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Xu H, Liu D, Xu X, Chen Y, Qu W, Tan Y, Wang Z, Zhao Y, Tan S. Suicide attempts and non-suicidal self-injury in Chinese adolescents: Predictive models using a neural network model. Asian J Psychiatr 2024; 97:104088. [PMID: 38810490 DOI: 10.1016/j.ajp.2024.104088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/14/2024] [Accepted: 04/26/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Suicide attempts (SA) are a significant contributor to suicide deaths, and non-suicidal self-injury (NSSI) can increase the risk of SA. Many adolescents experience both NSSI and SA, which are affected by various factors. This study aimed to identify the risk factors and essential warning signs of SA, establish a predictive model for SA using multiple dimensions and large samples, and provide a multidimensional perspective for clinical diagnosis and intervention. METHODS A total of 9140 participants aged 12-18 years participated in an online survey; 6959 participants were included in the statistical analysis. A multilayer perceptron algorithm was used to establish a prediction model for adolescent SA (with or without); adolescents with NSSI behavior were extracted as a subgroup to establish a prediction model. RESULTS Both the prediction model performance of the SA group and the NSSI-SA subgroup were strong, with high accuracy, and AUC values of 0.93 and 0.88, indicating good discrimination. Decision curve analysis (DCA) demonstrated that the clinical intervention value of the prediction results was high and that the clinical intervention benefits of the NSSI-SA subgroup were greater than those of the SA group. CONCLUSIONS Our study demonstrated that the predictive model has a high degree of accuracy and discrimination, thereby identifying significant factors associated with adolescent SA. As long as adolescents exhibit NSSI behavior, relative suicide interventions should be implemented to prevent future hazards. This study can provide guidance and more nuanced insights for clinical diagnosis as well as a foundation for clinical treatment.
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Affiliation(s)
- Hao Xu
- Beijing Huilonguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, China; North China University of Science and Technology, Tangshan 063210, China
| | - Dianying Liu
- Ganzhou Third People's Hospital No. 10, Jiangbei Avenue, Zhanggong District, Ganzhou, Jiangxi 341000, China.
| | - Xuejing Xu
- Temple University, Philadelphia, PA 19122, USA
| | - Yan Chen
- Beijing Huilonguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, China
| | - Wei Qu
- Beijing Huilonguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, China
| | - Yunlong Tan
- Beijing Huilonguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, China
| | - Zhiren Wang
- Beijing Huilonguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, China
| | - Yanli Zhao
- Beijing Huilonguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, China
| | - Shuping Tan
- Beijing Huilonguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing 100096, China; North China University of Science and Technology, Tangshan 063210, China.
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Teismann T, Eimen JJ, Cwik JC. Misclassification of Self-Directed Violence. CRISIS 2023; 44:525-528. [PMID: 36636794 PMCID: PMC10658634 DOI: 10.1027/0227-5910/a000897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 01/14/2023]
Abstract
Background: Classification of acts of self-directed violence has been shown to be inadequate in past research. Furthermore, level of expertise have been shown to be unrelated to classification correctness. Aim: The aim of the present study was to investigate whether participants provided with a definition are more reliable in their judgment than participants without a definition. Method: Two hundred sixty-one participants (psychology students, psychotherapists-in-training) were presented with case vignettes describing different acts of self-directed violence and were asked to make a classification. On the basis of randomized allocation, half of the participants received a definition of the different acts of self-directed violence, whereas the others did not. Results: Overall, 24.9% of the cases were misclassified. The presentation of a definition was not accompanied by a higher classification accuracy. Limitations: There may be issues about the validity of the case vignettes. Conclusions: The results highlight the importance of more methodological training of psychologists regarding suicidal issues.
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Affiliation(s)
- Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr University Bochum, Germany
| | - Jannik Julian Eimen
- Mental Health Research and Treatment Center, Ruhr University Bochum, Germany
| | - Jan Christopher Cwik
- Department of Clinical Psychology and Psychotherapy, University of Cologne, Germany
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Fortune S, Hetrick S. Suicide risk assessments: Why are we still relying on these a decade after the evidence showed they perform poorly? Aust N Z J Psychiatry 2022; 56:1529-1534. [PMID: 35786014 DOI: 10.1177/00048674221107316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Suicide deaths have a profound impact on whānau and community and are a tragic loss. However, from a statistical point of view, suicide is a relatively rare event. Predicting rare events is difficult, and the implications for suicide prevention were highlighted in an important editorial in this journal more than a decade ago, yet little seems to have changed. Risk assessment that focuses on accurate prediction of suicide in real-world contexts is given a great deal of attention in mental health services, despite the fact that current scientific knowledge and best practice guidelines in this area highlight that it is unlikely to be a good basis on which to provide access to treatment. It is our view that we have a good enough understanding of the common conditions people who struggle with suicidal distress experience and energy is better directed at acting to reduce exposure to these conditions and providing treatment for those who seek it. Blueprints for successful suicide prevention exist. If we lessen the focus on prediction, we will have greater resources to focus on treatment and prevention.
