engaged in NSSI differ from those who have never engaged in NSSI in terms of the severity of posttraumatic stress disorder (PTSD) and depressive symptoms, trauma-related cognitions, and recent suicidal ideation. Participants were 107 veterans (65 females, 42 males) with a history of MST who completed measures of NSSI, PTSD and depressive symptoms, recent suicidal ideation, and trauma-related cognitions. Approximately one-fourth of participants (n = 27; 25.23%) endorsed a history of NSSI. The majority of participants who engaged in NSSI reported that they first engaged in NSSI following MST (n = 18; 66.67%). MST survivors with a history of NSSI reported more severe PTSD symptoms, recent suicidal ideation, and trauma-related cognitions. NSSI was relatively common in the sample and was associated with a more severe clinical presentation. Longitudinal research is needed to understand the development, maintenance, and function of NSSI in MST survivors, especially as it pertains to risk for suicidal self-directed violence.
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Affiliation(s)
- Ryan Holliday
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Denver, CO, USA; University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Noelle B Smith
- VA Northeast Program Evaluation Center, West Haven, CT, USA
| | - Lindsey L Monteith
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Denver, CO, USA; University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Kawahara YY, Hashimoto S, Harada M, Sugiyama D, Yamada S, Kitada M, Sakurai T, Takahashi T, Yamashita K, Watanabe K, Mimura M, Fujisawa D. Predictors of short-term repetition of self-harm among patients admitted to an emergency room following self-harm: A retrospective one-year cohort study. Psychiatry Res 2017; 258:421-426. [PMID: 28865720 DOI: 10.1016/j.psychres.2017.08.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 07/06/2017] [Accepted: 08/27/2017] [Indexed: 11/16/2022]
Abstract
We conducted a retrospective chart-review study, examining predictors of the repetition of short-term self-harm (<1 month and <6 months) among the patients who were admitted to an emergency department in Japan following self-harm. A total of 405 patients were enrolled and were followed-up for a subsequent one year. The incidence of repeated self-harm within one- and six- months were 6.4% and 13.1%, respectively. Cox's proportional hazards model analyses demonstrated that history of self-harm and comorbid physical illness were associated with repeated self-harm within one month. The patients who lived alone and who were directly discharged from the emergency room after referral to a psychiatrist were at higher risk for repeated self-harm within both one and six months. Living on public assistance and having been discharged from psychiatric wards within the past 12 months were associated with repetition within six months. These risk factors should be incorporated into routine assessment at an emergency room, and elaborate follow-up plan should be provided to the patients with these risk factors upon discharge from the emergency room. Further prospective studies are warranted, addressing more comprehensive factors that are associated with short-term risk for self-harm and suicide.
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Affiliation(s)
- Yoko Yoshida Kawahara
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Department of Psychiatry, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan; Department of Emergency and Critical Care Center, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.
| | - Satoshi Hashimoto
- Department of Psychiatry, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan; Department of Emergency and Critical Care Center, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Masahiro Harada
- Department of Emergency and Critical Care Center, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Daisuke Sugiyama
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Shu Yamada
- Department of Emergency and Critical Care Center, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Maki Kitada
- Department of Emergency and Critical Care Center, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Toshihiro Sakurai
- Department of Emergency and Critical Care Center, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Takeshi Takahashi
- Department of Emergency and Critical Care Center, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Kensho Yamashita
- Department of Psychiatry, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Kenjiro Watanabe
- Department of Psychiatry, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
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Hunt T, Wilson CJ, Caputi P, Woodward A, Wilson I. Signs of current suicidality in men: A systematic review. PLoS One 2017; 12:e0174675. [PMID: 28355268 PMCID: PMC5371342 DOI: 10.1371/journal.pone.0174675] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 03/10/2017] [Indexed: 12/31/2022] Open
Abstract
Suicide signs have been identified by expert consensus and are relied on by service providers, community helpers' and family members to identify suicidal men. Whether signs that are reported in suicide literature accurately describe male presentations of suicidality is unclear. A systematic review of the literature was conducted to identify male-specific signs of current suicidality and identify gaps in the literature for future research. Searches through Medline, CINAHL, PsychInfo and the Behavioral Sciences Collection, guided by the PRISMA-P statement, identified 12 studies that met the study eligibility criteria. Although the results generally reflected suicide signs identified by expert consensus, there is little research that has examined male-specific signs of the current suicidal state. This review highlights the need for scientific research to clarify male presentation of suicidality. Implications for future research to improve the prompt identification of suicidal men are discussed.
