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Kivelä L, van der Does WAJ, Riese H, Antypa N. Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research. Front Digit Health 2022; 4:876595. [PMID: 35601888 PMCID: PMC9120419 DOI: 10.3389/fdgth.2022.876595] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/13/2022] [Indexed: 01/13/2023] Open
Abstract
Suicide and suicide-related behaviors are prevalent yet notoriously difficult to predict. Specifically, short-term predictors and correlates of suicide risk remain largely unknown. Ecological momentary assessment (EMA) may be used to assess how suicidal thoughts and behaviors (STBs) unfold in real-world contexts. We conducted a systematic literature review of EMA studies in suicide research to assess (1) how EMA has been utilized in the study of STBs (i.e., methodology, findings), and (2) the feasibility, validity and safety of EMA in the study of STBs. We identified 45 articles, detailing 23 studies. Studies mainly focused on examining how known longitudinal predictors of suicidal ideation perform within shorter (hourly, daily) time frames. Recent studies have explored the prospects of digital phenotyping of individuals with suicidal ideation. The results indicate that suicidal ideation fluctuates substantially over time (hours, days), and that individuals with higher mean ideation also have more fluctuations. Higher suicidal ideation instability may represent a phenotypic indicator for increased suicide risk. Few studies succeeded in establishing prospective predictors of suicidal ideation beyond prior ideation itself. Some studies show negative affect, hopelessness and burdensomeness to predict increased ideation within-day, and sleep characteristics to impact next-day ideation. The feasibility of EMA is encouraging: agreement to participate in EMA research was moderate to high (median = 77%), and compliance rates similar to those in other clinical samples (median response rate = 70%). More individuals reported suicidal ideation through EMA than traditional (retrospective) self-report measures. Regarding safety, no evidence was found of systematic reactivity of mood or suicidal ideation to repeated assessments of STBs. In conclusion, suicidal ideation can fluctuate substantially over short periods of time, and EMA is a suitable method for capturing these fluctuations. Some specific predictors of subsequent ideation have been identified, but these findings warrant further replication. While repeated EMA assessments do not appear to result in systematic reactivity in STBs, participant burden and safety remains a consideration when studying high-risk populations. Considerations for designing and reporting on EMA studies in suicide research are discussed.
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Affiliation(s)
- Liia Kivelä
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Willem A. J. van der Does
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
- Leiden University Treatment Center LUBEC, Leiden, Netherlands
| | - Harriëtte Riese
- Department of Psychiatry, The Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Universitair Medisch Centrum Groningen, University of Groningen, Groningen, Netherlands
| | - Niki Antypa
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
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Suicide in American Cities. CURRENT TRAUMA REPORTS 2021. [DOI: 10.1007/s40719-021-00220-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Holmes EA, Ghaderi A, Harmer CJ, Ramchandani PG, Cuijpers P, Morrison AP, Roiser JP, Bockting CLH, O'Connor RC, Shafran R, Moulds ML, Craske MG. The Lancet Psychiatry Commission on psychological treatments research in tomorrow's science. Lancet Psychiatry 2018; 5:237-286. [PMID: 29482764 DOI: 10.1016/s2215-0366(17)30513-8] [Citation(s) in RCA: 323] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/10/2017] [Accepted: 11/24/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Emily A Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Trust Foundation, Warneford Hospital, Oxford, UK
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Heath Trust, Manchester, UK; School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Claudi L H Bockting
- Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands
| | - Rory C O'Connor
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Roz Shafran
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW, Sydney, NSW, Australia
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Erford BT, Jackson J, Bardhoshi G, Duncan K, Atalay Z. Selecting Suicide Ideation Assessment Instruments: A Meta-Analytic Review. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2017. [DOI: 10.1080/07481756.2017.1358062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Bradley T. Erford
- Peabody College at Vanderbilt University, Human and Organizational Development, Nashville, TN, USA
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Steele IH, Thrower N, Noroian P, Saleh FM. Understanding Suicide Across the Lifespan: A United States Perspective of Suicide Risk Factors, Assessment & Management. J Forensic Sci 2017. [PMID: 28639299 DOI: 10.1111/1556-4029.13519] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Suicide is a troubling, preventable phenomenon. Prior to attempts, individuals often seek help, prompting practitioners to perform risk assessments that ideally use evidence-based risk management strategies. A literature review was performed using Harvard Countway Library of Medicine, Google Scholar, PubMed. Key words used were "Forensic Science," "Suicide Risk Management," "Pediatric Suicide Risk Factors," "Adult Suicide Risk Factors," "Geriatric Suicide Risk Factors," "Suicide Risk Assessment." Parameters limited articles to studies/reviews completed in the past twenty years in the United States. Results indicated predictors of suicide in juveniles were insomnia, burdensomeness, and recent conflicts with family or a romantic partner. Adults had greater risk if male, substance abusing, with marital/job loss. Elderly individuals with multiple medical comorbidities, hopelessness, and isolation were at higher risk. Everyone evaluated should be screened for access to firearms. Management of suicide risk involves providing the least restrictive form of treatment which maintains an individual's safety.