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Affiliation(s)
- Sarah Fortune
- Department of Social and Community Health, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Sarah Hetrick
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand.,Suicide Prevention Office, Auckland, New Zealand
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Validation of a brief tool to assess and monitor suicidal ideation: The Youth Suicide Ideation Screen (YSIS-3). J Affect Disord 2021; 295:235-242. [PMID: 34481152 DOI: 10.1016/j.jad.2021.08.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/30/2021] [Accepted: 08/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND . Suicidal ideation is common in young people. Assessment and monitoring can help to understand its dynamic nature and inform treatment planning. AIMS . The aims were to evaluate psychometric properties of a brief screening tool - the Youth Suicide Ideation Screen-3 item (YSIS-3) and determine its correlation with the Suicidal Ideation Question-Junior (SIQ-JR) and measures of depressive and anxiety symptoms a. METHOD . Cronbach's alpha (α) was used to evaluate internal consistency of the YSIS-3 in 1107 young people. Convergent validity was evaluated using network analysis based on individual item polychoric correlations. Structural equation modelling was used to understand latent constructs; pearson product moment correlations to validate the integrity of the underlying construct. and two-way mixed Intraclass Correlation Coefficient to examine longitudinal stability and Cohen's d to assess sensitivity to change. RESULTS . The YSIS-3 was found to have internal consistency, convergent validity and criteria validity almost identical to the 15-item SIQ-JR. There was a high correlation (0.91) between the latent factor underpinning YSIS-3 and SIQ-JR. The YSIS-3 was more sensitive to change among those presenting with suicidal ideation at baseline. CONCLUSIONS . The YSIS-3 is a valid measure for the assessment and monitoring of suicidal ideation, and is sensitive to change. This brief measure can contribute to regular monitoring of the presence and nature of suicidal ideation, which when included in comprehensive assessment, will inform the clinical management of those at risk of suicide.
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Akkaya-Kalayci T, Kapusta ND, Winkler D, Kothgassner OD, Popow C, Özlü-Erkilic Z. Triggers for attempted suicide in Istanbul youth, with special reference to their socio-demographic background. Int J Psychiatry Clin Pract 2018; 22:95-100. [PMID: 28899223 DOI: 10.1080/13651501.2017.1376100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Suicidal behavior of young people is a topic of utmost importance because suicide is irreversible, and should be prevented. Knowing about the psychosocial background and the triggering events could help in preventing suicidal behavior. We therefore aimed at identifying psychosocial factors that may trigger suicidal behavior in youth. METHODS We analyzed retrospectively the standardized records of 2232 youths aged ≤25 years, who were treated after a suicide attempt at emergency units of public hospitals in Istanbul, Turkey during a period of 1 year. We describe this population according to sex and socio-economic conditions, like educational, occupational, relationship status and link them with their reported reasons for suicide attempts. RESULTS The majority of patients were female (81.6%, N = 1822 females, 18.4%, N = 410 males). Independent of their educational and occupational background, patients indicated most frequently intra-familial problems (females 45.8%, males 30.5%), intrapersonal problems (females 19.9%, males 18.5%), and relationship problems (females 11.3%, males 23.9%) as triggering reasons. CONCLUSIONS Because intra-familial problems were the most frequently reported triggers of suicide attempts, preventive measures should focus on handling intra-familial conflicts. As sex differences were observed for the second-most common trigger-reasons, prevention should also focus on differentially handling intrapersonal and relationship conflicts better.