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Affiliation(s)
- Tara Hunt
- School of Psychology, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, Wollongong, Australia
| | - Coralie J. Wilson
- Illawarra Health and Medical Research Institute, Wollongong, Australia
- School of Medicine, University of Wollongong, Wollongong, Australia
| | - Peter Caputi
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Alan Woodward
- Lifeline Research Foundation, Lifeline Australia, Canberra, Australia
- Suicide Prevention Australia, Sydney, Australia
- Centre for Mental Health, University of Melbourne, Melbourne, Australia
| | - Ian Wilson
- School of Medicine, University of Wollongong, Wollongong, Australia
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27
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Denneson LM, Smolenski DJ, Bush NE, Dobscha SK. Curiosity improves coping efficacy and reduces suicidal ideation severity among military veterans at risk for suicide. Psychiatry Res 2017; 249:125-131. [PMID: 28092792 DOI: 10.1016/j.psychres.2017.01.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 01/05/2017] [Accepted: 01/08/2017] [Indexed: 12/29/2022]
Abstract
Curiosity, the tendency to engage in novel and challenging opportunities, may be an important source of resilience for those at risk for suicide. We hypothesized that curiosity would have a buffering effect against risk conferred by multiple sources of distress, whereby curiosity would be associated with reduced suicidal ideation and increased coping efficacy. As part of a larger intervention trial designed to improve coping skills and reduce suicidal ideation, 117 military veterans with suicidal ideation completed measures of curiosity and distress (perceived stress, depression, anxiety, and sleep disturbances) at baseline, and completed measures of suicidal ideation and coping efficacy (to stop negative thoughts, to enlist support from friends and family) at baseline and 3-, 6-, and 12-week follow up. Growth curve models showed that curiosity moderated the association between distress and suicidal ideation at baseline and that curiosity moderated the association between distress and increased coping efficacy to stop negative thoughts over time. Findings suggest that curiosity may buffer against the effect of heightened levels of distress on suicidal ideation and help facilitate stronger gains in coping efficacy over time. Additional work should further examine the role of curiosity as a protective factor for veterans with suicidal ideation.
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Affiliation(s)
- Lauren M Denneson
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, PO Box 1034 (R&D66), Portland, OR 97207, USA; Department of Psychiatry, Oregon Health & Science University, 3181 Sam Jackson Park Rd, Portland, OR 97239, USA.
| | - Derek J Smolenski
- National Center for Telehealth and Technology (T2), Defense Health Agency, 9933 West Hayes Street, Tacoma, WA 98431-9500, USA
| | - Nigel E Bush
- National Center for Telehealth and Technology (T2), Defense Health Agency, 9933 West Hayes Street, Tacoma, WA 98431-9500, USA
| | - Steven K Dobscha
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, PO Box 1034 (R&D66), Portland, OR 97207, USA; Department of Psychiatry, Oregon Health & Science University, 3181 Sam Jackson Park Rd, Portland, OR 97239, USA
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28
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Denneson LM, Kovas AE, Britton PC, Kaplan MS, McFarland BH, Dobscha SK. Suicide Risk Documented During Veterans' Last Veterans Affairs Health Care Contacts Prior to Suicide. Suicide Life Threat Behav 2016; 46:363-74. [PMID: 26833711 DOI: 10.1111/sltb.12226] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 10/11/2015] [Indexed: 11/28/2022]
Abstract
A total of 295 veterans who died by suicide in 2009 across 11 states and received Veterans Affairs (VA) health care in the 6 months prior to death were identified. The suicide risk factors documented and the care received at these veterans' last VA contacts are described, and the study explores whether veterans present differently to VA care (i.e., different risk factors documented or different care settings accessed) based on the proximity of their last contact to suicide. Many veterans were seen in primary care (n = 136; 46%) for routine follow-up (n = 168; 57%). Fifty-three (18%) were assessed for suicidal thoughts; 20 (38%) of whom endorsed such thoughts. Although higher frequencies of some risk factors at last contacts more proximal to suicide compared to those more distal were observed, findings overall highlight the challenges clinicians face detecting enhanced risk prior to suicide.
