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Monson ET, Colbert SMC, Andreassen OA, Ayinde OO, Bejan CA, Ceja Z, Coon H, DiBlasi E, Izotova A, Kaufman EA, Koromina M, Myung W, Nurnberger JI, Serretti A, Smoller JW, Stein MB, Zai CC, Aslan M, Barr PB, Bigdeli TB, Harvey PD, Kimbrel NA, Patel PR, Ruderfer D, Docherty AR, Mullins N, Mann JJ. Defining Suicidal Thought and Behavior Phenotypes for Genetic Studies. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.27.24311110. [PMID: 39132474 PMCID: PMC11312669 DOI: 10.1101/2024.07.27.24311110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Background Standardized definitions of suicidality phenotypes, including suicidal ideation (SI), attempt (SA), and death (SD) are a critical step towards improving understanding and comparison of results in suicide research. The complexity of suicidality contributes to heterogeneity in phenotype definitions, impeding evaluation of clinical and genetic risk factors across studies and efforts to combine samples within consortia. Here, we present expert and data-supported recommendations for defining suicidality and control phenotypes to facilitate merging current/legacy samples with definition variability and aid future sample creation. Methods A subgroup of clinician researchers and experts from the Suicide Workgroup of the Psychiatric Genomics Consortium (PGC) reviewed existing PGC definitions for SI, SA, SD, and control groups and generated preliminary consensus guidelines for instrument-derived and international classification of disease (ICD) data. ICD lists were validated in two independent datasets (N = 9,151 and 12,394). Results Recommendations are provided for evaluated instruments for SA and SI, emphasizing selection of lifetime measures phenotype-specific wording. Recommendations are also provided for defining SI and SD from ICD data. As the SA ICD definition is complex, SA code list recommendations were validated against instrument results with sensitivity (range = 15.4% to 80.6%), specificity (range = 67.6% to 97.4%), and positive predictive values (range = 0.59-0.93) reported. Conclusions Best-practice guidelines are presented for the use of existing information to define SI/SA/SD in consortia research. These proposed definitions are expected to facilitate more homogeneous data aggregation for genetic and multisite studies. Future research should involve refinement, improved generalizability, and validation in diverse populations.
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Pollak OH, Sheehan AE, Walsh RFL, Stephenson AR, Zell H, Mayes J, Lawrence HR, Bettis AH, Liu RT. Assessment of suicidal thoughts and behaviors in adults: A systematic review of measure psychometric properties and implications for clinical and research utility. Clin Psychol Rev 2024; 112:102464. [PMID: 39106741 DOI: 10.1016/j.cpr.2024.102464] [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: 02/02/2024] [Revised: 06/12/2024] [Accepted: 07/06/2024] [Indexed: 08/09/2024]
Abstract
High-quality clinical care and research on suicidal thoughts and behaviors (STBs) depends on availability and implementation of reliable and valid measures of STBs. In contrast to studies examining STB risk factors, screening instruments, or treatment, little research has rigorously examined the content, characteristics, and psychometric properties of STB measures themselves. This systematic review (1) identified STB measures that conform to empirically supported definitions of STBs, and (2) identified peer-reviewed papers reporting on the psychometric properties of these measures in adults. Data on psychometric properties and other measure characteristics were extracted. A total of 21 eligible measures were identified in the first stage. In the second stage, 70 articles (with 79 independent samples) were included with psychometric data in adult samples for 19 measures. Although there was support for strong internal consistency and content validity across many measures, face validity and clinical utility concerns were prevalent. Few measures comprehensively assessed suicidal behaviors, and interview-based assessments tended to show the strongest psychometric properties and clinical utility. Findings are discussed in the context of recommendations for improving existing measures, including future research to increase utility and translatability across clinical settings, delivery methods, and diverse populations.
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Affiliation(s)
- Olivia H Pollak
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Ana E Sheehan
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Rachel F L Walsh
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Auburn R Stephenson
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Holly Zell
- School of Psychological Science, Oregon State University, Corvallis, OR, USA
| | - Jenna Mayes
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Alexandra H Bettis
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Richard T Liu
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
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Mournet AM, Bal VH, Kleiman EM. Concordance Between the Ask Suicide Screening Questions (ASQ) and Self-Injurious Thoughts and Behaviors Interview-Self Report (SITBI-SR) Among Autistic and Non-Autistic Adults. Arch Suicide Res 2024; 28:905-916. [PMID: 37641571 DOI: 10.1080/13811118.2023.2252027] [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] [Indexed: 08/31/2023]
Abstract
OBJECTIVE This study sought to examine concordance between two commonly used measures of suicidal thoughts and behaviors: the Ask Suicide-Screening Questions (ASQ) and the Self-Injurious Thoughts and Behaviors Interview-Self Report (SITBI-SR). Agreement was operationalized as the presence past month suicidal ideation and lifetime suicide attempts. To explore the utilization of these tools among neurodiverse samples, we also examined the concordance across autistic and non-autistic adults. METHODS The sample consisted of 200 individuals recruited online. Half of the sample self-reported a diagnosis of autism. A series of Cohen's kappas and confidence intervals were computed to assess agreement between the ASQ and SITBI-SR. Cohen's kappa was computed separately for each set of comparisons for the autistic and non-autistic samples. RESULTS Past month suicidal ideation had a kappa of 0.61 (95%CI = 0.48-0.73). The kappa for lifetime suicide attempts was 0.86 (95%CI = 0.78-0.94). There were no significant differences in agreement between the two measures for autistic versus non-autistic individuals. CONCLUSIONS Current findings suggest that the ASQ and SITBI-SR have high concordance with one another. Given that the ASQ and the SITBI-SR are both validated in the general population and that concordance was high and not significantly different based on autism status, the current study provides preliminary evidence that the ASQ and the SITBI-SR function similarly for autistic individuals.HIGHLIGHTSPeople do not always respond consistently to different STB assessment methods.Findings suggest that the ASQ and SITBI-SR have high concordance with one another.Evidence provided that these measures function similarly for autistic individuals.
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Lyu XC, Chen C, Lee LH, Akkadechanunt T, Yang CI, Tao XB. Dealing With a Stressful Extra Duty: The Intrapersonal Conflict Experiences of Nurses Caring for Survivors of Suicide Attempts on Medical-Surgical Wards. Int J Ment Health Nurs 2024. [PMID: 38951125 DOI: 10.1111/inm.13386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 06/10/2024] [Accepted: 06/19/2024] [Indexed: 07/03/2024]
Abstract
Nurses are the frontline professionals caring for patients who have attempted suicide. When clinical nurses learn from medical records or nursing handover, or are proactively informed by patients or family members, that the patients they are caring for have suicidal tendencies, they often experience pressure and face challenges. However, little attention has been given to the experiences of the nurses caring for patients with suicidal intent on medical and surgical wards. We aimed to address this knowledge gap. The purpose of this study was to explore medical and surgical nurses' experiences, especially the internal conflicts they might experience while caring for patients who have a history of attempted suicide. A qualitative descriptive design and semi-structured interviews were used in this study. Twenty-three nurses were recruited and interviewed individually. Data were analysed by qualitative content analysis. The focus of this paper is to examine the emergent theme of intrapersonal conflict experienced by the participants. Nurses' experiences can be clustered into two themes: (1) Pity and annoyance and (2) Hard work does not necessarily pay off. Intrapersonal conflict was identified by participants as considerable fear and anxiety about the possibility of a patient's suicide, as well as a mixture of pity for and annoyance with the patients. Nurses feel sorry for such patients, but they are also annoyed by the extra work required to prevent suicide attempts in the ward. Additionally, having limited time and ability, they see that their hard work does not necessarily pay off and may sometimes lead to punishment. Our findings raise serious concerns about the adequacy of the knowledge of the nurses, their competence and their difficulties in caring for such patients. In addition, there is a need to provide them with appropriate on-the-job education and immediate emotional support relevant to caring for survivors of suicide attempts.
