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Keefner T, Minton M. Acquired Capability for Suicide: An Evolutionary Concept Analysis. Issues Ment Health Nurs 2024; 45:734-745. [PMID: 38718381 DOI: 10.1080/01612840.2024.2346594] [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] [Indexed: 07/18/2024]
Abstract
While virtually all suicide attempters experience ideations, not all who think about suicide will attempt or die by suicide. The ideation-to-action framework has led to new theories distinguishing suicide ideators from suicide attempters. The framework suggests that suicide progresses on a spectrum of thoughts and behaviors with different identifiers and explanations. The concept of acquired capability for suicide (ACS), conceptualized by the Interpersonal Psychological Theory of Suicide, is the first to explain the movement from ideation to action. This concept analysis of ACS is timely and relevant for greater clarification of the role ACS has in the movement from ideation to action. Rodgers' evolutionary concept analysis method is used. The six-step evolutionary method highlights the concept's attributes, antecedents, and consequences and provides a basis for further inquiry and development rather than a final definition.
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Affiliation(s)
- Tamara Keefner
- Department of Nursing, University of South Dakota, Vermillion, South Dakota, USA
| | - Mary Minton
- South Dakota State University, Brookings, South Dakota, USA
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2
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Luo Z, Wang J, Zhou Y, Mao Q, Lang B, Xu S. Workplace bullying and suicidal ideation and behaviour: a systematic review and meta-analysis. Public Health 2023; 222:166-174. [PMID: 37544128 DOI: 10.1016/j.puhe.2023.07.007] [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: 12/15/2022] [Revised: 06/11/2023] [Accepted: 07/06/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES Suicidal ideation and behaviour are potential outcomes of workplace bullying. This review aimed to determine the extent of the association between workplace bullying and suicidal ideation and behaviour. STUDY DESIGN The study incorporated a systematic review and meta-analysis. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed to conduct a comprehensive systematic review and meta-analysis. A combination of subject terms and free words was used to search nine electronic databases. Two reviewers independently screened articles and extracted information according to the inclusion criteria. A meta-analysis was performed with averaged weighted correlations across samples using the STATA software (version 16.0) from pooled estimates of the main results from all studies. RESULTS In total, 25 articles of high or medium quality were included in the systematic review; 15 of these were included in the meta-analysis. The prevalence of suicidal ideation and behaviour was 18% and 4%, respectively. Individuals who experienced workplace bullying had 2.03-times and 2.67-times higher odds of reporting suicidal ideation and behaviour, respectively, after adjustment for confounding factors. Moderating and mediating factors may help reduce the risk of suicidal ideation and behaviour for individuals experiencing workplace bullying. CONCLUSION This study indicated that exposure to workplace bullying significantly increased the risk of suicidal ideation and behaviour.
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Affiliation(s)
- Z Luo
- Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (West China Hospital Sichuan University Tibet Chengdu Branch Hospital), No. 20 Ximianqiao Hengjie, Chengdu 610041, China.