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Affiliation(s)
- Lauren M Denneson
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Anne E Kovas
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA
| | - Peter C Britton
- VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Canandaigua, NY, USA.,Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Mark S Kaplan
- Department of Social Welfare, University of California - Los Angeles Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Bentson H McFarland
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Steven K Dobscha
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
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Ballard ED, Vande Voort JL, Luckenbaugh DA, Machado-Vieira R, Tohen M, Zarate CA. Acute risk factors for suicide attempts and death: prospective findings from the STEP-BD study. Bipolar Disord 2016; 18:363-72. [PMID: 27233466 PMCID: PMC4925294 DOI: 10.1111/bdi.12397] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 02/26/2016] [Accepted: 04/22/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Suicide is unfortunately common in psychiatric practice, but difficult to predict. The present study sought to assess which clinical symptoms increase in the months before suicidal behavior in a sample of psychiatric outpatients with bipolar disorder. METHODS Data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) trial were used. A total of 103 participants who attempted suicide or died by suicide during the trial were included; a 15% random sample of the remaining participants (n = 427) was used as a comparison sample. Linear mixed models in the six months before suicidal behavior were conducted for each of five proposed acute risk factors for suicidal behavior. Participants were assessed using the Clinical Monitoring Form (CMF) at each visit for the following potential acute risk factors for suicidal behavior: suicidal ideation, loss of interest, anxiety, psychomotor agitation, and high-risk behavior. RESULTS Each of the five symptoms was elevated overall in individuals who engaged in suicidal behavior (p < 0.05). The severity of both suicidal ideation and loss of interest significantly increased in the months before suicidal behavior (p < 0.001). Anxiety demonstrated comparable effect sizes across multiple models. Psychomotor agitation and high-risk behavior were not significantly elevated before suicidal behavior. CONCLUSIONS Suicidal ideation, loss of interest and, to a lesser extent, anxiety may represent acute suicide risk factors up to four months before suicidal behavior in outpatients with bipolar disorder. Further investigation of these potential acute risk factors in prospective analyses is warranted.
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Affiliation(s)
- Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer L Vande Voort
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - David A Luckenbaugh
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Rodrigo Machado-Vieira
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, Health Sciences Center, University of New Mexico, Albuquerque, NM, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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30
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Treatment of veterans with mental health symptoms in VA primary care prior to suicide. Gen Hosp Psychiatry 2016; 38:65-70. [PMID: 26412146 DOI: 10.1016/j.genhosppsych.2015.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/21/2015] [Accepted: 08/26/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We describe Veterans Affairs (VA) primary care received by veterans with mental health symptoms in the year prior to suicide to identify opportunities to improve care. METHOD Death certificate data from 11 states were linked to VA national patient care data for veterans who died by suicide in 2009 and had received VA care. We identified 118 age-, sex- and clinician-matched case-control pairs (suicide decedents and living controls) with mental health symptoms. Using McNemar's chi-square and paired t tests, we compare primary care follow-up received during the year prior to death. RESULTS Cases and controls received similar primary care clinician follow-up and treatment for mental health symptoms. Cases were less likely than controls to fill 90 or more total days of an antidepressant during the year (P=.02), despite no differences in prescription orders from clinicians (P=.05). Cases and controls were equally likely to fill 90 or more consecutive days of an antidepressant (P=.47). Across both groups, 48% (n=113) received assessment for suicidal ideation in primary care. CONCLUSION We identified two areas to improve primary care for veterans at risk for suicide: monitoring antidepressant treatment adherence and improving suicidal ideation assessment and follow-up for veterans with mental health symptoms.
