Coping and suicide risk in high risk psychiatric patients

Positive psychological functioning, resilience and styles of coping as buffers against suicidal behaviours. A case-control study

BACKGROUND

Studies in the literature mainly focus on understanding the risk factors for suicide, giving little relevance to protective variables. This study aimed at exploring the specific contribution of protective variables (resilience, coping and psychological well-being) in hospitalized suicide attempt (SA) makers.

METHODS

We recruited 50 inpatients who made a SA before admission and 50 inpatients with no history of SA matched for DSM-5 diagnosis, gender and age. Protective variables were evaluated with: Brief COPE questionnaire, Dispositional Resilience Scale (DRS-15), Psychological Well-Being Scale (PWB-18). Psychopathological features and symptom severity were assessed with: Global Assessment of Functioning Scale (GAF), Rapid Dimensional Assessment Scale (SVARAD), Brief Psychiatric Rating Scale (BPRS), Clinical Global Impressions (CGI), Hamilton Depression Rating Scale (HDRS17).

RESULTS

The DRS-15 total score was significantly lower in SA makers. SA makers displayed significantly lower scores on the Engagement and Cognitive Restructuring subscales of the Brief COPE. On the PWB-18, the Self-Acceptance subscale score was lower in SA makers.

LIMITATIONS

The small sample size suggests the need for caution in interpreting the results. Matching was carried out by excluding diagnoses of personality disorders.

CONCLUSIONS

Patients hospitalized following a SA are more often diagnosed with personality disorders, have deficit areas concerning resilience and coping, and lower psychological well-being compared to patients without a SA. When approaching a patient who has committed a SA, it may be useful to evaluate protective variables as well as risk factors, and encourage the development of adaptive coping mechanisms and positive self-evaluation through more dynamic therapeutic paths.

Classifying coping strategies from suicide prevention safety plans

INTRODUCTION

Understanding the specific strategies individuals use to cope with their suicidal thoughts may have implications for suicide prevention. This study developed a classification system of coping strategies and applied this system to individual coping behaviors documented in a safety planning intervention smartphone application called Beyond Now.

METHOD

725 Beyond Now safety planning app users, aged 16 to over 55 years, entered coping strategies that were used to develop a classification system through content analysis. Entries were either user generated or selected from a list of suggested coping strategies, and 2960 entries were classified using the system.

RESULTS

Our classification system featured 11 distinct descriptive categories, with media consumption being the most popular coping strategy among Beyond Now users, followed by relaxation and self-care activities, exercise and creative activities. More than half (57%) of the entries were suggested coping strategies with the remainder being user-generated entries (43%).

CONCLUSION

A wide range of coping strategies were entered into safety plans, with activities that aim to either distract or provide reductions in emotional arousal common. Future research is needed to evaluate the efficacy of the coping strategies listed in safety plans.

Suicidal ideation in men during COVID-19: an examination of protective factors

BACKGROUND

Men account for three-quarters of all suicide deaths in many Western nations including Australia. Whilst extensive research has examined risk factors for suicidal ideation and behaviour in men, protective factors remain underexplored, particularly social support, resilience and coping behaviours. Such factors are important to examine particularly in the context of COVID-19, where enforced isolation (among other negative lifestyle effects) has created widespread risk for the development of suicidal ideation. This mixed-methods study aimed to examine associations of various protective factors with suicidal ideation in men, using data from an online survey conducted during the COVID-19 pandemic. In addition, we aimed to qualitatively investigate men's self-reported protective strategies when experiencing suicidal thoughts and behaviour.

METHODS

A convenience sample of 700 men (age M = 50.3 years; SD = 15.2 years) responded to an online survey including quantitative measures of suicidal ideation, planning and attempt, alongside employment and relationship status, coping, social support, resilience, and a qualitative free-text item gauging men's self-reported protective strategies. Multinomial logistic regression was applied to compare odds of sub-categories of suicide risk (ideation; planning) according to protective factors. Qualitative responses were analysed via thematic analysis.

RESULTS

Men in a relationship, and those lower in emotion-focused and avoidant coping reported lower odds of suicidal ideation. Maintaining employment throughout the pandemic was protective against suicidal ideation and planning; as was greater perceived social support from friends. Greater self-reported resilience was protective against suicidal ideation and planning. Qualitative analyses led to the development of two themes: coping and connecting, reflecting men's intra- and interpersonal management strategies; and sustaining selflessness, where men's imaginings of the collateral damage of their suicidal behaviour was protective against action on suicidal thoughts or plans.

CONCLUSIONS

Findings of this study speak to the nuanced roles of interpersonal connections, resilience and coping behaviours in protecting against suicidal ideation and planning in men. In addition, qualitative insights further cement men's identification with familial protector and/or provider roles as protective against suicidal action.