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Affiliation(s)
- Xiao-Chen Lyu
- Outpatient Operating Room, The First Affiliated Hospital of Wannan Medical College, Anhui, China
| | - Cheng Chen
- Department of Pain, The Affiliated Hospital of Chengdu University, Sichuan, China
| | - Li-Hung Lee
- Department of Nursing, Hungkuang University, Taichung, Taiwan
| | | | - Cheng-I Yang
- Department of Nursing, Hungkuang University, Taichung, Taiwan
| | - Xiu-Bin Tao
- Department of Nursing, The First Affiliated Hospital of Wannan Medical College, Anhui, China
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Pao M, Horowitz L. Palliative care and suicidality: Complicated conversations at two ends of the spectrum. Pediatr Blood Cancer 2024; 71:e30956. [PMID: 38511908 PMCID: PMC11039356 DOI: 10.1002/pbc.30956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Maryland Pao
- Office of the NIMH Clinical Director, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa Horowitz
- Office of the NIMH Clinical Director, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
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Do L, Piper K, Barczyk AN, Shahidullah JD, Lawson KA. Universal Suicidality Screening in a Pediatric Emergency Department to Improve Mental Health Safety Risk. J Emerg Nurs 2024; 50:354-363. [PMID: 38530699 DOI: 10.1016/j.jen.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/12/2024] [Accepted: 01/27/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Suicide is the second leading cause of death for youth 12 to 18 years of age. Suicidal ideation can be predictive of suicide attempt, so screening for suicidal ideation by emergency nurses can help identify those at risk and facilitate timely intervention. This study evaluates the use of a universal suicide screening using the Patient Safety Screener 3 and the Columbia Suicide Severity Rating Scale to identify youth ages 12 to 18 years experiencing suicide risk and assess factors predictive of suicide risk level. METHODS We conducted a retrospective cohort study using data from patients presenting to the emergency department at an acute care hospital that uses a universal screening program for suicide risk. We determined the frequency of positive screens and performed multivariate analyses to identify predictive factors of scoring high on the Columbia Suicide Severity Rating Scale. RESULTS Notably, 9.1% of patients were experiencing some level of suicide risk; 10% of those with positive scores had no mental health history and were not presenting for a mental health reason. After controlling for other independent variables, insurance status, mental health presentation, and known mental health history were significantly associated with Columbia Suicide Severity Rating Scale score. DISCUSSION Universal screening for suicide risk in pediatric emergency departments by nurses is critical for all patients older than 12 years, given that we identified patients at risk of suicide who presented for non-mental health reasons. These patients may not have been identified or referred to treatment if they were not screened for suicidality increasing risk of future suicide attempt.
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Yang C, Huebner ES, Tian L. Prediction of suicidal ideation among preadolescent children with machine learning models: A longitudinal study. J Affect Disord 2024; 352:403-409. [PMID: 38387673 DOI: 10.1016/j.jad.2024.02.070] [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: 08/19/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Machine learning (ML) has been widely used to predict suicidal ideation (SI) in adolescents and adults. Nevertheless, studies of accurate and efficient models of SI prediction with preadolescent children are still needed because SI is surprisingly prevalent during the transition into adolescence. This study aimed to explore the potential of ML models to predict SI among preadolescent children. METHODS A total of 4691 Chinese children (54.89 % boys, Mage = 10.92 at baseline) and their parents completed relevant measures at baseline and the children provided 6-month follow-up data for SI. The current study compared four ML models: Random Forest (RF), Decision Tree (DT), Support Vector Machine (SVM), and Multilayer Perceptron (MLP), to predict SI and to identify variables with predictive value based on the best-performing model among Chinese preadolescent children. RESULTS The RF model achieved the highest discriminant performance with an AUC of 0.92, accuracy of 0.93 (balanced accuracy = 0.88). The factors of internalizing problems, externalizing problems, neuroticism, childhood maltreatment, and subjective well-being in school demonstrated the highest values in predicting SI. CONCLUSION The findings of this study suggested that ML models based on the observation and assessment of children's general characteristics and experiences in everyday life can serve as convenient screening and evaluation tools for suicide risk assessment among Chinese preadolescent children. The findings also provide insights for early intervention.
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Affiliation(s)
- Chi Yang
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents, South China Normal University, Ministry of Education, Guangzhou 510631, People's Republic of China; School of Psychology, South China Normal University, Guangzhou 510631, People's Republic of China
| | - E Scott Huebner
- Department of Psychology, University of South Carolina, Columbia, SC 29208, USA
| | - Lili Tian
- Philosophy and Social Science Laboratory of Reading and Development in Children and Adolescents, South China Normal University, Ministry of Education, Guangzhou 510631, People's Republic of China.
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Rappolt EL, Hadenfeldt CJ. Using Virtual Reality to Increase Nurses' Knowledge of Adolescent Suicide Precautions. J Contin Educ Nurs 2024; 55:165-168. [PMID: 38063800 DOI: 10.3928/00220124-20231130-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Adolescents are disproportionately impacted by suicide, making it imperative nurses know how to identify those at high risk of suicide and provide safe care in the hospital setting. The purpose of this pilot study was to determine the efficacy of a virtual escape room as a learning strategy to increase nursing knowledge of suicide precautions for adolescent patients. METHOD A 360-degree virtual escape room was developed to increase nursing knowledge of hospital policy related to suicide. Small groups of participants navigated through two virtual hospital rooms with embedded clues and questions related to suicide screening and precautions. Pretest-posttest questionnaires were used to measure changes in knowledge. RESULTS Nurses demonstrated improved knowledge of hospital policy following completion of the activity. Participants also expressed a high level of satisfaction with this form of learning. CONCLUSION The use of a virtual escape room was an effective method for educating nurses on standards related to suicide prevention. [J Contin Educ Nurs. 2024;55(4):165-168.].
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Lowry NJ, Goger P, Hands Ruz M, Ye F, Cha CB. Suicide Risk Screening Tools for Pediatric Patients: A Systematic Review of Test Accuracy. Pediatrics 2024; 153:e2023064172. [PMID: 38356410 DOI: 10.1542/peds.2023-064172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/16/2024] Open
Abstract
CONTEXT Health care settings have increasingly adopted universal suicide risk screening tools into nonpsychiatric pediatric care; however, a systematic review examining the accuracy of these tools does not yet exist. OBJECTIVE Identify and review research on the test accuracy of suicide risk screening tools for pediatric patients in nonpsychiatric medical settings. DATA SOURCES PubMed and PsycINFO were searched to identify peer-reviewed articles published before March 23, 2023. STUDY SELECTION Articles that quantified the accuracy of a suicide risk screening tool (eg, sensitivity, specificity) in a nonpsychiatric medical setting (eg, primary care, specialty care, inpatient or surgical units, or the emergency department) were included. DATA EXTRACTION A total of 13 studies were included in this review. Screening tool psychometric properties and study risk of bias were evaluated. RESULTS Sensitivity among individual studies ranged from 50% to 100%, and specificity ranged from 58.8% to 96%. Methodological quality was relatively varied, and applicability concerns were low. When stratifying results by screening tool, the Ask Suicide-Screening Questions and Computerized Adaptive Screen for Suicidal Youth had the most robust evidence base. LIMITATIONS Because of considerable study heterogeneity, a meta-analytic approach was deemed inappropriate. This prevented us from statistically testing for differences between identified screening tools. CONCLUSIONS The Ask Suicide-Screening Questions and Computerized Adaptive Screen for Suicidal Youth exhibit satisfactory test accuracy and appear promising for integration into clinical practice. Although initial findings are promising, additional research targeted at examining the accuracy of screening tools among diverse populations is needed to ensure the equity of screening efforts.
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Affiliation(s)
- Nathan J Lowry
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, New York
| | - Pauline Goger
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, New York
| | - Maria Hands Ruz
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, New York
| | - Fangfei Ye
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, New York
| | - Christine B Cha
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, New York
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10
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Klein DN. Assessment of Depression in Adults and Youth. Assessment 2024; 31:110-125. [PMID: 37081793 DOI: 10.1177/10731911231167446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
This article selectively reviews the key issues and measures for the assessment of depressive disorders and symptoms in youth and adults. The first portion of the article addresses the nature and conceptualization of depression and some key issues that must be considered in its assessment. Next, the diagnostic interview and clinician- and self-administered rating scales that are most widely used to diagnose, screen for, and assess the severity of depression in adults and youth are selectively reviewed. In addition, the assessment of three transdiagnostic clinical features (anhedonia, irritability, and suicidality) that are frequently associated with both depression and other forms of psychopathology is discussed. The article concludes with some broad recommendations for assessing depression in research and clinical practice and suggestions for future research.
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Bullington C, Kroenke K. P4 suicidality screener: Literature synthesis and results from two randomized trials. Gen Hosp Psychiatry 2023; 85:177-184. [PMID: 37948795 DOI: 10.1016/j.genhosppsych.2023.11.004] [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: 08/10/2023] [Revised: 11/05/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To synthesize the literature on use of the P4 suicidality screener since its introduction in 2010 and to summarize results from 2 randomized clinical trials. METHOD A PubMed search was conducted from 2010 to 2023 to retrieve studies reporting on use of the P4. Also, data was extracted from the CAMMPS and SCOPE trials in which the P4 was periodically administered over 12 months when the 9th item of the PHQ-9 was endorsed. RESULTS A total of 21 research studies using the P4 were found, of which 12 provided some data on P4 findings. Additionally, another 7 protocol papers reported intended use of the P4 as a study measure. In our 2 trials, the 9th item was endorsed 259 (12.5%) times in 2068 administrations of the PHQ-9. Higher risk suicidal ideation was identified in 4.1% (12/294) of CAMMPS participants and 2.8% (7/250) of SCOPE participants. No suicide attempts occurred over the 12 months in either trial. CONCLUSIONS The P4 has had moderate use as a brief suicidality screener and is an efficient way to identify the small proportion of depressed patients with higher risk suicidality. Studies comparing the P4 with other common suicidality screeners would further inform use.
