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Canter BE, Hart J, Clayton MG, Prinstein MJ, Mann-Rosan R, Solomon S. Does Psychological Flourishing Have the Potential to Mitigate Self-Injurious Thoughts and Behaviors? A Preliminary Analysis of the Protective Influence of Flourishing. Arch Suicide Res 2024; 28:964-978. [PMID: 37837203 DOI: 10.1080/13811118.2023.2265418] [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] [Indexed: 10/15/2023]
Abstract
AIM The purpose of this article was to examine whether psychological flourishing, a multi-dimensional construct of well-being, has the potential to play a preventative role in suicidal and nonsuicidal thoughts and actions. METHODS This two-part study utilized cross-sectional survey data from college students across the United States, assessing levels of psychological distress, loneliness, and psychological flourishing. Frequencies of suicidal ideation, intent, previous suicidal attempts, and nonsuicidal self-injury (NSSI) were also assessed. Data collected in 2019 were used for Study 1 (n = 38,679) and data collected in 2020 were used for Study 2 (n = 50,307). RESULTS Psychological flourishing is significantly inversely related to suicide and NSSI risk when controlling for loneliness and psychological distress. There were two-way interactions between flourishing and distress, whereby under conditions of high distress, the inverse effect of flourishing on suicidal ideation, intent, and attempts and NSSI was more pronounced. These results were consistent across both studies. Subgroup analyses revealed similar results regardless of participants' race, sexual orientation, and gender identity. CONCLUSION Inverse associations between flourishing and self-injurious thoughts and behaviors suggest that flourishing may buffer risk of suicide and NSSI, and these findings may have important implications for developing evidence-based therapeutic interventions. Additional research, including longitudinal and clinical work, is warranted.
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Gromatsky M, Edwards ER, Sullivan SR, van Lissa CJ, Lane R, Spears AP, Mitchell EL, Armey MF, Cáceda R, Goodman M. Characteristics of suicide attempts associated with lethality and method: A latent class analysis of the Military Suicide Research Consortium. J Psychiatr Res 2022; 149:54-61. [PMID: 35231792 DOI: 10.1016/j.jpsychires.2022.02.016] [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: 09/14/2021] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
Abstract
While suicide prevention is a national priority, particularly among service members and veterans (SMVs), understanding of suicide-related outcomes remains poor. Person-centered approaches (e.g., latent class analysis) have promise to identify unique risk profiles and subgroups in the larger population. The current study identified latent subgroups characterized by prior self-directed violence history and proximal risk factors for suicide among suicide attempt survivors, and compared subgroups on demographics and most-lethal attempt characteristics. Participants included civilians and SMVs reporting lifetime suicide attempt(s) (n = 2643) from the Military Suicide Research Consortium. Two classes emerged from Common Data Elements: suicide attempt and non-suicidal self-injury frequency, suicide attempt method, perceived likelihood of future suicide, suicide disclosure, suicide intent, and perceived and actual lethality of attempt. A Higher-Risk History class was characterized by greater intent to die, certainty about attempt fatality and method lethality, belief injury would be medically unfixable, and likelihood of prior non-suicidal self-injury. A Lower-Risk History class was characterized by greater ambivalence toward death and methods. Higher-Risk class members were more likely to be male, older, SMVs, have less formal education, use firearms as most-lethal attempt method, and require a higher degree of medical attention. Lower-Risk class members were more likely to be female, civilian, use cutting as most-lethal attempt method, and require less medical attention for attempts. Findings have implications for risk assessments and highlight the importance of subjective perceptions about suicidal behavior. Further investigation of real-time individual-level is necessary, especially for SMVs who may be at greatest risk for potentially lethal suicidal behavior.