| | - J Wang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 610041, China
| | - Y Zhou
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 610041, China
| | - Q Mao
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Shierqiao Road, Jinniu District, Chengdu 6100752, China
| | - B Lang
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Shierqiao Road, Jinniu District, Chengdu 6100752, China
| | - S Xu
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Shierqiao Road, Jinniu District, Chengdu 6100752, China
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Wastler HM, Núñez D. Psychotic experiences, emotion regulation, and suicidal ideation among Chilean adolescents in the general population. Front Psychiatry 2022; 13:983250. [PMID: 36465305 PMCID: PMC9710630 DOI: 10.3389/fpsyt.2022.983250] [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: 06/30/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022] Open
Abstract
Psychotic experiences are associated with increased risk for suicide. Despite this well-established finding, very little is known about factors that contribute to this relationship. The current study investigated the relationship between psychotic experiences, emotion regulation, and suicidal ideation among 1,590 Chilean adolescents in the general population. Participants completed self-report measures of psychotic experiences (Community Assessment of Psychic Experiences), emotion regulation (Emotion Regulation Questionnaire), depression (Patient Health Questionnaire-9), and suicidal ideation (Columbia Suicide Severity Rating Scale). Statistical analyses included Mann-Whitney U tests, point-biserial correlations, logistic regression, and moderation analyses. Results suggest that paranoid ideation, bizarre experiences, and perceptual abnormalities were moderately associated with suicidal ideation. Additionally, greater expressive suppression and cognitive reappraisal were associated with suicidal ideation. Results from the logistic regression indicate that paranoid ideation, perceptual abnormalities, and expressive suppression have the strongest relationship with suicidal ideation, even when controlling for depression and relevant demographic variables. Additionally, paranoid ideation interacted with expressive suppression to predict suicidal ideation, with expressive suppression having the strongest relationship with suicidal ideation when paranoid ideation was low to moderate. Taken together, these findings support the broader literature suggesting that emotion regulation might be a transdiagnostic risk factor for suicidal ideation. Additional longitudinal research is needed to examine whether expressive suppression and other maladaptive emotion regulation strategies serve as a mechanism for suicidal ideation both in the general population and among individuals with psychotic experiences.
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Affiliation(s)
- Heather M. Wastler
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, United States
| | - Daniel Núñez
- Faculty of Psychology, Universidad de Talca, Talca, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile
- Programa de Investigación Asociativa, Faculty of Psychology, Centro de Investigación en Ciencias Cognitivas, Universidad de Talca, Talca, Chile
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Stapelberg NJC, Bowman C, Woerwag-Mehta S, Walker S, Davies A, Hughes I, Michel K, Pisani AR, Van Engelen H, Delos M, Hageman T, Fullerton-Smith K, Krishnaiah R, McDowell S, Cameron A, Scales TL, Dillon C, Gigante T, Heddle C, Mudge N, Zappa A, Edwards M, Gutjahr S, Joshi H, Turner K. A lived experience co-designed study protocol for a randomised control trial: the Attempted Suicide Short Intervention Program (ASSIP) or Brief Cognitive Behavioural Therapy as additional interventions after a suicide attempt compared to a standard Suicide Prevention Pathway (SPP). Trials 2021; 22:723. [PMID: 34674732 PMCID: PMC8529364 DOI: 10.1186/s13063-021-05658-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Despite being preventable, suicide is a leading cause of death and a major global public health problem. For every death by suicide, many more suicide attempts are undertaken, and this presents as a critical risk factor for suicide. Currently, there are limited treatment options with limited underpinning research for those who present to emergency departments with suicidal behaviour. The aim of this study is to assess if adding one of two structured suicide-specific psychological interventions (Attempted Suicide Short Intervention Program [ASSIP] or Brief Cognitive Behavioural Therapy [CBT] for Suicide Prevention) to a standardised clinical care approach (Suicide Prevention Pathway [SPP]) improves the outcomes for consumers presenting to a Mental Health Service with a suicide attempt. METHODS This is a randomised controlled trial with blinding of those assessing the outcomes. People who attempt suicide or experience suicidality after a suicide attempt, present to the Gold Coast Mental Health and Specialist Services, are placed on the Suicide Prevention Pathway (SPP), and meet the eligibility criteria, are offered the opportunity to participate. A total of 411 participants will be recruited for the study, with 137 allocated to each cohort (participants are randomised to SPP, ASSIP + SPP, or CBT + SPP). The primary outcomes of this study are re-presentation to hospitals with suicide attempts. Presentations with suicidal ideation will also be examined (in a descriptive analysis) to ascertain whether a rise in suicidal ideation is commensurate with a fall in suicide attempts (which might indicate an increase in help-seeking behaviours). Death by suicide rates will also be examined to ensure that representations with a suicide attempt are not due to participants dying, but due to a potential improvement in mental health. For participants without a subsequent suicide attempt, the total number of days from enrolment to the last assessment (24 months) will be calculated. Self-reported levels of suicidality, depression, anxiety, stress, resilience, problem-solving skills, and self- and therapist-reported level of therapeutic engagement are also being examined. Psychometric data are collected at baseline, end of interventions, and 6,12, and 24 months. DISCUSSION This project will move both ASSIP and Brief CBT from efficacy to effectiveness research, with clear aims of assessing the addition of two structured psychological interventions to treatment as usual, providing a cost-benefit analysis of the interventions, thus delivering outcomes providing a clear pathway for rapid translation of successful interventions. TRIALS REGISTRATION ClinicalTrials.gov NCT04072666 . Registered on 28 August 2019.