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Affiliation(s)
- Craig Bullington
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kurt Kroenke
- Regenstrief Institute, Inc, Indianapolis, IN, USA.
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Brousseau-Paradis C, Lesage A, Larue C, Labelle R, Giguère CÉ, Rassy J. Suicidality and mood disorders in psychiatric emergency patients: Results from SBQ-R. Int J Ment Health Nurs 2023; 32:1301-1314. [PMID: 37150928 DOI: 10.1111/inm.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 05/09/2023]
Abstract
Patients with mood disorders are at high risk of suicidality, and emergency departments (ED) are essential in the management of this risk. This study aims to (1) describe the suicidal thoughts and behaviours of patients with mood disorders who come to ED; (2) assess the psychometric properties of the Suicidal Behaviours Questionnaire-Revised (SBQ-R) in a psychiatric ED; and (3) determine the best predictors of suicidality for these patients. A total of 300 participants with mood disorders recruited for the Signature Bank of the Institut universitaire en santé mentale de Montréal (IUSMM) were retained. Suicidality was assessed using the SBQ-R. Other clinical and demographic details were recorded. Bivariate analyses, correlations and multivariate regression analyses were conducted. SBQ-R's internal consistency, construct and convergent validities were also tested. In the Patient Health Questionnaire-9 (PHQ-9), 53.3% of the sample stated they had suicidal or self-harm thoughts in the last 2 weeks. The mean score obtained at the SBQ-R was 8.3. Multivariate analysis found that SBQ-R scores were associated with depressive symptoms and substance use, especially alcohol, accounting for 44.3% of the model variance. Cronbach's alpha was 0.81 [0.78, 0.84] and factor loadings for items 1-4 were 0.68, 0.88, 0.54, and 0.85, respectively. The confirmatory factor analysis indicated that the model fit the data well. The SBQ-R is a brief and valid instrument that can easily be used in busy emergency departments to assess suicide risk. Depressive symptoms and alcohol use shall also be assessed, as they are determinants of increased risk of suicidality.
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Affiliation(s)
- Camille Brousseau-Paradis
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
- Department of Psychiatry, University of Montreal, Montréal, Quebec, Canada
| | - Alain Lesage
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
- Department of Psychiatry, University of Montreal, Montréal, Quebec, Canada
- Quebec Network on Suicide, Mood Disorders and Associated Disorders, Montréal, Quebec, Canada
| | - Caroline Larue
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
- Faculty of Nursing, University of Montreal, Montréal, Quebec, Canada
- Quebec Network on Nursing Intervention Research, Montréal, Quebec, Canada
| | - Réal Labelle
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
- Department of Psychiatry, University of Montreal, Montréal, Quebec, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, Quebec, Canada
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, Quebec, Canada
| | - Charles-Édouard Giguère
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
| | - Jessica Rassy
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montréal, Quebec, Canada
- Quebec Network on Suicide, Mood Disorders and Associated Disorders, Montréal, Quebec, Canada
- Quebec Network on Nursing Intervention Research, Montréal, Quebec, Canada
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, Quebec, Canada
- School of Nursing, University of Sherbrooke, Montréal, Quebec, Canada
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Schluessel S, Halfter K, Haas C, Kroenke K, Lukaschek K, Gensichen J. Validation of the German Version of the P4 Suicidality Tool. J Clin Med 2023; 12:5047. [PMID: 37568448 PMCID: PMC10420186 DOI: 10.3390/jcm12155047] [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: 05/05/2023] [Revised: 07/21/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023] Open
Abstract
For general practitioners (GPs), it may be challenging to assess suicidal ideation (SI) in patients. Although promising instruments exist for the use in primary care, only a few have been validated in German. The objectives of this study were to examine the validity of the brief P4 screener for assessing SI in a cross-sectional study including outpatients. Inclusion criteria were a PHQ-9 score ≥ 10 or an affirmative answer to its SI item. Construct validity of the P4 was examined by comparison with the four-item Suicide Behaviors Questionnaire-Revised (SBQ-R), the PHQ-9 (convergent), and the positive mental health (PMH) scale (divergent). The study sample included 223 patients (mean age 47.61 ± 15 years; 61.9% women) from 20 primary care practices (104 patients) and 10 psychiatric/psychotherapeutic clinics (119 patients). The first three items of the P4 correlate positively with most of the four items of the reference standard SBQ-R (convergent validity); the fourth item of the P4 (preventive factors) correlates significantly with the PMH scale. The most common preventive factor (67%) is family or friends. The German P4 screener can be used to assess SI in outpatient care. It explores preventive or protective factors of suicide, which may support the GP's decision on treatment. We recommend a further clinical interview for patients flagged by P4 assessment in order to more formally assess suicidal risk.
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Affiliation(s)
- Sabine Schluessel
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (S.S.); (C.H.); (J.G.)
| | - Kathrin Halfter
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians University, 81377 Munich, Germany;
| | - Carolin Haas
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (S.S.); (C.H.); (J.G.)
- Graduate Program “POKAL—Predictors and Outcomes in Primary Care Depression Care” (DFG-GrK 2621), 80336 Munich, Germany
| | - Kurt Kroenke
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
- Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Karoline Lukaschek
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (S.S.); (C.H.); (J.G.)
- Graduate Program “POKAL—Predictors and Outcomes in Primary Care Depression Care” (DFG-GrK 2621), 80336 Munich, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, 80336 Munich, Germany; (S.S.); (C.H.); (J.G.)
- Graduate Program “POKAL—Predictors and Outcomes in Primary Care Depression Care” (DFG-GrK 2621), 80336 Munich, Germany
- DZPG (German Center for Mental Health), 80336 Munich, Germany
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Donnelly HK, Han Y, Kim S, Lee DH. Predictors of suicide ideation among South Korean adolescents: A machine learning approach. J Affect Disord 2023; 329:557-565. [PMID: 36828148 DOI: 10.1016/j.jad.2023.02.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND The current study developed a predictive model for suicide ideation among South Korean (Korean) adolescents using a comprehensive set of factors across demographic, physical and mental health, academic, social, and behavioral domains. The aim of this study was to address the pressing public health concerns of adolescent suicide in Korea and the methodological limitations of suicidal research. METHODS This study used machine learning methods (decision tree, logistic regression, naive Bayes classifier) to improve the accuracy of predicting suicidal ideation and related factors among a nationally representative sample of Korean middle school students (N = 6666). RESULTS Factors within all domains, including demographic characteristics, physical and mental health, and academic, social, and behavioral, were important in predicting suicidal thoughts among Korean adolescents, with mental health being the most important factor. LIMITATIONS The predictive model of the current research does not infer causality, and there may have been some loss of information due to measurement issues. CONCLUSIONS Study results provide insights for taking a multidimensional approach when identifying adolescents at risk of suicide, which may be used to further address their needs through intervention programs within the school setting. Considering the cultural stigma attached to disclosing suicidal ideation and behavior, the current study proposes the need for a preventive screening process based on the observation and assessment of adolescents' general characteristics and experiences in everyday life.
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Affiliation(s)
- Hayoung Kim Donnelly
- Boston University, Department of Counseling Psychology and Applied Human Development, USA.
| | - Yoonsun Han
- Seoul National University, Department of Social Welfare, South Korea.
| | - Suna Kim
- Seoul National University, Department of International Studies, South Korea.
| | - Dong Hun Lee
- Sungkyunkwan University, Traumatic Stress Center, Department of Education, South Korea.
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Horowitz LM, Ryan PC, Wei AX, Boudreaux ED, Ackerman JP, Bridge JA. Screening and Assessing Suicide Risk in Medical Settings: Feasible Strategies for Early Detection. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:145-151. [PMID: 37201144 PMCID: PMC10172561 DOI: 10.1176/appi.focus.20220086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Early detection of risk is a key suicide prevention strategy. Given that most individuals who die by suicide visit a health care provider in the year leading up to their death, medical settings are ideal venues for identifying those at elevated risk and bridging them to life-saving care. Clinicians are presented with an opportunity to engage in proactive suicide prevention efforts through practical and adaptable suicide risk screening, assessment, and management processes. Psychiatrists and mental health clinicians are well positioned to assist nonpsychiatric clinicians on the frontlines of this public health problem. This article discusses the importance of identifying people at elevated suicide risk through screening, differentiates screening from assessment procedures, and presents practical strategies for implementing evidence-based screening and assessment tools into practice as part of a three-tiered clinical pathway. Specifically, this article discusses key components that guide embedding suicide prevention strategies into the workflows of busy medical settings.