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Affiliation(s)
- Molly Gromatsky
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Emily R Edwards
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sarah R Sullivan
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Caspar J van Lissa
- Methodology & Statistics, Social and Behavioural Sciences, Utrecht University, Netherlands; Open Science Community Utrecht, Utrecht University, Netherlands
| | - Robert Lane
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Angela Page Spears
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Emily L Mitchell
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Michael F Armey
- Psychosocial Research Program, Butler Hospital, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ricardo Cáceda
- Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY, USA; Psychiatry Service, Northport Veterans Affairs Medical Center, Northport, NY, USA
| | - Marianne Goodman
- VISN 2 Mental Illness Research, Education and Clinical Center (MIRECC), James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Foster A, Alderman M, Safin D, Aponte X, McCoy K, Caughey M, Galynker I. Teaching Suicide Risk Assessment: Spotlight on the Therapeutic Relationship. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:257-261. [PMID: 33786778 DOI: 10.1007/s40596-021-01421-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
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Kang M, Kim H. Unique characteristics that distinguish suicide attempters from patients with nonsuicidal self-injury admitted to the emergency department following self-harm behavior: Psychological scales and biochemical markers. Turk J Emerg Med 2021; 21:62-68. [PMID: 33969241 PMCID: PMC8091993 DOI: 10.4103/2452-2473.309134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/23/2020] [Accepted: 09/04/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The objective was to investigate the characteristics of suicide attempters as distinguished from nonsuicidal self-injury (NSSI) among those who are admitted to the emergency department (ED) following self-harm behavior using psychological scales and biochemical markers. MATERIALS AND METHODS The initial assessment forms and medical records of patients referred to the ED after self-harm behavior between March 2017 and December 2019 were retrospectively reviewed. Based on the patients' statements, two groups were formed: the NSSI group and the suicide attempt (SA) group. RESULTS This study included 578 patients, 76.6% (n = 443) in the SA group and 23.4% (n = 135) in the NSSI group. A univariate analysis comparing the SA and NSSI groups revealed that the SA group was statistically significantly associated with male sex, chronic disease, history of depression, unemployment, not seeking help after the attempt, reduced consciousness, and psychiatric consultation. Further, the SA group was older and showed higher Risk-Rescue Rating Scale (RRRS) value and white blood cell value compared to the NSSI group. However, multivariate logistic analysis did not produce statistically significant results for RRRS and any of the biological markers, with one exception for the accessibility to rescue item in the RRRS, where the NSSI group showed a statistically higher "ask for help" score compared to the SA group (P < 0.01). CONCLUSIONS Among patients who were admitted to the ED following self-harm behaviors, the risk factors for SA as opposed to NSSI were chronic disease and not seeking help after the attempt. In addition, suicide attempters tended to be more cooperative in psychiatric consultation following ED admission. In clinical practice, patients admitted due to NSSI should be administered treatment equivalent to that for suicide attempters if they exhibit the characteristics of suicide attempters.
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Affiliation(s)
- Minhyuk Kang
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hyejin Kim
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Deng Y, Li X, Liu L, Chui WH. Suicide Attempts and Perceived Social Support among Chinese Drug Users: The Mediating Role of Self-Esteem and Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010208. [PMID: 33396608 PMCID: PMC7796389 DOI: 10.3390/ijerph18010208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/13/2020] [Accepted: 12/25/2020] [Indexed: 11/22/2022]
Abstract
Suicidal behavior is a severe problem among drug users. This study examines influential factors related to suicide attempts and analyzes possible mediators of the relationship between perceived social support and suicide attempts amongst Chinese drug users under compulsory institutional drug treatment. Taking perceived social support as the independent variable, we found that the relationship between suicide attempts and perceived social support is mediated by self-esteem as a protective factor and depression as a risk factor. Path analysis shows that self-esteem contributes relatively more to the indirect effects than depression does, accounting for 31.1% and 24.2% of the total effect, respectively. Generally speaking, the findings of this study point to an urgent need for addressing suicide attempts among Chinese drug users while treating self-esteem as the protective factor that deserves as substantial attention as depression receives.
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Affiliation(s)
- Yali Deng
- School of Social Work, University of Maryland Baltimore, Baltimore, MD 21201, USA;
| | - Xuemeng Li
- The Graduate Center, City University of New York, New York, NY 10016, USA;
| | - Liu Liu
- School of Social and Behavioral Sciences, Nanjing University, Nanjing 210023, China
- Correspondence: ; Tel.: +86-25-896-809-58 (ext. 409)
| | - Wing Hong Chui
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China;
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Levi-Belz Y, Gvion Y, Levi U, Apter A. Beyond the mental pain: A case-control study on the contribution of schizoid personality disorder symptoms to medically serious suicide attempts. Compr Psychiatry 2019; 90:102-109. [PMID: 30852349 DOI: 10.1016/j.comppsych.2019.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 01/12/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Clinical and research findings have highlighted the role of interpersonal factors in suicidal behavior with high levels of intent and lethality. Schizoid personality disorder (SPD) is at the extreme end of interpersonal difficulties. Thus, we aimed to understand the contribution of SPD symptoms to suicide behavior and specifically to more lethal suicide attempts. METHOD Four groups were investigated (N = 338): medically serious suicide attempters, medically non-serious suicide attempters, psychiatric and healthy controls. SPD symptoms, mental pain variants, and clinical characteristics were assessed. RESULTS Overall, attempters were characterized by higher levels of most SPD symptoms. Solitary lifestyle and emotional detachment were higher among medically serious suicide attempters relative to less-serious attempters. Emotional detachment doubled the risk for high lethality, beyond mental pain variables. CONCLUSIONS SPD symptoms of interpersonal difficulties and low levels of emotional expressions are important risk factors for more severe suicidal behavior. Implications for identification of at-risk groups for suicide are discussed.