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Affiliation(s)
- Ian H Steele
- Harvard Longwood Psychiatry Resident Training Program Beth Israel Deaconess Medical Center, Department of Psychiatry, 330 Brookline Ave, Rabb-2, Boston, MA 02215
| | - Natasha Thrower
- Harvard Longwood Psychiatry Resident Training Program Brigham and Women's Hospital, Department of Psychiatry 221 Longwood Ave, Boston, MA 02115
| | - Paul Noroian
- Forensic Psychiatry Fellowship, Law and Psychiatry Program, Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655
| | - Fabian M Saleh
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115.,Sexual Violence Prevention and Risk Management Program, Department of Psychiatry, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Rabb-2, Boston, MA 02215
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Schaffer A, Isometsä ET, Tondo L, Moreno DH, Sinyor M, Kessing LV, Turecki G, Weizman A, Azorin JM, Ha K, Reis C, Cassidy F, Goldstein T, Rihmer Z, Beautrais A, Chou YH, Diazgranados N, Levitt AJ, Zarate CA, Yatham L. Epidemiology, neurobiology and pharmacological interventions related to suicide deaths and suicide attempts in bipolar disorder: Part I of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder. Aust N Z J Psychiatry 2015; 49:785-802. [PMID: 26185269 PMCID: PMC5116383 DOI: 10.1177/0004867415594427] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Bipolar disorder is associated with elevated risk of suicide attempts and deaths. Key aims of the International Society for Bipolar Disorders Task Force on Suicide included examining the extant literature on epidemiology, neurobiology and pharmacotherapy related to suicide attempts and deaths in bipolar disorder. METHODS Systematic review of studies from 1 January 1980 to 30 May 2014 examining suicide attempts or deaths in bipolar disorder, with a specific focus on the incidence and characterization of suicide attempts and deaths, genetic and non-genetic biological studies and pharmacotherapy studies specific to bipolar disorder. We conducted pooled, weighted analyses of suicide rates. RESULTS The pooled suicide rate in bipolar disorder is 164 per 100,000 person-years (95% confidence interval = [5, 324]). Sex-specific data on suicide rates identified a 1.7:1 ratio in men compared to women. People with bipolar disorder account for 3.4-14% of all suicide deaths, with self-poisoning and hanging being the most common methods. Epidemiological studies report that 23-26% of people with bipolar disorder attempt suicide, with higher rates in clinical samples. There are numerous genetic associations with suicide attempts and deaths in bipolar disorder, but few replication studies. Data on treatment with lithium or anticonvulsants are strongly suggestive for prevention of suicide attempts and deaths, but additional data are required before relative anti-suicide effects can be confirmed. There were limited data on potential anti-suicide effects of treatment with antipsychotics or antidepressants. CONCLUSION This analysis identified a lower estimated suicide rate in bipolar disorder than what was previously published. Understanding the overall risk of suicide deaths and attempts, and the most common methods, are important building blocks to greater awareness and improved interventions for suicide prevention in bipolar disorder. Replication of genetic findings and stronger prospective data on treatment options are required before more decisive conclusions can be made regarding the neurobiology and specific treatment of suicide risk in bipolar disorder.
