On the Iatrogenic Risk of Assessing Suicidality: A Meta-Analysis

Feasibility and Acceptability of Ecological Momentary Assessment to Assess Suicide Risk among Young People with Mood Disorder in China

Suicidal thoughts and behaviors (STBs) are increasing among young people (aged 12-24 years) in China. Although Ecological Momentary Assessment (EMA) has been increasingly used to study STBs worldwide, no study has been conducted on young people with mood disorders (MD) in China. This mixed-method study aimed to evaluate the feasibility and acceptability of suicide risk monitoring in 75 young people with MD. Participants completed five to eight daily EMA surveys and wore smart bands for the EMA study. Semi-structured interviews were used to collect feedback. High adherence to EMA surveys (73.0 %) and smart bands (87.4 %) indicated feasibility. Participants reported an overall positive experience with the EMA study (helpful, friendly, and acceptable). Additionally, the reasons they were willing to comply with the EMA study were: (1) seeing the possibility of returning to "normal," and (2) experiencing the process of returning. However, a small proportion of participants had negative experiences (e.g., annoyance and missing prompts). The results of this mixed-methods study provide preliminary support for the feasibility and acceptability of using EMA (combined smartphones and wearable sensor devices) to assess suicidality among young people with MD in the Chinese cultural and social context.

Examination of Acceptability, Feasibility, and Iatrogenic Effects of Ecological Momentary Assessment (EMA) of Suicidal Ideation

Ecological momentary assessment (EMA) can be used to examine the dynamics of suicidal ideation in daily life. While the general acceptability and feasibility of EMA in suicide research has been established, further examination of potential iatrogenic effects (i.e., negative reactivity) and identifying those more likely to react negatively is needed. Participants (N = 82) with current suicidal ideation completed 21 days of EMA (4×/day) and filled in M = 78% (Med = 84%) of the EMA. No positive or negative affect reactivity was observed in EMA ratings over the study period. Retrospectively, most participants rated their experience as positive (69%); 22% indicated mood worsening, and 18% suicidal ideation reactivity. Those with more borderline personality traits, posttraumatic stress disorder (PTSD), and higher depressive, anxiety, and suicidal ideation symptoms, were more likely to report iatrogenic effects. In conclusion, while high compliance rates and lack of affect reactivity during EMA indicate that EMA is well tolerated in suicide research, a minority of participants may report subjective mood effects in retrospect.

Participation in a daily diary study about suicide ideation yields no iatrogenic effects: A mixed method analysis

INTRODUCTION

Despite evidence that participation in suicide research is not associated with worsening ideation, behaviors, or intent, the rise of intensive longitudinal methods to assess ideation and behaviors necessitates further investigation for potential iatrogenic effects. The present study assessed rates of change in suicide ideation (SI) in a 10-day daily diary study.

METHODS

Seventy-two adult participants with ongoing SI participated in 10 daily diary surveys and three follow-up assessments. One open-ended item was included to address participant experiences in the study.

RESULTS

A multilevel piecewise growth model revealed steady declines in SI for participants over the 10 days. However, rates of SI increased during the follow-up assessments, indicating that participation in the daily surveys was associated with general reductions in SI. Further, qualitative analyses of experiences in the study revealed the following themes: Useful (n = 34), Heightened Awareness (n = 21), Functional (n = 6), Not Useful (n = 6), and Beneficence (n = 4).

CONCLUSION

This study demonstrated that participation in suicide research, including intensive longitudinal methods such as daily diary studies, did not have iatrogenic effects on participants with SI. Qualitative results demonstrated the numerous benefits participants derived while taking part in this study.

Machine Learning-Based Evaluation of Suicide Risk Assessment in Crisis Counseling Calls

OBJECTIVE

Counselor assessment of suicide risk is one key component of crisis counseling, and standards require risk assessment in every crisis counseling conversation. Efforts to increase risk assessment frequency are limited by quality improvement tools that rely on human evaluation of conversations, which is labor intensive, slow, and impossible to scale. Advances in machine learning (ML) have made possible the development of tools that can automatically and immediately detect the presence of risk assessment in crisis counseling conversations.

METHODS

To train models, a coding team labeled every statement in 476 crisis counseling calls (193,257 statements) for a core element of risk assessment. The authors then fine-tuned a transformer-based ML model with the labeled data, utilizing separate training, validation, and test data sets.

RESULTS

Generally, the evaluated ML model was highly consistent with human raters. For detecting any risk assessment, ML model agreement with human ratings was 98% of human interrater agreement. Across specific labels, average F1 (the harmonic mean of precision and recall) was 0.86 at the call level and 0.66 at the statement level and often varied as a result of a low base rate for some risk labels.

CONCLUSIONS

ML models can reliably detect the presence of suicide risk assessment in crisis counseling conversations, presenting an opportunity to scale quality improvement efforts.

Introducing FRED: Software for Generating Feedback Reports for Ecological Momentary Assessment Data

Ecological Momentary Assessment (EMA) is a data collection approach utilizing smartphone applications or wearable devices to gather insights into daily life. EMA has advantages over traditional surveys, such as increasing ecological validity. However, especially prolonged data collection can burden participants by disrupting their everyday activities. Consequently, EMA studies can have comparably high rates of missing data and face problems of compliance. Giving participants access to their data via accessible feedback reports, as seen in citizen science initiatives, may increase participant motivation. Existing frameworks to generate such reports focus on single individuals in clinical settings and do not scale well to large datasets. Here, we introduce FRED (Feedback Reports on EMA Data) to tackle the challenge of providing personalized reports to many participants. FRED is an interactive online tool in which participants can explore their own personalized data reports. We showcase FRED using data from the WARN-D study, where 867 participants were queried for 85 consecutive days with four daily and one weekly survey, resulting in up to 352 observations per participant. FRED includes descriptive statistics, time-series visualizations, and network analyses on selected EMA variables. Participants can access the reports online as part of a Shiny app, developed via the R programming language. We make the code and infrastructure of FRED available in the hope that it will be useful for both research and clinical settings, given that it can be flexibly adapted to the needs of other projects with the goal of generating personalized data reports.

Effects of frequent assessments on the severity of suicidal thoughts: an ecological momentary assessment study

Objective

In recent years, there has been a significant increase in research using ecological momentary assessment (EMA) to explore suicidal thoughts and behaviors (STBs). Meanwhile, concerns have been raised regarding the potential impacts of frequent and intense STBs assessments on the study participants.

Methods

From November 2021 to June 2023, a total of 83 adolescent and young adult outpatients (Mage = 21.0, SDage = 6.3, 71.1% female), who were diagnosed with mood disorders, were recruited from three psychiatric clinics in China. Smartphone-based EMA was used to measure suicidal thoughts three times per day at randomly selected times. We examined the change of suicidal thoughts in each measurement and within 1 day to evaluate potential adverse effects using Bayesian multilevel models.

Results

The 3,105 effective surveys were nested in 83 participants (median follow-up days: 14 days). The results of two-level models indicated that suicidal thoughts decreased during the monitoring period. However, this effect varied among different individuals in the two-level model.

Conclusion

Our findings did not support the notion that repeated assessment of suicidal thoughts is iatrogenic, but future research should continue to investigate the impact of frequent assessment on suicidal thoughts, taking into account individual differences and utilizing larger sample sizes.