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Affiliation(s)
- Nicolas J C Stapelberg
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
- Faculty Health Sciences and Medicine, Bond University, 14 University Drive, Robina, Queensland, 4226, Australia
| | - Candice Bowman
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia.
| | - Sabine Woerwag-Mehta
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
- Faculty Health Sciences and Medicine, Bond University, 14 University Drive, Robina, Queensland, 4226, Australia
| | - Sarah Walker
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Angela Davies
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
- Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Ian Hughes
- Office for Research Governance and Development, Gold Coast Health, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Konrad Michel
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anthony R Pisani
- Departments of Psychiatry and Pediatrics, University of Rochester, 300 Crittenden Blvd., BOX PSYCH, Rochester, NY, 14642, USA
| | - Heidy Van Engelen
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Mia Delos
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Tamara Hageman
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Kim Fullerton-Smith
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Ravikumar Krishnaiah
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Sarah McDowell
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Alison Cameron
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Trudy-Lee Scales
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Cherie Dillon
- Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Titta Gigante
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
- Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Cindy Heddle
- Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Natalie Mudge
- Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Anne Zappa
- Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Michelle Edwards
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
- Lived Experience Suicide Prevention Research Advisory Committee (this committee was convened specifically for this study and is supported by the Gold Coast Mental Health and Specialist Services Peer Workers), Southport, Australia
| | - Sigi Gutjahr
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Hitesh Joshi
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
| | - Kathryn Turner
- Department of Mental Health and Specialist Services Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Queensland, 4215, Australia
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Forkmann T, Glaesmer H, Paashaus L, Rath D, Schönfelder A, Juckel G, Gauggel S, Beginn-Göbel U, Teismann T. Testing the Four Main Predictions of the Interpersonal-Psychological Theory of Suicidal Behavior in an Inpatient Sample Admitted Due to Severe Suicidality. Behav Ther 2021; 52:626-638. [PMID: 33990238 DOI: 10.1016/j.beth.2020.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022]
Abstract
This study aimed to evaluate four main predictions of the Interpersonal Psychological Theory of Suicide (IPTS): the importance of perceived burdensomeness (PB), thwarted belongingness (TB), hopelessness (H), and capability for suicide (CS) for (passive/active) suicide ideation, suicide intent and suicide attempts. N = 308 psychiatric inpatients admitted due to severe suicidality (53.6% female: n = 165; age: M = 36.82, SD = 14.30, range: 18-81) completed self-report measures of TB, PB, H, CS and suicide ideation as well as interviews on suicide intent and suicide attempts. TB and PB were associated with (passive/active) suicidal ideation, whereas the three-way interaction PB, TB, and H was not associated with active suicide ideation. Fearlessness about death in conjunction with active suicidal ideation was not associated with suicide intent and the interaction of PB, TB, and CS was neither predictive of recent suicide attempt status nor lifetime number of suicide attempts. Given the cross-sectional nature of the data, conclusions on causality should be handled carefully. The results challenge the theoretical validity of the IPTS and its clinical utility-at least within the methodological limitations of the current study. Yet, findings underscore the importance of PB in understanding suicidality.
