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Xu I, Millner AJ, Fortgang RG, Nock MK. Suicide decision-making: Differences in proximal considerations between individuals who aborted and attempted suicide. Suicide Life Threat Behav 2024; 54:814-830. [PMID: 39221628 DOI: 10.1111/sltb.13127] [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: 12/19/2023] [Revised: 08/14/2024] [Accepted: 08/17/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION The transition from suicidal thoughts to behaviors often involves considering the consequences of suicide as part of the decision-making process. This study explored the relationship between this consideration process and the decision to either abort or carry out a suicide attempt. METHODS Among inpatients with a suicide-related event in the past 2 weeks (suicide attempt n = 30 or aborted attempt n = 16), we assessed the degree to which they considered six domains of consequences, the impact of these considerations on their inclination to attempt suicide, and the duration of their decision-making. RESULTS All the participants who aborted and 87% of those who attempted considered consequences of suicide. Participants who aborted took longer to progress through decision-making stages and considered more suicide-hindering factors, especially interpersonal ones, though these differences were no longer significant after correction. Group status moderated the relationship between the balance of suicide-facilitating and suicide-hindering considerations and decision-making duration. Considering the consequences of suicide more favorably was related to a shorter ideation-to-action period before a suicide attempt and a longer ideation period before aborting an attempt. CONCLUSION This study highlights the complexity of suicide decision-making and its role in better understanding the progression from ideation to action.
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Affiliation(s)
- Irene Xu
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Alexander J Millner
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rebecca G Fortgang
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
- Mental Health Research, Franciscan Children's, Brighton, Massachusetts, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
- Mental Health Research, Franciscan Children's, Brighton, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Teismann T, Siebert AM, Forkmann T. Suicidal ambivalence: A scoping review. Suicide Life Threat Behav 2024; 54:802-813. [PMID: 38709556 DOI: 10.1111/sltb.13092] [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: 12/18/2023] [Accepted: 04/30/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Suicidal ambivalence is considered a characteristic condition of suicidal individuals. At the same time, there is a lack of a uniform definition, conception and assessment of suicidal ambivalence. On this background, the current scoping review aims to explore the extent, range, and nature of research activity on suicidal ambivalence and to summarize research findings. METHODS A systematic literature search was conducted in four different databases (PubMed, Psychinfo, Web of Science, and Google Scholar) using an array of search terms (e.g., ambivalence, internal suicide debate, reasons for living and reasons for dying, wish to live and wish to die). RESULTS In total, 28 articles published between 1977 and 2023 were included in the scoping review. The study situation lacks a clear definition, conceptualization and operationalization of suicidal ambivalence. Nonetheless, suicidal ambivalence is a common experience in persons contemplating suicide and suicidal ambivalence seems to be present before, during and after a suicide attempt. Suicidal ambivalence is associated with diverse markers of negative/positive mental health as well as suicidal ideation and behavior. CONCLUSION Results point to the relevance of suicidal ambivalence. At the same time, there are large gaps in knowledge about the development, impact and therapeutic responsiveness of suicidal ambivalence.
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Affiliation(s)
- Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-University, Bochum, Germany
| | | | - Thomas Forkmann
- Department of Clinical Psychology and Psychotherapy, University of Duisburg, Essen, Germany
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Matheson L, Rasmussen S, Moxie J, Cramer RJ. A Qualitative Assessment of Reasons for Living and Dying in the Context of Feeling Trapped Among Adults in the United Kingdom. Arch Suicide Res 2024:1-15. [PMID: 39259004 DOI: 10.1080/13811118.2024.2400915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
OBJECTIVE Contemporary approaches to suicide assessment and treatment incorporate reasons for living (RFL) and reasons for dying (RFD). This study qualitatively explored individuals' self-described RFL and RFD in the context of suicidal thinking and behaviors. METHOD Within a community United Kingdom (UK) sample, adults (N = 331, aged 16+) responded to eight open-ended questions probing their experiences of suicide, defeat, and entrapment. Utilizing these data, which were collected from a larger online survey examining risk and protective factors for suicidal behaviors, this study explored RFL and RFD within these narratives. After the research team established an initial code book, RFL and RFD codes were subsequently analyzed through inductive and deductive thematic analyses. RESULTS The present study identified five complimentary RFD-RFL themes: (1) Hopelessness-Hopefulness, (2) Stress of Responsibilities-Duty to Responsibilities, (3) Social Disconnection-Social Connection, (4) Death as Sin-Desire for an Afterlife, and (5) Temporary Escapes as Coping-Entrapment (i.e., a lack of escape). Three subthemes within the RFD theme Entrapment were General/Unspecified, By Feelings, and Within Self. CONCLUSIONS Identified themes reflect the existing quantitative RFL and RFD literature. The identified RFL and RFD themes are discussed with reference to their clinical applications in advancing suicide-specific assessments and interventions. We propose a dimensional framework for RFD and RFL which informs future suicidal behaviors research and practice.