Examining the effects of response monitoring instructions on endorsements of suicidal ideation in an online study

INTRODUCTION

It is common practice for researchers to monitor responses to items assessing suicidal ideation and follow-up with high-risk participants, when their identities are known. However, it is becoming increasingly common for researchers to administer fully anonymous online surveys that do not allow for follow-ups with participants at higher risk. The aim of the current study was to investigate whether these two different approaches-monitoring and follow-up versus no monitoring or follow-up-affect the willingness of participants to endorse suicidal ideation.

METHODS

The sample included N = 555 undergraduate students, who were randomly assigned to the monitoring (n = 275) or anonymous (n = 280) instruction conditions, with the monitoring condition shifting to anonymous, non-monitored responses at Time 2.

RESULTS

There were no significant differences in self-reported suicidal ideation between those in the monitoring and anonymous condition at Time 1. At Time 2, no significant interaction was identified between condition and time, suggesting that the change in instructions across timepoints for the monitoring condition had no impact on endorsement of suicidal ideation.

CONCLUSION

Findings indicate that both monitoring and anonymous instruction methods should elicit the same pattern of endorsements of suicidal ideation.

Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis

Background

Risk assessment is a key process when a child or adolescent presents at risk for self-harm or suicide in a mental health crisis or emergency. Risk assessment by a healthcare professional should be included within a biopsychosocial assessment. However, the predictive value of risk-screening tools for self-harm and suicide in children and adolescents is consistently challenged. A review is needed to explore how best to undertake risk assessment and the appropriate role for tools/checklists within the assessment pathway.

Aims

To map research relating to risk assessment for child and adolescent mental health and to identify features that relate to a successful risk assessment.

Objectives

To review factors within the clinical encounter that impact upon risk assessments for self-harm and suicide in children and adolescents: i. to conduct a realist synthesis to understand mechanisms for risk assessment, why they occur and how they vary by context ii. to conduct a mapping review of primary studies/reviews to describe available tools of applicability to the UK.

Data sources

Databases, including MEDLINE, PsycINFO®, EMBASE, CINAHL, HMIC, Science and Social Sciences Citation Index and the Cochrane Library, were searched (September 2021). Searches were also conducted for reports from websites.

Review methods

A resource-constrained realist synthesis was conducted exploring factors that impact upon risk assessments for self-harm and suicide. This was accompanied by a mapping review of primary studies/reviews describing risk-assessment tools and approaches used in UK child and adolescent mental health. Following piloting, four reviewers screened retrieved records. Items were coded for the mapping and/or for inclusion in the realist synthesis. The review team examined the validity and limitations of risk-screening tools. In addition, the team identified structured approaches to risk assessment. Reporting of the realist synthesis followed RAMESES guidelines.

Results

From 4084 unique citations, 249 papers were reviewed and 41 studies (49 tools) were included in the mapping review. Eight reviews were identified following full-text screening. Fifty-seven papers were identified for the realist review. Findings highlight 14 explanations (programme theories) for a successful risk assessment for self-harm and suicide. Forty-nine individual assessment tools/approaches were identified. Few tools were developed in the UK, specifically for children and adolescents. These lacked formal independent evaluation. No risk-screening tool is suitable for risk prediction; optimal approaches incorporate a relationship of trust, involvement of the family, where appropriate, and a patient-centred holistic approach. The objective of risk assessment should be elicitation of information to direct a risk formulation and care plan.

Limitations

Many identified tools are well-established but lack scientific validity, particularly predictive validity, or clinical utility. Programme theories were generated rapidly from a survey of risk assessment.

Conclusions

No single checklist/approach meets the needs of risk assessment for self-harm and suicide. A whole-system approach is required, informed by structured clinical judgement. Useful components include a holistic assessment within a climate of trust, facilitated by family involvement.

Study registration

This study is registered as PROSPERO CRD42021276671.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135079) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.

A survey of suicide literacy in Japanese school teachers

School teachers are in a unique position to recognize suicide-related problems in their students and to appropriately support them; teachers may need high levels of suicide literacy. However, few studies have examined current levels of suicide literacy in teachers. This study aimed to investigate suicide literacy in school teachers. Teachers (n = 857) from 48 Japanese schools (primary and junior-/senior-high) answered a self-administered questionnaire assessing (a) knowledge about suicide, (b) intention to ask about students' suicidal thoughts/plans, and (c) attitudes towards talking to students with mental health problems. The average proportion of correct answers to the knowledge questions (10 items) was 55.2%. Over half of the teachers knew that suicide is a leading cause of death in adolescents (55.0%), and that asking about suicidality is needed (56.2%). Half of the teachers intended to ask students about their suicidal thoughts (50.2%) and fewer intended to ask about experiences of planning suicide (38.8%). Most of the teachers (90.4%) agreed with the idea that talking to students with mental health problems was a teacher's responsibility. Intention to ask about students' suicidal thoughts/plans were higher in teachers in their 20s (vs. 40s-60s) and working at junior-/senior-high schools (vs. primary schools). Suicide literacy in Japanese school teachers was observed to be limited. However, teachers felt responsibility for helping students with mental health problems. The development and implementation of education programs may help improve teachers' suicide literacy, which, in turn, could encourage effective helping behaviors of teachers for students struggling with suicidality.

Validation of the Farsi version of the Suicide Ideation and Behavior Scale

Objective

Suicide ideation and suicide attempts are prevalent in Farsi speaking populations. The present study aimed at validating the Farsi version of the Suicide Ideation and Behavior Scale (SIBS).

Methods

Reliability and validity of the Farsi version of the SIBS were established in a highly burdened Afghan student sample (N = 279). Internal consistency, convergent and discriminant validity were investigated, and confirmatory factor analysis was conducted.

Results

The Farsi version of the SIBS was shown to have a unidimensional structure with excellent internal consistency, as well as good convergent and divergent validity.

Discussion

The results suggest that the SIBS is a brief, reliable, and valid measure of current suicidal ideation and behavior that can be used in Farsi speaking populations.

The use of advanced technology and statistical methods to predict and prevent suicide

In the past decade, two themes have emerged across suicide research. First, according to meta-analyses, the ability to predict and prevent suicidal thoughts and behaviours is weaker than would be expected for the size of the field. Second, review and commentary papers propose that technological and statistical methods (such as smartphones, wearables, digital phenotyping and machine learning) might become solutions to this problem. In this Review, we aim to strike a balance between the pessimistic picture presented by these meta-analyses and the optimistic picture presented by review and commentary papers about the promise of advanced technological and statistical methods to improve the ability to understand, predict and prevent suicide. We divide our discussion into two broad categories. First, we discuss the research aimed at assessment, with the goal of better understanding or more accurately predicting suicidal thoughts and behaviours. Second, we discuss the literature that focuses on prevention of suicidal thoughts and behaviours. Ecological momentary assessment, wearables and other technological and statistical advances hold great promise for predicting and preventing suicide, but there is much yet to do.

Integrating the interpersonal theory of suicide and the dualistic model of passion among adults at risk for suicide

The dualistic model of passion proposes two passion types, harmonious and obsessive, representing adaptive and maladaptive passion, respectively. Studies suggest interpersonal experiences explain harmonious passion benefits and obsessive passion negative consequences. However, research has not examined passion among individuals with clinically elevated suicide risk, nor the associations between passion types and suicide-related outcomes. The present study presents a conceptual model linking the dualistic model of passion and the interpersonal theory of suicide constructs [specifically, thwarted belongingness (TB) and perceived burdensomeness (PB)]. U.S. adults with clinically elevated suicide risk (N = 484) completed online, cross-sectional assessments of harmonious and obsessive passion, TB, PB, and future dispositions (i.e., positive focus, negative focus, and suicide orientation). A mediation model indicated the effects of harmonious and obsessive passion on positive and negative focus and suicide orientation were largely explained by TB and PB. The present findings suggest engaging in a passion activity may be meaningfully related to suicide-related interpersonal perceptions (i.e., TB and PB).