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Affiliation(s)
- Türkan Akkaya-Kalayci
- a Outpatient Clinic of Transcultural Psychiatry and Migration-Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Nestor D Kapusta
- b Department of Psychoanalysis and Psychotherapy , Medical University of Vienna , Vienna , Austria
| | - Dietmar Winkler
- c Department for Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Oswald D Kothgassner
- d Division of Clinical Psychology , Medical Directorate of the Vienna General Hospital - Medical University Campus , Vienna , Austria.,e Department of Child and Adolescent Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Christian Popow
- e Department of Child and Adolescent Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Zeliha Özlü-Erkilic
- a Outpatient Clinic of Transcultural Psychiatry and Migration-Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry , Medical University of Vienna , Vienna , Austria
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Cwik JC, Teismann T. Misclassification of Self-Directed Violence. Clin Psychol Psychother 2016; 24:677-686. [PMID: 27481725 DOI: 10.1002/cpp.2036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Inconsistent nomenclature and classification of suicidal behaviour have plagued the field of suicidology for a long time. Recently, the United States Centers for Disease Control (CDC) advocated for the usage of a specific classification system. Aim of the current study was to determine the extent of misdiagnosed acts of self-directed violence-controlling for the level of expertise in psychology/psychotherapy. Additionally, the effect of gender and diagnosis on misclassifications was assessed. METHOD A total of 426 participants (laypersons, psychology students, psychotherapists-in-training, licensed psychotherapists) were presented with an array of case vignettes describing different acts of self-directed violence (e.g., non-suicidal self-directed violence, suicide attempt, suicide ideation) and were asked to make a classification. Gender and given diagnosis were varied systematically in two vignettes. RESULTS Overall 51.6% of the cases were misclassified (according to the Self-Directed Violence Classification System). The level of expertise was almost unrelated to classification correctness. Yet, psychotherapists were more confident about their judgments. Female gender of the character described in the vignette and an ascribed diagnosis of Borderline Personality Disorder were associated with higher misclassification rates. LIMITATIONS The validity of case vignettes is discussible. CONCLUSIONS The results highlight the importance of more methodological and diagnostic training of psychologists regarding suicidal issues. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE Misclassification of non-suicidal and suicidal events is common. Expertise is only weakly associated with classification correctness. Misclassification of suicide attempts occurs more often in women. Misclassification of suicide attempts occurs more often in Borderline Personality Disorder. The use of standardized diagnostic tools in relation to self-directed violence is highly recommended.
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Affiliation(s)
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany
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Freedenthal S. Challenges in Assessing Intent to Die: Can Suicide Attempters Be Trusted? OMEGA-JOURNAL OF DEATH AND DYING 2016; 55:57-70. [PMID: 17877081 DOI: 10.2190/5867-6510-3388-3517] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Assessing a person's intent to die in a suicide attempt is crucial for risk assessment and research, yet suicidal intent is notoriously difficult to measure. People who intended to die when they hurt themselves may deny it, and others may feign intent for secondary gain. Additionally, ambivalence, memory gaps, impulsivity, and fluidity of intent can hinder accurate assessment of intent. Circumstantial evidence, such as a suicide note, may illuminate true intentions but also has substantial limitations. This article summarizes disparate challenges to the measurement of suicidal intent; describes strengths and weaknesses of circumstantial indicators; reviews evidence from studies using the Suicide Intent Scale to show that subjective and circumstantial indicators do not strongly correlate with each other; and concludes with a call to place more trust in individuals whose disclosures of suicidal intent are questionable, even if the possibility for manipulation exists.
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Berk MS, Asarnow JR. Assessment of suicidal youth in the emergency department. Suicide Life Threat Behav 2015; 45:345-59. [PMID: 25327838 DOI: 10.1111/sltb.12133] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 08/08/2014] [Indexed: 11/28/2022]
Abstract
Accurate evaluation of suicidal adolescents in the emergency department (ED) is critical for safety and linkage to follow-up care. We examined self-reports of 181 adolescents who presented to an ED with suicidal ideation (SI) or a suicide attempt (SA). Parents also completed self-reports. Results showed fair agreement between parents and youth on the reason for the ED visit (e.g., SI vs. SA) and greater agreement between independent judges and youths than between judges and parents. In accordance with accepted definitions of suicide attempts (e.g., Crosby, Ortega, & Melanson, 2011; O'Carroll, Berman, Maris, Moscicki, Tanney, & Silverman, 1996, p. 237; Posner, Oquendo, Gould, Stanley, & Davies, 2007, p. 1035; Silverman, Berman, Sanddal, O'Carroll, & Joiner, 2007, p. 248), most youth with SA as the reason for the ED visit reported some intent to die associated with the attempt. Finally, youth presenting to the ED with SA did not differ clinically from youth presenting with SI, and almost half of youths with SI reported past suicide attempts. These results highlight the need to emphasize adolescents' reports in clinical decision making, suggest adolescents' defined suicide attempts similarly to published definitions, and show that assessment of past SAs, as well as present suicidal thoughts and behaviors, is critical in determining future risk.