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Affiliation(s)
- Y Levi-Belz
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel; The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel.
| | - Y Gvion
- Department of Child Clinical Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - U Levi
- Department of Behavioral Sciences, Peres Academic Center, Rehovot, Israel
| | - A Apter
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel; Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
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7
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Cramer RJ, Rasmussen S, Webber WB, Sime VL, Haile C, McFadden C, McManus MC. Preferences in Information Processing and suicide: Results from a young adult health survey in the United Kingdom. Int J Soc Psychiatry 2019; 65:46-55. [PMID: 30488744 DOI: 10.1177/0020764018815206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Suicide prevention literature currently suffers from inconsistent measurement and incomplete theoretical development. AIMS Using a recommended suicide measurement approach for epidemiological studies (i.e. the Suicidal Behaviors Questionnaire-Revised (SBQ-R)), the present investigation assessed United Kingdom young adult suicide prevalence rates. This study also investigated the utility of a Preferences in Information Processing (PIP) model of suicide in identifying those at increased odds for elevated suicide risk, as well as lifetime ideation and attempt. METHOD A cross-sectional mental health and well-being survey study ( n = 414) was conducted. RESULTS The prevalence rates of elevated risk (49.8%), lifetime ideation only (55.3%) and lifetime attempt (13.5%) were high. Bivariate associations demonstrated that elevated depression, anxiety and Need for Affect (NFA) Avoidance were associated with worsened suicide outcomes, whereas elevated Need for Cognition (NFC) was associated with decreased suicide risk. Logistic regression results identified depression and NFA Avoidance as the strongest predictors of elevated suicide risk. Multinomial logistic regression results established several PIP-based moderation effects for depression and anxiety in which NFA Approach and NFC differentially influenced odds of suicide attempt group membership. CONCLUSION The SBQ-R is an appropriate tool for UK young adult suicide research. NFA and NFC demonstrated potential for inclusion in young adult suicide prevention programming. Further research is needed to fully evaluate the PIP model of suicide and effectiveness of proposed theory-based approaches to suicide prevention.
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Affiliation(s)
- Robert J Cramer
- 1 School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA
| | - Susan Rasmussen
- 2 School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Wesley B Webber
- 3 Department of Educational Studies in Psychology, Research Methodology, and Counseling, The University of Alabama, Tuscaloosa, AL, USA
| | - Victoria L Sime
- 2 School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Caitlin Haile
- 2 School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Claire McFadden
- 2 School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Moira C McManus
- 4 College of Health Sciences, Old Dominion University, Norfolk, VA, USA
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8
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Rodriguez VJ, Mandell LN, Babayigit S, Manohar RR, Weiss SM, Jones DL. Correlates of Suicidal Ideation During Pregnancy and Postpartum Among Women Living with HIV in Rural South Africa. AIDS Behav 2018; 22:3188-3197. [PMID: 29752621 PMCID: PMC6230517 DOI: 10.1007/s10461-018-2153-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In developing countries, up to 20% of maternal deaths during pregnancy are due to suicide, and being HIV-infected confers additional risk. This manuscript sought to identify perinatal correlates of suicidal ideation among women living with HIV (WLHIV) in rural South Africa. Pregnant WLHIV (N = 681) were recruited and re-assessed at 12-months postpartum. Mean age was 28.3 (SD = 5.7) years and 68% were below the poverty line. Prenatal suicidal ideation was 39%; suicidal ideation continued for 7% at 12 months, 13% experienced incident suicidal ideation, and for 19% suicidal ideation had stopped postnatally. Intimate partner violence (AOR = 1.17) and depression (AOR = 1.14) predicted sustained suicidal ideation. Increased income (AOR = 2.25) and greater stigma (AOR = 1.33) predicted incident suicidal ideation. Younger age (AOR = 0.94), disclosure of HIV status to partner (AOR = 0.60), and greater stigma (AOR = 1.24) predicted postnatal cessation of suicidal ideation. Perinatal care may provide windows of opportunity for identification and treatment of suicidal ideation.