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31
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Bentley KH, Franklin JC, Ribeiro JD, Kleiman EM, Fox KR, Nock MK. Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: A meta-analytic review. Clin Psychol Rev 2015; 43:30-46. [PMID: 26688478 DOI: 10.1016/j.cpr.2015.11.008] [Citation(s) in RCA: 212] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/18/2015] [Accepted: 11/24/2015] [Indexed: 02/08/2023]
Abstract
Suicidal thoughts and behaviors are highly prevalent public health problems with devastating consequences. There is an urgent need to improve our understanding of risk factors for suicide to identify effective intervention targets. The aim of this meta-analysis was to examine the magnitude and clinical utility of anxiety and its disorders as risk factors for suicide ideation, attempts, and deaths. We conducted a literature search through December 2014; of the 65 articles meeting our inclusion criteria, we extracted 180 cases in which an anxiety-specific variable was used to longitudinally predict a suicide-related outcome. Results indicated that anxiety is a statistically significant, yet weak, predictor of suicide ideation (OR=1.49, 95% CI: 1.18, 1.88) and attempts (OR=1.64, 95% CI: 1.47, 1.83), but not deaths (OR=1.01, 95% CI: 0.87, 1.18). The strongest associations were observed for PTSD. Estimates were reduced after accounting for publication bias, and diagnostic accuracy analyses indicated acceptable specificity but poor sensitivity. Overall, the extant literature suggests that anxiety and its disorders, at least when these constructs are measured in isolation and as trait-like constructs, are relatively weak predictors of suicidal thoughts and behaviors over long follow-up periods. Implications for future research priorities are discussed.
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Affiliation(s)
- Kate H Bentley
- Center for Anxiety and Related Disorders, Boston University, USA.
| | | | - Jessica D Ribeiro
- Department of Psychology, Harvard University, USA; Military Suicide Research Consortium, USA
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Tucker RP, Crowley KJ, Davidson CL, Gutierrez PM. Risk Factors, Warning Signs, and Drivers of Suicide: What Are They, How Do They Differ, and Why Does It Matter? Suicide Life Threat Behav 2015; 45:679-89. [PMID: 25858332 DOI: 10.1111/sltb.12161] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 01/30/2015] [Indexed: 11/29/2022]
Abstract
Research investigating suicide attempts and deaths by suicide has yielded many specific risk factors and warning signs for future suicidal behaviors. Yet, even though these variables are each valuable for suicide prevention efforts, they may be limited in their applicability to clinical practice. The differences among risk factors, warning signs, and "drivers," which are person-specific variables that lead individuals to desire death by suicide, are highlighted. The scarce evidence on drivers is described and specific recommendations for conducting future drivers-focused research and targeting them in clinical practice are suggested.
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Affiliation(s)
- Raymond P Tucker
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Kevin J Crowley
- Capital Institute for Cognitive Therapy, Washington, DC, USA
| | | | - Peter M Gutierrez
- VA VISN 19 MIRECC, Denver VA Medical Center, Denver, CO, USA.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
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Denneson LM, Teo AR, Ganzini L, Helmer DA, Bair MJ, Dobscha SK. Military Veterans' Experiences with Suicidal Ideation: Implications for Intervention and Prevention. Suicide Life Threat Behav 2015; 45:399-414. [PMID: 25367753 DOI: 10.1111/sltb.12136] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/15/2014] [Indexed: 11/27/2022]
Abstract
We sought to understand Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans' experiences with suicidal ideation. Semi-structured interviews with 34 OEF/OIF veterans addressed circumstances leading up to disclosure of suicidal ideation during brief clinical assessments. We used an iterative, inductive and deductive thematic analysis approach. Results revealed three pervasive, persistent domains that reinforce the uniqueness of veteran suicidal thoughts: military culture, difficult deployment experiences, and postdeployment adjustment challenges. Within postdeployment, we identified four themes that serve as intervention targets: adjusting to civilian culture, changes to sense of self, feeling overwhelmed by stressors, and lacking life purpose or meaning.