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Affiliation(s)
| | | | | | - Dajana Rath
- University of Duisburg-Essen; Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH, Aachen
| | | | - Georg Juckel
- LWL-University Hospital, Ruhr-Universität Bochum
| | - Siegfried Gauggel
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH, Aachen
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Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev 2021; 4:CD013668. [PMID: 33884617 PMCID: PMC8094743 DOI: 10.1002/14651858.cd013668.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most counties, often repeated, and associated with suicide. There has been a substantial increase in both the number of trials and therapeutic approaches of psychosocial interventions for SH in adults. This review therefore updates a previous Cochrane Review (last published in 2016) on the role of psychosocial interventions in the treatment of SH in adults. OBJECTIVES To assess the effects of psychosocial interventions for self-harm (SH) compared to comparison types of care (e.g. treatment-as-usual, routine psychiatric care, enhanced usual care, active comparator) for adults (aged 18 years or older) who engage in SH. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic reviews [CDSR]), together with MEDLINE, Ovid Embase, and PsycINFO (to 4 July 2020). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing interventions of specific psychosocial treatments versus treatment-as-usual (TAU), routine psychiatric care, enhanced usual care (EUC), active comparator, or a combination of these, in the treatment of adults with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratio (ORs) and their 95% confidence intervals (CIs). For continuous outcomes, we calculated mean differences (MDs) or standardised mean differences (SMDs) and 95% CIs. The overall quality of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS We included data from 76 trials with a total of 21,414 participants. Participants in these trials were predominately female (61.9%) with a mean age of 31.8 years (standard deviation [SD] 11.7 years). On the basis of data from four trials, individual cognitive behavioural therapy (CBT)-based psychotherapy may reduce repetition of SH as compared to TAU or another comparator by the end of the intervention (OR 0.35, 95% CI 0.12 to 1.02; N = 238; k = 4; GRADE: low certainty evidence), although there was imprecision in the effect estimate. At longer follow-up time points (e.g., 6- and 12-months) there was some evidence that individual CBT-based psychotherapy may reduce SH repetition. Whilst there may be a slightly lower rate of SH repetition for dialectical behaviour therapy (DBT) (66.0%) as compared to TAU or alternative psychotherapy (68.2%), the evidence remains uncertain as to whether DBT reduces absolute repetition of SH by the post-intervention assessment. On the basis of data from a single trial, mentalisation-based therapy (MBT) reduces repetition of SH and frequency of SH by the post-intervention assessment (OR 0.35, 95% CI 0.17 to 0.73; N = 134; k = 1; GRADE: high-certainty evidence). A group-based emotion-regulation psychotherapy may also reduce repetition of SH by the post-intervention assessment based on evidence from two trials by the same author group (OR 0.34, 95% CI 0.13 to 0.88; N = 83; k = 2; moderate-certainty evidence). There is probably little to no effect for different variants of DBT on absolute repetition of SH, including DBT group-based skills training, DBT individual skills training, or an experimental form of DBT in which participants were given significantly longer cognitive exposure to stressful events. The evidence remains uncertain as to whether provision of information and support, based on the Suicide Trends in At-Risk Territories (START) and the SUicide-PREvention Multisite Intervention Study on Suicidal behaviors (SUPRE-MISS) models, have any effect on repetition of SH by the post-intervention assessment. There was no evidence of a difference for psychodynamic psychotherapy, case management, general practitioner (GP) management, remote contact interventions, and other multimodal interventions, or a variety of brief emergency department-based interventions. AUTHORS' CONCLUSIONS Overall, there were significant methodological limitations across the trials included in this review. Given the moderate or very low quality of the available evidence, there is only uncertain evidence regarding a number of psychosocial interventions for adults who engage in SH. Psychosocial therapy based on CBT approaches may result in fewer individuals repeating SH at longer follow-up time points, although no such effect was found at the post-intervention assessment and the quality of evidence, according to the GRADE criteria, was low. Given findings in single trials, or trials by the same author group, both MBT and group-based emotion regulation therapy should be further developed and evaluated in adults. DBT may also lead to a reduction in frequency of SH. Other interventions were mostly evaluated in single trials of moderate to very low quality such that the evidence relating to the use of these interventions is inconclusive at present.