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Affiliation(s)
- Violeta J Rodriguez
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA, 30605, USA
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Avenue, Dominion Tower 404A, Miami, FL, 33136, USA
| | - Lissa N Mandell
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Avenue, Dominion Tower 404A, Miami, FL, 33136, USA
| | - Suat Babayigit
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Avenue, Dominion Tower 404A, Miami, FL, 33136, USA
| | - Rhea R Manohar
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Avenue, Dominion Tower 404A, Miami, FL, 33136, USA
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Avenue, Dominion Tower 404A, Miami, FL, 33136, USA
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Avenue, Dominion Tower 404A, Miami, FL, 33136, USA.
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Johnson D, Dupuis G, Piche J, Clayborne Z, Colman I. Adult mental health outcomes of adolescent depression: A systematic review. Depress Anxiety 2018; 35:700-716. [PMID: 29878410 DOI: 10.1002/da.22777] [Citation(s) in RCA: 234] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 04/12/2018] [Accepted: 04/23/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Adolescent depression may increase risk for poor mental health outcomes in adulthood. The objective of this study was to systematically review the literature on the association between adolescent depression and adult anxiety and depressive disorders as well as suicidality. METHODS EMBASE, MEDLINE, and PSYCinfo databases were searched and longitudinal cohort studies in which depression was measured in adolescence (age 10-19) and outcomes of depressive disorders, anxiety disorders, or suicidality were measured in adulthood (age 21+), were selected. Meta-analysis using inverse variance and random effects modeling, along with sensitivity analyses, were used to synthesize article estimates. RESULTS Twenty articles were identified, representing 15 unique cohorts. Seventeen of 18 articles showed adolescent depression increased risk for adult depression; eleven pooled cohorts estimated that adolescents with depression had 2.78 (1.97, 3.93) times increased odds of depression in adulthood. Seven of eight articles that investigated the association between adolescent depression and any adult anxiety found a significant association. Three of five articles showed a significant association between adolescent depression and adult suicidality. CONCLUSION This review shows that adolescent depression increases the risk for subsequent depression later in life. Articles consistently found that adolescent depression increases the risk for anxiety disorders in adulthood, but evidence was mixed on whether or not a significant association existed between adolescent depression and suicidality in adulthood. Early intervention in adolescent depression may reduce long-term burden of disease.
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Affiliation(s)
- Dylan Johnson
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Gabrielle Dupuis
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin Piche
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Zahra Clayborne
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian Colman
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Levi-Belz Y, Gvion Y, Grisaru S, Apter A. When the Pain Becomes Unbearable: Case-Control Study of Mental Pain Characteristics Among Medically Serious Suicide Attempters. Arch Suicide Res 2018; 22:380-393. [PMID: 28786756 DOI: 10.1080/13811118.2017.1355288] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The unbearable mental pain experience is recognized as a key antecedent of suicidal behavior. We aimed to examine the precise nature of the mental pain among medically serious suicide attempters (MSSAs), a population closely resembling those who died by suicide. We evaluated various factors of mental pain from the Orbach and Mikulincer Mental Pain Scale, as well as medical lethality and suicide intent. MSSAs were higher than non-MSSAs and psychiatric controls for Irreversibility of pain. Moreover, Emptiness predicted medical lethality, while Cognitive Confusion negatively predicted suicide intent level, controlling for hopelessness and depression. high sense of Irreversibility of pain as well as high Emptiness and low Cognitive Confusion are important risk factors for more severe suicidal behavior. Implications for identification of at-risk groups for suicide as well as for suicide prevention and treatment of suicidal individuals are discussed.
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Kim DW, Jeong KY, Kim KS. Psychological scales as predictors of emergency department hospitalizations in suicide attempters. Am J Emerg Med 2017; 36:93-99. [PMID: 28743477 DOI: 10.1016/j.ajem.2017.07.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/07/2017] [Accepted: 07/12/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the psychological scales reflecting lethality and intent as predictors of suicide attempter's hospitalization. METHODS Data of suicide attempters aged over 15years, who visited the ED from January 2013 to June 2016, were retrospectively collected and they were divided into the hospitalization and discharge groups. We evaluated the Risk-Rescue Rating Scale (RRRS) and Self-Inflicted Injury Severity Form (SIISF) for lethality and Suicide Intent Scale (SIS) for intent, respectively. The predictive abilities of these scales for hospitalization were compared in terms of performance (AUCs) and goodness-of-fit (the Bayesian information criterion [BIC]). RESULTS A total of 382 suicide attempters were enrolled, of which 233 (61%) were hospitalized. The scores of all psychological scales were significantly higher in the hospitalization group and all scales were identified as independent predictors of hospitalization. The AUC of the RRRS tended to be higher than those of the SIS and SIISF; similarly, the RRRS demonstrated the best overall fit (the lowest BIC). The AUC of combined the RRRS and SIS was superior to that of any of the individual scales alone. While the AUC of combined the SIISF and SIS was superior to that of either individual scale, it was comparable to that of the RRRS. CONCLUSIONS The psychological scales can be helpful for predicting suicide attempter's hospitalization in emergency settings. Especially, the RRRS seemed to have a superior predictive ability. Moreover, combining the scales had significantly better predictive performance than use of the individual scale alone did.