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Affiliation(s)
- Lauren M Denneson
- Portland Center to Improve Veteran Involvement in Care (CIVIC), Portland VA Medical Center, Portland, OR.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Alan R Teo
- Portland Center to Improve Veteran Involvement in Care (CIVIC), Portland VA Medical Center, Portland, OR.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Linda Ganzini
- Portland Center to Improve Veteran Involvement in Care (CIVIC), Portland VA Medical Center, Portland, OR.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Drew A Helmer
- War-Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ.,Department of Medicine, Rutgers University-New Jersey Medical School, Newark, NJ, USA
| | - Matthew J Bair
- Richard L. Roudebush Veteran Affairs Medical Center, Indianapolis, IN, USA
| | - Steven K Dobscha
- Portland Center to Improve Veteran Involvement in Care (CIVIC), Portland VA Medical Center, Portland, OR.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
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Dobscha SK, Denneson LM, Kovas AE, Teo A, Forsberg CW, Kaplan MS, Bossarte R, McFarland BH. Correlates of suicide among veterans treated in primary care: case-control study of a nationally representative sample. J Gen Intern Med 2014; 29 Suppl 4:853-60. [PMID: 25355088 PMCID: PMC4239287 DOI: 10.1007/s11606-014-3028-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Veterans receiving Veterans Affairs (VA) healthcare have increased suicide risk compared to the general population. Many patients see primary care clinicians prior to suicide. Yet little is known about the correlates of suicide among patients who receive primary care treatment prior to death. OBJECTIVE Our aim was to describe characteristics of veterans who received VA primary care in the 6 months prior to suicide; and to compare these to characteristics of control patients who also received VA primary care. DESIGN This was a retrospective case-control study. SUBJECTS The investigators partnered with VA operations leaders to obtain death certificate data from 11 states for veterans who died by suicide in 2009. Cases were matched 1:2 to controls based on age, sex, and clinician. MAIN MEASURES Demographic, diagnosis, and utilization data were obtained from VA's Corporate Data Warehouse. Additional clinical and psychosocial context data were collected using manual medical record review. Multivariate conditional logistic regression was used to examine associations between potential predictor variables and suicide. KEY RESULTS Two hundred and sixty-nine veteran cases were matched to 538 controls. Average subject age was 63 years; 97 % were male. Rates of mental health conditions, functional decline, sleep disturbance, suicidal ideation, and psychosocial stressors were all significantly greater in cases compared to controls. In the final model describing men in the sample, non-white race (OR = 0.51; 95 % CI = 0.27-0.98) and VA service-connected disability (OR = 0.54; 95 % CI = 0.36-0.80) were associated with decreased odds of suicide, while anxiety disorder (OR = 3.52; 95 % CI = 1.79-6.92), functional decline (OR = 2.52; 95 % CI = 1.55-4.10), depression (OR = 1.82; 95 % CI = 1.07-3.10), and endorsement of suicidal ideation (OR = 2.27; 95 % CI = 1.07-4.83) were associated with greater odds of suicide. CONCLUSIONS Assessment for anxiety disorders and functional decline in addition to suicidal ideation and depression may be especially important for determining suicide risk in this population. Continued development of interventions that support identifying and addressing these conditions in primary care is indicated.
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Affiliation(s)
- Steven K Dobscha
- Center to Improve Veteran Involvement in Care, Portland Veterans Affairs Medical Center, P.O. Box 1034 (R&D 66), Portland, OR, 97207, USA,
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35
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Mental health utilization of new-to-care Iraq and Afghanistan Veterans following suicidal ideation assessment. Psychiatry Res 2014; 217:147-53. [PMID: 24726814 DOI: 10.1016/j.psychres.2014.03.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 02/08/2014] [Accepted: 03/14/2014] [Indexed: 11/23/2022]
Abstract
We evaluated the impact of brief structured suicidal ideation (SI) assessments on mental health care among new-to-care Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) veterans. National datasets provided military, demographic, and clinical information. For all new-to-care OEF/OIF veterans administered depression screens (PHQ-2: Patient Health Questionnaire-2) and structured SI assessments in primary care or ambulatory mental health settings of three Veterans Affairs (VA) Medical Centers between April 2008 and September 2009 (N=465), generalized estimating equations were used to examine associations between SI and number of subsequent-year specialty mental health visits and antidepressant prescriptions. Approximately one-third of the veterans reported SI. In multivariate models, PTSD and anxiety diagnoses, severe depression symptoms, being married, and SI assessment by a mental health clinician were associated with more mental health visits in the subsequent year. Depression, PTSD, and anxiety diagnoses, and SI assessment by a mental health clinician were associated with receiving antidepressants. Presence of SI did not significantly affect subsequent year mental health utilization when adjusting for diagnostic and clinician variables, but inaugural visits involving mental health clinicians were consistently associated with subsequent mental health care.
