Sense of coherence and suicidality in suicide attempters: a prospective study

Proximal and Distal Factors Distinguishing Between Individuals With Suicidal Ideation Only and Suicide Attempters

ABSTRACT

Prior studies identifying variables that may differentiate suicide attempters from suicidal ideators mostly focused on distal risk factors and have not included the severity of suicidal ideation. The aim of this study was to consider the extent to which proximal (consumption of alcohol and psychotropic substances, intake of medication, interpersonal contact during the suicidal phase) and distal (resilience, sense of coherence, reasons for living) factors differ among nonideators, suicidal ideators (graded with regard to each individual's self-assessed mental distance to a suicidal act), and suicide attempters. A sample of 464 individuals recruited via an online link were compared by using RS-13, SOC-13, RFLI, and questions concerning the suicidal phase. There was a gradual decrease respectively increase in proximal and distal factors, as well as significant differences among the groups. Sense of coherence and reasons for living were independent protective factors, whereas consumption of alcohol and intake of medication were independent risk factors.

Mental Health among Higher Education Students during the COVID-19 Pandemic: A Cross-Sectional Survey from Lithuania

Mental health issues—anxiety, depression, suicidal ideation and behavior—are prevalent among students of higher education. The COVID-19 pandemic further affected students’ daily life through academic and socioeconomic disturbances. We set out to investigate students’ mental health amidst the COVID-19 pandemic and conducted a cross-sectional online survey at higher education institutions in Lithuania in 2021. The questionnaire consisted of the Hospital Anxiety and Depression scale (HADS) and the Sense of Coherence scale (SOC-3) questionnaires, evaluation of suicidal risk, experiences during the COVID-19 pandemic and self-rated health status (SRHS). Among 1001 students who completed the survey, the prevalence of clinically relevant anxiety was high (46.6%) and contrasted with the lower prevalence of depression (11.1%). 37.5% of all students admitted that they had thought about suicide at least once during their lifetime and a similar number of students thought about suicide during the previous year. High levels of anxiety and depression were statistically significant predictors of suicidal ideation and planning during the past year in binary regression models. High SRHS (higher score refers to more positive health status) was the only significant independent variable associated with less frequent suicidal attempts in the past year (p < 0.01, OR = 0.29, 95% CI = 0.12 to 0.66). Our study highlights anxiety and suicidality to be burdensome mental health issues among higher education students in Lithuania during the COVID-19 pandemic.

Patterns of suicide ideation across eight countries in four continents during the COVID-19 pandemic era: repeated cross-sectional study

BACKGROUND

The coronavirus disease (COVID-19) pandemic, and countries' response measures, have had a globally significant mental health impact. This mental health burden has also been fuelled by an infodemic; an information overload, which includes misinformation and disinformation. Suicide, the worst mental health outcome, is a serious public health problem which can be prevented with timely, evidence-based, and often low-cost interventions. Suicide ideation, one important risk factor for suicide, is thus important to measure and monitor, as are the factors which may impact on it.

OBJECTIVE

This investigation has two primary aims: (1) to estimate and compare country specific prevalence of suicide ideation at two different time points, overall and by gender and age groups; and, (2) to investigate the influence of sociodemographic and infodemic variables on suicide ideation.

METHODS

A repeated online eight country (Canada, United States of America, England, Switzerland, Belgium, Hong Kong, Philippines and New Zealand) cross-sectional study was undertaken of adults aged ≥18 years; with measurement wave 1 conducted from 29th May 29 to 12th June 2020, and measurement wave 2 conducted from 6-18th November 2021. Self-reported suicide ideation was derived from item 9 of the Patient Health Questionnaire-9 (PHQ-9). Age standardized suicide ideation rates were reported, a binomial regression model was used to estimate suicide ideation indication rates for each country and measurement wave, and logistic regression models were then employed to relate sociodemographic, pandemic, and infodemic variables to suicide ideation.

RESULTS

The final sample totalled 17,833 adults; 8,806 (49.4%) from measurement wave 1 and 9,027 (50.6%) from wave 2 - with over 1,000 from each country at each time-point. Overall, 24.2% and 27.5% of participants reported suicide ideation at measurement waves 1 and 2, respectively, a difference that was significant (P<.001). Considerable variability was observed in suicide ideation age standardized rates between countries, ranging from 15.6% in Belgium (wave 1) to 42.9% in Hong Kong (wave 2). Frequent social media usage was associated with increased suicide ideation at wave 2 (adjusted odds ratio [AOR]=1.47, 95% confidence interval [CI] 1.25-1.72; P<.001) but not wave 1 (AOR=1.11, 95% CI .96-1.23; P=.16). However, having a weaker sense of coherence (SOC) (AOR=3.80, 95% CI 3.18-4.55, at wave 1 and AOR=4.39, 95% CI 3.66-5.27, at wave 2; both P<.001) had the largest overall effect size.

