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Rogers ML, Richards JA, Peterkin D, Park JY, Astudillo-García CI, Barzilay S, Blum Y, Chistopolskaya K, Dudeck M, Enikolopov S, Husain MI, Jiménez A, Yilmaz FK, Kuśmirek O, Lee MB, Menon V, Peper-Nascimento J, Pilecka B, Streb J, Ünübol B, Valvassori SS, Contreras MV, Wu CY, You S, Galynker I. Intentions to use mental health and suicide prevention resources among individuals with symptoms of the suicide crisis syndrome and/or suicidal ideation. Suicide Life Threat Behav 2024; 54:728-740. [PMID: 38747546 DOI: 10.1111/sltb.13083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION The suicide crisis syndrome (SCS) has demonstrated efficacy in predicting suicide attempts, showing potential utility in detecting at-risk individuals who may not be willing to disclose suicidal ideation (SI). The present international study examined differences in intentions to utilize mental health and suicide prevention resources among community-based adults with varying suicide risk (i.e., presence/absence of SCS and/or SI). METHODS A sample of 16,934 community-based adults from 13 countries completed measures about the SCS and SI. Mental health and suicide prevention resources were provided to all participants, who indicated their intentions to use these resources. RESULTS Individuals with SCS (55.7%) were just as likely as those with SI alone (54.0%), and more likely than those with no suicide-related symptoms (45.7%), to report willingness to utilize mental health resources. Those with SI (both with and without SCS) were more likely to seek suicide prevention resources (52.6% and 50.5%, respectively) than those without SI (41.7% and 41.8%); however, when examining endorsements for personal use, those with SCS (21.6%) were more likely to use resources than individuals not at risk (15.1%). CONCLUSIONS These findings provide insight into individuals' willingness to use resources across configurations of explicitly disclosed (SI) and indirect (SCS) suicide risk.
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Affiliation(s)
- Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Jenelle A Richards
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
| | - Devon Peterkin
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
| | - Ji Yoon Park
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
| | | | - Shira Barzilay
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Yarden Blum
- Department of Psychology, College of Management, Rishon LeZion, Israel
| | | | - Manuela Dudeck
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Germany
| | | | - M Ishrat Husain
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Alberto Jiménez
- Dirección de Investigaciones Epidemiológicas y Sociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | | | - Oskar Kuśmirek
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | | | - Vikas Menon
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Jefté Peper-Nascimento
- Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Santa Catarina, Brazil
| | | | - Judith Streb
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Germany
| | | | - Samira S Valvassori
- Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, Santa Catarina, Brazil
| | | | - Chia-Yi Wu
- National Taiwan University Hospital, Taipei, Taiwan
| | - Sungeun You
- Department of Psychology, Chungbuk National University, Cheongju, Chungbuk, South Korea
| | - Igor Galynker
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
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Tanaka K, Ikeuchi S. Insights from primary care workers supporting people at risk of suicide in local communities in Japan: A qualitative descriptive study. J Adv Nurs 2024; 80:3264-3277. [PMID: 38093474 DOI: 10.1111/jan.16024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 07/13/2024]
Abstract
AIM To identify insights for supporting people at risk of suicide in the community based on primary healthcare workers' experiences. DESIGN Qualitative descriptive design. METHODS Semi-structured interviews were conducted with fifteen primary healthcare workers employed by Japanese municipalities between August and October 2019. The data were subjected to qualitative descriptive analysis. RESULTS The analysis revealed eleven subthemes, clustered under the following three themes: (1) fostering 'opportunities for discovery' for people at risk of suicide by encompassing strategies such as increasing access to services and promoting a holistic understanding of the life cycle; (2) fostering 'meaningful connections' by searching for channels to reach the heart and taking approaches from different objectives; and (3) engaging in 'risk management', by understanding and coping with real-life struggles and implementing timely crisis intervention. CONCLUSION Not only direct care targeting suicide prevention but also holistic care that includes atypical perspectives such as 'approaches from different objectives' may provide important insights for supporting people with suicide risk. IMPLICATIONS FOR PRACTICE Beyond the limitations of existing suicide risk screening methods, this study highlights the importance of a holistic approach that sees people at risk of suicide in the context of their daily lives and aims to alleviate the difficulties in their lives that have brought them to the point of considering suicide. IMPACT By describing support focused on the difficulties that people at risk of suicide face in their daily lives, this study identified insights for supporting people at risk of suicide in communities where screening and intervention are difficult. These findings will contribute to the relief of people at risk of suicide by stimulating suicide prevention measures in primary healthcare settings. REPORTING METHOD This study complied with the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Koji Tanaka
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Satomi Ikeuchi
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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Menon V. The Narrative-crisis Model of Suicide as an Emerging Framework for Suicide Risk Stratification, Management, and Prevention. Indian J Psychol Med 2024; 46:285-288. [PMID: 39056028 PMCID: PMC11268272 DOI: 10.1177/02537176241253335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024] Open
Affiliation(s)
- Vikas Menon
- Dept. of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Fischer IC, Nichter B, Trachik B, Bryan CJ, Pietrzak RH. Suicide-Specific Cognitions and Suicidal Behavior in U.S. Military Veterans. Psychiatry 2024:1-10. [PMID: 38832675 DOI: 10.1080/00332747.2024.2352883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND U.S. military veterans may be reluctant to disclose suicidal thoughts and behaviors. Suicide-specific cognitions, which generally avoid direct mention of suicide, may be reliable indicators of risk among those reluctant to disclose such thoughts and behaviors. METHODS Data from a population-based, cross-sectional study of 2,430 U.S. military veterans were analyzed to examine the associations between the Brief Suicide Cognitions Scale (B-SCS), suicidal ideation, and suicide planning. RESULTS After adjusting for age, sex, number of adverse childhood experiences, cumulative trauma burden, depressive symptom severity, and lifetime history of suicide attempt, total scores on the B-SCS (excluding the item mentioning suicide) were uniquely associated with suicidal ideation (odds ratio [OR] = 1.23, 95% confidence interval [CI] = 1.15-1.32) and suicide planning (OR = 1.27, 95%CI = 1.18-1.37). Exploratory post-hoc analyses revealed that difficulties with solving and coping with one's problems were uniquely linked to these outcomes. CONCLUSIONS Assessment of suicide-specific cognitions may help to enhance suicide detection and prevention in veterans, especially in those who may not directly disclose thoughts of suicide. Intervention efforts to bolster perceived deficits in coping and problem-solving may help mitigate suicide risk in this population.
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Schimpf MG, Gershengoren L, Moschenross D, Winston H, Simpson SA. Consultation-Liaison Case Conference: Assessment and Management of a Physician With Thoughts of Suicide. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00062-4. [PMID: 38844207 DOI: 10.1016/j.jaclp.2024.05.006] [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: 01/31/2024] [Revised: 05/19/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024]
Abstract
We present the case of a physician who engages with a peer response team and discloses suicidal ideation while himself seeing patients in the hospital. Top experts in consultation-liaison psychiatry provide guidance for this clinical case based on their experience and a review of the available literature. Key teaching topics include a general approach to suicide risk assessment, peer response programs for healthcare workers, and ethical and clinical considerations in treating colleagues. Consultation-liaison psychiatrists should be familiar with suicide risk management, take a pro-active approach to addressing modifiable risk factors, and keep in mind unique challenges of treating colleagues referred for care.
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Affiliation(s)
| | | | - Darcy Moschenross
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Helena Winston
- Department of Behavioral Health Services, Denver Health, Denver, CO
| | - Scott A Simpson
- Department of Behavioral Health Services, Denver Health, Denver, CO; Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO.
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Zuromski KL, Wilks C, Al-Suwaidi M, Wittler E, Scherban L, Hite B, Raymond L, Dempsey CL, Stein MB, Ursano RJ, Benedek D, Nock MK. Perspectives of suicide loss survivors: Qualitative analysis of data from a psychological autopsy study of U.S. Army soldiers. Suicide Life Threat Behav 2024; 54:437-449. [PMID: 38353139 PMCID: PMC11164635 DOI: 10.1111/sltb.13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Suicide loss survivors can provide information not otherwise available about the circumstances preceding a suicide. In this study, we analyzed interview data from suicide loss survivors collected as part of a psychological autopsy study of U.S. Army soldiers. METHODS Next-of-kin (NOK) (n = 61) and Army supervisors (SUP) (n = 107) of suicide decedents (n = 135) who had died in the last 2-3 months answered open-ended questions about suicide risk factors, ideas for improving suicide prevention, and the impact of the suicide. Responses were coded using conventional content analysis methods to identify common themes. RESULTS Many NOK (30%) and SUP (50%) did not observe any signs of risk preceding the soldier's suicide. The most common idea regarding suicide prevention from SUP was that the suicide was inevitable, whereas NOK were more likely to emphasize the importance of increasing mental health treatment and reducing stigma. Both NOK and SUP reported negative effects of the suicide, but SUP reported some positive effects (e.g., increased unit connectedness). CONCLUSIONS Results underscore the challenges of using informants to identify soldiers at high risk of suicide, given many respondents did not observe any warning signs. Findings also highlight attitudinal barriers present in the military that, if targeted, may increase soldiers' help-seeking and willingness to disclose their risk.
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Affiliation(s)
| | | | | | | | | | - Blake Hite
- Department of Psychology, Harvard University
| | | | - Catherine L. Dempsey
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
| | - Murray B. Stein
- Department of Psychiatry and Family Medicine & Public Health, University of California, San Diego
- Veterans Affairs San Diego Healthcare System
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
| | - David Benedek
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of Health Sciences
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Ajluni V, Amarasinghe D. Youth suicide crisis: identifying at-risk individuals and prevention strategies. Child Adolesc Psychiatry Ment Health 2024; 18:58. [PMID: 38783338 PMCID: PMC11119010 DOI: 10.1186/s13034-024-00753-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- Victor Ajluni
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Daniel Amarasinghe
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
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De Luca GP, Parghi N, El Hayek R, Bloch-Elkouby S, Peterkin D, Wolfe A, Rogers ML, Galynker I. Machine learning approach for the development of a crucial tool in suicide prevention: The Suicide Crisis Inventory-2 (SCI-2) Short Form. PLoS One 2024; 19:e0299048. [PMID: 38728274 PMCID: PMC11086905 DOI: 10.1371/journal.pone.0299048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 02/04/2024] [Indexed: 05/12/2024] Open
Abstract
The Suicide Crisis Syndrome (SCS) describes a suicidal mental state marked by entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal that has predictive capacity for near-term suicidal behavior. The Suicide Crisis Inventory-2 (SCI-2), a reliable clinical tool that assesses SCS, lacks a short form for use in clinical settings which we sought to address with statistical analysis. To address this need, a community sample of 10,357 participants responded to an anonymous survey after which predictive performance for suicidal ideation (SI) and SI with preparatory behavior (SI-P) was measured using logistic regression, random forest, and gradient boosting algorithms. Four-fold cross-validation was used to split the dataset in 1,000 iterations. We compared rankings to the SCI-Short Form to inform the short form of the SCI-2. Logistic regression performed best in every analysis. The SI results were used to build the SCI-2-Short Form (SCI-2-SF) utilizing the two top ranking items from each SCS criterion. SHAP analysis of the SCI-2 resulted in meaningful rankings of its items. The SCI-2-SF, derived from these rankings, will be tested for predictive validity and utility in future studies.