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Affiliation(s)
- Dae Woong Kim
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Ki Young Jeong
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea; Department of Emergency Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
| | - Kyung Su Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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12
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Freeman A, Mergl R, Kohls E, Székely A, Gusmao R, Arensman E, Koburger N, Hegerl U, Rummel-Kluge C. A cross-national study on gender differences in suicide intent. BMC Psychiatry 2017; 17:234. [PMID: 28662694 PMCID: PMC5492308 DOI: 10.1186/s12888-017-1398-8] [Citation(s) in RCA: 177] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/22/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Suicide accounts for over 58,000 deaths in Europe per annum, where suicide attempts are estimated to be 20 times higher. Males have been found to have a disproportionately lower rate of suicide attempts and an excessively higher rate of suicides compared to females. The gender difference in suicide intent is postulated to contribute towards this gender imbalance. The aim of this study is to explore gender differences in suicide intent in a cross-national study of suicide attempts. The secondary aims are to investigate the gender differences in suicide attempt across age and country. METHODS Data on suicide attempts (acquired from the EU-funded OSPI-Europe project) was obtained from eight regions in Germany, Hungary, Ireland and Portugal. Suicide intent data was categorized into 'Non-habitual Deliberate Self-Harm' (DSH), 'Parasuicidal Pause' (SP), 'Parasuicidal Gesture' (SG), and 'Serious Suicide Attempt' (SSA), applying the Feuerlein scale. Gender differences in intent were explored for significance by using χ2-tests, odds ratios, and regression analyses. RESULTS Suicide intent data from 5212 participants was included in the analysis. A significant association between suicide intent and gender was found, where 'Serious Suicide Attempts' (SSA) were rated significantly more frequently in males than females (p < .001). There was a statistically significant gender difference in intent and age groups (p < .001) and between countries (p < .001). Furthermore, within the most utilised method, intentional drug overdose, 'Serious Suicide Attempt' (SSA) was rated significantly more often for males than females (p < .005). CONCLUSIONS Considering the differences in suicidal intent between males and females highlighted by the current study, gender targeted prevention and intervention strategies would be recommended.
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Affiliation(s)
- Aislinné Freeman
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Leipzig, Semmelweisstraße 10, Haus 13, 04103, Leipzig, Germany.
| | - Roland Mergl
- 0000 0001 2230 9752grid.9647.cKlinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Leipzig, Semmelweisstraße 10, Haus 13, 04103 Leipzig, Germany ,Forschungszentrum Depression der Stiftung Deutsche Depressionshilfe, Leipzig, Germany
| | - Elisabeth Kohls
- 0000 0001 2230 9752grid.9647.cKlinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Leipzig, Semmelweisstraße 10, Haus 13, 04103 Leipzig, Germany
| | - András Székely
- 0000 0001 0942 9821grid.11804.3cSemmelweis University, Budapest, Hungary
| | - Ricardo Gusmao
- 0000000121511713grid.10772.33New University of Lisbon, Lisbon, Portugal
| | - Ella Arensman
- 0000000123318773grid.7872.aNational Suicide Research Foundation & Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Nicole Koburger
- 0000 0001 2230 9752grid.9647.cKlinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Leipzig, Semmelweisstraße 10, Haus 13, 04103 Leipzig, Germany ,Forschungszentrum Depression der Stiftung Deutsche Depressionshilfe, Leipzig, Germany
| | - Ulrich Hegerl
- 0000 0001 2230 9752grid.9647.cKlinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Leipzig, Semmelweisstraße 10, Haus 13, 04103 Leipzig, Germany ,Forschungszentrum Depression der Stiftung Deutsche Depressionshilfe, Leipzig, Germany
| | - Christine Rummel-Kluge
- 0000 0001 2230 9752grid.9647.cKlinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Leipzig, Semmelweisstraße 10, Haus 13, 04103 Leipzig, Germany ,Forschungszentrum Depression der Stiftung Deutsche Depressionshilfe, Leipzig, Germany
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13
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Fazakas-DeHoog LL, Rnic K, Dozois DJA. A Cognitive Distortions and Deficits Model of Suicide Ideation. EUROPES JOURNAL OF PSYCHOLOGY 2017; 13:178-193. [PMID: 28580021 PMCID: PMC5450979 DOI: 10.5964/ejop.v13i2.1238] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 01/21/2017] [Indexed: 12/22/2022]
Abstract
Although cognitive distortions and deficits are known risk factors for the development and escalation of suicide ideation and behaviour, no empirical work has examined how these variables interact to predict suicide ideation. The current study proposes an integrative model of cognitive distortions (hopelessness and negative evaluations of self and future) and deficits (problem solving deficits, problem solving avoidance, and cognitive rigidity). To test the integrity of this model, a sample of 397 undergraduate students completed measures of deficits, distortions, and current suicide ideation. A structural equation model demonstrated excellent fit, and findings indicated that only distortions have a direct effect on suicidal thinking, whereas cognitive deficits may exert their effects on suicide ideation via their reciprocal relation with distortions. Findings underscore the importance of both cognitive distortions and deficits for understanding suicidality, which may have implications for preventative efforts and treatment.