CONCLUSIONS

Suicide ideation is prevalent and significantly increasing over time in this COVID-19 pandemic era, with considerable variability between countries. Younger adults and those residing in Hong Kong carried disproportionately higher rates. Social media appears to have an increasingly detrimental association with suicide ideation, although having a stronger SOC had a larger protective effect. Policies and promotion of SOC, together with disseminating health information that explicitly tackles the infodemic's misinformation and disinformation, may importantly reduce the rising mental health morbidity and mortality triggered by this pandemic.

CLINICALTRIAL

Development and Effect of a Salutogenic Program for Rural Elderly Women on Depression and Suicidal Ideation

This study aimed to develop and evaluate the effects of a Salutogenic program on sense of coherence, depression, and suicidal ideation among rural older adults. Quasi-experimental, nonequivalent control group pretest-posttest design was used. Participants were female, aged 65 years and older from G and O province, South Korea. The experimental group (n = 22) received a 12-session Salutogenic program for 6 weeks, twice a week. The control group (n = 19) was put on a waiting list to receive the intervention after completing the study. Collected data were analyzed using descriptive statistics, a χ² test, independent t-test, and repeated measure ANOVA with SPSS WIN 26.0. There were significant differences in sense of coherence (F = 19.34, p < .001), depression (F = 12.93, p < .001), and suicidal ideation (F = 4.40, p = .027) over time pretest, posttest, and follow-up test after intervention between two groups. The study discussed the effect of Salutogenic program on sense of coherence, depression, and suicidal ideation, and considered its benefits in suicide prevention for elderly women. The Salutogenic program can be recommended as useful strategies to enhance sense of coherence and to reduce depression and suicidal ideation of elderly women in community.

Patient safety in inpatient mental health settings: a systematic review

OBJECTIVES

Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology.

DESIGN

Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model.

RESULTS

Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control.

CONCLUSIONS

Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice.

PROSPERO REGISTRATION NUMBER

CRD42016034057.

Suicide risk around the world: a meta-analysis of longitudinal studies

PURPOSE

Suicidal thoughts and behaviors (STBs) have been a persistent problem worldwide. Identifying risk factors for STBs across distinct areas of the world may help predict who or where requires the greatest attention. However, risk factors for STBs are infrequently explored cross-nationally. The present study examined whether psychopathology prospectively predicts STBs across different areas of the world, and whether certain country-level factors moderate the degree of risk conferred.

METHODS

We conducted a meta-analysis of 71 longitudinal studies from 30 different countries that featured psychopathology-related variables predicting STB outcomes. Meta-regression was used to evaluate whether the following country-level factors modified risk: geographic region, income level, and degree of mental health structural stigma.

RESULTS

Over 90% of studies had been conducted in North America and Europe. When assessed by country income level, it was found that only one longitudinal study on psychopathology and STB was conducted outside of a high-income country. Moreover, less than 10% of studies were conducted in high structural stigma contexts. Meta-regression findings revealed that the variation in risk effect sizes across studies was not explained by models including country-level factors.

CONCLUSIONS

Our findings show critical underrepresentation of low- and middle-income countries, which account for a large proportion of global suicide deaths. This reveals a need to broaden the scope of longitudinal research on STB risk, such that countries across more regions, income levels, and degrees of structural stigma are fully accounted for. Such lines of research will improve generalizability of findings, and more precisely inform prevention efforts worldwide.

Sense of Coherence and Gambling: Exploring the Relationship Between Sense of Coherence, Gambling Behaviour and Gambling-Related Harm

Understanding why some people experience problems with gambling whilst others are able to restrict gambling to recreational levels is still largely unexplained. One potential explanation is through salutogenesis, which is a health promotion approach of understanding factors which move people towards health rather than disease. An important aspect of salutogenesis is sense of coherence. Individuals with stronger sense of coherence perceive their environment as comprehensible, manageable and meaningful. The present study examined the relationship of individuals' sense of coherence on their gambling behaviour and experience of gambling related harm. This exploratory study utilised an archival dataset (n = 1236) from an online, cross sectional survey of people who had experienced negative consequences from gambling. In general, a stronger sense of coherence was related to lower problem gambling severity. When gambling behaviour was controlled for, sense of coherence was significantly related to the experience of individual gambling harms. A strong sense of coherence can be seen as a protective factor against problematic gambling behaviour, and subsequent gambling related harms. These findings support the value of both primary and tertiary prevention strategies that strengthen sense of coherence as a harm minimisation strategy. The present study demonstrates the potential value of, and provides clear direction for, considering sense of coherence in order to understand gambling-related issues.

