Prevalence and factors associated with suicidal ideation among family caregivers of people with mental disorders

Early Childhood Adversity Predicts Risk of Family Caregiver Suicidal Ideation:Roles of Neuroticism and Self-Compassion

Background

Despite high rates of family caregiver suicidal ideation (SI), little is known about its relationship with childhood adversity. Those with a history of adverse childhood experiences (ACEs) have been shown to have higher neuroticism, lower self-compassion, and higher rates of late life mental health disorders. Caregiving for a family member with dementia may pose a particular challenge for those with ACEs.

Methods

In a secondary analysis of 81 family caregivers of people living with dementia enrolled in clinical trials, we undertook a cross-sectional baseline analysis of the association between childhood adversity, measured with the ACE questionnaire, and self-reported suicidal ideation (SI). We further assessed whether the relationship between ACE and SI was mediated by neuroticism and self-compassion.

Results

18 caregivers self-reported SI (22%). 89% of caregivers with SI reported childhood adversity (ACE > 0), versus 63% of those without SI (p=.04). The relative risk of SI was 3.6x higher in those with childhood adversity than in those without (p=.04), and for those with a specific history childhood abuse, the relative risk of SI was 3.4x higher (p=.005). Neuroticism and self-compassion mediated the relationship between ACE and SI (p<.05), with neuroticism strengthening the association and self-compassion weakening it.

Conclusions

The association of SI with history of childhood adversity is high in family caregivers. Whereas elevated neuroticism might be one mechanism linking ACEs and SI, training self-compassion is a promising target for reducing SI. The phenotypic relationship between childhood adversity and SI in family caregivers should be further explored in larger samples, and could represent a new treatment target to improve the efficacy of therapies on caregiver emotional symptoms.

Prevalence and incidence of suicide, suicidal ideation and self-harm in caregivers of cancer patients: A systematic review and meta-analysis

OBJECTIVE

Caregiving burden is set to increase with the rising incidence of cancer globally. The meta-analysis seeks to investigate the prevalence of suicide, suicidal ideation and self-harm among the caregivers of patients with cancer (CPCs).

METHODS

This PRISMA-adherent systematic review involved a systematic search of PubMed, Embase, Cochrane and PsycINFO for all studies that evaluated the prevalence of suicide, suicidal ideation and self-harm in CPCs. Random effects meta-analyses were used for primary analysis.

RESULTS

Eleven studies were included. Meta-analyses indicated that the prevalence of suicidal ideation in CPCs was 11% (95%CI:6-18), suicide prevalence was 6% (95%CI:3-12), and self-harm prevalence was 15% (95%CI:8-26). Subgroup analyses revealed that CPCs above the age of 50 experienced a greater prevalence of suicidal ideation (17%, 95%CI:10-28) as compared to CPCs below 50 (6%, 95%CI:3-12). Family caregivers particularly spouses were also found to have a higher prevalence of suicidal ideation (17%, 95%CI:13-23), as compared to children (5%, 95%CI:2-10) or mothers (3%, 95%CI:1-8). Systematic review found that having a pre-existing mental health condition and lower socioeconomic status increased likelihood of suicidality.

CONCLUSION

We highlight the need for more support of CPCs at risk of suicidality. Additional research is warranted to identify other risk and protective factors.

Fatalism, Emotional Regulation, and Suicide Risk in Colombian Adults During the SAR-Cov-2 Disease Epidemic

The current pandemic of Severe Acute Syndrome (SAR-CoV-2) is a public health problem with implications for mental health. The study aimed to determine the prevalence of suicide risk and its association with fatalism and emotional regulation during SARS-CoV-2 in Colombia's adult population. A cross-sectional study was designed, an online format was used, which evaluated sociodemographic variables, CES-D-SI, the Fatalism Questionnaire against COVID-19, and the Emotional Regulation Scale. 435 Colombian adults participated, aged between 18 and 79 years. A prevalence of suicide risk was found in 5.3%, and it was associated with the interaction between living in rural area and less education (OR = 5.60, 95%CI 1.28-24.53), emotional dysregulation (OR = 3.54, 95%CI 1.77-7.09), and fatalistic beliefs (OR = 3.09, 95%CI 1.53-6.27). 5.3% of the population presented an elevated suicide risk. It was associated with less education, rural areas, fatalistic beliefs, and emotional dysregulation in the Colombian population during mandatory confinement due to SAR-CoV-2.

Perceived social support and family members of patients with mental disorders: A mixed method study

Introduction

Family members are the caregivers to patients with mental disorders at home, and the mental and spiritual pressures caused by this responsibility necessitate physical, mental, and perceived social support for these families. The present mixed method study is an attempt to elaborate on the perceived social support by Iranian families of patients with chronic mental disorders.