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Affiliation(s)
- Michele S Berk
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joan R Asarnow
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Menon V. Silverman revisited: A relook at some of the pitfalls and challenges in suicide nomenclature and few suggestions. Ind Psychiatry J 2014; 23:73-4. [PMID: 25535452 PMCID: PMC4261221 DOI: 10.4103/0972-6748.144979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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Hausmann-Stabile C, Kuhlberg J, Zayas LH, Nolle AP, Cintron S. Means, Intent, Lethality, Behaviors, and Psychiatric Diagnosis in Latina Adolescent Suicide Attempters. PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE 2012; 43:241-248. [PMID: 27147812 DOI: 10.1037/a0026258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article describes the means, intent, lethality, behavioral profile, and psychiatric diagnosis of adolescent Latina suicide attempters. From a large mixed-methods project studying the sociocultural processes of Latina suicide attempts, we selected 76 subjects for this report. In addition to quantitative research data, medical records were available for all 76 subjects and qualitative data from in-depth interviews for 34 of them. Using the qualitative and quantitative research data, we explored the intent and behavioral profile of the suicidal adolescents. Medical records provided additional information about the means the adolescents used in their attempts and about their psychiatric diagnosis. The lethality of suicide attempts was coded using the LSARS and the LSARS-II. Findings showed that Latina adolescent suicide attempts are of low lethality. Consistent with the literature, most adolescents reported that they attempted by using means available in their homes (cutting and overdosing with medications were the predominant methods). Interesting discrepancies emerged when comparing adolescents' self-reported behavioral profiles with clinicians' psychiatric diagnoses. This report has implications for diagnosis and treatment approaches for both inpatient and outpatient service providers.
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Fedyszyn IE, Harris MG, Robinson J, Paxton SJ. Classification Algorithm for the Determination of Suicide Attempt and Suicide (CAD-SAS). CRISIS 2012; 33:151-61. [DOI: 10.1027/0227-5910/a000122] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: One methodological difficulty in research into suicide attempts and suicide is distinguishing these phenomena from nonsuicidal self-harming behaviors and accidents. This is problematic because a reliable assessment of the presence or absence of the outcome variable is fundamental for the validity of the findings. Aims: To develop a standardized rating system, the Classification Algorithm for the Determination of Suicide Attempt and Suicide (CAD-SAS), and to investigate its psychometric properties. Methods: To examine the test-retest reliability, one investigator rated 217 narratives of real-life self-harming incidents at initial assessment and 4 weeks later. To establish the interrater reliability, three independent raters assessed a random sample of 70 narratives using the CAD-SAS. To examine the validity, one investigator using the CAD-SAS compared ratings to clinical judgments made by a consultant psychiatrist without the CAD-SAS on the same random set of 70 narratives. Results: Test-retest reliability was excellent (97.2% agreement) and interrater reliability was substantial (70.0% agreement, κ = 0.70). Agreement in the classification of incidents with the “real-world” clinical judgments supports the validity of the CAD-SAS (64.3% agreement, κ = 0.46). Conclusions: The reliability and validity of future studies can be enhanced through the standardized assessment and classification of incidents.
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Affiliation(s)
| | - Meredith G. Harris
- School of Population Health, University of Queensland, Brisbane, Australia
| | - Jo Robinson
- Orygen Youth Health Research Centre, The Centre for Youth Mental Health, University of Melbourne, Australia
| | - Susan J. Paxton
- School of Psychological Science, La Trobe University, Melbourne, Australia
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Andover MS, Morris BW, Wren A, Bruzzese ME. The co-occurrence of non-suicidal self-injury and attempted suicide among adolescents: distinguishing risk factors and psychosocial correlates. Child Adolesc Psychiatry Ment Health 2012; 6:11. [PMID: 22463065 PMCID: PMC3379960 DOI: 10.1186/1753-2000-6-11] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 03/30/2012] [Indexed: 11/17/2022] Open
Abstract
Although attempted suicide and non-suicidal self-injury (NSSI) are distinct behaviors differing in intent, form, and function, the behaviors co-occur at a high rate in both adults and adolescents. Researchers have begun to investigate the association between attempted suicide and NSSI among adolescents. The purpose of this paper is to present current research on this association. First, we discuss definitional issues associated with self-injurious behaviors. Next, we present research on the co-occurrence of attempted suicide and NSSI, including prevalence and associations with self-injury characteristics. We then discuss psychosocial variables associated with engaging in both NSSI and attempted suicide or one type of self-injury alone. Finally, we present the research to date on risk factors uniquely associated with either attempted suicide or NSSI. Implications for mental health professionals and future avenues of research are discussed.