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Affiliation(s)
- Gabriele P. De Luca
- Department of Psychiatry, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Neelang Parghi
- Department of Biology, New York University, New York City, New York, United States of America
| | - Rawad El Hayek
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Sarah Bloch-Elkouby
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Devon Peterkin
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Amber Wolfe
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Megan L. Rogers
- Department of Psychology, Texas State University, San Marcos, Texas, United States of America
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
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9
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Cohen LJ, Liang Y, Peterkin D, McGibbon K, Rappa F, Rogers ML, You S, Chistopolskaya K, Enikolopov S, Barzilay S, Menon V, Husain MI, Dudeck M, Streb J, Çinka E, Yilmaz FK, Kuśmirek O, Valvassori SS, Blum Y, Galynker I. Relationship Between Severity and Length of Exposure to COVID-19 Parameters and Resulting Government Responses and the Suicide Crisis Syndrome (SCS). Disaster Med Public Health Prep 2024; 18:e68. [PMID: 38618875 DOI: 10.1017/dmp.2023.235] [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] [Indexed: 04/16/2024]
Abstract
OBJECTIVE The COVID-19 pandemic has had a globally devastating psychosocial impact. A detailed understanding of the mental health implications of this worldwide crisis is critical for successful mitigation of and preparation for future pandemics. Using a large international sample, we investigated in the present study the relationship between multiple COVID-19 parameters (both disease characteristics and government responses) and the incidence of the suicide crisis syndrome (SCS), an acute negative affect state associated with near-term suicidal behavior. METHODS Data were collected from 5528 adults across 10 different countries in an anonymous web-based survey between June 2020 and January 2021. RESULTS Individuals scoring above the SCS cut-off lived in countries with higher peak daily cases and deaths during the first wave of the pandemic. Additionally, the longer participants had been exposed to markers of pandemic severity (eg, lockdowns), the more likely they were to screen positive for the SCS. Findings reflected both country-to-country comparisons and individual variation within the pooled sample. CONCLUSION Both the pandemic itself and the government interventions utilized to contain the spread appear to be associated with suicide risk. Public policy should include efforts to mitigate the mental health impact of current and future global disasters.
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Affiliation(s)
- Lisa J Cohen
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Yinan Liang
- Department of Psychology, University of Georgia, GA, USA
| | - Devon Peterkin
- Teachers College, Department of Psychology, Columbia University, NY, USA
| | - Kamryn McGibbon
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Frank Rappa
- Department of Psychology, Binghamton University, NY, USA
| | - Megan L Rogers
- Department of Psychology, Texas State University, TX, USA
| | - Sungeun You
- Department of Psychology, Chungbuk National University, Cheongju, Korea
| | - Ksenia Chistopolskaya
- Eramishantsev Moscow, Department of Psychiatry, City Clinical Hospital, Moscow, Russia
| | | | - Shira Barzilay
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Tamil Nadu, India
| | - M Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, and Department of Psychiatry, University of Toronto, ON, Canada
| | - Manuela Dudeck
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Judith Streb
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Elif Çinka
- Department of Health Management, University of Health Sciences, İstanbul, Turkey
| | - Fatma Kantas Yilmaz
- Department of Health Management, University of Health Sciences, İstanbul, Turkey
| | | | - Samira S Valvassori
- Program of Health Sciences, Universidade do Extremo Sul Catarinense, Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Criciuma, Brazil
| | - Yarden Blum
- Department of Psychology, The College of Management Academic Studies, Rishon LeZion, Israel
| | - Igor Galynker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, USA
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Meda N, Miola A, Cattarinussi G, Sambataro F. Whole-brain structural and functional neuroimaging of individuals who attempted suicide and people who did not: A systematic review and exploratory coordinate-based meta-analysis. Eur Neuropsychopharmacol 2024; 79:66-77. [PMID: 38237538 DOI: 10.1016/j.euroneuro.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 02/06/2024]
Abstract
Suicide is the cause of death of approximately 800,000 people a year. Despite the relevance of this behaviour, risk assessment tools rely on clinician experience and subjective ratings. Given that previous suicide attempts are the single strongest predictors of future attempts, we designed a systematic review and coordinate-based meta-analysis to demonstrate whether neuroimaging features can help distinguish individuals who attempted suicide from subjects who did not. Out of 5,659 publications from PubMed, Scopus, and Web of Science, we summarised 102 experiments and meta-analysed 23 of them. A cluster in the right superior temporal gyrus, a region implicated in emotional processing, might be functionally hyperactive in individuals who attempted suicide. No statistically significant differences in brain morphometry were evidenced. Furthermore, we used JuSpace to show that this cluster is enriched in 5-HT1A heteroreceptors in the general population. This exploratory meta-analysis provides a putative neural substrate linked to previous suicide attempts. Heterogeneity in the analytical techniques and weak or absent power analysis of the studies included in this review currently limit the applicability of the findings, the replication of which should be prioritised.
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Affiliation(s)
- Nicola Meda
- Department of Neuroscience, University of Padova, Via Giustiniani, 3, Padua, Italy; Padova University Hospital, Padua, Italy
| | - Alessandro Miola
- Department of Neuroscience, University of Padova, Via Giustiniani, 3, Padua, Italy; Padova Neuroscience Center, University of Padova, Padua, Italy; Casa di Cura Parco dei Tigli, Padova, Italy
| | - Giulia Cattarinussi
- Department of Neuroscience, University of Padova, Via Giustiniani, 3, Padua, Italy; Padova Neuroscience Center, University of Padova, Padua, Italy
| | - Fabio Sambataro
- Department of Neuroscience, University of Padova, Via Giustiniani, 3, Padua, Italy; Padova University Hospital, Padua, Italy; Padova Neuroscience Center, University of Padova, Padua, Italy.
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Sarli G, Rogers ML, Bloch-Elkouby S, Lawrence OC, Gomes de Siqueira A, Yao H, Lok B, Foster A, Galynker I. Using Virtual Patients to Assess and Improve Clinicians' Emotional Self-awareness: a Randomized Controlled Study. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024; 48:18-28. [PMID: 38057550 DOI: 10.1007/s40596-023-01909-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/18/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Working with suicidal patients can elicit negative emotional responses that can impede clinicians' empathy and affect clinical outcomes. Virtual human interactions represent a promising tool to train clinicians. The present study investigated the impact of virtual human interaction training to enhance clinicians' emotional self-awareness and empathy when working with suicidal patients. METHODS Clinicians were randomly assigned into two groups. Both groups interviewed a virtual patient presenting with a suicidal crisis; clinicians in the intervention condition (n = 31) received immediate feedback about negative emotional responses and empathic communication, whereas those in the control condition (n = 33) did not receive any feedback. All clinicians interviewed a second virtual patient 1 week later. Clinicians' emotional response to the two virtual patients and their empathic communication with each of them were assessed immediately after each interaction. Linear mixed models were used to assess change in clinicians' emotional response and verbal empathy between the two interactions across conditions. RESULTS Clinicians' emotional responses toward the suicidal virtual patients were unchanged in both conditions. Clinicians in the intervention condition presenting low empathy level with the first virtual patient showed higher empathy level with the second virtual patient than with the first (B = 1.15, SE = 0.25, p < 0.001, 95% CI [0.42, 1.89]). CONCLUSIONS This work demonstrates the feasibility of using virtual human interactions to improve empathic communication skills in clinicians with poor empathy skills. Further refinement of this methodology is needed to create effective training modules for a broader array of clinicians.
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Affiliation(s)
- Giuseppe Sarli
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | - Sarah Bloch-Elkouby
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | | | | | - Heng Yao
- University of Florida, Gainesville, FL, USA
| | | | - Adriana Foster
- Hospital Corporation of America Florida Woodmont Hospital, Tamarac, FL, USA
| | - Igor Galynker
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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Menon V, Balasubramanian I, Rogers ML, Grover S, Lakdawala B, Ranjan R, Sarkhel S, Nebhinani N, Kallivayalil RA, Raghavan V, Mishra KK, Aneja J, Abhivant N, Deep R, Singh LK, De Sousa A, Nongpiur A, Subramanyam AA, Mohapatra D, Kar SK, Dhiman V, Kumar PNS, Shreekantiah U, Bhandari SS, Ransing R, Ramasubramanian V, Praharaj SK. Factor structure, reliability, and validity of the revised Suicide Crisis Inventory in major depression: A multicentric Indian study. J Affect Disord 2024; 345:226-233. [PMID: 37898473 DOI: 10.1016/j.jad.2023.10.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/07/2023] [Accepted: 10/15/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND The revised Suicide Crisis Inventory (SCI)-2 is a self-report measure to assess the suicide crisis syndrome (SCS). We aimed to assess the factor structure, reliability, and validity of SCI-2 among adults with major depression. METHODS Using a cross-sectional design, between November 2021 and August 2022, the Hindi SCI-2, along with other self-report measures, was administered to Indian adult respondents clinically diagnosed with major depression across 24 centers in India. Confirmatory factor analysis was carried out to test the factor structure of SCI-2. Additionally, convergent, discriminant, and criterion validity were tested using bivariate or biserial correlations, as appropriate. RESULTS We obtained responses from 654 participants (Mean age = 36.9 ± 11.9 years, 50.2 % female). The SCI-2 fit both a one-factor (χ2[1769] = 14,150.74, p < .001, CFI = 0.98, RMSEA = 0.10), and five-factor solution (χ2[1759] = 13,130.83, p < .001,CFI = 0.98, RMSEA = 0.10) with the five-factor solution providing a significantly better fit. Internal consistencies of the SCI-2 total and subscale scores ranged from good to excellent. Most subscales significantly converged with each other and with other relevant measures although these associations were weak for thwarted belongingness and goal reengagement subscales. Small to moderate associations were noted in support of discriminant and criterion validity. LIMITATIONS We could not assess the predictive validity of SCI-2 for suicidal behaviors. CONCLUSION Consistent with prior data, the Hindi SCI-2 fit a five-factor solution and showed good psychometric properties. These findings support the use of SCI-2 to assess SCS among Indian adults with major depression.