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Affiliation(s)
- Laura L Fazakas-DeHoog
- St. Joseph's Health Care - Regional Mental Health Care St. Thomas, St. Thomas, Ontario, Canada.,Department of Psychology, The University of Western Ontario, London, Ontario, Canada
| | - Katerina Rnic
- Department of Psychology, The University of Western Ontario, London, Ontario, Canada
| | - David J A Dozois
- Department of Psychology, The University of Western Ontario, London, Ontario, Canada
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Sgobin SMT, Traballi ALM, Botega NJ, Coelho OR. Direct and indirect cost of attempted suicide in a general hospital: cost-of-illness study. SAO PAULO MED J 2015; 133:218-26. [PMID: 26176926 PMCID: PMC10876379 DOI: 10.1590/1516-3180.2014.8491808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 03/03/2014] [Accepted: 08/15/2014] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Knowledge of socioeconomic impact of attempted suicide may sensitize managers regarding prevention strategies. There are no published data on this in Brazil. The aim here was to describe the direct and indirect costs of care of hospitalized cases of attempted suicide and compare these with the costs of acute coronary syndrome cases. DESIGN AND SETTING Cost-of-illness study at a public university hospital in Brazil. METHOD The costs of care of 17 patients hospitalized due to attempted suicide were compared with those of 17 acute coronary syndrome cases at the same hospital, over the same period. The direct costs were the summation of the hospital and out-of-hospital costs resulting from the event, determined from the medical records. The indirect costs were estimated through the human capital lost. The Mann-Whitney test and analysis of covariance (ANCOVA) with transformation adjusted for age were used for comparisons. RESULTS The average costs per episode of attempted suicide were: direct cost, US$ 6168.65; indirect cost, US$ 688.08; and total cost, US$ 7163.75. Comparative analysis showed a difference between the indirect costs to family members, with significantly higher costs in the attempted suicide group (P = 0.0022). CONCLUSION The cost of care relating to attempted suicide is high and the indirect cost to family members reinforces the idea that suicidal behavior not only affects the individual but also his social environment.
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Affiliation(s)
- Sara Maria Teixeira Sgobin
- MSc. Collaborating Physician, Department of Medical Psychology and Psychiatry Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.
| | - Ana Luisa Marques Traballi
- MD. Collaborating Physician, Department of Medical Psychology and Psychiatry Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.
| | - Neury José Botega
- PhD. Titular Professor, Department of Medical Psychology and Psychiatry, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.
| | - Otávio Rizi Coelho
- PhD. Titular Professor, Department of Cardiology, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.
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Rimkeviciene J, O'Gorman J, De Leo D. Impulsive suicide attempts: a systematic literature review of definitions, characteristics and risk factors. J Affect Disord 2015; 171:93-104. [PMID: 25299440 DOI: 10.1016/j.jad.2014.08.044] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/26/2014] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extensive research on impulsive suicide attempts, but lack of agreement on the use of this term indicates the need for a systematic literature review of the area. The aim of this review was to examine definitions and likely correlates of impulsive attempts. METHODS A search of Medline, Psychinfo, Scopus, Proquest and Web of Knowledge databases was conducted. Additional articles were identified using the cross-referencing function of Google Scholar. RESULTS 179 relevant papers were identified. Four different groups of research criteria used to assess suicide attempt impulsivity emerged: (a) time-related criteria, (b) absence of proximal planning/preparations, (c) presence of suicide plan in lifetime/previous year, and (d) other. Subsequent analysis used these criteria to compare results from different studies on 20 most researched hypotheses. Conclusions regarding the characteristics of impulsive attempts are more consistent than those on the risk factors specific to such attempts. No risk factors were identified that uniformly related to suicide attempt impulsivity across all criteria groups, but relationships emerged between separate criteria and specific characteristics of suicide attempters. LIMITATIONS Only published articles were included. Large inconsistencies in methods of the studies included in this review prevented comparison of effect sizes. CONCLUSIONS The vast disparities in findings on risk factors for impulsive suicide attempts among different criteria groups suggest the need to address the methodological issues in defining suicide attempt impulsivity before further research into correlates of such attempts can effectively progress. Specific recommendations are offered for necessary research.