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Affiliation(s)
- Lisa M Horowitz
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland (Horowitz, Ryan, Wei); Department of Emergency Medicine, Department of Psychiatry, and Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux); Center for Suicide Prevention and Research, Big Lots Behavioral Health Pavilion, Nationwide Children's Hospital, Columbus, Ohio (Ackerman, Bridge); Department of Psychiatry and Behavioral Health (Ackerman, Bridge) and Department of Pediatrics (Bridge), College of Medicine, The Ohio State University, Columbus
| | - Patrick C Ryan
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland (Horowitz, Ryan, Wei); Department of Emergency Medicine, Department of Psychiatry, and Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux); Center for Suicide Prevention and Research, Big Lots Behavioral Health Pavilion, Nationwide Children's Hospital, Columbus, Ohio (Ackerman, Bridge); Department of Psychiatry and Behavioral Health (Ackerman, Bridge) and Department of Pediatrics (Bridge), College of Medicine, The Ohio State University, Columbus
| | - August X Wei
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland (Horowitz, Ryan, Wei); Department of Emergency Medicine, Department of Psychiatry, and Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux); Center for Suicide Prevention and Research, Big Lots Behavioral Health Pavilion, Nationwide Children's Hospital, Columbus, Ohio (Ackerman, Bridge); Department of Psychiatry and Behavioral Health (Ackerman, Bridge) and Department of Pediatrics (Bridge), College of Medicine, The Ohio State University, Columbus
| | - Edwin D Boudreaux
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland (Horowitz, Ryan, Wei); Department of Emergency Medicine, Department of Psychiatry, and Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux); Center for Suicide Prevention and Research, Big Lots Behavioral Health Pavilion, Nationwide Children's Hospital, Columbus, Ohio (Ackerman, Bridge); Department of Psychiatry and Behavioral Health (Ackerman, Bridge) and Department of Pediatrics (Bridge), College of Medicine, The Ohio State University, Columbus
| | - John P Ackerman
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland (Horowitz, Ryan, Wei); Department of Emergency Medicine, Department of Psychiatry, and Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux); Center for Suicide Prevention and Research, Big Lots Behavioral Health Pavilion, Nationwide Children's Hospital, Columbus, Ohio (Ackerman, Bridge); Department of Psychiatry and Behavioral Health (Ackerman, Bridge) and Department of Pediatrics (Bridge), College of Medicine, The Ohio State University, Columbus
| | - Jeffrey A Bridge
- Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland (Horowitz, Ryan, Wei); Department of Emergency Medicine, Department of Psychiatry, and Department of Population and Quantitative Health Sciences, Chan Medical School, University of Massachusetts, Worcester (Boudreaux); Center for Suicide Prevention and Research, Big Lots Behavioral Health Pavilion, Nationwide Children's Hospital, Columbus, Ohio (Ackerman, Bridge); Department of Psychiatry and Behavioral Health (Ackerman, Bridge) and Department of Pediatrics (Bridge), College of Medicine, The Ohio State University, Columbus
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16
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Shim EJ, Ha H, Kim BR, Kim SM, Moon JY, Hwang JH, Hahm BJ. The Multi-dimensional Assessment of Suicide Risk in Chronic illness-20 (MASC-20): Development and validation. Gen Hosp Psychiatry 2023; 83:140-147. [PMID: 37187033 DOI: 10.1016/j.genhosppsych.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND We developed and tested the psychometric properties of the Multi-dimensional assessment of suicide risk in chronic illness-20 (MASC-20), which assess suicidal behavior (SB), and its associated distress in chronic physical illness (CPI). METHODS Items were developed by incorporating inputs from patient interviews, a review of existing instruments, and expert consultations. Pilot testing with 109 patients and field testing with 367 patients with renal, cardiovascular, and cerebrovascular diseases were conducted. We analyzed Time (T) 1 data to select items and T2 data to examine psychometric properties. RESULTS Forty preliminary items were selected through pilot testing; 20 were finalized from field testing. Optimal internal consistency (α = 0.94) and test-retest reliability (Intra class correlation coefficient = 0.92) of the MASC-20 supported reliability. Good fit of the four-factor model (physical distress, psychological distress, social distress, and SB) from exploratory structural equation modeling demonstrated factorial validity. Its correlations with MINI suicidality (r = 0.59) and the Schedule of Attitudes Toward Hastened Death-abbreviated scores (r = 0.62) indicated convergent validity. Higher MASC-20 scores in patients with clinical levels of depression and anxiety and low health status demonstrated known-group validity. The MASC-20 distress score predicted SB beyond known SB risk factors, supporting incremental validity. A cutoff score of 16 was optimal for identifying suicide risk. The area under the curve was within a moderately accurate range. The sum of sensitivity and specificity (1.66) indicated diagnostic utility. LIMITATIONS MASC-20's applicability to other patient populations and its sensitivity to change requires testing. CONCLUSIONS The MASC-20 appears to be a reliable and valid tool for assessing SB in CPI.
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Affiliation(s)
- Eun-Jung Shim
- Department of Psychology, Pusan National University, Busan, Republic of Korea
| | - Hyeju Ha
- Department of Psychology, Pusan National University, Busan, Republic of Korea
| | - Bo-Ram Kim
- Department of Rehabilitation Medicine, Gyeongin Regional Rehabilitation Hospital, Incheon, Republic of Korea
| | - Sun Mi Kim
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Jung Yoon Moon
- Department of Psychiatry, Chamjoeun Hospital, Gwangju-si, Gyeongi-do, Republic of Korea
| | - Jin Ho Hwang
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Bong-Jin Hahm
- Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.
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17
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Ongeri L, Theuri C, Nyawira M, Penninx BWJH, Tijdink JK, Kariuki SM, Newton CRJC. Risk of suicidality in mental and neurological disorders in low and middle-income countries: A systematic review and meta-analysis. Compr Psychiatry 2023; 123:152382. [PMID: 36905857 DOI: 10.1016/j.comppsych.2023.152382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/07/2023] [Accepted: 02/28/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Both fatal and nonfatal suicidal behaviours are important complications of mental, neurological, and substance use disorders (MNSDs) worldwide. We aimed at quantifying the association of suicidal behaviour with MNSDs in Low and Middle Income Countries (LMICs) where varying environmental and socio-cultural factors may impact outcome. METHODS We conducted a systematic review and meta-analysis to report the associations between MNSDs and suicidality in LMICs and the study-level factors of these associations. We searched the following electronic databases: PUBMED, PsycINFO, MEDLINE, CINAHL, World Cat, and Cochrane library for studies on suicide risk in MNSDs, with a comparison/control group of persons without MNSDs, published from January 1, 1995 to September 3, 2020. Median estimates were calculated for relative risks for suicide behaviour and MNSDs, and when appropriate, these were pooled using random effects metanalytic model. This study was registered with PROSPERO, CRD42020178772. RESULTS The search identified 73 eligible studies: 28 were used for quantitative synthesis of estimates and 45 for description of risk factors. Studies included came from low and upper middle-income countries with a majority of these from Asia and South America and none from a low-income country. The sample size was 13,759 for MNSD cases and 11,792 hospital or community controls without MNSD. The most common MNSD exposure for suicidal behaviour was depressive disorders (47 studies (64%)), followed by schizophrenia spectrum, and other psychotic disorders (28 studies (38%)). Pooled estimates from the meta-analysis were statistically significant for suicidal behaviour with any MNSDs (odds ratios (OR) = 1∙98 (95%CI = 1∙80-2∙16))) and depressive disorder (OR = 3∙26 (95%CI = 2∙88-3∙63))), with both remaining significant after inclusion of high-quality studies only. Meta-regression identified only hospital-based studies (ratio of OR = 2∙85, CI:1∙24-6∙55) and sample size (OR = 1∙00, CI:0∙99-1∙00) as possible sources of variability in estimates. Risk for suicidal behaviour in MNSDs was increased by demographic factors (e.g., male sex, and unemployment), family history, psychosocial context and physical illness. INTERPRETATION There is an association between suicidal behaviour and MNSDs in LMICs, the association is greater for depressive disorder in LMICs than what has been reported in High Income Countries (HICs). There is urgent need to improve access for MNSDs care in LMICs. FUNDING None.