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Affiliation(s)
- Vikas Menon
- Dept of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India.
| | - Ilambaridhi Balasubramanian
- Dept of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
| | - Megan L Rogers
- Dept of Psychology, Texas State University, TX 78666 4684, USA
| | - Sandeep Grover
- Dept of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Rajeev Ranjan
- Dept of Psychiatry, All India Institute of Medical Sciences (AIIMS), Patna 801507, India
| | - Sujit Sarkhel
- Dept of Psychiatry, Institute of Psychiatry, Kolkata 700025, India
| | - Naresh Nebhinani
- Dept of Psychiatry, All India Institute of Medical Sciences (AIIMS), Jodhpur 342005, India
| | - Roy Abraham Kallivayalil
- Dept of Psychiatry, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla 689101, Kerala, India
| | - Vijaya Raghavan
- Dept of Psychiatry, Schizophrenia Research Foundation (SCARF), Chennai 600101, India
| | - Kshirod Kumar Mishra
- Dept of Psychiatry, Mahatma Gandhi Institute of Medical Science (MGIMS), Sevagram, Maharashtra 442102, India
| | - Jitender Aneja
- Dept of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhatinda, Punjab 151001, India
| | - Niteen Abhivant
- Dept of Psychiatry, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune 411001, India
| | - Raman Deep
- Dept of Psychiatry, All India Institute of Medical Sciences (AIIMS), Delhi 110029, India
| | - Lokesh Kumar Singh
- Dept of Psychiatry, All India Institute of Medical Sciences (AIIMS), Raipur, Chhattisgarh 492009, India
| | - Avinash De Sousa
- Dept of Psychiatry, Lokmanya Tilak Municipal Medical College (LTMMC), Mumbai 400022, India
| | - Arvind Nongpiur
- Dept of Psychiatry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya 793018, India
| | - Alka A Subramanyam
- Dept of Psychiatry, Topiwala National Medical College and Bai Yamunabai Laxmanrao (BYL) Nair Charitable Hospital, Mumbai 400008, India
| | - Debadatta Mohapatra
- Dept of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha 751019, India
| | - Sujita Kumar Kar
- Dept of Psychiatry, King George's Medical University (KGMU), Lucknow, Uttar Pradesh 226003, India
| | - Vishal Dhiman
- Dept of Psychiatry, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand 249203, India
| | - P N Suresh Kumar
- Dept of Psychiatry, Iqraa International Hospital and Research Center, Calicut, Kerala 673009, India
| | - Umesh Shreekantiah
- Dept of Psychiatry, Central Institute of Psychiatry (CIP), Ranchi, Jharkhand 834006, India
| | - Samrat Singh Bhandari
- Dept of Psychiatry, Sikkim Manipal Institute of Medical Sciences (SMIMS), Sikkim Manipal University, Tadong, Gangtok, Sikkim 737102, India
| | - Ramdas Ransing
- Dept of Psychiatry, All India Institute of Medical Sciences (AIIMS), Guwahati, Assam 781101, India
| | | | - Samir Kumar Praharaj
- Dept of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
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Jobes DA, Mandel AA, Kleiman EM, Bryan CJ, Johnson SL, Joiner TE. Facets of Suicidal Ideation. Arch Suicide Res 2024:1-16. [PMID: 38174735 DOI: 10.1080/13811118.2023.2299259] [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] [Indexed: 01/05/2024]
Abstract
According to SAMHSA (2023), approximately 16,600,000 American adults and teens reported having serious thoughts of suicide in 2022. While suicide prevention has primarily focused on suicide deaths and attempts, we contend that suicidal ideation (SI) deserves more in-depth investigation and should be an essential intervention target on its own. In support of this point, we provide three examples of ways to improve specificity in understanding of SI through the study of controllability of SI, the language used to assess SI, and measuring SI in real time. We also consider qualitative work on the content of SI, its treatment, and definitional considerations. We thus call for an increased general focus on SI within research, clinical care, and policy.
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Langford VM. Risk Factors for Suicide in Men. Nurs Clin North Am 2023; 58:513-524. [PMID: 37832996 DOI: 10.1016/j.cnur.2023.06.010] [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] [Indexed: 10/15/2023]
Abstract
Suicide and the risk factors associated with it have been researched with increasing interest over the last 5 decades with respect to socioeconomic status, age, geographic location, and ethnic background. There has been less focus related to the risk factors specific to gender and how to incorporate clinical screening and interventions to reduce the mortality of suicide in males. With men accounting for a disproportionate number of deaths from suicide in the United States and worldwide, how gender could impact suicidal behavior and ideations remains a topic understudied and with great potential for significant improvement in clinical recognition and treatment.
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Bryan CJ, Allen MH, Bryan AO, Thomsen CJ, Baker JC, May AM. Does Suicide Risk Screening Improve the Identification of Primary Care Patients Who Will Attempt Suicide Versus Depression Screening Alone? Jt Comm J Qual Patient Saf 2023; 49:680-688. [PMID: 37739828 DOI: 10.1016/j.jcjq.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE The effectiveness of suicide risk screening relative to depression screening alone among primary care patients has not been tested rigorously. This study compared the performance of multiple depression screening methods (Patient Health Questionnaire [PHQ]-2, PHQ-8, and PHQ-9) and multiple suicide risk screening methods (PHQ-9 item 9 and suicide-focused screening of "thoughts of killing yourself" during the entire lifespan, within the past month, and within the past week) in a convenience sample of primary care patients. METHODS A total of 2,744 patients (military personnel, family members, and retirees) from six military primary care clinics completed the PHQ-9 and screening for suicidal ideation (SI) during routine clinic visits. Follow-up phone interviews were conducted for one year post-baseline to assess the incidence of suicide attempts, the study's primary outcome. Sensitivity, specificity, accuracy, and F1 statistics were calculated for each screening method for identifying patients who attempted suicide. RESULTS More than 65% of patients who screened positive for SI also screened positive for depression on the PHQ-9. Depression screening with the PHQ-9 correctly identified more patients who attempted suicide during follow-up than the PHQ-2, past week SI, and past month SI. The PHQ-9 correctly identified more patients who attempted suicide within 3 months than lifetime SI, but lifetime SI correctly identified more patients who attempted suicide within 6 and 12 months. CONCLUSION Depression screening with the PHQ-9 was the most effective strategy for identifying patients who attempted suicide in the near term. Universal suicide risk screening is unlikely to meaningfully improve identification of higher-risk patients beyond PHQ-9 depression screening.
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16
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Bankwitz A, Rüesch A, Adank A, Hörmann C, Villar de Araujo T, Schoretsanitis G, Kleim B, Olbrich S. EEG source functional connectivity in patients after a recent suicide attempt. Clin Neurophysiol 2023; 154:60-69. [PMID: 37562347 DOI: 10.1016/j.clinph.2023.06.025] [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: 12/23/2022] [Revised: 06/03/2023] [Accepted: 06/30/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Electroencephalogram (EEG) based frequency measures within the alpha frequency range (AFR), including functional connectivity, show potential in assessing the underlying pathophysiology of depression and suicide-related outcomes. We investigated the association between AFR connectivity, suicidal thoughts and behaviors, and depression in a transdiagnostic sample of patients after a recent suicide attempt (SA). METHODS Lagged source-based measures of linear and nonlinear whole-brain connectivity within the standard AFR ([sAFR], 8-12 Hz) and the individually referenced AFR (iAFR) were applied to 70 15-minute resting-state EEGs from patients after a SA and 70 age- and gender-matched healthy controls (HC). Hypotheses were tested using network-based statistics and multiple regression models. RESULTS Results showed no significant differences between patients after a SA and HC in any of the assessed connectivity modalities. However, a subgroup analysis revealed significantly increased nonlinear connectivity within the sAFR for patients after a SA with a depressive disorder or episode ([DD], n = 53) compared to matched HC. Furthermore, a multiple regression model, including significant main effects for group and global nonlinear connectivity within the sAFR outperformed all other models in explaining variance in depressive symptom severity. CONCLUSIONS Our study further supports the importance of the AFR in pathomechanisms of suicidality and depression. The iAFR does not seem to improve validity of phase-based connectivity. SIGNIFICANCE Our results implicate distinct neurophysiological patterns in suicidal subgroups. Exploring the potential of these patterns for treatment stratification might advance targeted interventions for suicidal thoughts and behaviors.
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Affiliation(s)
- Anna Bankwitz
- University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Lenggstrasse 31, 8032 Zurich, Switzerland; Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
| | - Annia Rüesch
- University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Lenggstrasse 31, 8032 Zurich, Switzerland; Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
| | - Atalìa Adank
- University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Lenggstrasse 31, 8032 Zurich, Switzerland; Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
| | - Christoph Hörmann
- University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Lenggstrasse 31, 8032 Zurich, Switzerland; Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
| | - Tania Villar de Araujo
- University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Lenggstrasse 31, 8032 Zurich, Switzerland; Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
| | - Georgios Schoretsanitis
- Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland; The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, 75-59 263rd St, Queens, NY 11004, USA; Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, 500 Hofstra Blvd, Hempstead, NY 11549, USA.
| | - Birgit Kleim
- University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Lenggstrasse 31, 8032 Zurich, Switzerland; Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland; University of Zurich, Department of Psychology, Experimental Psychopathology and Psychotherapy, Binzmühlestrasse 14, 8050 Zurich, Switzerland.
| | - Sebastian Olbrich
- University of Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Lenggstrasse 31, 8032 Zurich, Switzerland; Psychiatric University Hospital Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
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17
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Ammerman BA, Jacobucci R. The impact of social connection on near-term suicidal ideation. Psychiatry Res 2023; 326:115338. [PMID: 37453309 DOI: 10.1016/j.psychres.2023.115338] [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: 01/17/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
While predominant suicide theories emphasize the role of social connectedness in suicidal thinking, there is a need to better understand (a) how specific aspects of social connection relate to suicidal ideation and (b) the timeframe over which these relationships persist. The current study examined ecological momentary assessment data over a 30-day period from 35 participants with past-year suicidal thoughts or behaviors (mean age = 25.88; 62.9% women; 68.6% White) to address these questions. Results demonstrated that absence of social contact was associated with next timepoint suicidal ideation, even after considering the suicidal ideation autoregressive effect (i.e., concurrent), with effects strongest in the short-term. Findings provide preliminary evidence of the need to assess for the presence of social contact, and for assessments to occur in close proximity (i.e., a few hours), to capture the true dynamics of risk for suicidal ideation. Although needing replication, results suggest importance of just-in-time interventions targeting suicidal ideation.