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Affiliation(s)
- Katrina G Witt
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gowri Rajaram
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
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Khazem LR, Rozek DC, Baker JC, Bryan CJ. The Marine Suicide Prevention and Intervention REsearch (M-SPIRE) study: A randomized clinical trial investigating potential treatment mechanisms for reducing suicidal behaviors among military personnel. Contemp Clin Trials Commun 2021; 21:100731. [PMID: 33665470 PMCID: PMC7897982 DOI: 10.1016/j.conctc.2021.100731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/01/2020] [Accepted: 01/15/2021] [Indexed: 11/03/2022] Open
Abstract
Suicides within the U.S. Armed Forces remain elevated. Brief cognitive behavioral therapy for suicide prevention (BCBT) has demonstrated preliminary efficacy as a psychotherapeutic intervention that reduces suicide attempts among U.S. Army Soldiers. The generalizability of BCBT's effects in other military groups and its underlying mechanisms of action remain unknown, however. The Marine Suicide Prevention and Intervention REsearch (M-SPIRE) study is designed to test the efficacy of BCBT for the prevention of suicide attempts among active duty U.S. Marines with recent suicidal ideation or attempts and to identify potential mechanisms of change contributing to BCBT's effects. In this protocol paper, we describe M-SPIRE's rationale and methods with a particular emphasis on measuring treatment fidelity and BCBT's hypothesized mechanisms of action.
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Rojas SM, Gold SD, Bryan CJ, Pruitt LD, Felker BL, Reger MA. Brief Cognitive-Behavioral Therapy for Suicide Prevention (BCBT-SP) via Video Telehealth: A Case Example During the COVID-19 Outbreak. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 29:446-453. [PMID: 34602808 PMCID: PMC8479594 DOI: 10.1016/j.cbpra.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/19/2020] [Indexed: 11/20/2022]
Abstract
Although veterans living in remote/rural areas are at elevated risk for suicide, there is very little research specific to treating suicidal veterans who present with barriers to in-person care. The current study aims to examine the delivery of brief cognitive-behavioral therapy for suicide prevention (BCBT-SP) via Clinical Video Telehealth (CVT) to the home of a veteran discharged from the psychiatric inpatient unit after a recent suicide attempt. Preliminary data on acceptability, feasibility, and changes in symptoms were gathered. The veteran received treatment during the 2020 COVID-19 outbreak and additional adaptations were made accordingly. The veteran did not engage in any suicidal behavior during the course of treatment, and suicidal ideation, depression, and anxiety decreased as treatment progressed. The results provide initial support for the feasibility of BCBT-SP via CVT to the home.
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Affiliation(s)
- Sasha M Rojas
- VA Puget Sound Health Care System and VISN 20 Clinical Resource Hub, Boise, ID 83702
| | - Sari D Gold
- VA Puget Sound Health Care System and University of Washington
| | | | - Larry D Pruitt
- VA Puget Sound Health Care System and University of Washington
| | | | - Mark A Reger
- VA Puget Sound Health Care System and University of Washington
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9
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Bozzay ML, Primack JM, Swearingen HR, Barredo J, Philip NS. Combined transcranial magnetic stimulation and brief cognitive behavioral therapy for suicide: study protocol for a randomized controlled trial in veterans. Trials 2020; 21:924. [PMID: 33183345 PMCID: PMC7663863 DOI: 10.1186/s13063-020-04870-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND At least 17 veterans die every day from suicide. Although existing treatments such as brief cognitive behavioral therapy (BCBT) have been found to reduce suicide attempts in military personnel, a number of patients go on to attempt suicide after completing therapy. Thus, finding ways to enhance treatment efficacy to reduce suicide is critical. Repetitive transcranial magnetic stimulation (TMS) is a noninvasive technique that can be used to stimulate brain regions that are impaired in suicidal patients, that has been successfully used to augment treatments for psychiatric disorders implicated in suicide. The goal of this study is to test whether augmenting BCBT with TMS in suicidal veterans reduces rates of suicidal ideation, attempts, and other deleterious treatment outcomes. METHODS One hundred thirty veterans with a suicide plan or suicidal behavior in the prior 2 weeks will be recruited from inpatient and outpatient settings at the Providence VA Medical Center in the USA. Veterans will be randomly assigned to receive 30 daily sessions