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Affiliation(s)
- Linnet Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
| | - Cyrus Theuri
- Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Miriam Nyawira
- Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Joeri K Tijdink
- Department of Ethics, Law and Humanities, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Symon M Kariuki
- Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya; Department of Public Health, Pwani University, Kilifi, Kenya
| | - Charles R J C Newton
- Neuroscience Unit, Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya; Department of Psychiatry, University of Oxford, United Kingdom
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18
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Kim HJ, Kim S, Son Y, Youn I, Lee K. Reliability and Validity of the Korean Version of the Ask Suicide-Screening Questions (ASQ). J Korean Med Sci 2023; 38:e41. [PMID: 36786085 PMCID: PMC9925327 DOI: 10.3346/jkms.2023.38.e41] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/14/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The Ask Suicide-Screening Questions (ASQ) tool is a simple suicide screening tool developed to screen patient suicide risk (SR). The purpose of this study was to verify the reliability and validity of the ASQ tool in hospitalized patients. METHODS The internal consistency and test-retest reliability of the South Korean version of the ASQ tool were verified in 99 hospitalized patients admitted to a tertiary medical institution in Seoul. To verify the correlations and validity of each convergence with other scales, the Mini-International Neuropsychiatric Interview (MINI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Satisfaction with Life Scale (SWLS) were also conducted to determine convergent and discriminant validity. Then, the receiver operating characteristic (ROC) curve diagnosis values for suicide and depression levels with the highest correlations were analyzed. RESULTS As a result, Cronbach's alpha was 0.826, and when each item was removed sequentially, Cronbach's alpha ranged from 0.736-0.840, showing stable internal consistency. Most of the corrected item-total correlation were over 0.500; however, a relatively low correlation was shown for the fourth and fifth questions, which had values of 0.429 and 0.410, respectively. The test-retest reliability was 0.830, and the MINI and PHQ-9 showed high values of 0.872 and 0.672, respectively. The area under the curve (AUC) according to the ASQ diagnosis value was also the highest for the MINI (0.936). CONCLUSION The validity and reliability of the South Korean version of the ASQ tool were demonstrated. Through this validation, the ASQ tool can be used for simple suicide risk screening (SRS) in hospitalized patients.
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Affiliation(s)
- Hyun-Jin Kim
- School of Nursing, Hanyang University, Seoul, Korea
| | - Sunhae Kim
- Department of Psychiatry, College of Medicine, Hanyang University, Seoul, Korea
| | - Youkyoung Son
- Department of Nursing, Hanyang University Medical Center, Seoul, Korea
| | - Insook Youn
- Department of Nursing, Hanyang University Medical Center, Seoul, Korea
| | - Kounseok Lee
- Department of Psychiatry, College of Medicine, Hanyang University, Seoul, Korea.
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Powsner S, Goebert D, Richmond JS, Takeshita J. Suicide Risk Assessment, Management, and Mitigation in the Emergency Setting. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:8-17. [PMID: 37205029 PMCID: PMC10172543 DOI: 10.1176/appi.focus.20220072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Suicide is a serious public health issue and is a leading cause of death worldwide. Suicidal ideation is a common presentation in emergency department (ED) settings, with many nuanced complications. Therefore, understanding screening, assessment, and mitigation is paramount to successful encounters with individuals presenting to emergency settings in psychiatric crises. Screening helps to identify the few people at risk within a large group. Assessment seeks to decide whether a specific individual is at significant risk. Mitigation aims to reduce the risk of suicide or of a serious attempt for a person at risk. These aims cannot be achieved with perfect reliability, but some approaches are more effective than others. Suicide screening specifics are important, even to individual practitioners, because a positive screen triggers assessment. Most practitioners understand assessment well: beginning with early psychiatric training, they are taught signs and symptoms suggesting that a patient might be at risk of suicide. Mitigating suicide risk is increasingly important to reduce the misery of ED boarding for patients awaiting psychiatric admission. For many patients, hospital admission is unnecessary if support, monitoring, and contingency plans are workable. For any individual patient, there may be a complicated mix of findings, risks, and interventions. Evidence-based screening and assessment tools are inadequate for the possible complexities, making care of individual patients dependent on good clinical assessment. The authors review the available evidence and offer experienced recommendations for challenges not yet thoroughly researched.
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Affiliation(s)
- Seth Powsner
- Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut (Powsner); Department of Psychiatry, John A. Burns School of Medicine (Goebert, Takeshita), and Office of Public Health Studies (Goebert), University of Hawaii, Honolulu; Department of Psychiatry, Tufts University School of Medicine, Tufts University, Medford, Massachusetts, and Jamaica Plain Department of Veterans Affairs (VA) Medical Center, VA Boston Health Care System, Boston (Richmond); Department of Psychiatry, Queen's Medical Center, Honolulu (Goebert, Takeshita)
| | - Deborah Goebert
- Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut (Powsner); Department of Psychiatry, John A. Burns School of Medicine (Goebert, Takeshita), and Office of Public Health Studies (Goebert), University of Hawaii, Honolulu; Department of Psychiatry, Tufts University School of Medicine, Tufts University, Medford, Massachusetts, and Jamaica Plain Department of Veterans Affairs (VA) Medical Center, VA Boston Health Care System, Boston (Richmond); Department of Psychiatry, Queen's Medical Center, Honolulu (Goebert, Takeshita)
| | - Janet S Richmond
- Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut (Powsner); Department of Psychiatry, John A. Burns School of Medicine (Goebert, Takeshita), and Office of Public Health Studies (Goebert), University of Hawaii, Honolulu; Department of Psychiatry, Tufts University School of Medicine, Tufts University, Medford, Massachusetts, and Jamaica Plain Department of Veterans Affairs (VA) Medical Center, VA Boston Health Care System, Boston (Richmond); Department of Psychiatry, Queen's Medical Center, Honolulu (Goebert, Takeshita)
| | - Junji Takeshita
- Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut (Powsner); Department of Psychiatry, John A. Burns School of Medicine (Goebert, Takeshita), and Office of Public Health Studies (Goebert), University of Hawaii, Honolulu; Department of Psychiatry, Tufts University School of Medicine, Tufts University, Medford, Massachusetts, and Jamaica Plain Department of Veterans Affairs (VA) Medical Center, VA Boston Health Care System, Boston (Richmond); Department of Psychiatry, Queen's Medical Center, Honolulu (Goebert, Takeshita)
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20
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Balestrieri M, Rucci P, Murri MB, Caruso R, D'Agostino A, Ferrari S, Nanni MG, Palagini L, Pini S, Politi P, Rocchetti M, Zerbinati L, Grassi L. Suicide risk in medically ill inpatients referred to consultation-liaison psychiatric services: A multicenter study. J Affect Disord 2022; 319:329-335. [PMID: 36057291 DOI: 10.1016/j.jad.2022.08.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/23/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this multicenter study was to investigate the suicide risk in medically ill patients admitted to six Italian hospitals for whom a consultation-liaison intervention was requested. METHODS Participants completed socio-demographic and clinical report forms and the Brief Illness Perception Questionnaire. Suicidality was assessed using the P4 screener that investigates the presence of Past suicide attempts, Plans to commit a suicide, Probability of completing suicide, and Preventive factors. Participants were categorized as being at no, low or high suicide risk. Univariate and multivariable associations of categorical and continuous variables with suicide risk were investigated using multinomial logistic regression. RESULTS Of the 641 inpatients, with mean age 60 years (SD = 16.9) and 49.2 % male, 13.2 % were at high suicidal risk (HR), 7.6 % low risk (LR) and 79.2 % no risk. Contacts with psychiatrists in the previous six months were associated with LR and HR (OR = 2.159 and 2.634, respectively), ongoing benzodiazepine use was associated with a threefold likelihood of LR (OR = 3.005), and the experienced intensity of illness symptoms was associated with LR and HR (OR = 1.257 and OR = 1.248, respectively). CL psychiatrists prescribed appropriate psychotropic drugs and activated liaison interventions and psychological support for the level of suicidal risk. LIMITATIONS The use of self-report measures bears the risk of recall bias. CONCLUSIONS Our findings based on psychiatric consultations in the general hospital underscore the need to include suicide risk in the routine assessment of inpatients referred to CL psychiatric services and to plan an appropriate management of suicidal risk after discharge.
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Affiliation(s)
- Matteo Balestrieri
- Psychiatric Unit, Department of Medicine, University of Udine, Udine, Italy.
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy.
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy.
| | - Armando D'Agostino
- Department of Health Sciences, University of Milan, Italy; Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy.
| | - Silvia Ferrari
- Department of Diagnostic-Clinical Medicine and Public Health, Section of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy.
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy.
| | - Laura Palagini
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy.
| | - Pierluigi Politi
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy.
| | - Matteo Rocchetti
- Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy.
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy.
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy.