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Affiliation(s)
- Brooke A Ammerman
- Department of Psychology, University of Notre Dame, 390 Corbett Family Hall, Notre Dame, IN 46656, United States.
| | - Ross Jacobucci
- Department of Psychology, University of Notre Dame, 390 Corbett Family Hall, Notre Dame, IN 46656, United States
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18
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Ehlers CL, Karriker-Jaffe KJ, Bernert R. Poor self-reported sleep quality associated with suicide risk in a community sample of American Indian adults. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2023; 4:zpad024. [PMID: 37293513 PMCID: PMC10246582 DOI: 10.1093/sleepadvances/zpad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/18/2023] [Indexed: 06/10/2023]
Abstract
Study Objectives Although American Indian/Alaska Native (AI/AN) have high suicide rates few studies have systematically investigated sleep quality and its association with suicidal behaviors in AI/AN. This study is a cross-sectional investigation of self-reported sleep quality and suicidal behaviors in an adult AI population. Methods A semi-structured interview was used to collect data on suicidal ideation, suicidal plans, and suicidal attempts and the Pittsburgh Sleep Quality Index (PSQI) was collected to assess sleep quality in American Indian adults. Results In this sample (n = 477), 91 (19%) of the participants endorsed suicidal ideation (thoughts and plans), and 66 (14%) reported suicidal attempts, including four who subsequently died by suicide. More women reported suicidal thoughts or acts than men. Those endorsing suicidal thoughts slept fewer hours during the night, reported more nocturnal awakenings, and showed poorer subjective sleep quality according to PSQI total scores compared to those with no suicidal thoughts or acts. Participants with suicidal acts (n = 66) reported more bad dreams and higher PSQI total scores compared to those with no suicidal thoughts or acts. When those with any suicidal thoughts or acts (n = 157, 33%) were compared to those without, they were more likely to endorse nocturnal awakenings and bad dreams and demonstrated significantly higher PSQI total scores. Conclusions Although additional research is needed to evaluate sleep disturbances as a proximal, causal risk factor for suicidal behaviors in AI, findings highlight need for further study of sleep as a warning sign and intervention tool for suicide prevention among American Indian adults.
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Affiliation(s)
- Cindy L Ehlers
- Neurosciences Department, The Scripps Research Institute, La Jolla, CA, USA
| | | | - Rebecca Bernert
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, CAUSA
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19
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Rogers ML, McMullen L, Liang Y, Perez N, Richards JA, Akülker G, Barzilay S, Bilici R, Blum Y, Chistopolskaya K, Dudeck M, Husain MI, Kuśmirek O, Luiz JM, Menon V, Pilecka B, Sadovnichaya V, Titze L, Valvassori SS, You S, Galynker I. Cross-national presence and sociodemographic correlates of the suicide crisis syndrome. J Affect Disord 2023; 329:1-8. [PMID: 36828142 DOI: 10.1016/j.jad.2023.02.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The Suicide Crisis Syndrome (SCS) has been proposed as an acute, pre-suicidal mental state that precedes imminent suicidal behavior; however, its cross-national applicability and sociodemographic correlates have not yet been determined. The present study assessed the presence and severity of the SCS in ten countries and examined several potential sociodemographic correlates (i.e., age, gender, marital status, race/ethnicity) of the SCS. METHODS 5528 community-based adults across 10 participating countries provided information on their SCS symptoms and sociodemographic characteristics in an anonymous online survey obtained via convenience sampling during the first year of the COVID-19 pandemic. RESULTS The SCS occurred cross-nationally, with rates ranging from 3.6% (Israel) to 16.2% (Poland). Those in the United States, South Korea, Poland, and Turkey had the highest severity of symptoms. Participants who were older, identified as cisgender men, and married tended to have lower rates of the SCS than their respective counterparts. There were minimal differences in the SCS by race/ethnicity. LIMITATIONS These data were both cross-sectional and collected via convenience sampling, limiting generalizability of findings and information about the SCS's predictive utility. CONCLUSIONS These findings support the cross-national presence of the SCS during the COVID-19 pandemic. Sociodemographic correlates aligned with those of suicidal behavior more generally, providing additional evidence for the concurrent/predictive validity of the SCS.
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Affiliation(s)
- Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA.
| | - Lauren McMullen
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Yinan Liang
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Nazareth Perez
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Jenelle A Richards
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | | | - Shira Barzilay
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | | | - Yarden Blum
- Department of Psychology, College of Management, Rishon LeZion, Israel
| | | | - Manuela Dudeck
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Germany
| | - M Ishrat Husain
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Oskar Kuśmirek
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Jhoanne M Luiz
- Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Vikas Menon
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | | | - Larissa Titze
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Germany
| | - Samira S Valvassori
- Laboratório de Psiquiatria Translacional, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense (UNESC), Criciúma, SC, Brazil
| | - Sungeun You
- Department of Psychology, Chungbuk National University, Cheongju, Chungbuk, South Korea
| | - Igor Galynker
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
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20
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Rogers ML, Jeon ME, Zheng S, Richards JA, Joiner TE, Galynker I. Two sides of the same coin? Empirical examination of two proposed characterizations of acute suicidal crises: Suicide crisis syndrome and acute suicidal affective disturbance. J Psychiatr Res 2023; 162:123-131. [PMID: 37149921 DOI: 10.1016/j.jpsychires.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/11/2023] [Accepted: 05/01/2023] [Indexed: 05/09/2023]
Abstract
Two proposed suicide-specific diagnoses, with accumulating research support, characterize the phenomenology of acute suicidal crises: Suicide Crisis Syndrome (SCS) and Acute Suicidal Affective Disturbance (ASAD). Despite conceptual overlap and some similar criteria, the two syndromes have never been compared empirically. The present study addressed this gap by examining SCS and ASAD utilizing a network analysis approach. A sample of 1568 community-based adults (87.6% cisgender women, 90.7% White, Mage = 25.60 years, SD = 6.59) in the United States completed an online battery of self-report measures. SCS and ASAD were first examined in individual network models, followed by a combined network to determine changes in network structure, as well as identify bridge symptoms that connected SCS and ASAD. The proposed criteria of SCS and ASAD formed sparse network structures that were largely unaffected by the influence of the other syndrome in a combined network. Social disconnection/withdrawal and manifestations of overarousal-particularly agitation, insomnia, and irritability-emerged as bridge symptoms that may connect SCS and ASAD. Our findings indicate the network structures of SCS and ASAD exhibit patterns of independence, alongside interdependence between overlapping symptom domains (i.e., social withdrawal, overarousal). Future work should examine SCS and ASAD prospectively to better understand their temporal dynamics and predictive utility in relation to imminent suicide risk.
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Affiliation(s)
| | - Min Eun Jeon
- Department of Psychology, Florida State University, USA
| | - Sifan Zheng
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, USA
| | | | | | - Igor Galynker
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, USA
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21
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Pal S, Ramanathan S. Ethical Consideration in Dealing With Suicide in Different Populations. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:173-177. [PMID: 37201150 PMCID: PMC10172560 DOI: 10.1176/appi.focus.20220082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Affiliation(s)
- Sutanaya Pal
- Department of Psychiatry and Behavioral Sciences, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York
| | - Seetha Ramanathan
- Department of Psychiatry and Behavioral Sciences, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York
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22
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Rudd MD. Recognizing flawed assumptions in suicide risk assessment research and clinical practice. Psychol Med 2023; 53:2186-2187. [PMID: 34229771 PMCID: PMC10106284 DOI: 10.1017/s0033291721002750] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 12/22/2022]
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23
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Shim EJ, Ha H, Kim BR, Kim SM, Moon JY, Hwang JH, Hahm BJ. The Multi-dimensional Assessment of Suicide Risk in Chronic illness-20 (MASC-20): Development and validation. Gen Hosp Psychiatry 2023; 83:140-147. [PMID: 37187033 DOI: 10.1016/j.genhosppsych.2023.03.016] [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: 02/01/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND We developed and tested the psychometric properties of the Multi-dimensional assessment of suicide risk in chronic illness-20 (MASC-20), which assess suicidal behavior (SB), and its associated distress in chronic physical illness (CPI). METHODS Items were developed by incorporating inputs from patient interviews, a review of existing instruments, and expert consultations. Pilot testing with 109 patients and field testing with 367 patients with renal, cardiovascular, and cerebrovascular diseases were conducted. We analyzed Time (T) 1 data to select items and T2 data to examine psychometric properties. RESULTS Forty preliminary items were selected through pilot testing; 20 were finalized from field testing. Optimal internal consistency (α = 0.94) and test-retest reliability (Intra class correlation coefficient = 0.92) of the MASC-20 supported reliability. Good fit of the four-factor model (physical distress, psychological distress, social distress, and SB) from exploratory structural equation modeling demonstrated factorial validity. Its correlations with MINI suicidality (r = 0.59) and the Schedule of Attitudes Toward Hastened Death-abbreviated scores (r = 0.62) indicated convergent validity. Higher MASC-20 scores in patients with clinical levels of depression and anxiety and low health status demonstrated known-group validity. The MASC-20 distress score predicted SB beyond known SB risk factors, supporting incremental validity. A cutoff score of 16 was optimal for identifying suicide risk. The area under the curve was within a moderately accurate range. The sum of sensitivity and specificity (1.66) indicated diagnostic utility. LIMITATIONS MASC-20's applicability to other patient populations and its sensitivity to change requires testing. CONCLUSIONS The MASC-20 appears to be a reliable and valid tool for assessing SB in CPI.
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Affiliation(s)
- Eun-Jung Shim
- Department of Psychology, Pusan National University, Busan, Republic of Korea
| | - Hyeju Ha
- Department of Psychology, Pusan National University, Busan, Republic of Korea
| | - Bo-Ram Kim
- Department of Rehabilitation Medicine, Gyeongin Regional Rehabilitation Hospital, Incheon, Republic of Korea
| | - Sun Mi Kim
- Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - Jung Yoon Moon
- Department of Psychiatry, Chamjoeun Hospital, Gwangju-si, Gyeongi-do, Republic of Korea
| | - Jin Ho Hwang
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Bong-Jin Hahm
- Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.