Materials and methods

Using a sequential mixed method explanatory study (quantitative and qualitative), 200 family members of patients with chronic mental disorders were selected through convenient sampling (quantitative phase). Data gathering was started using a demographics form and Stewart and Sherburne's perceived social support scale. The qualitative phase included 10 participants who obtained low scores in the quantitative phase and took part in private, face-to-face, in-depth, and semi-structured interviews. The data obtained in the quantitative phase were analyzed using statistical tests, and the interviews were analyzed using qualitative content analysis.

Findings

The perceived social support by the participants was at a moderate level in different fields of tangible support, information and emotional support, kindness, and positive social interactions. The results of the qualitative phase revealed social support status in 15 subcategories, 6 categories, and 2 themes of support and acceptance by family, relatives, and friends, with support and being understood by society. The results of the qualitative and quantitative sections emphasized the needs of the patient's family members (who acted as caregivers for patients) for support in family, social, and emotional areas.

Conclusion

The family members of patients with chronic mental disorders have different needs in the area of perceived social support. Such needs are more tangible in family members such as children with mentally ill parents or parents with mentally ill children. The results of this study can be used for educational and supportive planning for caregivers of patients, most of whom are family members.

Associations between Suicidal Ideation and Relatives' Physical and Mental Health among Community Residents: Differences between Family Members and Lineal Consanguinity

(1) Background: Despite the verified relationship between relatives’ characteristics and individual suicidal ideation, few studies have discussed the role of family members and lineal consanguinity independently according to whether they live together with the individuals or not. (2) Methods: The data in this study were collected in November 2019 and identified rural adults over 18 years old in Shandong as the survey objects, with a total of 879 valid cases included in this survey. Logistic regression analysis was employed to examine the risk factors affecting adults’ suicidal ideation and differentiate the effects of a family member and lineal consanguinity’s physical and mental health. Relatives’ physical and mental health were estimated by three aspects: whether they were suffering from chronic diseases, mental illness, or alcoholism. (3) Results: The study showed that a family member’s physical (OR = 2.303, p < 0.01) and mental health (OR = 5.877, p < 0.05) was related to suicidal ideation, but the association between lineal consanguinities’ physical and mental health and suicidal ideation were not supported. People over 40 years old (OR = 6.528, p < 0.05), from only-child families (OR = 4.335, p < 0.01), with household indebtedness (OR = 2.992, p < 0.001), or difficulty falling asleep (OR = 3.165, p < 0.001) had risk factors of suicidal ideation. (4) Conclusions: The physical and mental health of individuals’ family members are related to their suicidal ideation, and their lineal consanguinities’ physical and mental health are not related to suicidal ideation. These findings imply the different associations between family environment, genetic factors, and suicidal ideation. Family members’ health should be considered as a factor to prevent and control suicidal behaviors, including suicidal ideation.

Mental health of nursing professionals during the COVID-19 pandemic: a cross-sectional study

OBJECTIVE

To identify the prevalence of and factors associated with: (1) major depressive episodes; (2) minor psychiatric disorders (MPDs); and (3) suicidal ideation among nursing professionals from a municipality in southern Brazil.

METHODS

Using a cross-sectional design, we recruited 890 nursing professionals linked to 50 Primary Care units, 2 walk-in clinics, 2 hospital services, 1 emergency room service, 1 mobile emergency care service, and 1 teleconsultation service, in addition to the municipal epidemiological surveillance service and the vacancy regulation center between June and July 2020. We used the Patient Health Questionnaire-9 and the Self-Reporting Questionnaire to evaluate the studied outcomes. Associations between the outcomes and variables related to sociodemographic profile, work, health conditions, and daily life were explored using Poisson regression models with robust variance estimators.

RESULTS

The observed prevalence of depression, MPDs, and suicidal ideation were 36.6%, 44%, and 7.4%, respectively. MPDs were associated with the assessment of support received by the service as 'regular' (PR: 1.48; 95% CI: 1.19-1.85) or 'poor' (PR: 1.54; 95% CI: 1.23-1.94), with a reported moderate (PR: 1.63; 95% CI: 1.29-2.07), or heavy (PR: 2.54; 95% CI: 2.05-3.15) workload, and with suspected COVID-19 infection (PR: 1.44; 95% CI: 1.25-1.66). Major depressive episodes were associated with a reported lack of personal protective equipment (PR: 1.20; 95% CI: 1.01-1.42), whereas suicidal ideation was inversely related to per capita income > 3 minimum monthly wages (PR: 0.28; 95% CI: 0.11-0.68), and positively related to the use of psychotropic drugs (PR: 3.14; 95% CI: 1.87-5.26).