Suicide Ideation, Distress, and Peer Perceptions as Predictors of Substance Use

BACKGROUND

Substance use and suicide ideation are common behaviors that often overlap among college students. However, clues about their temporal relationship, as well as moderating factors (e.g., distress, peer perceptions of substance use), are understudied. Indeed, those with a history of suicide ideation may use avoidance coping (including substance use) to manage distress, underscoring the possibility of substance use as a response to suicide ideation, an oft-stressful experience in and of itself. Further, as a low sense of belongingness confers risk for suicide ideation, distress may increase compliance with perceived cultural norms, thus increasing substance use behavior. This study examined the effect of the suicide ideation-distress-peer perception interaction on substance use.

METHOD

Participants were 3,608 undergraduate students across eleven college campuses. Measures of past month substance use frequency, general distress, peer perceptions of substance use, and past year suicide ideation were utilized.

RESULTS

Suicidal ideation was associated with e-cigarette, marijuana, and illicit drug use. There were main effects of suicide ideation (on e-cigarette and marijuana use) and peer perceptions of substance use (on tobacco, alcohol, e-cigarette, and marijuana use), but not distress, on past 30-day substance use. Further, the three-way interaction of suicide ideation, distress, and peer perceptions of substance use predicted frequency of past month tobacco and illicit drug use.

CONCLUSIONS

Suicide ideation may be temporally linked to use of specific substances. Peer perception and distress may strengthen the suicide ideation-substance use relationship. These factors should be carefully considered when treating individuals with substance use.

Mechanisms through which executive dysfunction influences suicidal ideation in combat-exposed Iraq and Afghanistan veterans

OBJECTIVE

Executive dysfunction has previously been associated with suicidality, but it remains unclear how deficits in executive functioning contribute to increased suicidal thoughts and behaviors. Although it has been proposed that poorer executive functioning leads to difficulty generating and implementing appropriate coping strategies to regulate distress and inhibit suicidal thoughts and behaviors, studies have not systematically examined these relationships. Therefore, the present study examined various hypotheses to elucidate the mechanisms through which executive dysfunction influences suicidal ideation (SI) in combat-exposed Iraq/Afghanistan veterans.

METHOD

Veterans who endorsed SI were compared to those who denied SI on demographic and diagnostic variables and measures of neuropsychological functioning, psychological symptoms, coping styles, and combat experiences. Serial mediation models were tested to examine mechanistic relationships among executive functioning, psychological distress, coping, and SI.

RESULTS

Those who endorsed SI had worse executive functioning, greater psychological distress, and greater avoidant coping relative to those who denied SI. Serial mediation model testing indicated a significant indirect path, such that executive dysfunction increased psychological distress, which in turn increased avoidant coping, leading to SI.

CONCLUSIONS

Findings support and extend previous hypotheses regarding how executive functioning contributes to increased risk of suicidality via increased distress and avoidant coping. Intervention efforts focused on reducing suicidality may benefit from techniques that enhance executive functioning (e.g. computerized training, cognitive rehabilitation) and in turn reduce distress prior to targeting coping strategies.

Male-Type Depression Mediates the Relationship between Avoidant Coping and Suicidal Ideation in Men

Despite known links between men's avoidant coping behaviours (e.g., distraction, denial, substance use) and suicide risk, little research has explored the mechanisms underpinning this relationship. This study sought to examine whether male-type depression symptoms (e.g., anger, aggression, emotion suppression), assessed by the Male Depression Risk Scale, mediate the association between avoidant coping and suicide/self-harm ideation in men. Data were drawn from an online survey of a community sample of 606 Australian men (M age = 50.11 years; SD = 15.00), conducted during the COVID-19 pandemic. Mediation analyses were applied to examine the effect of male-type depression on the association between avoidant coping and suicidal/self-harm ideation, controlling for age, resilience and the experience of two psychosocial stressors during the COVID-19 pandemic (financial stress and government restrictions). Avoidant coping was associated with suicidal/self-harm ideation, r = 0.45, p < 0.001. Results supported a mediating role of male-type depression symptoms in this relationship, R²= 0.29, P_M = 0.36, p < 0.001, underscoring the importance of screening for male-type depression symptoms to better identify men at risk of suicidal/self-harm ideation. Results also suggest a need to support men to develop effective coping strategies, particularly in the context of common psychosocial stressors experienced during the COVID-19 pandemic and beyond.

Development of a Checklist for Predicting Suicidality Based on Risk and Protective Factors: The Gwangju Checklist for Evaluation of Suicidality

OBJECTIVE

The aim of the study was to develop a checklist for mental health clinicians to predict and manage suicidality.