Screening and Assessing Suicide Risk in Medical Settings: Feasible Strategies for Early Detection

Early detection of risk is a key suicide prevention strategy. Given that most individuals who die by suicide visit a health care provider in the year leading up to their death, medical settings are ideal venues for identifying those at elevated risk and bridging them to life-saving care. Clinicians are presented with an opportunity to engage in proactive suicide prevention efforts through practical and adaptable suicide risk screening, assessment, and management processes. Psychiatrists and mental health clinicians are well positioned to assist nonpsychiatric clinicians on the frontlines of this public health problem. This article discusses the importance of identifying people at elevated suicide risk through screening, differentiates screening from assessment procedures, and presents practical strategies for implementing evidence-based screening and assessment tools into practice as part of a three-tiered clinical pathway. Specifically, this article discusses key components that guide embedding suicide prevention strategies into the workflows of busy medical settings.

Timing of childhood adversities and self-injurious thoughts and behaviors in adolescence

Greater childhood adversity predicts a higher likelihood of later self-injurious thoughts and behaviors (SITB). There is little research focused on whether the timing of childhood adversity predicts SITB. The current research examined whether the timing of childhood adversity predicted parent- and youth-reported SITB at age 12 and 16 years in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) cohort (n = 970). We found that greater adversity at age 11-12 years consistently predicted SITB at age 12 years, while greater adversity at age 13-14 years consistently predicted SITB at age 16 years. These findings suggest there may be sensitive periods during which adversity may be more likely to lead to adolescent SITB, which can inform prevention and treatment.

Towards a new approach to job-related distress: A three-sample study of the Occupational Depression Inventory

The Occupational Depression Inventory (ODI) was recently developed to assess depressive symptoms that individuals specifically attribute to their work. One purpose of the ODI is to respond to limitations of current assessments of job-related distress, most notably, assessments relying on the burnout construct. In this study, we conducted a thorough examination of the psychometric and structural properties of the ODI using exploratory structural equation modelling bifactor analysis and Mokken scale analysis. The study involved three samples of employed individuals, recruited in France (N = 3454), Switzerland (N = 1971), and Australia (N = 1485). Results were consistent across the three samples. The ODI exhibited essential unidimensionality and excellent total-score reliability-as indexed by McDonald's omega, Cronbach's alpha, Guttman's lambda-2, and the Molenaar-Sijtsma statistic. We found evidence for measurement invariance across sexes, age groups, and samples. Mokken scale analysis revealed that the ODI's scalability was strong. No monotonicity violation was detected. Invariant item ordering showed sufficient accuracy. In all three samples, suicidal ideation was the least commonly endorsed item-thus acting as a sentinel item-and fatigue/loss of energy was the most commonly endorsed item. The ODI exhibits excellent psychometric and structural properties, suggesting that occupational health specialists can effectively employ the instrument.

A Systematic Review of School-Based Suicide Prevention Interventions for Adolescents, and Intervention and Contextual Factors in Prevention

Suicide is the fourth leading cause of death among adolescents, globally. Though post-primary, school-based suicide prevention (PSSP) has the potential to be a key strategy for preventing adolescent suicidal thoughts and behaviours (STBs), there are persisting challenges to translating PSSP research to practice. Intervention and contextual factors relevant to PSSP are likely key to both PSSP effectiveness and implementation. As such, this systematic review aimed to summarise the effectiveness of PSSP for adolescent STBs and highlight important intervention and contextual factors with respect to PSSP. PsycINFO, Medline, Education Source, ERIC, Web of Science, and the Cochrane Central Register of Controlled Trials were searched to identify randomised and non-randomised studies evaluating the effectiveness of interventions located in post-primary, school-based settings targeting adolescent STBs. PSSP effectiveness and intervention and contextual factors were synthesised narratively. Twenty-eight studies were retained, containing nearly 47,000 participants. Twelve out of twenty-nine trials comparing intervention and independent control comparators reported statistically significant reductions in STBs postintervention, and 5/7 trials comparing preintervention and postintervention scores demonstrated significant reductions in STBs over time. Reporting and analysis of intervention and contextual factors were lacking across studies, but PSSP effectiveness and intervention acceptability varied across type of school. Although school personnel commonly delivered PSSP interventions, their input and perspectives on PSSP interventions were lacking. Notably, adolescents had little involvement in designing, inputting on, delivering and sharing their perspectives on PSSP interventions. Twenty out of twenty-eight studies were rated as moderate/high risk of bias, with non-randomised trials demonstrating greater risks of bias and trial effectiveness, in comparison to cluster randomised trials. Future research should prioritise complete reporting and analysis of intervention and contextual factors with respect to PSSP, involving key stakeholders (including adolescents and school personnel) in PSSP, and investigating key stakeholders' perspectives on PSSP. Given the inverse associations between both study quality and study design with PSSP effectiveness, particular consideration to study quality and design in PSSP research is needed. Future practice should consider PSSP interventions with universal components and PSSP which supports and involves key stakeholders in engaging with PSSP.

Exploring adolescents' perspectives on and experiences with post-primary school-based suicide prevention: a meta-ethnography protocol

BACKGROUND

Globally, suicide is the fourth leading cause of adolescent mortality. Although post-primary school-based suicide prevention (PSSP) interventions are an evidence-based strategy for targeting adolescent suicidal thoughts and behaviors (STBs), PSSP effectiveness does not easily translate to school settings. Adolescents' perspectives on PSSP are particularly important for (1) intervention effectiveness and implementation in both research and practice, (2) addressing PSSP evidence-practice gaps, and (3) enhancing meaningful adolescent involvement in PSSP, yet there is a gap in understanding adolescents' experiences of engaging with PSSP. As such, this protocol outlines a meta-ethnography which will explore and synthesize adolescents' perspectives on engaging with PSSP interventions, as participants/end-users, intervention advisors, facilitators, and co-designers and co-researchers.

METHODS

The meta-ethnography protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The protocol was guided by the seven-stage process for meta-ethnography proposed by Noblit and Hare. Searches of PsycINFO, MEDLINE, Web of Science, CINAHL, ERIC, Scopus, and study reference lists will identify peer-reviewed studies. Gray literature will be identified by searches in ProQuest, British Library EThOS, and DART-Europe E-theses Portal. The main reviewer will initially assess the eligibility of studies based on title and abstract, with full texts reviewed by at least two reviewers. Findings of the included studies will be synthesized in line with Noblit and Hare's stages and evaluated using the Critical Appraisal Skills Program (CASP) checklist.

DISCUSSION

To our knowledge, this is the first proposed meta-ethnography to explore and integrate the findings of qualitative studies exploring adolescents' perspectives on engaging with PSSP interventions. Understanding adolescents' experiences of engaging with PSSP will impact the field of PSSP in several ways by (1) enhancing research processes and intervention effectiveness and implementation, (2) informing decision-making and policymaking relevant to practice, (3) guiding meaningful adolescent involvement in PSSP, and (4) contributing to knowledge on the safety implications of engaging adolescents in PSSP. Finally, it is expected that the insights from this meta-ethnography will be widely applicable, given the growing demand for meaningful youth involvement in health-related fields.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022319424.

Assessment of suicide risk in mental health practice: shifting from prediction to therapeutic assessment, formulation, and risk management

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.