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21
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Weiss SJ, Simeonova DI, Koleva H, Muzik M, Clark KD, Ozerdem A, Cooper B, Ammerman RT. Potential paths to suicidal ideation and suicide attempts among high-risk women. J Psychiatr Res 2022; 155:493-500. [PMID: 36183603 DOI: 10.1016/j.jpsychires.2022.09.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 08/22/2022] [Accepted: 09/16/2022] [Indexed: 10/31/2022]
Abstract
Although men are more likely to die by suicide, women experience a greater and more rapidly increasing rate of suicidal ideation (SI) and are 3 times more likely to attempt suicide than men. Despite this increased risk, little is known about factors that contribute to SI or suicide attempts (SA) among women. We examined factors associated with SI and SA among women and identified mood-related symptoms that differentiate women who reported attempting suicide from those who did not. Women at elevated risk for depression from across the U.S. (N = 3372; age 18 to 90) completed a survey regarding depression, anxiety, sociodemographic and reproductive status, behavioral/mental health history, and exposure to adversity. Structural equation modeling and logistic regression were used to analyze the data. Variables with the most significant relationships to SI were severity of depression (OR = 5.2, p = 0.000) and perceived stress (OR = 1.18, p = 0.000) while frequency of suicidal thoughts (OR = 3.3, p = 0.000), family history of a depression diagnosis (OR = 1.6, p = 0.000) and exposure to violence (OR = 1.9, p = 0.000) had the strongest association with SA. Childhood abuse/trauma was associated with SA (OR = 1.13, p = 0.000) but not SI. 'Feeling bad about themselves, a failure, or having let themselves or their family down' was the symptom that most clearly differentiated women who attempted suicide from women who reported suicidal ideation but no SA. The salience of childhood abuse and domestic/community violence to women's risk for a suicide attempt reinforces previous findings that these adversities may differentiate suicide risk for women versus men. Continued research is essential to understand varied paths that may lead to suicidal behavior among women, some which appear unrelated to the frequency or intensity of their suicidal thoughts.
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Affiliation(s)
- Sandra J Weiss
- University of California, 2 Koret Way, Box 0608, San Francisco, CA, 94143, USA.
| | - Diana I Simeonova
- Emory University, 12 Executive Park Drive NE, Atlanta, GA, 30329, USA.
| | - Hristina Koleva
- University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Maria Muzik
- University of Michigan, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA.
| | - Kristen D Clark
- University of New Hampshire, 4 Library Way, Hewitt Hall, Durham, NH, 03824, USA.
| | - Aysegul Ozerdem
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Bruce Cooper
- University of California, 2 Koret Way, Box 0610, San Francisco, CA, 94143, USA.
| | - Robert T Ammerman
- University of Cincinnati, Cincinnati Children's Hospital, 333 Burnet Avenue, ML7039, Cincinnati, OH, 45229, USA.
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Saab MM, Murphy M, Meehan E, Dillon CB, O'Connell S, Hegarty J, Heffernan S, Greaney S, Kilty C, Goodwin J, Hartigan I, O'Brien M, Chambers D, Twomey U, O'Donovan A. Suicide and Self-Harm Risk Assessment: A Systematic Review of Prospective Research. Arch Suicide Res 2022; 26:1645-1665. [PMID: 34193026 DOI: 10.1080/13811118.2021.1938321] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Suicide and self-harm are widespread yet underreported. Risk assessment is key to effective self-harm and suicide prevention and management. There is contradicting evidence regarding the effectiveness of risk assessment tools in predicting self-harm and suicide risk. This systematic review examines the effect of risk assessment strategies on predicting suicide and self-harm outcomes among adult healthcare service users. METHOD Electronic and gray literature databases were searched for prospective research. Studies were screened and selected by independent reviewers. Quality and level of evidence assessments were conducted. Due to study heterogeneity, we present a narrative synthesis under three categories: (1) suicide- and self-harm-related outcomes; (2) clinician assessment of suicide and self-harm risk; and (3) healthcare utilization due to self-harm or suicide. RESULTS Twenty-one studies were included in this review. The SAD PERSONS Scale was the most used tool. It outperformed the Beck Scale for Suicide Ideation in predicting hospital admissions and stay following suicide and self-harm, yet it failed to predict repeat suicide and self-harm and was not recommended for routine use. There were mixed findings relating to clinician risk assessment, with some studies recommending clinician assessment over structured tools, whilst others found that clinician assessment failed to predict future attempts and deaths. CONCLUSIONS There is insufficient evidence to support the use of any one tool, inclusive of clinician assessment of risk, for self-harm and suicidality. The discourse around risk assessment needs to move toward a broader discussion on the safety of patients who are at risk for self-harm and/or suicide.HIGHLIGHTSThere is insufficient evidence to support using standalone risk assessment tools.There are mixed findings relating to clinician assessment of risk.Structured professional judgment is widely accepted for risk assessment.
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Ayer L, Horowitz LM, Colpe L, Lowry NJ, Ryan PC, Boudreaux E, Little V, Erban S, Ramirez-Estrada S, Schoenbaum M. Clinical Pathway for Suicide Risk Screening in Adult Primary Care Settings: Special Recommendations. J Acad Consult Liaison Psychiatry 2022; 63:497-510. [PMID: 35618222 PMCID: PMC9489622 DOI: 10.1016/j.jaclp.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/21/2022]
Abstract
Suicide is a serious public health concern. On average, 80% of suicide decedents had contact with primary care within 1 year of their suicide. This and other research underscore the importance of screening for suicide risk within primary care settings, and implementation of suicide risk screening is already underway in many practices. However, while primary care practices may be familiar with screening for other mental health concerns (e.g., depression), many feel uncomfortable or unprepared for suicide risk screening. To meet the increasing demand for evidence-based suicide-risk-screening guidance, we provide a clinical pathway for adult primary care practices (to include family medicine, internal medicine, women's health). The pathway was developed by experts with research, clinical expertise, and experience in suicide risk screening and primary care. We also provide detailed guidance to aid primary care practices in their decisions about how to implement the clinical pathway.
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Affiliation(s)
| | | | - Lisa Colpe
- National Institute of Mental Health, North Bethesda, MD
| | | | | | | | | | - Stephen Erban
- University of Massachusetts Medical School, Worcester, MA
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24
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Moss AC, Roberts AJ, Yi-Frazier JP, Read KL, Taplin CE, Weaver KW, Pihoker C, Hirsch IB, Malik FS. Identifying Suicide Risk in Adolescents and Young Adults With Type 1 Diabetes: Are Depression Screeners Sufficient? Diabetes Care 2022; 45:1288-1291. [PMID: 35147698 PMCID: PMC9375441 DOI: 10.2337/dc21-1553] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/20/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Examine the utility of suicide-risk items embedded within depression screeners for identifying the presence of suicide risk in adolescents and young adults (AYA) with type 1 diabetes. RESEARCH DESIGN AND METHODS Sensitivity, specificity, and predictive value of self-report of suicide risk on the Patient Health Questionniaire-9 (PHQ-9) were compared with the pediatric psychologist-administered Columbia-Suicide Severity Rating Scale (C-SSRS) as the reference standard for AYA with type 1 diabetes seen in a multidisciplinary AYA Diabetes Program clinic. RESULTS Of 133 participants, 9.8% and 11.3% reported suicide risk on the PHQ-9 and C-SSRS, respectively. Sensitivity of the PHQ-9 risk item was 53.3% (95% CI 27.4%-77.7%), specificity was 95.7% (95% CI 89.9%-98.4%), positive predictive value was 61.5% (95% CI 32.3%-84.9%), and negative predictive value was 94.2% (95% CI 87.9-97.4%). CONCLUSIONS Depression screeners appear to under-identify AYA with type 1 diabetes who may otherwise be at risk for suicide.
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Affiliation(s)
- Ashley C Moss
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Alissa J Roberts
- Department of Pediatrics, University of Washington, Seattle, WA.,Seattle Children's Research Institute, Seattle, WA
| | | | - Kendra L Read
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Craig E Taplin
- Department of Pediatrics, University of Washington, Seattle, WA.,Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Kathryn W Weaver
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA.,Seattle Children's Research Institute, Seattle, WA
| | - Irl B Hirsch
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA
| | - Faisal S Malik
- Department of Pediatrics, University of Washington, Seattle, WA.,Seattle Children's Research Institute, Seattle, WA
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25
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Rufino KA, Kerr T, Beyene H, Hill RM, Saxena J, Kurian S, Saxena K, Williams L. Suicide Screening in a Large Pediatric Emergency Department: Results, Feasibility, and Lessons Learned. Pediatr Emerg Care 2022; 38:e1127-e1132. [PMID: 34534161 DOI: 10.1097/pec.0000000000002530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study examined the feasibility of screening all patients entering the ED using the Columbia-Suicide Severity Rating Scale as well as examining the rates of suicide ideation and attempts endorsed by adolescents who present at the ED. METHODS This study used a sample of 12,113 patients between the ages of 11 and 19 years. RESULTS Results revealed that 13.5% of the participants endorsed passive suicide ideation in the month leading up to their ED visit and 11.3% of the participants reported active ideation in the prior month. Results also revealed that patients whose chief complaints were coded as psychiatric or medical trauma were more likely to endorse either active or passive suicidal ideation than other presenting problems. Patients with a psychiatric or medical trauma chief complaint were also more likely to report lifetime suicidal behavior and suicidal behavior 3 months before the ED visit. CONCLUSIONS In addition to findings, implications, feasibility, and lessons learned are discussed for other institutions or departments considering implementation of a widespread screening.Highlights:• Suicide screenings were implemented in a large pediatric emergency department.• One in 5 endorsed suicidal ideation or behavior regardless of presenting problem.• Feasibility and lessons learned are discussed for others hoping to implement a widespread screening.