METHODS

A literature review of the risk and protective factors for suicide was conducted to develop a checklist for evaluating suicidality.

RESULTS

The fixed risk factors included sex (male), age (older individuals), history of childhood adversity, and a family history of suicide. Changeable risk factors included marital status (single), economic status (poverty), physical illness, history of psychiatric hospitalization, and history of suicide attempts. Recent discharge from a mental hospital and a recent history of suicide attempts were also included. Manageable risk factors included depression (history and current), alcohol problems (frequent drinking and alcohol abuse), hopelessness, agitation, impulsivity, impaired reality testing, and command hallucinations. Protective factors included responsibility to family, social support, moral objections to suicide, religiosity, motivation to get treatment, ability to cope with stress, and a healthy lifestyle. A final score was assigned based on the sum of the risk and protective factor scores.

CONCLUSION

We believe that the development of this checklist will help mental health clinicians to better assess those at risk for suicidal behavior. Further studies are necessary to validate the checklist.

25(OH)D levels are decreased in patients with difficult-to-treat depression

Objectives

The aims of the study are i) to compare 25-hydroxyvitamin D (25(OH)D) levels between clinically depressed individuals with insufficient treatment response and healthy controls and ii) to test the association between 25(OH)D levels and different affective disorder diagnoses (i.e., major depressive disorder (MDD) single episode, MDD recurrent episode, chronic MDD, and dysthymia), as well as grade of suicidal ideation.

Method

We quantified serum 25(OH)D in 202 individuals with difficult-to-treat depression (DTD) and 41 healthy controls. Patients were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV-TR). ANCOVA was used to test differences in mean 25(OH)levels between depressed and controls, adjusting for sex, age, smoking, sampling season, ethnicity, somatic illness, and body mass index (BMI). Binary logistic regression models were used to test the association between depression and 25(OH)D levels.

Results

Patients with difficult-to-treat depression had significantly lower levels of 25(OH)D compared to healthy controls (ANCOVA, F = 4.89; p = 0.03). Thirty percent of the depressed patients were 25(OH)D deficient (<50 nmol/L) compared to 5% of the controls (Chi-squared test, χ2 = 11.38; p < 0.01). The odds for being depressed decreased significantly with 17% per 10 nmol/L increase of 25(OH)D (Binary logistic regression, p < 0.05).

Limitations

The cross-sectional design of the study precludes any conclusions about causality. A large part of the patients took psychotropic drugs and/or had somatic illnesses, which might have affected the results.

Conclusion

The results of the present study add to the body of evidence linking 25(OH)D deficiency and depression. Further investigations are warranted to better understand any clinical implications of this association.

An Analysis of Suicide Risk Factors among Farmers in the Midwestern United States

Research on the complex relationships of variables contributing to farmer suicide is limited. The purpose of the study was to examine factors associated with suicide risk through the use of standardized instruments measuring psychological (depression, anxiety), social (social support), and contextual factors. A questionnaire was completed by 600 farmers in the Midwestern United States. A multiple linear regression model was used to analyze associations with suicide risk (SBQ-R), including depression (PHQ-9), anxiety (GAD-7), Brief COPE subscales (BC), social support (MSPSS), and select demographic and farming characteristics. The only variable that emerged as having a significant relationship with the natural log-transformed suicide risk score was coping through self-blame. While suicidality is often considered the outcome of mental illness, our findings do not suggest that suicide risk among farmers is related to mental illness, and a further examination of self-blame as a coping strategy is warranted.

Factors Related to the Level of Depression and Suicidal Behavior Among Men With Diagnosed Depression, Physically Ill Men, and Healthy Men

Depression is the most common psychiatric disorder in people who die by suicide. Awareness of risk factors for suicide in depression is important for clinicians. The study was aimed at establishing models of factors related to the level of depression and suicidal behavior among men from three different groups-in men with depressive disorder, in comparison to men with physical disorder and healthy men. A total of 598 men were included in the study. The following questionnaires were used in research model: test with sociodemographic variables, AUDIT Test, Fagerström Test, Generalized Self-Efficacy Scale (GSES), Inventory for Measuring Coping with Stress (Mini-COPE), Resilience Evaluation Questionnaire (KOP-26), Suicide Behaviors Questionnaire-Revised (SBQ-R) by Osman, and Gotland Male Depression Scale. In men with depression, the positive factors strongly related to the intensity of depression and suicidal behavior were as follows: vocational education, active coping, turning toward religion, social competence for resilience, and bachelor status. The factors negatively related to the intensity of depression and suicidal behavior in this group were as follows: unemployed status, student status, low satisfaction with the financial situation, having children, history of mental disorders in family, alcohol addiction, and seeking instrumental support. In the group of men with physical disorders, the following protection factors were identified: the medium or small city as a place of living, active coping, venting, and personal competence. The following risk factors were identified in this group: psychiatric treatment in the past. In the group of healthy men, the following protective factors were identified: the medium city as a place of living, positive reappraisal, planning abilities, and personal and social competence for resilience. In this group, the following risk factors were identified: vocational and higher education, student status, satisfaction with the financial situation, having more than one children, the occurrence of mental disorders in the family, the occurrence of alcohol abuse in the family, and use of psychoactive substances as a strategy of dealing with stress. The risk factors identified in this study should be included in the clinical assessment of depression and suicidal behavior risk in male patients. There are some protective factors identified, including productive coping and personal and social competencies, which can be developed and should be especially considered and strengthened in mental health promotion programs aimed at men.