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Affiliation(s)
- Ayal Schaffer
- Task Force on Suicide, The International Society for Bipolar Disorders (ISBD), Pittsburgh, PA, USA; Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Erkki T Isometsä
- Department of Psychiatry, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
| | - Leonardo Tondo
- Lucio Bini Center, Cagliari, Italy; Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA
| | - Doris H Moreno
- Section of Psychiatric Epidemiology and Mood Disorders Unit, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gustavo Turecki
- Research and Academic Affairs, Department of Psychiatry, McGill University, Montréal, QC, Canada; McGill Group for Suicide Studies, Montréal, QC, Canada; Depressive Disorders Program, Douglas Institute, Montréal, QC, Canada; Departments of Psychiatry, Human Genetics, and Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Abraham Weizman
- Laboratory of Biological Psychiatry, The Felsenstein Medical Research Center, Petah Tikva, Israel; Research Unit, Geha Mental Health Center, Petah Tikva, Israel; Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jean-Michel Azorin
- Department of Adult Psychiatry, Sainte Marguerite Hospital, Marseille, France; University of Aix-Marseille II, Marseille, France
| | - Kyooseob Ha
- Mood Disorders Clinic and Affective Neuroscience Laboratory, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Korea Association for Suicide Prevention, Seoul, Republic of Korea
| | - Catherine Reis
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Frederick Cassidy
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioural Sciences, Duke University, Durham, NC, USA
| | - Tina Goldstein
- Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zoltán Rihmer
- Department of Clinical and Theoretical Mental Health, and Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Budapest, Hungary
| | - Annette Beautrais
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Yuan-Hwa Chou
- Section of Psychosomatic Medicine, Department of Psychiatry, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Nancy Diazgranados
- Laboratory of Clinical and Translational Studies, National Institute of Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Carlos A Zarate
- Experimental Therapeutics & Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, Bethesda, MD, USA
| | - Lakshmi Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Betz ME, Arias SA, Miller M, Barber C, Espinola JA, Sullivan AF, Manton AP, Miller I, Camargo CA, Boudreaux ED. Change in emergency department providers' beliefs and practices after use of new protocols for suicidal patients. Psychiatr Serv 2015; 66:625-31. [PMID: 25726978 PMCID: PMC4852852 DOI: 10.1176/appi.ps.201400244] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined changes in self-reported attitudes and practices related to suicide risk assessment among providers at emergency departments (EDs) during a three-phase quasi-experimental trial involving implementation of ED protocols for suicidal patients. METHODS A total of 1,289 of 1,828 (71% response rate) eligible providers at eight EDs completed a voluntary, anonymous survey at baseline, after introduction of universal suicide screening, and after introduction of suicide prevention resources (nurses) and a secondary risk assessment tool (physicians). RESULTS Among participants, the median age was 40 years old, 64% were female, and there were no demographic differences across study phases; 68% were nurses, and 32% were attending physicians. Between phase 1 and phase 3, increasing proportions of nurses reported screening for suicide (36% and 95%, respectively, p<.001) and increasing proportions of physicians reported further assessment of suicide risk (63% and 80%, respectively, p<.01). Although increasing proportions of providers said universal screening would result in more psychiatric consultations, decreasing proportions said it would slow down clinical care. Increasing proportions of nurses reported often or almost always asking suicidal patients about firearm access (18%-69%, depending on the case), although these numbers remained low relative to ideal practice. Between 35% and 87% of physicians asked about firearms, depending on the case, and these percentages did not change significantly over the study phases. CONCLUSIONS These findings support the feasibility of implementing universal screening for suicide in EDs, assuming adequate resources, but providers should be educated to ask suicidal patients about firearm access.