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Affiliation(s)
- Jurgita Rimkeviciene
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organisation Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Australia.
| | - John O'Gorman
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organisation Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Australia; Griffith Health Institute, Australia
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, National Centre of Excellence in Suicide Prevention, World Health Organisation Collaborating Centre for Research and Training in Suicide Prevention, Griffith University, Australia
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Chapman AL, Gratz KL, Turner BJ. Risk-related and protective correlates of nonsuicidal self-injury and co-occurring suicide attempts among incarcerated women. Suicide Life Threat Behav 2014; 44:139-54. [PMID: 24138178 DOI: 10.1111/sltb.12058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/05/2013] [Indexed: 11/25/2022]
Abstract
Individual and environmental correlates of nonsuicidal self-injury (NSSI) and co-occurring suicide attempts (SA) among incarcerated women (N = 104) were examined. Participants completed measures of putative risk and protective factors, including coping styles, childhood maltreatment, and hopelessness. Results indicated that active coping was uniquely, negatively associated with the presence and frequency of NSSI, whereas avoidant coping and childhood physical/emotional abuse were positively associated with NSSI frequency. Conversely, among women with a history of NSSI, hopelessness was uniquely, positively associated with the presence and frequency of SA. Further, childhood sexual abuse was associated with the presence of SA, while physical/emotional abuse was associated with SA frequency. Hopelessness was more strongly related to SA frequency than NSSI frequency. These findings help disentangle the unique risk and protective factors for NSSI and co-occurring SA in incarcerated samples.
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Bethell J, Bondy SJ, Lou WYW, Guttmann A, Rhodes AE. Emergency department presentations for self-harm among Ontario youth. Canadian Journal of Public Health 2013. [PMID: 23618204 DOI: 10.1007/bf03405675] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Self-harm is an important public health issue among youth, including as a major risk factor for suicide (a leading cause of death in this age group). This study used population-based emergency department data to describe clinical and demographic characteristics of emergency department presentations for self-harm among youth (12-17 year-olds) in the province of Ontario, Canada. METHODS Administrative data capturing every emergency department visit in Ontario between April 1, 2002 and March 31, 2009 were used to identify and describe self-harm presentations. RESULTS Over the 7-year period between 2002/03 and 2008/09, there were 16,835 self-harm presentations by 12,907 youth. Two thirds of self-harm presentations were self-poisonings (almost always with medicinal agents), followed by self-cutting, which accounted for about one quarter. Incidence rates were higher in girls than boys, increased with age, were inversely related to neighbourhood income and were highest in rural areas. Self-harm accounted for about 1 in 100 emergency department presentations by youth, but also a disproportionate number of presentations triaged as high acuity or admitted to hospital (about 1 in 20). CONCLUSION Self-harm is an important public health issue, requiring a comprehensive approach to prevention. Ontario has useful data with which to study emergency department presentations for self-harm, and the similarities between self-harm presentations among Ontario youth and those reported from the United States and Europe suggest generalizability of results between populations. Further research is needed to address the reasons for the geographic differences in frequency of self-harm.
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Affiliation(s)
- Jennifer Bethell
- Suicide Studies Research Unit, St. Michael's Hospital, Toronto, ON.
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Abstract
Military veterans represent a unique, heterogeneous population with suicide prevalence rates, risk factors and preventative management needs that differ from those of the rest of community. Veterans worldwide receive high proportions of their healthcare from community providers, and sensitivity to these distinct needs is required for optimized care. An overview of the recent prevalence-study literature, with a focus upon statistical design, is presented in order to provide a critical orientation within this field with high levels of popular media attention. Attention to psychiatric comorbidity, subthreshold symptomology, select signature disorders of contemporary conflicts (namely, post-traumatic stress disorder and traumatic brain injury), and veteran life narratives before, within and beyond military service will guide our review of risk factor assessment and management strategies. This critical review of the literature provides an overview of this active field of neuropsychiatric research with a select focus upon these topics of special interest.