Clinical Pathway for Suicide Risk Screening in Adult Primary Care Settings: Special Recommendations

Suicide is a serious public health concern. On average, 80% of suicide decedents had contact with primary care within 1 year of their suicide. This and other research underscore the importance of screening for suicide risk within primary care settings, and implementation of suicide risk screening is already underway in many practices. However, while primary care practices may be familiar with screening for other mental health concerns (e.g., depression), many feel uncomfortable or unprepared for suicide risk screening. To meet the increasing demand for evidence-based suicide-risk-screening guidance, we provide a clinical pathway for adult primary care practices (to include family medicine, internal medicine, women's health). The pathway was developed by experts with research, clinical expertise, and experience in suicide risk screening and primary care. We also provide detailed guidance to aid primary care practices in their decisions about how to implement the clinical pathway.

A Psychometric Pilot Study Examining the Functions of Suicidal Communications Using IRT and Factor Analysis

BACKGROUND

Suicide prevention, an important public health issue, relies on suicidal communications to identify and intervene with those at risk. Scant research tests explicit theories of suicidal communication impeding applications to prevention science. The current study pilots a new measure assessing the functions of suicidal communications using factor analysis and item response theory.

METHODS

MTurk workers (n = 898) completed an anonymous survey. The original scale included 35 items refined using exploratory and confirmatory factor analysis, bifactor modeling, and item response theory.

RESULTS

The initial EFA identified a two-correlated-factor solution. The two-correlated-factor and unidimensional models yielded a poor fit. A bifactor model yielded a borderline to acceptable fit. The final four items were identified using a bifactor model and item response theory graded response models capturing ambivalence resolution defined as behaviors aimed to aid in suicide decision making. The final model yielded an excellent fit: 𝝌²(2) = 1.81, CFI (1.00), TLI (1.00), RMSEA (0.00), and SRMR (0.01).

CONCLUSIONS

There may be one function of suicidal communications. Disclosure may elicit connection and reasons for living that serve as barriers to suicide and resolve ambivalence. Key limitations include convenience sampling and limited validity measures. Future research should partner with participants to improve scale and theory development efforts.

How do trained palliative care providers experience open desire to die-conversations? An explorative thematic analysis

OBJECTIVES

Despite the potential benefits of open communication about possible desires to die for patients receiving palliative care, health professionals tend to avoid such conversations and often interpret desires to die as requests for medical aid in dying. After implementing trainings to foster an open, proactive approach toward desire to die, we requested trained health professionals to lead and document desire to die-conversations with their patients. In this article, we explore how trained health professionals experience an open (proactive) approach to desire to die-conversations with their patients.

METHODS

Between April 2018 and March 2020, health professionals recorded their conversation-experiences on documentation sheets by answering seven open questions. A subsample was invited to offer deeper insights through semi-structured qualitative interviews. Interviews and documentation sheets were transcribed verbatim and analyzed thematically, then findings from both sources were compared and synthesized.

RESULTS

Overall, N = 29 trained health professionals documented N = 81 open desire to die-conversations. A subsample of n = 13 health professionals participated in qualitative interviews. Desire to die-conversations after the training were reported as a complex but overall enriching experience, illustrated in seven themes: (1) beneficial (e.g., establishing good rapport) and (2) hindering aspects (e.g., patients' emotional barriers) of desire to die-conversations, (3) follow-up measures, (4) ways of addressing desire to die, as well as (5) patient reactions to it. The interviews offered space for health professionals to talk about (6) content of desire to die-conversation and (7) (self-)reflection (e.g., on patients' biographies or own performance).

SIGNIFICANCE OF RESULTS

As part of an open (proactive) approach, desire to die-conversations hold potential for health professionals' (self-)reflection and a deeper understanding of patient background and needs. They may lead to a strengthened health professional-patient relationship and potentially prevent suicide.

Biased reporting of past self-injurious thoughts and behaviors: A literature review

BACKGROUND

Accurate assessment of suicide risk is critical for clinical practice, empirical advances, and informing public policy. In this narrative review of the literature, we compiled evidence from longitudinal studies that identify reporting bias of past self-injurious thoughts and behaviors (SITB) and examined possible correlates of inconsistent reporting.

METHOD

We conducted an extensive literature search, including 19 longitudinal samples or subsamples who reported the presence of current or past SITB at an initial but not at a subsequent assessment (yes/no inconsistent reports).

RESULTS

The median was 33%, and the weighted mean was 39% (95% CI, 37%-41%) for the prevalence of inconsistent reporting of SITB across the longitudinal samples. Importantly, inconsistent reports were linked with less internalizing psychopathology and more adaptive functioning. The type of sample recruited and assessment interval may also be relevant factors to consider.

LIMITATIONS

Variability of sample characteristics and methodology made it challenging to draw firm conclusions across studies but provide information about critical sources of bias.

CONCLUSIONS

Results suggest considerable caution for clinical, empirical, and policy decision-making based on lifetime reports of suicide and encourage a continued consideration for identifying potential reporting biases for SITB.

Iatrogenesis in the Context of Residential Dementia Care: A Concept Analysis

Background and Objectives

This concept analysis aims to explore iatrogenesis within the context of residential dementia care and to distinguish this phenomenon from similar phenomena, such as abuse and inadvertent harm.

Research Design and Methods

Walker and Avant's method for concept analysis was used to define critical attributes of iatrogenesis within residential dementia care, and to explore antecedents and consequences of its occurrence. A review of the literature about iatrogenesis in the context of residential dementia was conducted across 4 electronic databases. Texts about iatrogenesis in surgery, medicine, social work, psychology, and other relevant disciplines were also reviewed to provide additional context for the concept.

Results

Iatrogenesis takes a unique form in residential dementia care. The final definition of the concept proposed in this article is habituated, forceful, hands-on care provided to residents who exhibit responsive behaviors that result in emotional, physical, spiritual, social harm, and/or gradual functional decline, that is provided with the intention of supporting the resident's safety and dignity.

Discussion and Implications

The definition of iatrogenesis proposed in this article is an initial step toward developing evidence-based practice for the provision of nonconsensual assistance in residential dementia care. A theoretical definition like the one proposed in this article may serve as a starting point for the operationalization of the concept, which would promote future empirical research into staff and residents' experiences of health care-inflicted harms in this context. Theoretically, it contributes to critical conversations about the narratives, myths, and misperceptions that facilitate the provision of nonconsensual care.

What's the harm in asking? A systematic review and meta-analysis on the risks of asking about suicide-related behaviors and self-harm with quality appraisal

Research emphasizes the importance of asking about suicidality. Unfortunately, misperceptions of harm remain which can compromise clinical care, research, and public health surveillance efforts. Our objective was to evaluate the empirical evidence on whether and how asking about suicide related behaviors (SRB), such as suicidal ideation and suicide attempts, and non-suicidal self-injury (NSSI) results in harmful outcomes. We reviewed and rated seventeen studies and conducted a systematic review and random-effects meta-analysis on eight studies comparing those asked vs. not asked on immediate and later SRB, NSSI, and psychological distress (PD). Forest plots demonstrated no statistically significant effects of asking on SRB, NSSI, or PD. Eight RCTs provided the strongest evidence and demonstrated either low or unclear risk of bias, and the remaining cohort studies were of low to moderate quality. With the current available evidence, we found no harmful outcomes of asking, however more RCTs with a low risk of bias are required to firmly conclude that asking through self-report and interview methods does not further exacerbate distress, SRB and NSSI compared to those not asked.