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Greydanus DE, Nazeer A, Qayyum Z, Patel DR, Rausch R, Hoang LN, Miller C, Chahin S, Apple RW, Saha G, Prasad Rao G, Javed A. Pediatric suicide: Review of a preventable tragedy. Dis Mon 2024; 70:101725. [PMID: 38480023 DOI: 10.1016/j.disamonth.2024.101725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
Concepts of suicide are explored in this issue with a focus on suicide in children and adolescents. The epidemiology of pediatric suicide in the United States is reviewed; also, risk and protective factors, as well as prevention strategies, are discussed. Suicide in the pediatric athlete and the potential protective effect of exercise are examined. In addition, this analysis addresses the beneficial role of psychological management as well as current research on pharmacologic treatment and brain stimulation procedures as part of comprehensive pediatric suicide prevention. Though death by suicide in pediatric persons has been and remains a tragic phenomenon, there is much that clinicians, other healthcare professionals, and society itself can accomplish in the prevention of pediatric suicide as well as the management of suicidality in our children and adolescents.
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Ahsan Nazeer
- Division of Child and Adolescent Psychiatry, Sidra Medicine/Weill Cornell Medicine, Doha, Qatar
| | - Zheala Qayyum
- Harvard Medical School, Boston, Massachusetts, United States
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Rebecca Rausch
- Division of Pediatric Psychology, Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Linh-Nhu Hoang
- Western Michigan University, Kalamazoo, MI, United States
| | - Caroline Miller
- Fielding Graduate University, Santa Barbara, CA, United States
| | - Summer Chahin
- Mott Children's Hospital, University of Michigan, Ann Arbor, MI, United States
| | - Roger W Apple
- Division of Pediatric Psychology, Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Gautam Saha
- Immediate Past President of the SAARC (South Asian Association for Regional Cooperation) Psychiatric Federation (SPF), India
| | - G Prasad Rao
- President, Asian Federation of Psychiatric Association (AFPA), India
| | - Afzal Javed
- Chairman Pakistan Psychiatric Research Centre, Immediate Past President of the World Psychiatric Association (WPA), Pakistan
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DuBois D, Richmond R, Stephanie Roberts L, Mahar A, Fear N, Gill K, Samantha Leroux J, Cramm H. A scoping review of military and Veteran families within international suicidality and suicide prevention research. Prev Med Rep 2023; 33:102206. [PMID: 37223562 PMCID: PMC10201831 DOI: 10.1016/j.pmedr.2023.102206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 05/25/2023] Open
Abstract
The impacts of suicidality on families are well known, which is particularly relevant in at-risk populations, such as active duty military personnel and Veteran communities. This scoping review describes how military and Veteran families have been conceptualized within suicide prevention research. A systematic, multi-database search was conducted, and 4,835 studies were screened. All included studies underwent quality assessment. Bibliographic, participant, methodological, and family-relevant data was extracted and descriptively analyzed into Factors, Actors, and Impacts. In total, 51 studies (2007 - 2021) were included. Most studies focused on suicidality rather than suicide prevention. Factor studies described family constructs as a suicidality risk or protective factor for military personnel or Veterans. Actor studies described families' roles or responsibilities to act in relation to the suicidality of military personnel or Veterans. Impacts studies described the impacts of suicidality on military and Veteran family members. The search was limited to English language studies. There were few studies on suicide prevention interventions for or including military and Veteran family members. Family was typically considered peripheral to the military personnel or Veteran experiencing suicidality. However, there was also emerging evidence of suicidality and its consequences in military-connected family members.