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24
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Nobile B, Belzeaux R, Aouizerate B, Dubertret C, Haffen E, Llorca PM, Roux P, Polosan M, Schwan R, Walter M, Rey R, Januel D, Leboyer M, Bellivier F, Etain B, Courtet P, Olié E. Clinical characteristics associated with discrepancies between self- and clinician-rated suicidal ideation in patients with bipolar disorder (FACE-BD cohort). Psychiatry Res 2023; 321:115055. [PMID: 36680982 DOI: 10.1016/j.psychres.2023.115055] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/27/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
Suicidal ideation (SI) is a major suicide risk factor; therefore, it is crucial to identify individuals with SI. Discrepancies between the clinicians and patients' estimation of SI may lead to under-evaluating the suicide risk. Yet, studies on discrepancies between self- and clinician-rated SI are lacking, although identifying the patients' sociodemographic and clinical characteristics associated with such discrepancies might help to reduce the under-evaluation risk. Therefore, the aim of this study was to identify features associated with SI rating discrepancies in patients with bipolar disorder (BD) because of the high prevalence of suicide in this population. Among the patients recruited by the French network of FondaMental expert centers for BD, patients with SI (i.e. ≥2 for item 12 of the Quick Inventory of Depressive Symptomatology-Self Report and/or ≥3 for item 10 of the clinician-rated Montgomery and Åsberg Depression Rating Scale) were selected and divided in concordant (i.e. SI in both self- and clinician-rated questionnaires; n = 130; 25.6%), and discordant (i.e. SI in only one questionnaire; n = 377; 74.4%). Depression severity was the feature most associated with SI evaluation discrepancy, especially in patients with SI identified only with the self-rated questionnaire. Clinician may under-evaluate SI presence in patients with low depression level.
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Affiliation(s)
- Bénédicte Nobile
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France; FondaMental Foundation, Créteil F-94000, France.
| | - Raoul Belzeaux
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, France; FondaMental Foundation, Créteil F-94000, France; Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - Bruno Aouizerate
- FondaMental Foundation, Créteil F-94000, France; Centre Hospitalier Charles Perrens, Bordeaux, France; Laboratoire NutriNeuro (UMR INRA 1286), Université de Bordeaux, Bordeaux, France
| | - Caroline Dubertret
- FondaMental Foundation, Créteil F-94000, France; Université Paris Cité, Paris, France; AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, Service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France; Université de Paris, Inserm UMR1266, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Emmanuel Haffen
- FondaMental Foundation, Créteil F-94000, France; Service de Psychiatrie de l'Adulte, CIC-1431 INSERM, CHU de Besançon, Laboratoire de Neurosciences, UFC, UBFC, Besançon, France
| | - Pierre-Michel Llorca
- FondaMental Foundation, Créteil F-94000, France; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Paul Roux
- FondaMental Foundation, Créteil F-94000, France; Université Paris-Saclay, UVSQ, CESP UMR1018, DevPsy-DisAP, Centre Hospitalier de Versailles, Pôle de Psychiatrie et Santé Mentale, 78157 Le Chesnay, France
| | - Mircea Polosan
- FondaMental Foundation, Créteil F-94000, France; Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Raymund Schwan
- FondaMental Foundation, Créteil F-94000, France; Université de Lorraine, Centre Psychothérapique de Nancy, Inserm U1254, Nancy, France
| | - Michel Walter
- FondaMental Foundation, Créteil F-94000, France; Service Hospitalo-Universitaire de Psychiatrie Générale et de Réhabilitation Psycho Sociale 29G01 et 29G02, CHRU de Brest, Hôpital de Bohars, Brest, France
| | - Romain Rey
- FondaMental Foundation, Créteil F-94000, France; INSERM U1028, CNRS UMR5292, Université Claude Bernard Lyon 1, Centre de Recherche en Neurosciences de Lyon, Equipe PSYR2, Centre Hospitalier Le Vinatier, Pole Est, 95 bd Pinel, BP 30039, 69678 Bron Cedex, France
| | - Dominique Januel
- FondaMental Foundation, Créteil F-94000, France; Unité de Recherche Clinique, EPS Ville-Evrard, 93332 Neuilly-sur-Marne, France
| | - Marion Leboyer
- FondaMental Foundation, Créteil F-94000, France; Univ Paris Est Créteil, INSERM U955, IMRB, Translational NeuroPsychiatry Laboratory, Créteil, France; AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Créteil, France
| | - Frank Bellivier
- FondaMental Foundation, Créteil F-94000, France; Université Paris Cité, Paris, France; AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Université Paris Cité, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris, France
| | - Bruno Etain
- FondaMental Foundation, Créteil F-94000, France; Université Paris Cité, Paris, France; AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU Neurosciences, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Université Paris Cité, INSERM UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie OTeN, Paris, France
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- FondaMental Foundation, Créteil F-94000, France
| | - Philippe Courtet
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France; FondaMental Foundation, Créteil F-94000, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France; FondaMental Foundation, Créteil F-94000, France
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Post-Discharge Suicide among High-Risk Psychiatric Inpatients: Risk factors and warnings signs. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023. [DOI: 10.1016/j.jadr.2023.100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
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26
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Bloch-Elkouby S, Zilcha-Mano S, Rogers ML, Park JY, Manlongat K, Krumerman M, Galynker I. Who are the patients who deny suicidal intent? Exploring patients' characteristics associated with self-disclosure and denial of suicidal intent. Acta Psychiatr Scand 2023; 147:205-216. [PMID: 36263445 DOI: 10.1111/acps.13511] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/09/2022] [Accepted: 10/16/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patients' non-disclosure of suicidal ideation and intent concealment represent a major obstacle to the effective assessment of suicide risk and to the delivery of suicide prevention treatments. The present study aimed to investigate this phenomenon and to assess (1) if outpatient psychiatric patients are more or less likely to disclose intent to mental health clinicians in the context of psychiatric/psychological treatment than they are to in the context of research interviews with non-clinicians; and (2) if certain demographic, trait-like, and state-like characteristics may predict such disclosure differences. METHODS A total of 780 psychiatric outpatient participants aged 18 to 84 and 193 clinician participants aged 25 to 54 were included in the study. The proportion of patients who disclosed to clinicians only, to research assistants (RAs) only, to both, and to none, was compared using a z-test. Univariate analyses were used to compare the participants' variables across disclosure groups, and significant individual predictors were included in multilevel regression analyses. RESULTS Participants were more significantly more likely to disclose to RAs (10.4%) than to clinicians (5.6%), p < 0.001. Neuroticism and trait anxiety predicted disclosure to RAs vs no disclosure; low extraversion predicted disclosure to clinician versus no disclosure; and extraversion and trait anxiety predicted disclosure to RAs versus to clinicians. DISCUSSION Patients' disclosure patterns, the personality variables predicting them, and their clinical implications were discussed in the context of the extant literature on patients' reasons for concealing suicidal ideation and intent.
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Affiliation(s)
- Sarah Bloch-Elkouby
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai Beth Israel, New York, USA
| | | | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, Texas, USA
| | - Ji Yoon Park
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai Beth Israel, New York, USA
| | - Katherine Manlongat
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai Beth Israel, New York, USA
| | - Mia Krumerman
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai Beth Israel, New York, USA
| | - Igor Galynker
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai Beth Israel, New York, USA
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27
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Soper C, Shackelford TK. Are depression and suicidality evolved signals? Evidently, no. EVOL HUM BEHAV 2023. [DOI: 10.1016/j.evolhumbehav.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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28
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Kim J, Gwak D, Kim S, Gang M. Identifying the suicidal ideation risk group among older adults in rural areas: Developing a predictive model using machine learning methods. J Adv Nurs 2023; 79:641-651. [PMID: 36534434 DOI: 10.1111/jan.15549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 10/10/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
AIMS The aim of this study was to develop a predictive model that can identify the suicidal ideation risk group among older adults in rural areas using machine learning methods. DESIGN This study applied an exploratory, descriptive and cross-sectional design. METHODS The participants were older adults (N = 650) aged over 65 living in rural areas of South Korea. Self-report questionnaires were used to collect the demographics, suicidal ideation, depression, socioeconomic information and basic health information from September to October 2020. The collected data were analysed using machine learning methods with R statistical software 4.1.0. RESULTS The predictive models indicated that depression, pain, age and loneliness were significant factors of suicidal ideation. Good performance was observed based on the area under the receiver operating characteristic curve in the decision tree, random forest and logistic regression. Finally, the evaluation of model performance indicated moderate to high sensitivity and specificity. CONCLUSION The predictive models using machine learning methods may be useful to predict the risk of suicidal ideation. Furthermore, depression with pain, age and feelings of loneliness should be included in the initial screening to assess suicide risk among older adults in rural areas. IMPACT Identifying suicidal risk among older adults is challenging. Thus, employing predictive models that can assess depression, pain, age and loneliness can enable public healthcare providers to detect suicidal risk groups. Particularly, the presented models from this study can facilitate healthcare providers with initiating early interventions to prevent suicide among older adults in clinical and community nursing care settings. REPORTING METHOD The reporting of this study (Observational, cross-sectional study) conforms to the STROBE statement. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public. IMPLICATION FOR THE PROFESSION AND/OR PATIENTS CARE Applying this model may help to prevent geriatric suicide because the nursing staff will have a greater awareness regarding the suicide ideation risk of older adults, thereby reducing the possibility of their suicide.
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Affiliation(s)
- Junglyun Kim
- College of Nursing, Chungnam National University, Daejeon, South Korea.,Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, USA
| | - DongHyeon Gwak
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Seonhee Kim
- Nursing Department, Songwon University, Gwangju, South Korea
| | - Moonhee Gang
- College of Nursing, Chungnam National University, Daejeon, South Korea
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29
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Yook V, Choi YH, Gu MJ, Lee D, Won H, Woo SY, Lee DH, Jeon HJ. Suicide Screening Questionnaire-Self-Rating (SSQ-SR): Development, reliability, and validity in a clinical sample of Korean adults. Compr Psychiatry 2023; 121:152360. [PMID: 36508776 DOI: 10.1016/j.comppsych.2022.152360] [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: 03/20/2022] [Revised: 11/25/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
The goal of the present study was to evaluate the psychometric properties of the Suicide Screening Questionnaire-Self-Rating (SSQ-SR). A 25-item SSQ-SR is a newly developed suicide screening tool that measures suicide risk factors, including a history of suicidal thoughts and behaviors (STBs), life stress, and mental health problems. To investigate the reliability and validity of the SSQ-SR, we conducted a longitudinal case-control study with adults with and without STBs in the past six months. A total of 176 participants were recruited through 12 hospital-based Crisis Response Centers across South Korea. At the baseline, we administered the SSQ-SR, the Beck Scale for Suicide Ideation (BSSI), and the Patient Health Questionnaire-9 (PHQ-9). In a 6-months follow-up, we investigated whether the participants engaged in suicidal ideation, plan, or attempt since the baseline assessment. As a result, the SSQ-SR demonstrated a strong internal consistency (Cronbach's alpha coefficient = 0.96). In addition, the total score of SSQ-SR had concurrent validity compared to the total scores of the BSSI and the PHQ-9. In comparing the suicidal groups with the control group, the ROC analysis indicated the optimal cut point at 31 with a sensitivity rate of 0.97 and a specificity rate of 0.98. Through explanatory factor analysis, two factors were identified: Mental Health and Environmental Factors and Active Suicidal Thoughts and Behaviors. The SSQ-SR total and sub-factor scores were prospectively associated with subsequent suicidal ideation, plan, and attempt. These findings support that the SSQ-SR is a promising tool in prospectively screening those who are at risk of suicidal thoughts, plans, and nonfatal attempts.