of active or sham TMS in concert with a 12-week BCBT protocol in a parallel group design. Veterans will complete interviews and questionnaires related to psychiatric symptoms, suicidal ideation and behavior, treatment utilization, and functioning during a baseline assessment prior to treatment, at treatment endpoint, and 6- and 12-month follow-ups. Primary analyses will use mixed effect regressions to examine effects of treatment condition on suicidal behaviors, improvements in psychosocial functioning, and psychiatric hospitalization. Similar models as well as exploratory latent growth curve analyses will examine mediators and moderators of treatment effects. DISCUSSION This protocol provides a framework for designing multilayered treatment studies for suicide. When completed, this study will be the first clinical trial evaluating the efficacy of augmenting BCBT for suicide with TMS. The results of this trial will have implications for treatment of suicide ideation and behaviors and implementation of augmented treatment designs. If positive, results from this study can be rapidly implemented across the VA system and will have a direct and meaningful impact on veteran suicide. TRIAL REGISTRATION This study was registered prior to participant enrollment with ClinicalTrials.gov NCT03952468 . Registered on May 16, 2019. TRIAL SPONSOR CONTACT Robert O'Brien (VA Health Services R&D), robert.obrien7@va.gov.
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Affiliation(s)
- Melanie L. Bozzay
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912 USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, 830 Chalkstone Boulevard, Providence, RI 02908 USA
| | - Jennifer M. Primack
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912 USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, 830 Chalkstone Boulevard, Providence, RI 02908 USA
| | - Hannah R. Swearingen
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, 830 Chalkstone Boulevard, Providence, RI 02908 USA
| | - Jennifer Barredo
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912 USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, 830 Chalkstone Boulevard, Providence, RI 02908 USA
| | - Noah S. Philip
- Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912 USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, 830 Chalkstone Boulevard, Providence, RI 02908 USA
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10
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Wastler H, Lucksted A, Phalen P, Drapalski A. Internalized stigma, sense of belonging, and suicidal ideation among veterans with serious mental illness. Psychiatr Rehabil J 2020; 43:91-96. [PMID: 31414842 PMCID: PMC7021557 DOI: 10.1037/prj0000386] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE There is emerging evidence that internalized stigma increases risk for suicide among individuals with serious mental illness. The purpose of the current study was to evaluate whether sense of belonging moderates the relationship between internalized stigma and suicidal ideation. METHOD Two hundred forty-two veterans with serious mental illness completed measures of internalized stigma, belongingness, and depression. Moderation analysis was used to determine whether sense of belonging interacts with internalized stigma to predict suicidal ideation when accounting for individual differences in depression and relevant demographic variables. RESULTS Consistent with our hypothesis, sense of belonging significantly moderated the relationship between internalized stigma and suicidal ideation. Specifically, the relationship between internalized stigma and suicidal ideation was strongest when sense of belonging was low. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Internalized stigma and belongingness interact to increase risk for suicide. Both constructs should be assessed and included in interventions to reduce suicide risk among veterans with serious mental illness. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Heather Wastler
- Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center (MIRECC)
| | - Alicia Lucksted
- Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center (MIRECC)
| | - Peter Phalen
- Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center (MIRECC)
| | - Amy Drapalski
- Veterans Affairs VISN 5 Mental Illness Research, Education, and Clinical Center (MIRECC)
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11