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Affiliation(s)
- Marian E Betz
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Sarah A Arias
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Matthew Miller
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Catherine Barber
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Janice A Espinola
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Ashley F Sullivan
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Anne P Manton
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Ivan Miller
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Carlos A Camargo
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
| | - Edwin D Boudreaux
- Dr. Betz is with the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora (e-mail: ). Dr. Arias and Dr. Ivan Miller are with the Department of Psychiatry and Human Behavior, Butler Hospital and Brown University Medical School, Providence, Rhode Island. Dr. Matthew Miller and Ms. Barber are with the Harvard Injury Control Research Center, Harvard School of Public Health, Boston. Ms. Espinola, Ms. Sullivan, and Dr. Camargo are with the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. Dr. Manton is with the Centers for Behavioral Health, Cape Cod Hospital, Hyannis, Massachusetts. Dr. Boudreaux is with the Departments of Emergency Medicine and Psychiatry, University of Massachusetts Medical School, Worcester
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Spangenberg L, Forkmann T, Glaesmer H. Investigating dynamics and predictors of suicidal behaviors using ambulatory assessment. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2015; 29:139-43. [PMID: 25868681 DOI: 10.1007/s40211-015-0142-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/09/2015] [Indexed: 10/23/2022]
Abstract
Ambulatory assessment studies may provide important insights in the etiology of suicidal behaviors, because suicidal behaviors and their risk factors fluctuate over time.The review aims at (1) evaluating the current state of research and (2) summarizing main findings in this field. Reviewed studies (N = 4) were heterogeneous. Up to 74% of participants reported suicidal ideation during ambulatory assessment sampling. Suicidal ideation was predicted by intensity and instability of negative affective states (e.g., worry, sadness). Ambulatory assessment studies seem a promising approach to uncover the dynamic course of suicidal ideation and its risk factors in clinically relevant time frames (i.e., real-time).
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Affiliation(s)
- Lena Spangenberg
- Department of Medical Psychology and Medical Sociology, Leipzig University, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany.
| | - Thomas Forkmann
- Department of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen University, Aachen, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, Leipzig University, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany
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9
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Schaffer A, Isometsä ET, Tondo L, Moreno D, Turecki G, Reis C, Cassidy F, Sinyor M, Azorin JM, Kessing LV, Ha K, Goldstein T, Weizman A, Beautrais A, Chou YH, Diazgranados N, Levitt AJ, Zarate CA, Rihmer Z, Yatham LN. International Society for Bipolar Disorders Task Force on Suicide: meta-analyses and meta-regression of correlates of suicide attempts and suicide deaths in bipolar disorder. Bipolar Disord 2015; 17:1-16. [PMID: 25329791 PMCID: PMC6296224 DOI: 10.1111/bdi.12271] [Citation(s) in RCA: 222] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/05/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Bipolar disorder is associated with a high risk of suicide attempts and suicide death. The main objective of the present study was to identify and quantify the demographic and clinical correlates of attempted and completed suicide in people with bipolar disorder. METHODS Within the framework of the International Society for Bipolar Disorders Task Force on Suicide, a systematic review of articles published since 1980, characterized by the key terms bipolar disorder and 'suicide attempts' or 'suicide', was conducted, and data extracted for analysis from all eligible articles. Demographic and clinical variables for which ≥ 3 studies with usable data were available were meta-analyzed using fixed or random-effects models for association with suicide attempts and suicide deaths. There was considerable heterogeneity in the methods employed by the included studies. RESULTS Variables significantly associated with suicide attempts were: female gender, younger age at illness onset, depressive polarity of first illness episode, depressive polarity of current or most recent episode, comorbid anxiety disorder, any comorbid substance use disorder, alcohol use disorder, any illicit substance use, comorbid cluster B/borderline personality disorder, and first-degree family history of suicide. Suicide deaths were significantly associated with male gender and first-degree family history of suicide. CONCLUSIONS This paper reports on the presence and magnitude of the correlates of suicide attempts and suicide deaths in bipolar disorder. These findings do not address causation, and the heterogeneity of data sources should limit the direct clinical ranking of correlates. Our results nonetheless support the notion of incorporating diagnosis-specific data in the development of models of understanding suicide in bipolar disorder.