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Affiliation(s)
- Timothy R Rice
- Department of Psychiatry, The Mount Sinai School of Medicine, 1425 Madison Avenue, Box 1230, New York, NY 10029, USA.
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Medically serious versus non-serious suicide attempts: relationships of lethality and intent to clinical and interpersonal characteristics. J Affect Disord 2012; 136:286-93. [PMID: 22197510 DOI: 10.1016/j.jad.2011.11.035] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 11/22/2011] [Accepted: 11/23/2011] [Indexed: 01/29/2023]
Abstract
BACKGROUND The study of near-fatal suicide attempts may provide insight into the minds of suicidal subjects. The aim of the study was to investigate the relationship of intent and lethality in medically serious and medically non-serious suicide attempts and to examine relationship of specific psychological and clinical variables with the subjective and objective components of suicide intent. METHODS The study group included 102 participants, 35 consecutive subjects hospitalized for a medically serious suicide attempt and 67 subjects who presented to the same tertiary medical center after a medically non-serious suicide attempt. All were interviewed with the SCID-I and completed the Suicide Intent Scale (SIS), the Lethality Rating Scale, and instruments measuring mental pain and communication difficulties. RESULTS Patients who made medically serious suicide attempts had higher total SIS score and higher objective and subjective subscale scores. The objective component of the SIS was highly correlated with the lethality of the suicide attempt and communication difficulties; the subjective component was associated with mental pain variables. The interaction of mental pain and communication difficulties was predictive of the severity of the objective suicide intent. LIMITATIONS Relatively small number of patients with medically serious suicide attempt and the relatively large number of questionnaires which may to some extent have diminished informant reliability. CONCLUSIONS Suicidal individuals with depression and hopelessness who cannot signal their pain to others are at high risk of committing a medically serious suicide attempts.
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Rhodes AE, Boyle MH, Tonmyr L, Wekerle C, Goodman D, Leslie B, Mironova P, Bethell J, Manion I. Sex differences in childhood sexual abuse and suicide-related behaviors. Suicide Life Threat Behav 2011; 41:235-54. [PMID: 21477094 DOI: 10.1111/j.1943-278x.2011.00025.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Child sexual abuse and suicide-related behaviors are associated, but it remains unclear if the strength of this association differs in boys and girls. In a systematic review of this association in children and youth, we identified 16 relevant studies, all cross-sectional surveys of students. The association is stronger in boys specific to suicide attempt(s). Adjustments for potential confounding variables explained some, but not all of this sex difference. While additional research would strengthen causal inferences, this sex difference may be influenced by the nature and timing of child sexual abuse as well as the sex of the perpetrator, which in turn shapes the disclosure of these events.
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Affiliation(s)
- Anne E Rhodes
- The Suicide Studies Research Unit and the Keenan Research Centre at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada
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Differences between younger and older adults in the structure of suicidal intent and its correlates. Am J Geriatr Psychiatry 2010; 18:839-47. [PMID: 20220600 DOI: 10.1097/jgp.0b013e3181d145b0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze differences in the variables associated with severity of suicidal intent and in the main factors associated with intent when comparing younger and older adults. DESIGN Observational, descriptive cross-sectional study. SETTING Four general hospitals in Madrid, Spain. PARTICIPANTS Eight hundred seventy suicide attempts by 793 subjects split into two groups: 18-54 year olds and subjects older than 55 years. MEASUREMENTS The authors tested the factorial latent structure of suicidal intent through multigroup confirmatory factor analysis for categorical outcomes and performed statistical tests of invariance across age groups using the DIFFTEST procedure. Then, they tested a multiple indicators-multiple causes (MIMIC) model including different covariates regressed on the latent factor "intent" and performed two separate MIMIC models for younger and older adults to test for differential patterns. RESULTS Older adults had higher suicidal intent than younger adults (z = 2.63, p = 0.009). The final model for the whole sample showed a relationship of intent with previous attempts, support, mood disorder, personality disorder, substance-related disorder, and schizophrenia and other psychotic disorders. The model showed an adequate fit (chi²[12] = 22.23, p = 0.035; comparative fit index = 0.986; Tucker-Lewis index = 0.980; root mean square error of approximation = 0.031; weighted root mean square residual = 0.727). All covariates had significant weights in the younger group, but in the older group, only previous attempts and mood disorders were significantly related to intent severity. CONCLUSIONS The pattern of variables associated with suicidal intent varies with age. Recognition, and treatment of geriatric depression may be the most effective measure to prevent suicidal behavior in older adults.
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