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Abstract
To be, or not to be, that is the question - Whether 'tis nobler in the mind to suffer The slings and arrows of outrageous fortune, Or to take arms against a sea of troubles, And by opposing end them? To die, to sleep; … Hamlet, III i Hamlet's soliloquy is surely the most famous expression of suicidal ideation in English literature. However, by the end of the play, it is not Hamlet, but Ophelia who has taken her own life, even though she gave no prior hint of self-destruction.
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Affiliation(s)
- M Large
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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Ahmedani BK, Simon GE, Stewart C, Beck A, Waitzfelder BE, Rossom R, Lynch F, Owen-Smith A, Hunkeler EM, Whiteside U, Operskalski BH, Coffey MJ, Solberg LI. Health care contacts in the year before suicide death. J Gen Intern Med 2014; 29:870-7. [PMID: 24567199 PMCID: PMC4026491 DOI: 10.1007/s11606-014-2767-3] [Citation(s) in RCA: 395] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/23/2013] [Accepted: 12/20/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND Suicide prevention is a public health priority, but no data on the health care individuals receive prior to death are available from large representative United States population samples. OBJECTIVE To investigate variation in the types and timing of health services received in the year prior to suicide, and determine whether a mental health condition was diagnosed. DESIGN Longitudinal study from 2000 to 2010 within eight Mental Health Research Network health care systems serving eight states. PARTICIPANTS In all, 5,894 individuals who died by suicide, and were health plan members in the year before death. MAIN MEASURES Health system contacts in the year before death. Medical record, insurance claim, and mortality records were linked via the Virtual Data Warehouse, a federated data system at each site. KEY RESULTS Nearly all individuals received health care in the year prior to death (83 %), but half did not have a mental health diagnosis. Only 24 % had a mental health diagnosis in the 4-week period prior to death. Medical specialty and primary care visits without a mental health diagnosis were the most common visit types. The individuals more likely to make a visit in the year prior to death (p < 0.05) tended to be women, individuals of older age (65+ years), those where the neighborhood income was over $40,000 and 25 % were college graduates, and those who died by non-violent means. CONCLUSIONS This study indicates that opportunities for suicide prevention exist in primary care and medical settings, where most individuals receive services prior to death. Efforts may target improved identification of mental illness and suicidal ideation, as a large proportion may remain undiagnosed at death.
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Affiliation(s)
- Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA,
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Large MM, Nielssen OB. Suicide ideas and immediate suicide risk. Psychiatry Res 2013; 209:746. [PMID: 23890699 DOI: 10.1016/j.psychres.2013.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 01/18/2013] [Accepted: 06/06/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Matthew M Large
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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Contacts with health professionals before suicide: missed opportunities for prevention? Compr Psychiatry 2013; 54:1117-23. [PMID: 23768696 DOI: 10.1016/j.comppsych.2013.05.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 04/29/2013] [Accepted: 05/01/2013] [Indexed: 11/20/2022] Open
Abstract
AIM This study aims to examine contacts with different health professionals in the three months prior to death in suicide cases compared to sudden death controls; and, to analyse contacts with health professionals among people who died by suicide having a diagnosable mental health disorder at the time of suicide compared to those who did not have such a diagnosis within four major groups of conditions. METHODS The psychological autopsy method was utilised to investigate suicides of individuals over the age of 35years. A case-control study design was applied using sudden death cases as controls. Odds ratios with a 95% confidence interval were calculated. RESULTS In total, 261 suicides and 182 sudden deaths were involved. In terms of contacts during the last three months prior to death, 76.9% of suicides and 81.9% of sudden deaths visited a general practitioner (GP). Persons who died by suicide had significantly more frequently contacts with mental health professionals than sudden death controls did. People with a diagnosable mental health disorder at the time of suicide attended GP surgeries with approximately the same frequency of people without a diagnosis at GP level. CONCLUSION Similarly, approximately 90% of people who die by suicide and by sudden death seek for help from health care system, mainly from GPs in three months prior to their death. With reference to health care contacts, people who had or did not have a diagnosable psychiatric disorder are not distinguishable at the GP surgery level.