Is trained communication about desire to die harmful for patients receiving palliative care? A cohort study

BACKGROUND

Palliative patients frequently express a desire to die. Health professionals report uncertainty regarding potential risks of addressing it.

AIM

We aim to evaluate effects of desire to die-conversations on palliative patients.

DESIGN

Within a prospective mixed-methods cohort study, we trained health professionals in dealing with desire to die. Afterwards, they held conversations about it with patients. Effects on depressiveness, hopelessness, wish to hasten death, death anxiety, patient-health professional-relationship, and will to live were evaluated at baseline (t0), 1 (t1), and 6 weeks afterwards (t2). Results were analyzed descriptively.

SETTING/PARTICIPANTS

From April 2018 to March 2020, 43 health professionals asked 173 patients from all stationary and ambulatory palliative care settings (within 80 km radius) for participation. Complete assessments were obtained from n = 85 (t0), n = 64 (t1), and n = 46 (t2).

RESULTS

At t1, patients scored significantly lower on depressiveness (med = 8, M = 8.1, SD = 5.4) than at t0 (med = 9.5, M = 10.5, SD = 5.8) with Z = -3.220, p = 0.001 and Cohen's d = 0.42. This was due to medium-severely depressed patients: At t1, their depressiveness scores decreased significantly (med = 9, M = 9.8; SD = 5.1) compared to t0 (med = 14, M = 15.2; SD = 3.9) with Z = -3.730, p ⩽ 0.000 and Cohen's d = 1.2, but others' did not. All other outcomes showed positive descriptive trends.

CONCLUSIONS

Desire to die-conversations through trained health professionals do not harm palliative patients. Results cautiously suggest temporary improvement.

Effect of frequent assessment of suicidal thinking on its incidence and severity: high-resolution real-time monitoring study

Researchers, clinicians and patients are increasingly using real-time monitoring methods to understand and predict suicidal thoughts and behaviours. These methods involve frequently assessing suicidal thoughts, but it is not known whether asking about suicide repeatedly is iatrogenic. We tested two questions about this approach: (a) does repeatedly assessing suicidal thinking over short periods of time increase suicidal thinking, and (b) is more frequent assessment of suicidal thinking associated with more severe suicidal thinking? In a real-time monitoring study (n = 101 participants, n = 12 793 surveys), we found no evidence to support the notion that repeated assessment of suicidal thoughts is iatrogenic.

Understanding suicidal pathways through the lens of a Dual-System Model of Suicidality in real-time: The potential of ecological momentary assessments

Within the ideation-to-action framework, existing theories of suicidal thoughts and behaviors (STBs) primarily focus on the linear progression of suicide risk. This, however, neglects growing evidence that many suicidal individuals do not experience their suicide attempt as a planned action, and in some instances deny even having experienced any suicidal thoughts. Furthermore, recent research has found that risk factors differ substantially between persons and that this is reflected in the variety of suicidal pathways. Considering the strong variability of STBs, new innovative theoretical concepts and assessment methods are needed to advance our understanding of multiple suicidal pathways. In this review, we apply a dual-system framework to suicidality, the Dual-System Model of Suicidality (DSMS), which accounts for two different systems of information processing and behavior. The first of these described is the reflective system, whereby STBs are viewed from a self-regulation perspective and thusly considered as maladaptive coping behavior to perceived discrepancies regarding important goals. Applying a feedback-based view such as this to STBs provides a deeper understanding into underlying psychological processes involved in the development of STBs. The second system described by the DSMS is the impulsive system. Here, STBs are seen as a maladaptive self-organizing pattern that gets activated in high-risk situations of acute stress, negative affect, and when resources of the reflective system are depleted. In this context, the DSMS is informed by a strength model of self-regulation, which assumes that self-regulation resources are limited, an aspect with important theoretical and clinical implications for the development of STBs. In order to demonstrate the theoretical and practical utility of the DSMS, this review draws mainly on studies using ecological momentary assessment (EMA), a technology that allows to investigate moment-to-moment changes in STBs, and is therefore well suited for capturing the complex interplay of self-regulatory and impulsive processes proposed by the DSMS. The application of a dual-system framework to suicide research represents an innovative and integrative approach for expanding our knowledge about fundamental processes and how their dynamics lead to STBs. The usefulness of the DSMS, implications for future suicide research with EMA, and clinical implications are discussed.

Suicide Screening Tools for Pediatric Emergency Department Patients: A Systematic Review

BACKGROUND

According to the Centers for Disease Control and Prevention, suicidality and suicidal behavior among youth continues to increase significantly each year. Many of those who die by suicide interact with health services in the year before death. This systematic review sought to identify and describe empirically tested screening tools for suicidality in youth presenting to Emergency Departments (ED).

OBJECTIVE

(1) To identify and compare existing tools used to screen for suicidality in children and adolescents who present to the ED and (2) to ascertain the prevalence of suicidality in pediatric populations found with these tools.

METHODS

We searched Ovid Medline, CINAHL, Scopus, and Cochrane databases for primary research studies that identified and evaluated screening tools for suicide risk in pediatric ED patients. A total of 7,597 publications published before August 25, 2021 met search criteria and were screened by two independent reviewers based on our inclusion and exclusion criteria, with any conflicts resolved via consensus meetings or an independent reviewer. A total of 110 papers were selected for full text review, of which 67 were excluded upon further inspection. Covidence was used to extract and synthesize results.

RESULTS

43 articles were eligible for inclusion. Most studies (n = 33) took place in general pediatric EDs; the quality was generally high. Patients ranged from 4-24 years old, with most screening tested in patients 12 years and older. The most researched tools were the Ask-Suicide Screening Questions (ASQ) (n = 15), Columbia-Suicide Severity Rating Scale (C-SSRS) (n = 12), Suicidal Ideation Questionnaire (SIQ) (n = 11), and the Risk of Suicide Questionnaire (RSQ) (n = 7). Where screening was applied to all patients, about one-fifth of pediatric ED patients screened positive; where suicide screening was applied to psychiatric patients only, over half screened positive. Positive screens were more likely to be female and older than negative screens and they were more likely to be assessed and admitted.

CONCLUSION

Several validated screening tools exist for the purpose of screening pediatric populations in EDs for suicidality. Such tools may help to support early detection and appropriate intervention for youth at risk of suicide.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=276328, identifier: 276328.

Just-in-Time Adaptive Interventions for Suicide Prevention: Promise, Challenges, and Future Directions

The suicide rate (currently 14 per 100,000) has barely changed in the United States over the past 100 years. There is a need for new ways of preventing suicide. Further, research has revealed that suicidal thoughts and behaviors and the factors that drive them are dynamic, heterogeneous, and interactive. Most existing interventions for suicidal thoughts and behaviors are infrequent, not accessible when most needed, and not systematically tailored to the person using their own data (e.g., from their own smartphone). Advances in technology offer an opportunity to develop new interventions that may better match the dynamic, heterogeneous, and interactive nature of suicidal thoughts and behaviors. Just-In-Time Adaptive Interventions (JITAIs), which use smartphones and wearables, are designed to provide the right type of support at the right time by adapting to changes in internal states and external contexts, offering a promising pathway toward more effective suicide prevention. In this review, we highlight the potential of JITAIs for suicide prevention, challenges ahead (e.g., measurement, ethics), and possible solutions to these challenges.