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Kuehn KS, King KM, Linehan MM, Harned MS. Modeling the suicidal behavior cycle: Understanding repeated suicide attempts among individuals with borderline personality disorder and a history of attempting suicide. J Consult Clin Psychol 2020; 88:570-581. [PMID: 32162931 PMCID: PMC7228857 DOI: 10.1037/ccp0000496] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Suicide remains a leading cause of death in the United States, and recent reports have suggested the suicide rate is increasing. One of the most robust predictors of future suicidal behavior is a history of attempting suicide. Despite this, little is known about the factors that reduce the likelihood of reattempting suicide. This study compares theoretically derived suicide risk indicators to determine which factors are most predictive of future suicide attempts. METHOD We used data from a randomized, controlled trial comparing 3 forms of dialectical behavior therapy (DBT; Linehan et al., 2015). Participants (N = 97, mean age = 30.3 years, 100% female, 71% White) met criteria for borderline personality disorder and had repeated and recent self-injurious behavior. Assessments occurred at 4-month intervals throughout 1 year of treatment and 1 year of follow-up. Time-lagged generalized linear mixed models (GLMMs) were used to evaluate relationship satisfaction, emotion dysregulation, and coping styles as predictors of suicide attempts. RESULTS Both univariate and multivariate models suggested that higher between-person variance in problem-focused coping and lack of access to emotion regulation strategies were weakly associated with additional suicide attempts over the 2-year study. Within-person variance in the time-lagged predictors was not associated with subsequent suicide attempts. CONCLUSIONS Among individuals with a recent suicide attempt, problem-focused coping and specific deficits in emotion regulation may differentiate those likely to reattempt from those who stop suicidal behavior during and after psychotherapy. These results suggest that treatments for recent suicide attempters should target increasing problem-focused coping and decreasing maladaptive emotion regulation skills. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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12
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Kramer EB, Gaeddert LA, Jackson CL, Harnke B, Nazem S. Use of the acquired capability for suicide scale (ACSS) among United States military and Veteran samples: A systematic review. J Affect Disord 2020; 267:229-242. [PMID: 32217223 DOI: 10.1016/j.jad.2020.01.153] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/26/2019] [Accepted: 01/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Military personnel and Veterans are at increased risk for suicide. Theoretical and conceptual arguments have suggested that elevated levels of acquired capability (AC) could be an explanatory factor accounting for this increased risk. However, empirical research utilizing the Acquired Capability for Suicide Scale (ACSS) in military populations has yielded mixed findings. METHODS To better ascertain what factors are associated with AC, and whether methodological limitations may be contributing to mixed findings, a systematic review was conducted. RESULTS A total of 31 articles utilized the ACSS to examine factors associated with AC, including combat history, in United States (U.S.) military personnel and Veterans. Nearly all studies (96.8%) were rated high risk of bias. Use of the ACSS varied, with seven different iterations utilized. Nearly all studies examined correlations between the ACSS and sample characteristics, mental health and clinical factors, Interpersonal Theory of Suicide constructs, and/or suicide-specific variables. Results of higher-level analyses, dominated by cross-sectional designs, often contradicted correlational findings, with inconsistent findings across studies. LIMITATIONS Included studies were non-representative of all U.S. military and Veteran populations and may only generalize to these populations. CONCLUSIONS Due to the high risk of bias, inconsistent use of the ACSS, lack of sample heterogeneity, and variability in factors examined, interpretation of current ACSS empirical data is cautioned. Suggestions for future research, contextualized by these limitations, are discussed.
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Affiliation(s)
- Emily B Kramer
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Building G3, Room 189, Aurora, CO 80045, USA
| | - Laurel A Gaeddert
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Building G3, Room 189, Aurora, CO 80045, USA
| | - Christine L Jackson
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Building G3, Room 189, Aurora, CO 80045, USA
| | - Ben Harnke
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, 12950 E. Montview Blvd., MS A003, Aurora, CO 80045, USA
| | - Sarra Nazem
- Rocky Mountain Mental Illness, Research, Education and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VAMC, 1700 N. Wheeling Street, Building G3, Room 189, Aurora, CO 80045, USA; Departments of Psychiatry and Physical Medicine and Rehabilitation, University of Colorado Anschutz School of Medicine, 13001 E. 17th Place, Room C2000C, Aurora, CO 80045, USA.