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Affiliation(s)
- Vidal Yook
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Hwan Choi
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Jeong Gu
- Department of Education, Traumatic Stress Center, Sungkyunkwan University College of Education, Seoul, Republic of Korea
| | - Deokhee Lee
- Department of Education, Traumatic Stress Center, Sungkyunkwan University College of Education, Seoul, Republic of Korea
| | - Hojeong Won
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Republic of Korea
| | - Sook-Young Woo
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Republic of Korea
| | - Dong Hun Lee
- Department of Education, Traumatic Stress Center, Sungkyunkwan University College of Education, Seoul, Republic of Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
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30
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Park JY, Rogers ML, Bloch-Elkouby S, Richards JA, Lee S, Galynker I, You S. Factor Structure and Validation of the Revised Suicide Crisis Inventory in a Korean Population. Psychiatry Investig 2023; 20:162-173. [PMID: 36891601 PMCID: PMC9996151 DOI: 10.30773/pi.2022.0208] [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: 07/19/2022] [Accepted: 12/07/2022] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE Because of the exceptionally high suicide rates in South Korea, new assessment methods are needed to improve suicide prevention. The current study aims to validate the revised Suicide Crisis Inventory-2 (SCI-2), a self-report measure that assesses a cognitiveaffective pre-suicidal state in a Korean sample. METHODS With data from 1,061 community adults in South Korea, confirmatory factor analyses were first conducted to test the proposed one-factor and five-factor structures of the SCI-2. Also, an exploratory factor analysis (EFA) was performed to examine possible alternative factor structure of the inventory. RESULTS The one-factor model of the SCI-2 resulted in good model fit and similarly, the five-factor model also exhibited strong fit. Comparing the two models, the five-factor was evaluated as the superior model fit. An alternative 4-factor model derived from EFA exhibited a comparable model fit. The Korean version of the SCI-2 had high internal consistency and strong concurrent validity in relation to symptoms of suicidal ideation, depression, and anxiety. CONCLUSION The SCI-2 is an appropriate and a valid tool for measuring one's proximity to imminent suicide risk. However, the exact factor structure of the SCI-2 may be culture-sensitive and warrants further study.
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Affiliation(s)
- Ji Yoon Park
- Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY, USA.,Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | | | | | - Sungwoo Lee
- Department of Psychology, Chungbuk National University, Cheongju, Republic of Korea
| | - Igor Galynker
- Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Sungeun You
- Department of Psychology, Chungbuk National University, Cheongju, Republic of Korea
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Emergency Psychiatry: Updates, Future Directions, and Core Concepts. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:70-71. [PMID: 37205034 PMCID: PMC10172547 DOI: 10.1176/appi.focus.23022003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Rozel JS, Toohey T, Amin P. Legal Considerations in Emergency Psychiatry. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:3-7. [PMID: 37205030 PMCID: PMC10172539 DOI: 10.1176/appi.focus.20220071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Emergency psychiatry stands at the fulcrum between the general principles of autonomy and liberty balanced against illnesses that both subvert autonomy and amplify risks for violence and suicide. Although all specialties of medicine must operate in adherence with the law, emergency psychiatry is particularly constrained and guided by state and federal laws. Routine matters of emergency psychiatric care-including involuntary assessment, admission and treatment, management of agitation, medical stabilization and transfer, confidentiality, voluntary and involuntary commitment, and duties to third parties-all occur within carefully delimited legal boundaries, rules, and processes. This article provides a basic overview of critical legal principles relevant to the practice of emergency psychiatry.
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Affiliation(s)
- John S Rozel
- Department of Psychiatry (Rozel, Amin) and School of Law (Rozel), University of Pittsburgh, Pittsburgh, Pennsylvania; UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania (Rozel, Amin); Department of Psychiatry, University of Hawaii, Honolulu (Toohey)
| | - Tara Toohey
- Department of Psychiatry (Rozel, Amin) and School of Law (Rozel), University of Pittsburgh, Pittsburgh, Pennsylvania; UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania (Rozel, Amin); Department of Psychiatry, University of Hawaii, Honolulu (Toohey)
| | - Priyanka Amin
- Department of Psychiatry (Rozel, Amin) and School of Law (Rozel), University of Pittsburgh, Pittsburgh, Pennsylvania; UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania (Rozel, Amin); Department of Psychiatry, University of Hawaii, Honolulu (Toohey)
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33
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Tanaka K, Ikeuchi S. Difficulties in suicide prevention facing primary healthcare workers based on the characteristics of people with suicide risk and healthcare systems. J Adv Nurs 2022. [DOI: 10.1111/jan.15522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 11/03/2022] [Accepted: 11/23/2022] [Indexed: 12/09/2022]
Affiliation(s)
- Koji Tanaka
- Faculty of Health Sciences Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University Kanazawa Japan
| | - Satomi Ikeuchi
- Faculty of Health Sciences Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University Kanazawa Japan
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Bafna A, Rogers ML, Galynker II. Predictive validity and symptom configuration of proposed diagnostic criteria for the Suicide Crisis Syndrome: A replication study. J Psychiatr Res 2022; 156:228-235. [PMID: 36270061 DOI: 10.1016/j.jpsychires.2022.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/13/2022] [Accepted: 10/06/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The Suicide Crisis Syndrome (SCS) is a new proposed suicide-specific diagnosis. In the present large replication study, we examine SCS diagnostic criteria to determine which configuration of symptoms demonstrates the strongest convergent and predictive validity for near-term suicidal behaviour. METHODS We conducted confirmatory factor analysis (CFA) to examine the factor structure of the proxy-SCS variables derived from an extensive self-report test battery and administered to 903 psychiatric patients (age (M = 36.70, SD = 13.91); gender (64.0% female)) at intake and 4-8-week follow-up assessments. Convergent and predictive validity of five configurations of the proposed SCS diagnostic criteria for suicidal ideation (SI) and attempts (SA) were examined using regression analyses. The new clinician-rated SCS-Checklist was piloted with 68 participants. RESULTS Both the one-factor and the five-factor models of proxy-SCS variables exhibited strong model fit, supporting the uni-dimensionality as well as the five-criteria structure of the SCS. All four configurations were uniquely related to the presence of a suicide attempt at follow-up when controlling for intake SI, lifetime SA, age, and gender, but none were significantly associated with intake SA when controlling for intake SI, age, and gender. All bivariate correlations between proxy-assessed and checklist-assessed SCS symptom configurations were significant and positive. CONCLUSION The proposed five-symptom structure of the SCS diagnostic criteria was supported and appears to describe a clinically meaningful syndrome specifically related to near-term suicidal behaviour. SCS assessment may significantly improve clinical evaluation of imminent suicide risk. Future studies are needed to assess the utility of the syndrome in clinical settings.
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Affiliation(s)
- Anokhi Bafna
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY, USA; Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA.
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA.
| | - Igor I Galynker
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA.
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35
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Fortune S, Hetrick S. Suicide risk assessments: Why are we still relying on these a decade after the evidence showed they perform poorly? Aust N Z J Psychiatry 2022; 56:1529-1534. [PMID: 35786014 DOI: 10.1177/00048674221107316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Suicide deaths have a profound impact on whānau and community and are a tragic loss. However, from a statistical point of view, suicide is a relatively rare event. Predicting rare events is difficult, and the implications for suicide prevention were highlighted in an important editorial in this journal more than a decade ago, yet little seems to have changed. Risk assessment that focuses on accurate prediction of suicide in real-world contexts is given a great deal of attention in mental health services, despite the fact that current scientific knowledge and best practice guidelines in this area highlight that it is unlikely to be a good basis on which to provide access to treatment. It is our view that we have a good enough understanding of the common conditions people who struggle with suicidal distress experience and energy is better directed at acting to reduce exposure to these conditions and providing treatment for those who seek it. Blueprints for successful suicide prevention exist. If we lessen the focus on prediction, we will have greater resources to focus on treatment and prevention.
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Affiliation(s)
- Sarah Fortune
- Department of Social and Community Health, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Sarah Hetrick
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand.,Suicide Prevention Office, Auckland, New Zealand
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36
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Hawton K, Lascelles K, Pitman A, Gilbert S, Silverman M. Assessment of suicide risk in mental health practice: shifting from prediction to therapeutic assessment, formulation, and risk management. Lancet Psychiatry 2022; 9:922-928. [PMID: 35952701 DOI: 10.1016/s2215-0366(22)00232-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 12/20/2022]
Abstract
Suicide prevention in psychiatric practice has been dominated by efforts to predict risk of suicide in individual patients. However, traditional risk prediction measures have been shown repeatedly in studies from high income countries to be ineffective. Several factors might contribute to clinicians' preoccupation with risk prediction, which can have negative effects on patient care and also on clinicians where prediction is seen as failing. The model of therapeutic risk assessment, formulation, and management we outline in this article regards all patients with mental health problems as potentially at increased risk of suicide. It is aimed at reducing risk through use of a person-centred approach. We describe how a move towards therapeutic risk assessment, formulation, and risk management, including collaborative safety planning, could help clinicians develop a more tailored approach to managing risk for all patients, incorporating potentially therapeutic effects as well as helping to identify other risk reduction interventions. Such an approach could lead to enhanced patient safety and quality of care, which is more acceptable to patients.