'A Safe Place Where I Am Welcome to Unwind When I Choose to'-Experiences of Brief Admission by Self-Referral for Adolescents Who Self-Harm at Risk for Suicide: A Qualitative Study

Evidence is lacking on how to manage imminent suicidality in adolescents with self-harm. Brief Admission by Self-referral (BA) is a crisis-management intervention, developed for adults with self-harm at risk for suicide. Structured, individualized and based on responsible autonomy, BA aims to provide a respite while minimizing negative effects of hospitalization. This qualitative interview study illuminates adolescents' experiences of BA, adapted for this target group. Nineteen adolescents aged 14 to 19 years, described BA as helpful for timely rest and recovery to save themselves from impulses to self-harm. The individual contract, which is a prerequisite for access to BA, was perceived to give access to professional support in a safe environment, also among adolescents not using their contract. Being trusted with responsibility to self-admit was also hard work with struggles of self-doubt. Challenges included experiencing distrust from staff and fear of not being able to abstain from self-harm, which BA is conditioned upon. However, this condition was also perceived to induce self-motivation and growth. BA appeared well-adapted to the target group, fulfilling needs of predictability, autonomy, and opportunity for recovery to prevent self-harm. Suggestions for improvement included continually informing staff about important features of BA. To further evaluate benefits and challenges of BA, future research may evaluate clinical and health-economic outcomes and perspectives from parents and caregivers.

Opening the Black Box of Daily Life in Nonsuicidal Self-injury Research: With Great Opportunity Comes Great Responsibility

Although nonsuicidal self-injury (NSSI)-deliberate damaging of body tissue without suicidal intent-is a behavior that occurs in interaction with real-world contexts, studying NSSI in the natural environment has historically been impossible. Recent advances in real-time monitoring technologies have revolutionized our ability to do exactly that, providing myriad research and clinical practice opportunities. In this viewpoint paper, we review new research pathways to improve our ability to understand, predict, and prevent NSSI, and provide critical perspectives on the responsibilities inherent to conducting real-time monitoring studies on NSSI. Real-time monitoring brings unique opportunities to advance scientific understanding about (1) the dynamic course of NSSI, (2) the real-time predictors thereof and ability to detect acute risk, (3) the ecological validity of theoretical models, (4) the functional mechanisms and outcomes of NSSI, and (5) the promotion of person-centered care and novel technology-based interventions. By considering the opportunities of real-time monitoring research in the context of the accompanying responsibilities (eg, inclusive recruitment, sound and transparent research practices, participant safety and engagement, measurement reactivity, researcher well-being and training), we provide novel insights and resources to open the black box of daily life in the next decade(s) of NSSI research.

The mediating role of tolerance for psychological pain in the relationship of childhood trauma to suicidal ideation in individuals with a substance use disorder

OBJECTIVES

The association between childhood trauma and suicidal ideation has been well documented in several populations, including individuals with a substance use disorder (SUD). However, a gap still exists in the literature regarding the mechanisms by which childhood trauma later impacts suicide risk. This cross-sectional study tested the effect of childhood trauma on suicidal ideation, as well as the mediating effect of tolerance for psychological pain (managing the pain and enduring the pain) in that relationship, controlling for the effect of depressive symptoms, in individuals with a SUD.

METHODS

A sample of 102 adults with a SUD participated in the study. Path analysis by structural equation␣modelling tested a mediation model.

RESULTS

Depressive symptoms and lower levels of managing the pain were found to fully mediate the association between childhood trauma and suicidal ideation.

CONCLUSIONS

Our results suggest that depressive symptoms and a lack of ability to manage psychological pain contribute towards explaining why traumatic childhood experiences may result in suicidal cognitions in individuals with SUDs. Moreover, they have relevant implications for prevention and clinical interventions regarding suicidal ideation in this population.

PRACTITIONER POINTS

Childhood trauma relates to suicidal ideation in individuals with a substance use disorder. Depressive symptoms contribute towards explaining why traumatic childhood experiences may result in suicidal cognitions. A lack of ability to manage psychological pain also contributes towards explaining this relationship. The obtained results have relevant implications for the prevention of and clinical intervention for suicidal ideation in SUD individuals.

"Withstanding ambivalence is of particular importance"-Controversies among experts on dealing with desire to die in palliative care

In order to investigate controversies surrounding the desire to die phenomenon in palliative care by analyzing expert opinions on the topic, we carried out a secondary qualitative data analysis of free text comments collected during a Delphi survey that was designed to develop a conversation aid for dealing with desire to die in everyday clinical practice. Between 01/2018 and 03/2018, a two-round Delphi survey was carried out with national (German) and international palliative care experts. Free text comments were reinvestigated to identify controversies surrounding the desire to die phenomenon. An additional in-depth analysis focused on statements expressing attitudes towards proactively addressing (potential) desires to die. Within the Delphi survey, 103 of 149 multi-professional participants (almost all of them with practical and only six with exclusively theoretical expertise in palliative care) generated 444 free text comments. Thereof, we identified three main categories related to dealing with desire to die: "outer framework", "extended care system" and "health-professional-patient-relationship". Ambivalences, taboos and uncertainties surrounding desire to die in palliative care became apparent. Experts are divided concerning the practice of proactively addressing desire to die. Even if these conversations-especially the proactive approach-are also viewed critically, we conclude that open-ended and respectful communication about desire to die between health professionals and patients can be understood as an eligible intervention in palliative care. Proactively addressing the topic is a possible way to open up such conversations.

Evaluating Potential Iatrogenic Effects of a Suicide-Focused Research Protocol

Background: Concerns regarding the potential iatrogenic effects of suicide assessment have long impeded suicide research. Aims: We sought to examine the effects of an intensive, suicide-focused assessment protocol on mood, suicidality, and urges to harm oneself or others. Method: Participants were adults admitted to a psychiatric inpatient unit for recent suicidal ideation or behavior, or reasons unrelated to suicide. Our study protocol included clinical interviews evaluating suicide history and laboratory tasks with suicide-related stimuli. We modified an existing measure to create a brief, 6-item interview, the Assessment Session Check-In, which was administered before and after research procedures. Results: These indicated overall reductions in distress, suicidal intent, and urges to harm oneself or others from preassessment to postassessment. Postassessment reductions in stress predicted lower likelihood of a suicide attempt at follow-up. Limitations: Although beneficial to examine a high-risk sample, it is possible that an intensive suicide-focused protocol could prove more problematic for those with lower baseline levels of negative affect and suicidal thoughts. Conclusions: Results challenge the belief that assessing suicide elevates distress or suicidality, even among a high-risk sample of adults admitted to a psychiatric inpatient unit.

Validation and Feasibility of the ASQ Among Pediatric Medical and Surgical Inpatients

OBJECTIVES

To validate the use of a brief suicide risk screening tool, the Ask Suicide-Screening Questions (ASQ) instrument, in pediatric inpatient medical and surgical settings.

METHODS

Pediatric patients (10-21 years) hospitalized on inpatient medical and surgical units were recruited through convenience sampling for participation in a cross-sectional instrument validation study. The Suicidal Ideation Questionnaire was used as a standard criterion to validate the ASQ. Patient opinions about screening and parent consent to enroll in a suicide risk screening study were assessed to determine the feasibility of administering the ASQ in this venue.

RESULTS

A total of 600 pediatric medical inpatients were screened. Compared with the gold standard, the ASQ had strong psychometric properties, with a sensitivity of 96.67% (95% confidence interval [CI]: 82.78 to 99.92), a specificity of 91.05% (95% CI: 88.40 to 93.27), a negative predictive value of 99.81% (95% CI: 98.93 to 99.99), and an area under curve of 0.94 (95% CI: 0.90 to 0.97). Only 3 participants (0.5%) had acute positive screen results on the ASQ, endorsing current suicidal ideation, whereas 77 participants (12.8%) screened nonacute positive, and 48 participants (8.0%) reported a past suicide attempt.