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Affiliation(s)
| | | | | | - Ryan M Hill
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | | | - Sherin Kurian
- Department of Psychiatry, Baylor College of Medicine
| | - Kirti Saxena
- Department of Psychiatry, Baylor College of Medicine
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26
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Betthauser LM, Hoffberg AS, Stearns-Yoder KA, Harmon M, Coons D, Brenner LA. A systematic review of suicidal ideation and behaviors among adults with spinal cord injury. J Spinal Cord Med 2022:1-12. [PMID: 35192444 DOI: 10.1080/10790268.2022.2029282] [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: 10/19/2022] Open
Abstract
CONTEXT Suicide is a public health crisis within the United States. Individuals with spinal cord injury (SCI) are vulnerable to negative outcomes such as suicide. OBJECTIVE This systematic review describes frequency of suicidal ideation (SI) and behaviors (suicide attempt [SA] and deaths) among samples of adults living with SCI. Associated risk and protective factors of SI and suicidal behaviors were also explored. METHODS On July 7, 2021, OVID Medline, EMBASE, OVID PsycINFO, Web of Science Core Collection, CINAHL, Cochrane Library, and Google Scholar databases were searched for SI, SA, and deaths by suicide among adults with a history of SCI. Risk of bias (RoB) was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool. Results were synthesized descriptively considering the likely impact of RoB. The updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 reporting method was used. RESULTS Sixty-nine articles were included. Frequency of SI and SAs within study samples ranged from 4% to 67%, and 0% to approximately 66%, respectively. While assessment methods for SI and SA widely varied, suicide deaths data sources were more consistent. Studies assessing SI and SA generally had high RoB and the overall strength of evidence was low. Stronger observational study designs assessing death by suicide had low RoB and the overall strength of evidence was high. Very few studies examined protective factors. DISCUSSION Findings support previous work. Quality of evidence, and therefore confidence in the frequency of these outcomes, was impacted by the use of assessment measures without sufficient psychometric properties. The field will benefit from use of psychometrically sound measures to assess for SI, SA and suicide deaths. Furthermore, additional work is needed to elucidate risk and protective factors and to clearly characterize samples to increase generalizability of findings to the larger SCI community, including standardized reporting of SCI characteristics (e.g. use of American Spinal Injury Association classification system). Ultimately, improved suicide assessment and risk management is expected to prevent suicide among those living with SCI. REGISTRATION CRD42020164686.
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Affiliation(s)
- Lisa M Betthauser
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (RM MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMR VAMC), Eastern Colorado Health Care System, Aurora, Colorado, USA.,Department of Physical Medicine & Rehabilitation (PM&R), University of Colorado, Aurora, Colorado, USA
| | - Adam S Hoffberg
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (RM MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMR VAMC), Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Kelly A Stearns-Yoder
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (RM MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMR VAMC), Eastern Colorado Health Care System, Aurora, Colorado, USA.,Department of Physical Medicine & Rehabilitation (PM&R), University of Colorado, Aurora, Colorado, USA
| | - Matthew Harmon
- Department of Physical Medicine & Rehabilitation (PM&R), University of Colorado, Aurora, Colorado, USA
| | - David Coons
- Department of Physical Medicine & Rehabilitation (PM&R), University of Colorado, Aurora, Colorado, USA.,Spinal Cord Injury/Disorder Clinic, RMR VAMC, Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Lisa A Brenner
- VA Rocky Mountain Mental Illness Research Education and Clinical Center (RM MIRECC), Rocky Mountain Regional Veterans Affairs Medical Center (RMR VAMC), Eastern Colorado Health Care System, Aurora, Colorado, USA.,Department of Physical Medicine & Rehabilitation (PM&R), University of Colorado, Aurora, Colorado, USA.,Departments of Psychiatry, & Neurology, University of Colorado, Aurora, Colorado, USA
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27
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Cervantes PE, Seag DEM, Baroni A, Gerson R, Knapp K, Tay ET, Wiener E, Horwitz SM. Universal Suicide Risk Screening for Youths in the Emergency Department: A Systematic Review. Psychiatr Serv 2022; 73:53-63. [PMID: 34106741 PMCID: PMC8655012 DOI: 10.1176/appi.ps.202000881] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To address escalating youth suicide rates, universal suicide risk screening has been recommended in pediatric care settings. The emergency department (ED) is a particularly important setting for screening. However, EDs often fail to identify and treat mental health symptoms among youths, and data on implementation of suicide risk screening in EDs are limited. A systematic review was conducted to describe the current literature on universal suicide risk screening in EDs, identify important gaps in available studies, and develop recommendations for strategies to improve youth screening efforts. METHODS A systematic literature search of PubMed, MEDLINE, CINAHL, PsycINFO, and Web of Science was conducted. Studies focused on universal suicide risk screening of youths served in U.S. EDs that presented screening results were coded, analyzed, and evaluated for reporting quality. Eleven studies were included. RESULTS All screening efforts occurred in teaching or children's hospitals, and research staff administered suicide screens in eight studies. Thus scant information was available on universal screening in pediatric community ED settings. Large variation was noted across studies in participation rates (17%-86%) and in positive screen rates (4.1%-50.8%), although positive screen rates were influenced by type of presenting concern (psychiatric versus nonpsychiatric). Only three studies concurrently examined barriers to screening, providing little direction for effective implementation. STROBE guidelines were used to rate reporting quality, which ranged from 51.9% to 87.1%, with three studies having ratings over 80%. CONCLUSIONS Research is needed to better inform practice guidelines and clinical pathways and to establish sustainable screening programs for youths presenting for care in EDs.
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Affiliation(s)
- Paige E. Cervantes
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Dana E. M. Seag
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Ruth Gerson
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Katrina Knapp
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY
- Pediatric Emergency Medicine, Bellevue Hospital Center, New York, NY
| | - Ee Tein Tay
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY
- Pediatric Emergency Medicine, Bellevue Hospital Center, New York, NY
| | - Ethan Wiener
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY
- Pediatric Emergency Medicine, Bellevue Hospital Center, New York, NY
| | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
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28
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Hugunin J, Yuan Y, Rothschild AJ, Lapane KL, Ulbricht CM. Risk factors associated with suicidal ideation in newly admitted working-age nursing home residents. J Affect Disord 2021; 295:243-249. [PMID: 34482055 PMCID: PMC8551025 DOI: 10.1016/j.jad.2021.08.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Suicide is a leading cause of mortality in the United States and recent initiatives have sought to increase monitoring of suicide risk within healthcare systems. Working-age adults (22-64 years) admitted to nursing homes may be at risk for suicidal ideation, yet little is known about this population. METHODS The national nursing home database, Minimum Dataset 3.0, was used to identify 323,436 working-age adults newly admitted to a nursing home in 2015. This cross-sectional study sought to describe sociodemographic and clinical characteristics, examine behavioral health treatment received, and determine resident characteristics associated with suicidal ideation at nursing home admission using logistic regression and reports adjusted odds ratios (aOR). RESULTS Suicidal ideation was present among 1.27% of newly admitted working-age residents. Almost 25% of those with suicidal ideation had no psychiatric diagnosis. Factors associated with increased odds of suicidal ideation included younger age (aOR 1.90), admission from the community (aOR 1.92) or a psychiatric hospital (aOR 2.38), cognitive impairments (aOR 1.46), pain (aOR 1.40), rejection of care (aOR 1.91), and psychiatric comorbidity (aOR depression: 1.91, anxiety disorder: 1.11, bipolar disorder: 1.62, schizophrenia: 1.32, post-traumatic stress disorder: 1.17). LIMITATIONS Due to the cross-sectional nature of this study, no causal inferences about suicidal ideation and the explored covariates can be made. The Minimum Dataset 3.0 has only one measure of suicidal ideation the Patient Health Questionnaire. CONCLUSION Factors other than psychiatric diagnosis may be important in identifying newly admitted working-age nursing home residents who require on-going suicide screening and specialized psychiatric care.