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13
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Hom MA, Duffy ME, Rogers ML, Hanson JE, Gutierrez PM, Joiner TE. Examining the link between prior suicidality and subsequent suicidal ideation among high-risk US military service members. Psychol Med 2019; 49:2237-2246. [PMID: 30355371 DOI: 10.1017/s0033291718003124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Research is needed to identify the factors that explain the link between prior and future suicidality. This study evaluated possible mediators of the relationship between: (1) the severity of prior suicidality and (2) suicidal ideation severity at 3-month follow-up among a sample of high-risk military personnel. METHODS US military service members referred to or seeking care for suicide risk (N = 624) completed self-report psychiatric domain measures and a clinician interview assessing prior suicidality severity at baseline. Three months later, participants completed a self-report measure of suicidal ideation severity. Three separate percentile bootstrap mediation models were used to examine psychiatric factors (i.e. alcohol abuse, anxiety sensitivity, hopelessness, insomnia, posttraumatic stress symptoms, suicidal ideation, and thwarted belongingness) as parallel mediators of the relationship between prior suicidality severity (specifically, suicidal ideation, suicide attempt, and overall suicidality - i.e. ideation/attempt severity combined) at baseline and suicidal ideation severity at follow-up. RESULTS Hopelessness, specifically, and the total effect of all mediators, each significantly accounted for the relationship between prior suicidality severity and subsequent ideation severity across models. In the models with attempt severity and overall suicidality severity as predictors, thwarted belongingness was also a significant mediator. CONCLUSIONS Hopelessness, thwarted belongingness, and overall severity of psychiatric indices may explain the relationship between prior suicidality severity and future suicidal ideation severity among service members at elevated suicide risk. Research is needed to replicate these findings and examine other possible mediators.
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Affiliation(s)
- Melanie A Hom
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Mary E Duffy
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Megan L Rogers
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Jetta E Hanson
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, USA
| | - Peter M Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Aurora, CO, USA
- Denver Veterans Affairs Medical Center, Aurora, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
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14
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Mediation of suicide ideation in prolonged exposure therapy for posttraumatic stress disorder. Behav Res Ther 2019; 119:103409. [DOI: 10.1016/j.brat.2019.103409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/21/2018] [Accepted: 05/22/2019] [Indexed: 02/06/2023]
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15
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Early maladaptive schemas of emotional deprivation, social isolation, shame and abandonment are related to a history of suicide attempts among patients with major depressive disorders. Compr Psychiatry 2017. [PMID: 28636896 DOI: 10.1016/j.comppsych.2017.05.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Patients with psychiatric disorders have an exceptionally high risk of completed or attempted suicide. This holds particularly true for patients with major depressive disorders. The aim of the present study was to explore whether patients with major depressive disorders (MDD) and a history of suicide attempts differed in their early maladaptive schemas from patients with MDD but without such a history or from healthy controls. METHOD Ninety participants took part in the study. Of these, 30 were patients with MDD who had made a recent suicide attempt; 30 were patients with MDD but no suicide attempts, and 30 were gender- and age-matched healthy controls. Participants completed questionnaires covering socio-demographic characteristics and the Young Schema Questionnaire (YSQ- RE2R) to assess early maladaptive schemas. Experts rated patients' MDD with the Montgomery-Asberg Depression Rating Scale. RESULTS Patients did not differ in experts' ratings of symptoms of depression. Compared to healthy controls, patients with MDD recorded higher scores on maladaptive schemas such as recognition seeking, negativity/pessimism, and insufficient self-control. Compared to patients without suicide attempts and healthy controls, those who had made a suicide attempt had higher scores on dimensions such as failure, mistrust, emotional inhibition, social isolation, and abandonment/instability. CONCLUSION Compared to healthy controls, patients with MDD had more pronounced maladaptive schemas, but this was more marked in patients with a history of suicide attempts. The results suggest that suicide attempts and poorer psychological functioning are related.
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