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Affiliation(s)
- Denise DuBois
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Rachel Richmond
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Lauren Stephanie Roberts
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Alyson Mahar
- Max Rady College of Medicine, Community Health Sciences, University of Manitoba, Winnipeg, Ontario R3E 3P5, Canada
| | - Nicola Fear
- Department of Military Mental Health, Institute of Psychiatry, King’s College London, London WC2R 2LS, England, United Kingdom
| | - Kamaldeep Gill
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Janette Samantha Leroux
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
| | - Heidi Cramm
- Families Matter Research Group, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario K7L 3N6, Canada
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Oakey-Frost N, Cowan T, Moscardini EH, Pardue-Bourgeois S, de Beurs D, Cohen A, Bryan CJ, Tucker RP. Examining the Interrelationships Among Suicide Cognitions, Suicidal Ideation, and Theoretically Derived Protective Factors. Arch Suicide Res 2022:1-18. [PMID: 35818724 DOI: 10.1080/13811118.2022.2096521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Several protective factors for mitigating suicidal ideation (SI) such as positive affect, reasons for living, purpose in life, meaning in life, gratitude, grit, optimism, social support, and hope have been identified and received empirical support. However, few studies have examined the interrelationships of these protective factors and the identification of protective factors most closely linked to lower levels of SI may be useful for both theory-building initiatives and improvement of suicide-specific interventions. Network analysis offers an approach for testing the relation among these constructs, SI, and suicide risk factors. METHODS A sample N = 557 undergraduate students oversampled for lifetime SI completed a cross-sectional, online survey. The data was used to estimate an undirected, cross-sectional network of the aforementioned protective factors. RESULTS The resulting inferred network implicates strong negative influence of suicide cognitions, but not recent SI, and the strong positive influence of presence of meaning in life, trait hope, and low negative affect. CONCLUSIONS Implications for dimensionality of SI versus suicide cognitions, targeting presence of meaning in life, trait hope, and negative affect in treatment, and cross-cultural variations in reasons for living are discussed. The study is limited by the cross-sectional and convenience sampling methodology.HighlightsProtective factors may have less direct influence on suicidal ideationSuicide cognitions and the suicidal mode may be of phenomenological importancePresence of meaning and trait hope may be primary targets for suicide interventions.
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Gysin-Maillart AC, Jansen R, Walther S, Jobes DA, Brodbeck J, Marmet S. Longitudinal Development of Reasons for Living and Dying With Suicide Attempters: A 2-Year Follow-Up Study. Front Psychiatry 2022; 13:865831. [PMID: 35633806 PMCID: PMC9133363 DOI: 10.3389/fpsyt.2022.865831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/08/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Clinical interventions for patients after a suicide attempt might include a focus on Reasons for Living (RFL) and/or Reasons for Dying (RFD). The present study examined the longitudinal development of RFL and RFD in patients with and without a suicide-specific intervention - the Attempted Suicide Short Intervention Program (ASSIP). METHODS In this secondary analysis of a 2-year follow-up randomized controlled study, participants completed the Suicide Status Form II to assess RFL and RFD, at baseline, as well as at 6-, 12-, 18-, and 24-months follow-up. Growth models and latent class analysis were used to investigate longitudinal developments in RFL and RFD. Regression models were used to test the association between RFL, RFD and suicidal reattempts and ideation. RESULTS Cross-sectionally and longitudinally, RFD, but not RFL, were associated with suicide reattempts and suicidal ideation. The number of RFD decreased significantly across the 24 month period (from 1.90 at t1 to 1.04 at t5 in the control group and from 2.32 at t1 to 0.51 at t5 in the intervention group), and this decrease was stronger (b = -0.02; p = 0.004) in the ASSIP group than in the control group. There was no overall change in RFL. Three latent trajectories of RFD were identified: a decreasing (n = 77), a steady high (n = 17) and a trajectory with first increasing and then decreasing RFD (n = 26). The proportion of patients in the ASSIP intervention was highest in the decreasing trajectory and lowest in the steady high trajectory. Patients in the steady high trajectory were characterized by worse mental health and fewer social obligations (partner, children) at baseline. CONCLUSION The results confirm the importance of RFD within the suicidal process and show that the number of RFD can be further reduced over the period of 24 months with short interventions such as ASSIP. The relevance of number of RFL in the suicidal process, as protective factor, was not confirmed. In the subgroup of patients whose RFD did not decrease over a long period of time, there is a particularly high risk of suicidal ideation/behavior. Clinical interventions should focus more closely on RFD, their etiology and maintenance.
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Affiliation(s)
- Anja C Gysin-Maillart
- Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Unit for Clinical Suicide Research, Department of Clinical Sciences, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Rahel Jansen
- Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - David A Jobes
- Department of Psychology, The Catholic University of America, Washington, DC, United States
| | - Jeannette Brodbeck
- Institute for Counseling, Coaching and Social Management, School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland.,Department for Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Simon Marmet
- Institute for Counseling, Coaching and Social Management, School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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