Instruments for the assessment of suicide risk: A systematic review evaluating the certainty of the evidence

Background

Instruments have been developed to facilitate suicide risk assessment. We aimed to evaluate the evidence for these instruments including assessment of risk of bias and diagnostic accuracy for suicide and suicide attempt.

Methods

PubMed (NLM), PsycInfo, Embase, Cinahl and the Cochrane Library databases were searched until December 2014. We assessed risk of bias with QUADAS-2. The average sensitivity and specificity of each instrument was estimated and the certainty of the evidence was assessed with GRADE. We considered instruments with a sensitivity > 80% and a specificity > 50% to have sufficient diagnostic accuracy.

Results

Thirty-five relevant studies were identified but 14 were considered to have high risk of bias, leaving 21 studies evaluating altogether 15 risk assessment instruments. We could carry out meta-analyses for five instruments. For the outcome suicide attempt SAD PERSONS Scale had a sensitivity of 15% (95% CI 8–24) and specificity of 97% (96–98), and the Manchester Self-Harm Rule (MSHR) a sensitivity of 97% (97–97) and a specificity of 20% (20–21). ReACT, which is a modification of MSHR, had a similar low specificity, as did the Sodersjukhuset Self Harm Rule. For the outcome suicide, the Beck Hopelessness Scale had a sensitivity of 89% (78–95) and specificity of 42% (40–43).

Conclusions

Most suicide risk assessment instruments were supported by too few studies to allow for evaluation of accuracy. Among those that could be evaluated, none fulfilled requirements for sufficient diagnostic accuracy.

College Students' Sense of Coherence and Connectedness as Predictors of Suicidal Thoughts and Behaviors

This study aimed to explore the relationship between college students' sense of coherence and connectedness and their development of suicidal thoughts and behaviors. Using archival data from a larger survey with responses from 26,742 undergraduate and graduate students at 74 colleges and universities, we applied Exploratory Factor Analysis to derive these protective factors (coherence and connectedness) as well as hypothesized distal and proximal risk factors (pre-existing vulnerabilities and distress). Structural Equation Modeling was used to explore latent variable interactions among these factors with regards to outcomes on a continuum of suicidal thinking and behavior. Sense of coherence mitigated the impact of pre-existing vulnerabilities on movement along the continuum, while connectedness mitigated the impact of distress. Findings suggest that including both connectedness and coherence in suicide prevention frameworks will increase the impact of suicide prevention programming.

Comparing Antonovsky's sense of coherence scale across three UK post-industrial cities

OBJECTIVES

High levels of 'excess' mortality (ie, that seemingly not explained by deprivation) have been shown for Scotland compared to England and Wales and, especially, for its largest city, Glasgow, compared to the similarly deprived English cities of Liverpool and Manchester. It has been suggested that this excess may be related to differences in 'Sense of Coherence' (SoC) between the populations. The aim of this study was to ascertain whether levels of SoC differed between these cities and whether, therefore, this could be a plausible explanation for the 'excess'.

SETTING

Three post-industrial UK cities: Glasgow, Liverpool and Manchester.

PARTICIPANTS

A representative sample of more than 3700 adults (over 1200 in each city).

PRIMARY AND SECONDARY OUTCOME MEASURES

SoC was measured using Antonovsky's 13-item scale (SOC-13). Multivariate linear regression was used to compare SoC between the cities while controlling for characteristics (age, gender, SES etc) of the samples. Additional modelling explored whether differences in SoC moderated city differences in levels of self-assessed health (SAH).

RESULTS

SoC was higher, not lower, among the Glasgow sample. Fully adjusted mean SoC scores for residents of Liverpool and Manchester were, respectively, 5.1 (-5.1 (95% CI -6.0 to -4.1)) and 8.1 (-8.1 (-9.1 to -7.2)) lower than those in Glasgow. The additional modelling confirmed the relationship between SoC and SAH: a 1 unit increase in SoC predicted approximately 3% lower likelihood of reporting bad/very bad health (OR=0.97 (95% CI 0.96 to 0.98)): given the slightly worse SAH in Glasgow, this resulted in slightly lower odds of reporting bad/very bad health for the Liverpool and Manchester samples compared to Glasgow.