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Affiliation(s)
- Julie Hugunin
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
| | - Yiyang Yuan
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Anthony J Rothschild
- Department of Psychiatry, University of Massachusetts Medical School and UMass Memorial Health Care, Worcester, MA, United States
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Christine M Ulbricht
- National Institute of Mental Health, National Institutes of Health, the Department of Health and Human Services, Bethesda, MD, United States (formerly: Departments of Population and Quantitative Health Sciences & Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States)
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29
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Horowitz LM, Wharff EA, Mournet AM, Ross AM, McBee-Strayer S, He JP, Lanzillo EC, White E, Bergdoll E, Powell DS, Solages M, Merikangas KR, Pao M, Bridge JA. Validation and Feasibility of the ASQ Among Pediatric Medical and Surgical Inpatients. Hosp Pediatr 2021; 10:750-757. [PMID: 32826283 DOI: 10.1542/hpeds.2020-0087] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To validate the use of a brief suicide risk screening tool, the Ask Suicide-Screening Questions (ASQ) instrument, in pediatric inpatient medical and surgical settings. METHODS Pediatric patients (10-21 years) hospitalized on inpatient medical and surgical units were recruited through convenience sampling for participation in a cross-sectional instrument validation study. The Suicidal Ideation Questionnaire was used as a standard criterion to validate the ASQ. Patient opinions about screening and parent consent to enroll in a suicide risk screening study were assessed to determine the feasibility of administering the ASQ in this venue. RESULTS A total of 600 pediatric medical inpatients were screened. Compared with the gold standard, the ASQ had strong psychometric properties, with a sensitivity of 96.67% (95% confidence interval [CI]: 82.78 to 99.92), a specificity of 91.05% (95% CI: 88.40 to 93.27), a negative predictive value of 99.81% (95% CI: 98.93 to 99.99), and an area under curve of 0.94 (95% CI: 0.90 to 0.97). Only 3 participants (0.5%) had acute positive screen results on the ASQ, endorsing current suicidal ideation, whereas 77 participants (12.8%) screened nonacute positive, and 48 participants (8.0%) reported a past suicide attempt. CONCLUSIONS The brief 4-item ASQ is a valid tool to detect elevated suicide risk in pediatric medical and surgical inpatients. Our findings also reveal that screening is feasible in terms of detection of suicidal thoughts and behaviors and is acceptable to parents and patients.
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Affiliation(s)
| | | | | | | | - Sandra McBee-Strayer
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | - Jian-Ping He
- Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, Maryland;
| | | | - Erina White
- Boston Children's Hospital, Boston, Massachusetts
| | - Emory Bergdoll
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Martine Solages
- Children's National Hospital, Washington, District of Columbia; and
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, Maryland
| | | | - Jeffrey A Bridge
- The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio.,College of Medicine, The Ohio State University, Columbus, Ohio
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30
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Rozel JS. Broken promise: Challenges in achieving effective universal suicide screening. Acad Emerg Med 2021; 28:705-706. [PMID: 33349999 DOI: 10.1111/acem.14199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 02/06/2023]
Affiliation(s)
- John S. Rozel
- UPMC Western Psychiatric Hospital Pittsburgh Pennsylvania USA
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31
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Champion A, Oswald F, Pedersen CL. Technology-facilitated sexual violence and suicide risk: A serial mediation model investigating bullying, depression, perceived burdensomeness, and thwarted belongingness. THE CANADIAN JOURNAL OF HUMAN SEXUALITY 2021. [DOI: 10.3138/cjhs.2020-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Technology-facilitated sexual violence (TFSV) is a comprehensive term used to encompass all sexually aggressive and harassing behaviours involving technology. Although there is a growing knowledge base investigating the prevalence and consequences of TFSV, relatively little is known about the extent of aversive consequences experienced by victims and the pathways from victimization to suicidal affect, cognition, and behaviour. TFSV victimization and subsequent suicide has been a subject of several high-profile media cases in recent years. We examine TFSV in relation to two main constructs embedded within the interpersonal theory of suicide (ITS), perceived burdensomeness (PB) and thwarted belongingness (TB). Quantitative survey data ( N = 521) were used to evaluate PB and TB in the context of TFSV victimization. The objective was to analyze mechanisms underlying the relationship between TFSV victimization and suicide risk, exclusively accounting for mediating factors of interpersonal victimization, depression, TB, and PB. Pathway results showed that TFSV victimization increased suicide risk (i.e., suicidal affect, cognition, and behaviour) serially through bullying, depression, and PB—suggesting a cascade of victimization experiences. TB was not a significant mediator. The present results provide novel quantitative data substantiating the devastating risks of TFSV victimization and thus evidencing the importance of legal protections for victims of TFSV.
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Affiliation(s)
- Amanda Champion
- Department of Criminology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Flora Oswald
- Departments of Psychology and Women’s, Gender, & Sexuality Studies, The Pennsylvania State University, University Park, Pennsylvania, United States
| | - Cory L. Pedersen
- Department of Psychology, Kwantlen Polytechnic University, Surrey, British Columbia, Canada
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32
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Snyder DJ, Jordan BA, Aizvera J, Innis M, Mayberry H, Raju M, Lawrence D, Dufek A, Pao M, Horowitz LM. From Pilot to Practice: Implementation of a Suicide Risk Screening Program in Hospitalized Medical Patients. Jt Comm J Qual Patient Saf 2020; 46:417-426. [PMID: 32473966 PMCID: PMC11173372 DOI: 10.1016/j.jcjq.2020.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hospitals have become an important venue for identifying medical patients with occult suicidality. This article describes the implementation of a quality improvement project at the National Institutes of Health Clinical Center (NIHCC) to systematically screen medical/surgical inpatients for suicide risk. METHODS Using the Plan-Do-Study-Act method, questions from the Ask Suicide-Screening Questions (ASQ) tool were deployed with medical inpatients aged 10 years and older between April 2018 and April 2019. Goals included the development of a training program, policy and procedure review, electronic medical record integration and data collection, and ongoing management and troubleshooting. RESULTS A total of 4,284 patients were screened for suicide risk with a nurse screening compliance rate of 94.3%. Prevalence data on patients aged 10 years and older revealed an overall screen positive rate of 2.3% (97/4,284), with 3.1% of youth aged 10 to 24 years and 2.2% of adults screening positive. Of the 97 patients who screened positive, 96 were non-acute positive screens. Of the full sample, only 1 patient (0.02%) was deemed acute positive, requiring a 1:1 observer and full safety precautions. CONCLUSION Universal suicide risk screening was successfully implemented in the NIHCC without incurring a need for additional resources. The intermediate step of a brief suicide safety assessment is a critical part of the workflow, providing guidance for determining appropriate follow-up in a safe and efficient manner that spares limited mental health and hospital resources. Given the increasing suicide rates in the general population, medical venues offer important opportunities for early detection, assessment, and referral.
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33
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Becker JE, Smith JR, Hazen EP. Pediatric Consultation-Liaison Psychiatry: An Update and Review. PSYCHOSOMATICS 2020; 61:467-480. [PMID: 32482345 PMCID: PMC7194908 DOI: 10.1016/j.psym.2020.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022]
Abstract
Background In recent years, there has been an increasing burden of child and adolescent mental illness recognized in the United States, and the need for pediatric mental health care is growing. Pediatric consultation-liaison (C-L) psychiatrists are increasingly playing a role in the management of medical and psychiatric disease for pediatric patients. The field is a fast-moving one, with understanding of new neuropsychiatric disease entities; reformulation of prior disease entities; and new interdisciplinary treatments and models of care. Methods In this study, we aim to review recent advances in the field of pediatric C-L psychiatry, including new diagnostic entities, updated management of frequently encountered clinical presentations, and developments in systems of care. Conclusion The advances in pediatric C-L psychiatry are broad and serve to promote more streamlined, evidence-based care for the vulnerable population of psychiatrically ill pediatric medical patients. More work remains to determine the most effective interventions for the wide array of presentations seen by pediatric C-L psychiatrists.
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Affiliation(s)
- Jessica E Becker
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
| | - Joshua R Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Eric P Hazen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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34
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Validation of the Ask Suicide-Screening Questions for Adult Medical Inpatients: A Brief Tool for All Ages. PSYCHOSOMATICS 2020; 61:713-722. [PMID: 32487323 PMCID: PMC9773543 DOI: 10.1016/j.psym.2020.04.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Few brief suicide risk screening instruments are validated for use in both adult and pediatric medical populations. Using the pediatric Ask Suicide-Screening Questions (ASQ) development study as a model, this study aimed to determine whether the ASQ is a valid suicide risk-screening instrument for use among adults medical patients, as well as to evaluate a set of other potential screening questions for use in adults. METHODS Adult patients hospitalized on inpatient medical/surgical units from 4 hospitals were recruited to participate in a cross-sectional instrument-validation study. The 4-item ASQ and other candidate items were compared against the 25-item, previously validated Adult Suicidal Ideation Questionnaire as the criterion standard. RESULTS A total of 727 adult medical inpatients completed the screening process. Compared with the Adult Suicidal Ideation Questionnaire, the ASQ performed best among the full set of candidate items, demonstrating strong psychometric properties, with a sensitivity of 100% (95% confidence interval = 90%-100%), a specificity of 89% (95% confidence interval = 86%-91%), and a negative predictive value of 100% (95% confidence interval = 99%-100%). A total of 4.8% (35/727) of the participants screened positive for suicide risk based on the standard criterion Adult Suicidal Ideation Questionnaire. CONCLUSIONS The ASQ is a valid and brief suicide risk-screening tool for use among adults. Screening medical/surgical inpatients for suicide risk can be performed effectively for both adult and pediatric patients using this brief, primary screener.
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