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Affiliation(s)
- Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | | | - Alexandra Pitman
- UCL Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | | | - Morton Silverman
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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37
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Berman AL. Rates of denying suicide ideation proximate to death by suicide: A re-analysis. Gen Hosp Psychiatry 2022; 79:179. [PMID: 35914966 DOI: 10.1016/j.genhosppsych.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Alan L Berman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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38
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Hedley D, Batterham PJ, Bury SM, Clapperton A, Denney K, Dissanayake C, Fox P, Frazier TW, Gallagher E, Hayward SM, Robinson J, Sahin E, Trollor J, Uljarević M, Stokes MA. The Suicidal Ideation Attributes Scale-Modified (SIDAS-M): Development and preliminary validation of a new scale for the measurement of suicidal ideation in autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 27:1115-1131. [PMID: 36237153 DOI: 10.1177/13623613221131234] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Autistic people may be at higher risk of suicidal behavior than people in the general population. Suicidal behavior may include thinking about suicide or attempting to end one's own life by suicide. It is important to identify autistic people who may be thinking about suicide. People who are at risk of suicidal behavior can be identified by asking questions about whether they have been thinking about suicide. A specially designed questionnaire, or screening instrument, can help someone ask the best questions to find out if someone has been thinking about suicide. This information can help to identify supports to be put in place to prevent suicidal behavior, such as a suicide attempt. However, autistic people may interpret questions differently than non-autistic people. It is important to use screening tools that have been designed with, and for autistic people. In this study, we examined the Suicidal Ideation Attributes Scale (SIDAS). The SIDAS is an existing tool that was developed to screen for suicidal thinking in the general population. We modified SIDAS for use with autistic adults. We involved autistic people in the process of modifying SIDAS. We called the modified instrument the SIDAS-M. The results of our study showed SIDAS-M may be useful for screening for suicidal thinking in autistic adults who do not have an intellectual disability.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jo Robinson
- The University of Melbourne, Australia.,Orygen, Australia
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Rogers ML, Bafna A, Galynker I. Comparative clinical utility of screening for Suicide Crisis Syndrome versus suicidal ideation in relation to suicidal ideation and attempts at one-month follow-up. Suicide Life Threat Behav 2022; 52:866-875. [PMID: 35441411 DOI: 10.1111/sltb.12870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 02/03/2022] [Accepted: 04/05/2022] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Suicidal ideation (SI) has numerous limitations in predicting suicidal behavior. The Suicide Crisis Syndrome (SCS) is proposed as an alternative method of detecting risk. This study compares the relative utility of SI and SCS in statistically predicting SI and behaviors at one-month follow-up. METHODS 382 psychiatric patients (98 inpatients, 284 outpatients) completed baseline measures and provided information about suicide-related outcomes one month later. Participants were grouped based on responses to measures assessing SCS and SI. RESULTS Rates of follow-up suicidal behavior were significantly higher among those reporting both SCS and SI (22.2%) than those reporting SI alone (6.0%) or neither SCS nor SI (0.9%). SCS alone (8.3%) had descriptively, but not statistically, higher rates of suicidal behavior than those with neither SCS nor SI, and did not differ from SI alone and the combination of SCS and SI. Those reporting SI-with and without SCS-had higher levels of follow-up suicidal thoughts than those without SI. CONCLUSION The SCS was equivalent to SI, and incrementally informative alongside SI, in detecting individuals at risk of future suicidal behavior, whereas SI was more strongly related to future SI than SCS. The combination of SCS and SI may be clinically useful in detecting individuals who are at risk for suicide.
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Affiliation(s)
- Megan L Rogers
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
| | - Anokhi Bafna
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
| | - Igor Galynker
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA
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Resilience to suicidal behavior in young adults: a cross-sectional study. Sci Rep 2022; 12:11419. [PMID: 35794217 PMCID: PMC9259642 DOI: 10.1038/s41598-022-15468-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/24/2022] [Indexed: 02/03/2023] Open
Abstract
Despite decades of research on suicide risk factors in young people, there has been no significant improvement in our understanding of this phenomenon. This study adopts a positive deviance approach to identify individuals with suicide resilience and to describe their associated psychological and sociodemographic profiles. Australian young adults aged 18–25 years with suicidal thoughts (N = 557) completed an online survey covering sociodemographic, mental health status, emotion regulatory and suicide-related domains. Latent class analysis was used to identify the individuals with suicide resilience. The predictors of suicide resilience were assessed using logistic regression models. The results suggested that one in ten (n = 55) met the criteria for suicide resilience. Factors that had a significant association with suicide resilience included greater cognitive flexibility, greater self-efficacy in expressing positive affect, reduced use of digital technology and less self-harm and substance use as a response to emotional distress. This study identified the factors that may protect young adults with suicidal thoughts from progressing to suicide attempts. Suicide prevention programs might be optimised by shifting from a deficit-based to a strength-based approach through promoting cognitive flexibility, self-efficacy and reducing maladaptive coping.
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Menon V, Bafna AR, Rogers ML, Richards J, Galynker I. Factor structure and validity of the Revised Suicide Crisis Inventory (SCI-2) among Indian adults. Asian J Psychiatr 2022; 73:103119. [PMID: 35447538 DOI: 10.1016/j.ajp.2022.103119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 04/07/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is a dearth of cross-cultural data on the psychometric properties of the revised Suicide Crisis Inventory (SCI)- 2. Our objective was to examine the factor structure, reliability, and validity of the SCI-2 among Indian adults. METHODS Using an online survey method, between August 20, 2020 and January 31, 2021, an anonymous questionnaire containing general sociodemographic information and self-report measures was circulated over email and social media. Confirmatory factor analyses (CFA) of the SCI-2 was carried out. We also examined the internal consistency of the SCI-2 and tested its convergent validity against the Suicide Narrative Inventory (SNI) and the Perceived Stress Scale (PSS-10). RESULTS A total of 302 participants (Mean age = 43.5 ± 17.9 years, 53.6% female) were obtained. Results of the one-factor CFA indicated good model fit (χ2[1769] = 5368.75, p < 0.001, Comparative Fit Index [CFI] =0.99, Root mean square error of approximation [RMSEA] =0.08). Similarly, the five-factor CFA also exhibited strong model fit (χ2[1759] = 4215.54, p < 0.001, CFI = 1.00, RMSEA =0.07). Comparison of these models indicated that the five-factor model demonstrated superior model fit (Δχ2[10] = 278.88, p < 0.001). The SCI-2 total and subscale scores showed excellent internal consistency and good convergent validity against most domains of the SNI and PSS-10. CONCLUSION Among Indian adults, the SCI-2 demonstrated good psychometric properties with the proposed five-factor solution providing the best fit. These findings provide support for the SCI construct and its assessment with the SCI-2 in an Asian setting.
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Affiliation(s)
- Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India.
| | - Anokhi Rajiv Bafna
- Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York, NY 10003, USA
| | - Megan L Rogers
- Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York, NY 10003, USA
| | - Jenelle Richards
- Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York, NY 10003, USA
| | - Igor Galynker
- Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York, NY 10003, USA
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Bradford DRR, Biello SM, Russell K. Defeat and Entrapment Mediate the Relationship Between Insomnia Symptoms and Suicidal Ideation in Young Adults. Arch Suicide Res 2022; 26:1632-1643. [PMID: 33616024 DOI: 10.1080/13811118.2021.1885537] [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] [Indexed: 10/22/2022]
Abstract
AIM In recent years, there has been a growing interest in understanding the relationship between sleep disturbance and suicide. The current study aimed to advance understanding of the psychological processes driving these relationships by examining whether insomnia symptoms are related to suicidal ideation via perceptions of defeat and entrapment. METHODS Young adults (n = 259; 202 students [78.0%], 45 employed [17.4%], 12 unemployed [4.6%]) completed an anonymous self-report survey that was advertised via social media, university participant pools, and fliers. The survey was described as being related to sleep and mood/mental health. Validated measures were used to assess insomnia symptoms, chronotype, defeat, entrapment, suicidal ideation, and affective covariates. RESULTS Bivariate associations found insomnia severity to be related to poorer affective outcomes including severity of suicidal ideation. Insomnia and depression were significant independent variables in multiple linear regression with suidical ideation as the dependent variable. The relationship between insomnia and suicidal ideation was mediated by perceptions of defeat and entrapment. CONCLUSION Taken together, these findings shed light on the psychological mechanisms linking sleep disturbance and suicidal ideation by highlighting the role of defeat and entrapment. These findings have the potential to improve suicide risk assessment and prevention in young adults experiencing difficulties initiating or maintaining sleep.HighlightsDefeat and entrapment mediate relationship between insomnia and suicidal ideationEvidence for Integrated Motivational-Volitional Model of Suicidal Behavior in community sampleUses validated multi-item suicide measure.
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43
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Berman AL. Risk factors observed in the last 30 days of life among student suicides: distinguishing characteristics of college and university student suicides. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1275-1279. [PMID: 32693703 DOI: 10.1080/07448481.2020.1791884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/12/2020] [Accepted: 06/28/2020] [Indexed: 06/11/2023]
Abstract
Purpose: Studies of college and university student suicide have identified predictors only of suicide ideation and attempts and have relied solely on self-report data. This study explores risk factors observed in the last 30 days of life of college and university students who died by suicide, compared to those of high school and middle school students. Methods: Retrospective chart reviews of 16 college and university students (aged 19-26) were abstracted and compared to those of 24 middle and high school students (aged 12-18), all in, or recently in, clinical care. Results: Near-term risk factors for deaths by suicide largely were equivalent in compared groups, with only sleep problems, conduct problems, and passive suicide ideation found to be significantly different between student cohorts. Conclusions: These preliminary findings are hypotheses-generating for larger studies of more restricted age ranged youth cohorts needed to better differentiate near-term risk factors for suicide.
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Affiliation(s)
- Alan L Berman
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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SHIMAZAKI HIROMI, UTAGAWA ITARU, SANO CHIEMI, SAKURADA SHINOBU, YAMASHITA KYOUHEI, SHIBATA NOBUTO, OTA TUNEYOSHI, FUKUSHIMA TADASHI. Exploring the Objective Signs of Imminent Suicide Risk in Psychiatric In-patients. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2022; 68:261-270. [PMID: 39021720 PMCID: PMC11250009 DOI: 10.14789/jmj.jmj22-0002-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/09/2022] [Indexed: 07/20/2024]
Abstract
Objective This study retrospectively explores the objective signs of imminent suicide risk in psychiatric in-patients. Design The study analysed the diagnostic and nursing records of a psychiatric hospital that covered the last 14 days before the suicide attempts of 18 people, who, between March 2008 and July 2019, were found to have died by suicide during their hospital stay. Methods Three professionals used a fishbone diagram to separately identify the factors that led to each person's suicide, the objective signs that indicated imminent suicide risk, possible preventive strategies, and other observations. They compared their findings and used the KJ method (Kawakita Jiro Method) to categorise the items on which they all agreed. Results Objective signs of imminent suicide risk were condensed into five categories: 'signs emanating from the patient', 'signs gleaned through engagement', 'signs from response to treatment', 'signs associated with reports from the family', and 'signs inferred from multiple sources of information'. Five categories describing issues with the way in which the hospital staff handled information were extracted, namely 'omission in diagnostic records during admission', 'omission in conference records', 'communication lapse during transfer', 'need for integrated information', and 'systemic issues'. Conclusions The findings offer insights on assessing suicide risk and preventing suicide.