CONCLUSIONS

The reasons for the high levels of 'excess' mortality seen in Scotland and particularly Glasgow remain unclear. However, on the basis of these analyses, it appears unlikely that a low SoC provides any explanation.

Are gender and life attitudes associated with the wish to die in older psychiatric and somatic inpatients? An explorative study

BACKGROUND

Death wishes are not uncommon in older persons, and to date, several risk factors have been identified. The presence of these risk factors is insufficient to fully understand why some older people, who are exposed to them, develop a wish to die and why others do not. The purpose of the study was to explore whether Purpose in Life as well as other life attitudes are associated with a death wish in older males and females.

METHODS

The sample comprised 113 older inpatients (from a psychiatric and somatic ward) with a mean age of 74 years. Psychiatric diagnoses were assessed by the SCID-II. Logistic regression analyses estimated the unique contribution of (the interaction between) life attitudes and gender to the wish to die, controlling for sociodemographic variables, depressive disorder, and somatic symptoms.

RESULTS

We observed a statistically significant relationship between life attitudes and the wish to die. Purpose in Life and the Purpose in Life*Gender interaction explained significant additional variance in the prediction of the wish to die. Purposelessness in life might therefore be an important correlate of a wish to die, especially in older men, independently from sociodemographic and clinical features.

CONCLUSIONS

In assessing a wish to die in older adults, life attitudes need to be taken into account, besides the presence of a depressive disorder and/or somatic health. More specifically, finding or maintaining a purpose in later life might be an important feature in the prevention of the wish to die, especially in male persons.

Suicide reattempters: a systematic review

The aim of this study is to identify the characteristic features of suicide reattempters. The recognition of the suicide reattempters population as a distinct clinical population may encourage future preventive and clinical work with this high-risk subgroup and thus reduce deaths. A systematic literature review was carried out in order to identify the key demographic, psychological, and clinical variables associated with the repetition of suicide attempts. In addition, we wished to analyze the operational definitions of the repetition of suicide attempts proposed in the scientific literature. Studies published from 2000 to 2012 were identified in PubMed, PsycINFO, and Web of Science databases and were selected according to predetermined criteria. We examined a total of 1480 articles and selected 86 that matched our search criteria. The literature is heterogeneous, with no consensus regarding the operational definitions of suicide reattempters. Comparison groups in the literature have also been inconsistent and include subjects making a single lifetime attempt and subjects who did not reattempt during a defined study period. Suicide reattempters were associated with higher rates of the following characteristics: unemployment, unmarried status, diagnosis of mental disorders, suicidal ideation, stressful life events, and family history of suicidal behavior. Additional research is needed to establish adequate differentiation and effective treatment plans for this population.

Suicidal ideation among Métis adult men and women--associated risk and protective factors: findings from a nationally representative survey

Objective

To determine the prevalence of suicidal ideation among Métis men and women (20–59 years) and identify its associated risk and protective factors using data from the nationally representative Aboriginal Peoples Survey (2006).

Study design

Secondary analysis of previously collected data from a nationally representative cross-sectional survey.

Results

Across Canada, lifetime suicidal ideation was reported by an estimated 13.3% (or an estimated 34,517 individuals) of the total population of 20-to-59-year-old Métis. Of those who ideated, 46.2% reported a lifetime suicide attempt and 6.0% indicated that they had attempted suicide in the previous 12 months. Prevalence of suicidal ideation was higher among Métis men than in men who did not report Aboriginal identity in examined jurisdictions. Métis women were more likely to report suicidal ideation compared with Métis men (14.9% vs. 11.5%, respectively). Métis women and men had some common associated risk and protective factors such as major depressive episode, history of self-injury, perceived Aboriginal-specific community issues, divorced status, high mobility, self-rated thriving health, high self-esteem and positive coping ability. However, in Métis women alone, heavy frequent drinking, history of foster care experience and lower levels of social support were significant associated risk factors of suicidal ideation. Furthermore, a significant interaction was observed between social support and major depressive episode. Among Métis men, history of ever smoking was the sole unique associated risk factor.

Conclusion

The higher prevalence of suicidal ideation among Métis women compared with Métis men and the observed gender differences in associations with some associated risk and protective factors suggest the need for gender-responsive programming to address suicidal ideation.