Time Geography, a Method in Psychiatric Nursing Care

Patients' life history is of primary interest in psychiatric nursing care. Our aim was to illustrate how we used time geography as a method to identify individuals' patterns in relation to certain situations in place. We have used interviews and diaries to construct life charts by hand and with a computer software program. By using time geography, we provide a rich amount of information, which can generate a broader picture of a person's life, to identify stressful as well as social aspects of a person's life. Patients with mental ill health need and value the therapeutic relationship using time geography.

Suicide: A Précis!

Background

Suicide remains a psychiatric emergency, tragedy, a public health burden, and for those aged 15-29, is the second leading cause of death globally. Stigma attached to psychiatric disorders and suicide means many people feel unable to seek help.

Aim of Work

We highlighted confusing nosology, psychopathology, neurobiological underpinnings, typology, and, risk factor pertinent to suicide. A road-map to the clinical assessment and management of suicide has also been provided. Last, but not least, we tried to dispel the long-held myths about suicide.

Methods

EMBASE, Ovid MEDLINE, PubMed, Scopus, Web of Science, and Cochrane Database of Systemic Reviews were searched for all relevant studies up to date of Jan, 2020.

Results

Suicide is self-inflicted death with evidence (explicit/implicit) of intention to die. Suicide reflects many disparate determinants release/relief, response-to the disordered thinking, religious, revenge, rebirth, reunification or rational. 5-HT deficiency appears central to the neurobiology of suicide. Durkheim proposed 4 types of suicide (egoistic, altruistic, anomic, fatalistic). Risk factors for suicide entail both static and dynamic factors. Dynamic factors encompass both clinical and situational variables. Shneidman's concepts of perturbation and psychache are very crucial to consider when assessing the risk. Suicide rating scales are only ancillary with the Modified high-risk construct scale balances vectors of suicidality versus survivality. Myths germane to suicide abound that need to be demystified. Psychiatric management capitalizes on determining a setting for treatment and supervision, attending to patient's safety, as well as working to establish a cooperative and collaborative physician-patient relationship. This entails both psychosocial 'package' and somatic treatments and the best outcomes mandate well-keeled combined approaches. Pharmacologic interventions aim chiefly at acute symptomatic relief. Recently, heaps of data accrue speaking to the idea of ground-breaking 'anti-suicidal' agents that might alleviate suicidal ideation (SI).

Conclusion

Suicide continues to be a complex public health problem of global calibre. It is variably tied to a myriad of risk factors underscoring likely etiological heterogeneity. That said, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is portrayed in the media. A host of psychotherapeutic, pharmacological, or neuromodulatory treatments of mental disorders are readily available that can alter this acrimonious trajectory.

The personal experience of severe suicidal behaviour leads to negative attitudes towards self- and other's suicidal thoughts and behaviours: A study of temperaments, coping strategies, and attitudes towards suicide among medical students

The attitudes individuals have towards suicidal behaviour, be it their own or others', and their capacity for developing specific coping strategies are influenced by affective temperaments that play a significant role in emotional regulation. However, few studies have investigated these specific patterns with a view to stratify them according to the severity of suicidal behaviours in medical students. The Pearson χ2 test for the comparison of categorical variables, the t-test for independent samples of continuous variables and logistic regression analysis were used to compare the association among temperaments, coping strategies, and attitudes towards suicide in a sample of medical students who attend the School of Medicine, Genoa. Severe suicidal thoughts and behaviours relative to those who were not at risk for suicide were also revealed. The severe suicidal thought and behaviour group had significantly more anxious and cyclothymic temperaments together with a higher use of dis-adaptive, lower emotional focus coping strategies, and higher self-reproaching, criticizing, and judgemental attitudes towards suicidality compared to the no severe suicidal thought and behaviour group. The identified pattern suggests the need for clinicians to carefully consider the complex interplay of clinical features which characterize severely at risk for suicide young adults in order to develop effective and comprehensive prevention strategies.