CONCLUSION

Our results suggest that nursing professionals' working conditions are associated with their mental health status. The need to improve working conditions through adequate dimensioning, support and proper biosafety measures is only heightened in the context of the COVID-19 pandemic.

Suicidality in family caregivers of people with long-term illnesses and disabilities: A scoping review

An emerging body of international research suggests family caregivers may be a high-risk group for suicide, but the evidence has not been synthesised. Forty-eight peer-reviewed journal articles were included in this review, spanning low-, middle-, and high-income countries and a variety of illnesses and disabilities. The proportion of caregivers experiencing suicidal ideation ranged from 2.7% to 71%, with evidence of suicide attempts, deaths by suicide, and deaths by homicide-suicide also reported. Risk and protective factors varied across studies and there was little consideration of differences by caregiving relationship, type of illness/disability, or country. There is sufficient evidence to warrant concern for caregivers around the world and prompt action in policy and practice, but more rigorous research is required to draw clear, nuanced conclusions about risk and inform evidence-based prevention and intervention.

Phenotypes of caregiver distress in military and veteran caregivers: Suicidal ideation associations

The United States (US) has been at war for almost two decades, resulting in a high prevalence of injuries and illnesses in service members and veterans. Family members and friends are frequently becoming the caregivers of service members and veterans who require long-term assistance for their medical conditions. There is a significant body of research regarding the physical, emotional, and social toll of caregiving and the associated adverse health-related outcomes. Despite strong evidence of the emotional toll and associated mental health conditions in family caregivers, the literature regarding suicidal ideation among family caregivers is scarce and even less is known about suicidal ideation in military caregivers. This study sought to identify clusters of characteristics and health factors (phenotypes) associated with suicidal ideation in a sample of military caregivers using a cross-sectional, web-based survey. Measures included the context of caregiving, physical, emotional, social health, and health history of caregivers. Military caregivers in this sample (n = 458) were mostly young adults (M = 39.8, SD = 9.9), caring for complex medical conditions for five or more years. They reported high symptomology on measures of pain, depression, and stress. Many (39%) experienced interruptions in their education and 23.6% reported suicidal ideation since becoming a caregiver. General latent variable analyses revealed three distinct classes or phenotypes (low, medium, high) associated with suicidality. Individuals in the high suicidality phenotype were significantly more likely to have interrupted their education due to caregiving and live closer (within 25 miles) to a VA medical center. This study indicates that interruption of life events, loss of self, and caring for a veteran with mental health conditions/suicidality are significant predictors of suicidality in military caregivers. Future research should examine caregiver life experiences in more detail to determine the feasibility of developing effective interventions to mitigate suicide-related risk for military caregivers.

Prevalence of ideation and attempted suicide among users of a psychosocial care center

OBJECTIVE

This study aims at identifying and characterizing the prevalence of suicidal ideation and attempted suicide among users of a Psychosocial Care Center in the municipality of Pelotas (RS).

METHOD

Transversal study, documentary based study in 389 active medical records. Data collection were carried out between September 2017 and May 2018. Data were digitated in the software Microsoft Excel and afterwards converted for the statistical Stata 11 Software.

RESULTS

The prevalence of ideation and attempted suicide was 48,1% and 33,4%, respectively. Significant differences were observed in relation to hearing voices (p=<0,001) and history of violence (p=<0,001). Users who heard voices presented prevalence of suicidal ideation corresponding to 58,1%. Among those users who have reported suicidal ideation, the prevalence of attempt was 57,7%, while the users without report of ideation, the attempts were prevalent in 10,9% (p=<0.001).

CONCLUSIONS

The users presented a significant prevalence of ideation and attempted suicide.

Developing the Resilience Framework for Nursing and Healthcare

Despite four decades of resilience research, resilience remains a poor fit for practice as a scientific construct. Using the literature, we explored the concepts attributed to the development of resilience, identifying those that mitigate symptoms of distress caused by adversity and facilitate coping in seven classes of illness: transplants, cancer, mental illness, episodic illness, chronic and painful illness, unexpected events, and illness within a dyadic relationship. We identified protective, compensatory, and challenge-related coping-concept strategies that healthcare workers and patients use during the adversity experience. Healthcare-worker assessment and selection of appropriate coping concepts enable the individual to control their distress, resulting in attainment of equanimity and the state of resilience, permitting the resilient individual to work toward recovery, recalibration, and readjustment. We inductively developed and linked these conceptual components into a dynamic framework, The Resilience Framework for Nursing and Healthcare, making it widely applicable for healthcare across a variety of patients.