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Affiliation(s)
- Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Erkki T Isometsä
- Institute of Clinical Medicine University of Helsinki, Helsinki, Finland
| | - Leonardo Tondo
- Lucio Bini Center, Cagliari, Italy and Harvard Medical School, McLean Hospital, Boston, MA, USA
| | - Doris Moreno
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Gustavo Turecki
- Departments of Psychiatry, Human Genetics, and Neurology & Neurosurgery, McGill University, Montreal, QC, Canada
| | - Catherine Reis
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Frederick Cassidy
- Department of Psychiatry and Behavioural Sciences, Duke University, Durham, USA
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jean-Michel Azorin
- Department of Psychiatry, University of Aix-Marseille II, Marseille, France
| | - Lars Vedel Kessing
- Faculty of Health Sciences, University of Copenhagen, Psychiatric Center Copenhagen Department, Copenhagen, Denmark
| | - Kyooseob Ha
- Department of Psychiatry, Seoul National University, Bundang Hospital, Seoul, Republic of Korea
| | - Tina Goldstein
- Department of Child and Adolescent Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Abraham Weizman
- Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Annette Beautrais
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Yuan-Hwa Chou
- Department of Psychiatry, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | | | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Zoltán Rihmer
- Department of Clinical and Theoretical Mental Health and Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Budapest, Hungary
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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10
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Schaffer A, Sinyor M, Reis C, Goldstein BI, Levitt AJ. Suicide in bipolar disorder: characteristics and subgroups. Bipolar Disord 2014; 16:732-40. [PMID: 24890795 DOI: 10.1111/bdi.12219] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 11/12/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The development of more sophisticated models for understanding suicide among people with bipolar disorder (BD) requires diagnosis-specific data. The present study aimed to elucidate differences between people who die by suicide with and without BD, and to identify subgroups within those with BD. METHODS Data on all suicide deaths in the city of Toronto from 1998 to 2010 were extracted from the Office of the Chief Coroner of Ontario, including demographics, clinical variables, recent stressors, and details of the suicide. Comparisons of person- and suicide-specific variables between suicide deaths among those with BD (n = 170) and those without (n = 2,716) were conducted, and a cluster analysis was performed among the BD suicide group only. RESULTS Those in the BD suicide group were more likely than those in the non-BD suicide group to be female [odds ratio (OR) = 1.75, 95% confidence interval (CI): 1.27-2.42; p = 0.001], to have made a past suicide attempt (OR = 2.01, 95% CI: 1.45-2.80; p < 0.0001), and to have had recent contact with psychiatric or emergency services (OR = 1.59, 95% CI: 1.00-2.52; p = 0.049). Five clusters were identified within the BD group, with differences between clusters in age; sex; marital status; living circumstances; past suicide attempts; substance abuse; interpersonal, employment/financial, and legal/police stressors; and rates of death by fall/jump or self-poisoning. CONCLUSIONS The present findings identified differences between BD and non-BD suicide groups, providing support to the utilization of an illness-specific approach to better understanding suicide in BD. Subgroups of BD suicide deaths, if replicated, should also be incorporated into the design and analysis of future studies of suicide in BD.
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Affiliation(s)
- Ayal Schaffer
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Baethge C, Cassidy F. Fighting on the side of life: a special issue on suicide in bipolar disorder. Bipolar Disord 2013; 15:453-6. [PMID: 23919261 DOI: 10.1111/bdi.12097] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 04/26/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Christopher Baethge
- Department of Psychiatry and Psychotherapy; University of Cologne Medical School; Cologne; Germany
| | - Frederick Cassidy
- Department of Psychiatry and Behavioral Sciences; Duke University Medical School; Durham; NC; USA
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