CONCLUSIONS

The brief 4-item ASQ is a valid tool to detect elevated suicide risk in pediatric medical and surgical inpatients. Our findings also reveal that screening is feasible in terms of detection of suicidal thoughts and behaviors and is acceptable to parents and patients.

Universal suicide risk screening: Views of rural adults on acceptability and implementation in primary care

OBJECTIVE

This study gathered data from rural adult primary care patients regarding the acceptability of universal suicide risk screening and preferred methods of implementation.

METHOD

Patients from a rural primary care clinic in southern West Virginia participating in a pilot test of a suicide risk screening program were administered a Screening Opinions Survey and resulting data were evaluated using descriptive and content analyses.

RESULTS

The majority of participants (96%) believed that primary care providers (PCPs) should screen patients for suicide and noted multiple benefits to screening. Most participants described the experience of screening in primary care as positive or neutral and preferred a personalized screening process where the provider asked questions directly. Demographic analyses indicated that males and older adults were less likely to report being previously screened for suicide and that older adults were less likely to support the practice of screening.

CONCLUSIONS

Results provide support for the acceptability of universal suicide risk screening programs to patients in rural primary care and suggest that PCP involvement in the screening process may encourage patient participation. Additional training for PCPs and psychoeducational interventions for older adults may help to address demographic influences on screening practices and engagement.

Pediatric Suicide Screening: A Review of the Evidence

BACKGROUND

Suicide rates are increasing for youths and suicide is the second leading cause of death for 10-24 year olds. This evidence-based practice project critically reviews literature regarding the effectiveness of pediatric suicide screening.

METHODS

A literature search was guided by the following question: In pediatric patients, does suicide screening at every health encounter compared to an annual screen increase clinician identification of patients at-risk. Ten articles met inclusion criteria and were critically appraised and synthesized.

FINDINGS

Youths had high rates of suicidal ideation (SI), anxiety, and depression. Pediatric universal suicide screening identified SI in youths with both psychiatric and non-psychiatric medical complaints. Patients with chronic health conditions reported higher rates of mental health symptoms and SI. A specific suicide screening instrument should be used as general mental health screens likely miss youths at-risk for SI. The Ask Suicide-Screening Questions tool is an easy to use and highly sensitive instrument for detecting suicide risk in youths.

DISCUSSION

Many youths that screen positive for SI do not have known mental health concerns and would have been missed if not asked directly. Universal screening for SI identifies at-risk youth and allows nurses and other providers to intervene. The need for universal screening across pediatric health care settings using brief, validated screening tools is paramount.

APPLICATION TO PRACTICE

Nurses working in pediatric settings should champion universal screening for SI. Unit-based quality improvement projects using the Plan-Do-Study-Act change cycle provides a model for instituting universal screening for SI.

Longitudinal studies support the safety and ethics of virtual reality suicide as a research method

Many have expressed concerns about the safety and ethics of conducting suicide research, especially intense suicide research methods that expose participants to graphic depictions of suicidality. We conducted two studies to evaluate the effects of one such method called virtual reality (VR) suicide. Study 1 tested the effects of VR suicide exposure over the course of one month in participants with (n = 56) and without a history of suicidality (n = 50). Study 2 exposed some participants to VR suicide scenarios (n = 79) and others to control scenarios (n = 80). Participants were invited to complete a follow-up assessment after an average of 2 years. For both studies, the presence of suicidality post exposure was the primary outcome, with closely related constructs (e.g., capability for suicide, agitation) as secondary outcomes. Study 1 found no pre-post increases in suicidality or related variables, but revealed several significant decreases associated with small to medium effect sizes in suicide-related constructs. In Study 2, VR suicide exposure did not cause any significant increases in suicidality or related variables. Together with prior research, these findings suggest that methods involving intense suicide stimuli appear safe and consistent with utilitarian ethics.

Suizidalitäts-Barometer: Ursachen und Behandlung suizidalen Erlebens und Verhaltens aus Laienperspektive

<b><i>Hintergrund:</i></b> Ziel der vorliegenden Untersuchung war es, ein Meinungsbild über Ursachen und Behandlungsmöglichkeiten suizidalen Erlebens und Verhaltens aus Laiensicht zu erstellen. <b><i>Probanden:</i></b> Insgesamt nahmen 879 Personen (58,2% weiblich; Alter (Jahre): Mittelwert = 32,28, SD = 8,41) an einer internetbasierten Fragebogenstudie teil. <b><i>Ergebnisse:</i></b> Mehr als 90% der Befragten messen psychischen Erkrankungen, schwerwiegenden Lebensereignissen sowie den Wahrnehmungen keine Hoffnung zu haben, eine Last für andere und sozial isoliert zu sein, ursächliche Bedeutung für das Verständnis von Suiziden bei. Nahezu 100% halten eine Psychotherapie für eine angemessene Behandlung suizidalen Erlebens und Verhaltens. Die Zustimmungsraten zu verschiedenen Mythen über Suizidalität sind vergleichsweise niedrig (&#x3c;20%). <b><i>Diskussion und Schlussfolgerung:</i></b> Die Gesamtbefundlage stellt sich als positiv heraus: Sowohl bedeutsame Risikofaktoren für suizidales Erleben und Verhalten als auch zentrale Behandlungsmöglichkeiten sind den Befragten weitgehend bekannt.

The Occupational Depression Inventory: A new tool for clinicians and epidemiologists

BACKGROUND

Depressive symptoms induced by insurmountable job stress and sick leave for mental health reasons have become a focal concern among occupational health specialists. The present study introduces the Occupational Depression Inventory (ODI), a measure designed to quantify the severity of work-attributed depressive symptoms and establish provisional diagnoses of job-ascribed depression. The ODI comprises nine symptom items and a subsidiary question assessing turnover intention.

METHODS

A total of 2254 employed individuals were recruited in the U.S., New Zealand, and France. We examined the psychometric and structural properties of the ODI as well as the nomological network of work-attributed depressive symptoms. We adopted an approach centered on exploratory structural equation modeling (ESEM) bifactor analysis. We developed a diagnostic algorithm for identifying likely cases of job-ascribed depression (SPSS syntax provided).

RESULTS

The ODI showed strong reliability and high factorial validity. ESEM bifactor analysis indicated that, as intended, the ODI can be used as a unidimensional measure (Explained Common Variance = 0.891). Work-attributed depressive symptoms correlated in the expected direction with our other variables of interest-e.g., job satisfaction, general health status-and were markedly associated with turnover intention. Of our 2254 participants, 7.6% (n = 172) met the criteria for a provisional diagnosis of job-ascribed depression.

CONCLUSIONS

This study suggests that the ODI constitutes a sound measure of work-attributed depressive symptoms. The ODI may help occupational health researchers and practitioners identify, track, and treat job-ascribed depression more effectively. ODI-based research may contribute to informing occupational health policies and regulations in the future.

Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 1. Risk factors, protective factors, and assessment

Suicide is a global public health problem that causes the loss of more than 800,000 lives each year, principally among young people. In Brazil, the average mortality rate attributable to suicide is approximately 5.23 per 100,000 population. Although many guidelines have been published for the management of suicidal behavior, to date, there are no recent guidelines based on the principles of evidence-based medicine that apply to the reality of suicide in Brazil. The objective of this work is to provide key guidelines for managing patients with suicidal behavior in Brazil. This project involved 11 Brazilian psychiatry professionals selected by the Psychiatric Emergencies Committee (Comissão de Emergências Psiquiátricas) of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. For the development of these guidelines, 79 articles were reviewed (from 5,362 initially collected and 755 abstracts). In this review, we present definitions, risk and protective factors, assessments, and an introduction to the Safety Plan.

Systematic review registry number: CRD42020206517

Advancing Research in Child Suicide: A Call to Action

OBJECTIVE

To highlight the problem of child suicide, summarize what is known and not known about the problem in the empirical literature, and provide recommendations with ethical considerations for future research and practice.

METHOD

The development of this paper was informed by a meeting of national experts on the topic hosted by the National Institute of Mental Health, as well as by a review of the empirical literature.

RESULTS

We know something about demographic characteristics that are related to higher child suicide rates, but beyond that we know relatively little about risk factors, prevention, and intervention for suicide risk in children <12 years. It is important for child suicide researchers and practitioners to pay particular attention to ethical issues that may be likely to arise in doing this type of work.

CONCLUSION

Much more research is needed on child suicide in the areas of measurement, prevention, and intervention in order to advance the field and provide practitioners with the tools that they critically need.

Do Feelings of Defeat and Entrapment Change over Time? An Investigation of the Integrated Motivational-Volitional Model of Suicidal Behaviour Using Ecological Momentary Assessments

(1) Background. Defeat and entrapment have been highlighted as major risk factors of suicidal ideation and behavior. Nevertheless, little is known about their short-term variability and their longitudinal association in real-time. Therefore, this study aims to investigate whether defeat and entrapment change over time and whether defeat predicts entrapment as stated by the integrated motivational-volitional model of suicidal behavior. (2) Methods. Healthy participants (n = 61) underwent a 7-day smartphone-based ecological momentary assessment (EMA) on suicidal ideation/behavior and relevant risk factors, including defeat and entrapment and a comprehensive baseline (T0) and post (T2) assessment. (3) Results. Mean squared successive differences (MSSD) and intraclass correlations (ICC) support the temporal instability as well as within-person variability of defeat and entrapment. Multilevel analyses revealed that during EMA, defeat was positively associated with entrapment at the same measurement. However, defeat could not predict entrapment to the next measurement (approximately two hours later). (4) Conclusion. This study provides evidence on the short-term variability of defeat and entrapment highlighting that repeated measurement of defeat and entrapment-preferably in real time-is necessary in order to adequately capture the actual empirical relations of these variables and not to overlook significant within-person variability. Further research-especially within clinical samples-seems warranted.

Suicide Prevention Videos Developed by and for Adolescents

Background: One strategy to prevent youth suicide is awareness-raising video campaigns. To date, little is known about how best to include adolescents in the production process, and how they experience their involvement. Aims: This study used a participatory qualitative research approach to explore the experiences of adolescents producing suicide prevention videos targeting other adolescents in a school setting. Method: The project was conducted in Vienna, Austria, from 09/2018 to 01/2019. Eighteen high school students aged 15-19 produced suicide prevention videos. Focus group discussions with 17 of these students captured qualitative information on their experiences related to the process. Focus group content was analyzed following the documentary method. Results: Students produced seven suicide prevention videos in groups of two to three individuals. The production process was found to be positive, and numerous benefits and learning effects were noted. Limitations: No conclusions can be made about video effects on adolescents not involved in the process. Conclusion: Including adolescents in the process of developing suicide prevention videos has multiple benefits. The process researched here can inform similar campaigns with adolescents.

Developing a Suicide Prevention Social Media Campaign With Young People (The #Chatsafe Project): Co-Design Approach

BACKGROUND

Young people commonly use social media platforms to communicate about suicide. Although research indicates that this communication may be helpful, the potential for harm still exists. To facilitate safe communication about suicide on social media, we developed the #chatsafe guidelines, which we sought to implement via a national social media campaign in Australia. Population-wide suicide prevention campaigns have been shown to improve knowledge, awareness, and attitudes toward suicide. However, suicide prevention campaigns will be ineffective if they do not reach and resonate with their target audience. Co-designing suicide prevention campaigns with young people can increase the engagement and usefulness of these youth interventions.

OBJECTIVE

This study aimed to document key elements of the co-design process; to evaluate young people's experiences of the co-design process; and to capture young people's recommendations for the #chatsafe suicide prevention social media campaign.

METHODS

In total, 11 co-design workshops were conducted, with a total of 134 young people aged between 17 and 25 years. The workshops employed commonly used co-design strategies; however, modifications were made to create a safe and comfortable environment, given the population and complexity and sensitivity of the subject matter. Young people's experiences of the workshops were evaluated through a short survey at the end of each workshop. Recommendations for the campaign strategy were captured through a thematic analysis of the postworkshop discussions with facilitators.

RESULTS

The majority of young people reported that the workshops were both safe (116/131, 88.5%) and enjoyable (126/131, 96.2%). They reported feeling better equipped to communicate safely about suicide on the web and feeling better able to identify and support others who may be at risk of suicide. Key recommendations for the campaign strategy were that young people wanted to see bite-sized sections of the guidelines come to life via shareable content such as short videos, animations, photographs, and images. They wanted to feel visible in campaign materials and wanted all materials to be fully inclusive and linked to resources and support services.

CONCLUSIONS

This is the first study internationally to co-design a suicide prevention social media campaign in partnership with young people. The study demonstrates that it is feasible to safely engage young people in co-designing a suicide prevention intervention and that this process produces recommendations, which can usefully inform suicide prevention campaigns aimed at youth. The fact that young people felt better able to safely communicate about suicide on the web as a result of participation in the study augurs well for youth engagement with the national campaign, which was rolled out across Australia. If effective, the campaign has the potential to better prepare many young people to communicate safely about suicide on the web.

The desire to die in palliative care: a sequential mixed methods study to develop a semi-structured clinical approach

BACKGROUND

Although desire to die of varying intensity and permanence is frequent in patients receiving palliative care, uncertainty exists concerning appropriate therapeutic responses to it. To support health professionals in dealing with patients´ potential desire to die, a training program and a semi-structured clinical approach was developed. This study aimed for a revision of and consensus building on the clinical approach to support proactively addressing desire to die and routine exploration of death and dying distress.

METHODS

Within a sequential mixed methods design, we invited 16 palliative patients to participate in semi-structured interviews and 377 (inter-)national experts to attend a two-round Delphi process. Interviews were analyzed using qualitative content analysis and an agreement consensus for the Delphi was determined according to predefined criteria.

RESULTS

11 (69%) patients from different settings participated in face-to-face interviews. As key issues for conversations on desire to die they pointed out the relationship between professionals and patients, the setting and support from external experts, if required. A set of 149 (40%) experts (132/89% from Germany, 17/11% from 9 other countries) evaluated ten domains of the semi-structured clinical approach. There was immediate consensus on nine domains concerning conversation design, suggestions for (self-)reflection, and further recommended action. The one domain in which consensus was not achieved until the second round was "proactively addressing desire to die".

CONCLUSIONS

We have provided the first semi-structured clinical approach to identify and address desire to die and to respond therapeutically - based on evidence, patients' views and consensus among professional experts.

TRIAL REGISTRATION

The study is registered in the German Clinical Trials Register (DRKS00012988; registration date: 27.9.2017) and in the Health Services Research Database (VfD_DEDIPOM_17_003889; registration date: 14.9.2017).