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Corson K, Denneson LM, Bair MJ, Helmer DA, Goulet JL, Dobscha SK. Prevalence and correlates of suicidal ideation among Operation Enduring Freedom and Operation Iraqi Freedom veterans. J Affect Disord 2013; 149:291-8. [PMID: 23531358 DOI: 10.1016/j.jad.2013.01.043] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 01/29/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND We sought to determine the prevalence and correlates of suicidal ideation (SI) among Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) veterans following the Department of Veterans Affairs' (VA) 2007 implementation of required brief SI assessments for veterans who screen positive for depression and post-traumatic stress disorder. METHODS We retrospectively identified OEF/OIF veterans screened for depression using the Patient Health Questionnaire (PHQ-2) between April 2008 and September 2009 at three geographically-distinct VA Medical Centers' primary care or mental health clinics. Veteran responses to a two-item risk assessment tool (VA Pocket Card) or PHQ-9 9th item, administered following a positive depression screen (PHQ-2≥3), were determined using manual chart review. Generalized estimating equations were used to calculate adjusted odds ratios for demographic and clinical correlates of positive SI assessments. RESULTS Of 1340 OEF/OIF veterans with positive depression screens, 32.4% reported SI. In multivariate models, odds of SI were lower for non-Hispanic white veterans (AOR=0.68) and greater for those with PHQ-2≥5 (AOR=1.87), depression (AOR=1.45), bipolar disorder/schizophrenia (AOR=2.84), and 2 or ≥3 diagnoses (AORs=1.59 and 2.49, respectively). LIMITATIONS Study findings may not be generalizable to non-veteran patient populations and the study does not address the reliability and validity of tools employed for brief suicidal ideation assessment. CONCLUSIONS SI is common among OEF/OIF veterans who receive VA care, perhaps more so among non-white veterans. Targeting veterans with higher PHQ-2 scores for SI assessment should be considered to reduce patient and administrative burden.
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Affiliation(s)
- Kathryn Corson
- Portland Center for the Study of Chronic, Comorbid Physical and Mental Disorders, Portland Veterans Affairs Medical Center; Department of Psychiatry, Oregon Health & Science University, Portland, OR 97207, USA.
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Abstract
OBJECTIVE Suicidal ideation and behavior have been associated with a variety of neurological illnesses. Studies are ongoing in combat veterans and other groups to examine possible mechanisms and pathways that account for such associations. METHOD This article provides a review of the literature on suicide ideation and suicidal behavior in patients with neurological illnesses including publications on veteran's health and military medicine. Studies of suicide attempts and deaths in people with neurological illnesses are also reviewed. RESULTS The studies summarized in this review indicate that there are important linkages between suicidal ideation and behavior and neurological conditions, including epilepsy, multiple sclerosis, and amyotrophic lateral sclerosis. CONCLUSION Additional studies are needed to further clarify why suicide ideation and suicidal behavior are associated with neurological diseases, in order to improve quality of life, alleviate patient distress, and prevent nonfatal and fatal suicide attempts in veteran and non-veteran populations.
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Affiliation(s)
- Steven S Coughlin
- Post-Deployment Health Epidemiology Program, Office of Public Health, Department of Veterans Affairs, Washington, DC, USA
| | - Leo Sher
- James J. Peters Veterans’ Affairs Medical Center, New York, USA
- Mount Sinai School of Medicine, New York, USA
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