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Affiliation(s)
| | | | | | | | | | - NOBUTO SHIBATA
- Corresponding author: Nobuto Shibata (ORCID: 0000-0001-5654-5024), Department of Psychiatry, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo 136-0075, Japan, TEL: +81-3-5632-3111 FAX: +81-3-5632-3728 E-mail:
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45
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Rogers ML, Bloch-Elkouby S, Galynker I. Differential disclosure of suicidal intent to clinicians versus researchers: Associations with concurrent suicide crisis syndrome and prospective suicidal ideation and attempts. Psychiatry Res 2022; 312:114522. [PMID: 35378454 DOI: 10.1016/j.psychres.2022.114522] [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: 01/17/2022] [Revised: 03/11/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
Several patient and setting characteristics have been found to predict disclosure of suicidality to clinicians versus researchers. Less understood, however, is whether differential disclosure of suicidality predicts concurrent indirect indicators of suicide risk and future suicide-related outcomes. The present study examined differential disclosure of suicidal intent in clinical versus research settings as a predictor of (1) concurrent symptoms of the Suicide Crisis Syndrome (SCS); and (2) suicidal ideation and attempts within one month in patients (n = 1039) and their clinicians (n = 144), who completed a battery of self-report and interview measures at baseline. Patients who reported suicidal intent to anyone had higher concurrent SCS symptoms than those who denied suicidal intent, with no differences between those who reported intent to clinicians versus researchers only. Severity of suicidal ideation and rates of suicide attempts at one-month follow-up were higher among those who disclosed suicidal intent to a research assistant than among those who did not-regardless of whether suicidal intent was disclosed to their clinician. Overall, an improved understanding of the factors contributing to differential disclosure will improve both scientific inquiry and patient safety.
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Bentley KH, Zuromski KL, Fortgang RG, Madsen EM, Kessler D, Lee H, Nock MK, Reis BY, Castro VM, Smoller JW. Implementing Machine Learning Models for Suicide Risk Prediction in Clinical Practice: Focus Group Study With Hospital Providers. JMIR Form Res 2022; 6:e30946. [PMID: 35275075 PMCID: PMC8956996 DOI: 10.2196/30946] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 11/19/2022] Open
Abstract
Background Interest in developing machine learning models that use electronic health record data to predict patients’ risk of suicidal behavior has recently proliferated. However, whether and how such models might be implemented and useful in clinical practice remain unknown. To ultimately make automated suicide risk–prediction models useful in practice, and thus better prevent patient suicides, it is critical to partner with key stakeholders, including the frontline providers who will be using such tools, at each stage of the implementation process. Objective The aim of this focus group study is to inform ongoing and future efforts to deploy suicide risk–prediction models in clinical practice. The specific goals are to better understand hospital providers’ current practices for assessing and managing suicide risk; determine providers’ perspectives on using automated suicide risk–prediction models in practice; and identify barriers, facilitators, recommendations, and factors to consider. Methods We conducted 10 two-hour focus groups with a total of 40 providers from psychiatry, internal medicine and primary care, emergency medicine, and obstetrics and gynecology departments within an urban academic medical center. Audio recordings of open-ended group discussions were transcribed and coded for relevant and recurrent themes by 2 independent study staff members. All coded text was reviewed and discrepancies were resolved in consensus meetings with doctoral-level staff. Results Although most providers reported using standardized suicide risk assessment tools in their clinical practices, existing tools were commonly described as unhelpful and providers indicated dissatisfaction with current suicide risk assessment methods. Overall, providers’ general attitudes toward the practical use of automated suicide risk–prediction models and corresponding clinical decision support tools were positive. Providers were especially interested in the potential to identify high-risk patients who might be missed by traditional screening methods. Some expressed skepticism about the potential usefulness of these models in routine care; specific barriers included concerns about liability, alert fatigue, and increased demand on the health care system. Key facilitators included presenting specific patient-level features contributing to risk scores, emphasizing changes in risk over time, and developing systematic clinical workflows and provider training. Participants also recommended considering risk-prediction windows, timing of alerts, who will have access to model predictions, and variability across treatment settings. Conclusions Providers were dissatisfied with current suicide risk assessment methods and were open to the use of a machine learning–based risk-prediction system to inform clinical decision-making. They also raised multiple concerns about potential barriers to the usefulness of this approach and suggested several possible facilitators. Future efforts in this area will benefit from incorporating systematic qualitative feedback from providers, patients, administrators, and payers on the use of these new approaches in routine care, especially given the complex, sensitive, and unfortunately still stigmatized nature of suicide risk.
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Affiliation(s)
- Kate H Bentley
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychology, Harvard University, Cambridge, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Kelly L Zuromski
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Rebecca G Fortgang
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Emily M Madsen
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Daniel Kessler
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Hyunjoon Lee
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Ben Y Reis
- Harvard Medical School, Boston, MA, United States.,Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States
| | - Victor M Castro
- Research Information Science and Computing, Mass General Brigham, Somerville, MA, United States
| | - Jordan W Smoller
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, United States
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Hospital-Based Suicides: Challenging Existing Myths. Psychiatr Q 2022; 93:1-13. [PMID: 33169312 DOI: 10.1007/s11126-020-09856-w] [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] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
Myths are widely held and often based on false beliefs. To improve patient safety and speed the translation of research to clinical practice, we highlight and then debunk 10 common myths regarding the assessment, treatment, and management of hospitalized patients at risk for suicide. Myths regarding hospital-based suicides are examined and empirical evidence that counters each myth is offered. Ten common myths regarding hospital-based suicides are found to be untrue or unsupported based on existing empirical evidence. Rethinking common beliefs and practices that lack empirical support and seeking alternatives based on research evidence is consistent with an emphasis on evidence-based practices leading to improved patient care and protection.
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Berman AL, Silverman MM, Wortzel HS, McIntosh JL. Suicide and Life Insurance. J Psychiatr Pract 2022; 28:54-61. [PMID: 34989346 DOI: 10.1097/pra.0000000000000607] [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: 11/26/2022]
Abstract
Much has been written about the history of suicide and, notably, about societies that condemned both the act and the actor, resulting in a perpetuation of suicide being stigmatized in many cultures. One aspect of this perceived stigmatization involves exclusionary clauses in life insurance policies that reject paying benefits to survivor-beneficiaries of the decedent if the decedent has died by suicide within a prescribed time frame. From the perspective of the individual, life insurance is designed to protect the estate of a decedent from a significant financial burden. From the insurer's perspective, there are essentially 2 reasons for having a suicide exclusion clause: limiting risk and preventing or discouraging fraud. This column examines these rationales in light of the estimated few suicides that do occur during exclusionary clause time frames. Observations are made about the effect of these clauses on those impacted by the loss of a loved one who died by suicide within the exclusionary time frame. An examination of the perspectives of both the life insurance industry and the impacted survivors of suicide decedents raises questions about what are reasonable and appropriate exclusionary clause time frames that protect both the insurer and survivor-beneficiaries. The forensic expert consulting on such cases should be cognizant of these competing perspectives and engage in therapeutic assessment whenever possible, identifying opportunities to promote thoughtful suicide postvention.
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Peters EM, Dong LY, Thomas T, Khalaj S, Balbuena L, Baetz M, Osgood N, Bowen R. Instability of Suicidal Ideation in Patients Hospitalized for Depression: An Exploratory Study Using Smartphone Ecological Momentary Assessment. Arch Suicide Res 2022; 26:56-69. [PMID: 32654657 DOI: 10.1080/13811118.2020.1783410] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This study used ecological momentary assessment (EMA) to explore the correlates of suicidal ideation (SI) instability in patients hospitalized for depression and SI. Thirty-nine adult inpatients were given smartphones with visual analogue scales to rate current depressed mood, anger/irritability, feeling socially connected, and SI three times a day throughout hospitalization. Affective Lability Scales (ALS) were also completed at baseline. SI instability was correlated with SI intensity, depressed mood instability, and social connection instability. Social connection instability was not associated with SI instability after controlling for depressed mood instability. ALS scores were not associated with EMA-derived SI instability. Participants with multiple past suicide attempts experienced greater SI instability. More research examining the clinical significance of SI instability is warranted.
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Bellairs-Walsh I, Byrne SJ, Bendall S, Perry Y, Krysinska K, Lin A, Michail M, Lamblin M, Li TY, Hetrick S, Robinson J. Working with Young People at Risk of Suicidal Behaviour and Self-Harm: A Qualitative Study of Australian General Practitioners' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12926. [PMID: 34948536 PMCID: PMC8701929 DOI: 10.3390/ijerph182412926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/25/2022]
Abstract
General Practitioners (GPs) play a crucial role in the identification and support of young people at risk of suicidal behaviour and self-harm; however, no studies have explored GPs' perspectives, approaches, challenges, and resource needs when working with this cohort in an Australian setting. This was a qualitative study where fifteen GPs (Mage = 45.25 years) from multiple clinics in Western Australia took part in semi-structured interviews, and data were analysed thematically. Seven main themes were identified: (1) working with young people has its unique challenges; (2) screening and assessment tools can help to manage uncertainty and discomfort; (3) going beyond tools-the dialogue and relationship are most important; (4) there are limits to what we can offer in the time available; (5) the service access and referral pathways lack clarity and coordination; (6) the provision of mental health support should not fall on GPs alone; and (7) more comprehensive training in suicide and self-harm is needed. The findings highlight a number of opportunities to enhance care and better assist GPs working with young people who present with suicidal behaviour and self-harm, including considerations for conducting assessments, targeted resources such as training, and system and service improvements.
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Affiliation(s)
- India Bellairs-Walsh
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Sadhbh J. Byrne
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Centre for Global Health, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Sarah Bendall
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Yael Perry
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, WA 6009, Australia; (Y.P.); (A.L.)
| | - Karolina Krysinska
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Centre for Mental Health, School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, WA 6009, Australia; (Y.P.); (A.L.)
| | - Maria Michail
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham B15 2TT, UK;
| | - Michelle Lamblin
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Tina Yutong Li
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Townsville University Hospital, Douglas, QLD 4814, Australia
| | - Sarah Hetrick
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1010, New Zealand
| | - Jo Robinson
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
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