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Affiliation(s)
- Margaret S Andover
- Department of Psychology, Fordham University, 441 East Fordham Road, Bronx, NY 10458, USA
| | - Blair W Morris
- Department of Psychology, Fordham University, 441 East Fordham Road, Bronx, NY 10458, USA
| | - Abigail Wren
- Department of Psychology, Fordham University, 441 East Fordham Road, Bronx, NY 10458, USA
| | - Margaux E Bruzzese
- Department of Psychology, Fordham University, 441 East Fordham Road, Bronx, NY 10458, USA
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Assessment of suicidal ideation and behavior in clinical trials: challenges and controversies. ACTA ACUST UNITED AC 2012. [DOI: 10.4155/cli.12.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Daigle MS, Pouliot L, Chagnon F, Greenfield B, Mishara B. Suicide attempts: prevention of repetition. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:621-9. [PMID: 22014695 DOI: 10.1177/070674371105601008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present an overview of promising strategies to prevent repetition of suicidal behaviours. METHOD This literature review on tertiary preventive interventions of suicide attempts was produced using the computerized databases PubMed and PsycINFO from January 1966 to September 2010, using French- and English-language limits and the key words: suicid* or deliberate self-harm and treatment* or therapy or intervention* or management. RESULTS Thirteen of the 35 included studies showed statistically significant effects of fewer repeated attempts or suicides in the experimental condition. Overall, 22 studies focused on more traditional approaches, that is, pharmacological or psychological approaches. Only 2 of the 6 pharmacological treatments proved significantly superior to a placebo- a study of lithium with depression and flupenthixol with personality disorders. Eight out of 16 psychological treatments proved superior to treatment as usual or another approach: cognitive-behavioural therapy (CBT) (n = 4), (including dialectical behaviour therapy [n = 2]); psychodynamic therapy (n = 2); mixed (CBT plus psychodynamic therapy [n = 1]); and motivational approach and change in therapist (n = 1). Among the 8 studies using visit, postal, or telephone contact or green-token emergency card provision, 2 were significant: one involving telephone follow-up and the other telephone follow-up or visits. Hospitalization was not related to fewer attempts, and 1 of the 4 outreach approaches had significant results: a program involving individualized biweekly treatment. The rationale behind these single or multiple approaches still needs to be clarified. There were methodological flaws in many studies and some had very specific limited samples. CONCLUSIONS There is a need for more research addressing the problem in definitions of outcomes and measurement of the dependent variables, gender-specific effects, and inclusion of high-risk groups. There is a need for the development and evaluation of new approaches that support collaboration with community resources and more careful assessment and comparisons of existing treatments with different populations.
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Karver MS, Tarquini SJ, Caporino NE. The Judgment of Future Suicide-Related Behavior. CRISIS 2010; 31:272-80. [DOI: 10.1027/0227-5910/a000029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Judging whether a youth is at risk for suicide-related behavior (SRB) is considered an extremely challenging task. There are only few studies of helpline counselors, and little is known about their ability to accurately determine the level of risk for SRB. Aims: To examine whether helpline counselors can agree on judgments of risk for SRB, and whether their judgments are consistent with youths’ actual behavior in a 6-month period following intake. Methods: 34 helpline counselors, recruited from three helplines, were studied. Information was collected on their judgments of risk for SRB for each of 45 youths over a 6-month period following initial intake. Results: Contrary to expectations, the counselors had a high rate of agreement (k = .56), and their risk judgments could be used quite successfully (80.0% correct classification) in identifying youths who later engaged in SRB. Conclusions: Unlike most other groups represented in the decision-making literature, helpline counselors agree and are accurate in their judgments of risk for SRB. Our findings suggest that it might be beneficial to apply some of the procedures used to train helpline clinicians to other types of clinicians. Further studies of helpline clinicians are suggested.
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Abstract
OBJECTIVE To determine if brief standardized screening for suicide risk in pediatric primary care practices will increase detection rates of suicidal youth, maintain increased detection and referral rates, and be replicated in other practices. PATIENTS AND METHODS Physicians in 3 primary care practices received brief training in suicide risk, and 2 standardized questions were inserted into their existing electronic medical chart psychosocial interview. The questions automatically populated for all adolescents aged 12.0 to 17.9 years. Deidentified data were extracted during both intervention trials and for the same dates of the previous year. Referral rates were extracted from social work records. RESULTS The rates of inquiry about suicide risk increased 219% (clinic A odds ratio [OR]: 2.04 [95% confidence interval (CI): 1.56-2.51]; clinic B OR: 3.20 [95% CI: 2.69-3.71]; clinic C OR: 1.85 [95% CI: 1.38-2.31]). The rate of case detection increased in clinic A (OR: 4.99 [95% CI: 4.20-5.79]), was maintained over 6 months after the intervention began (OR: 4.38 [95% CI: 3.74-5.02]), and was replicated in both clinic B (OR: 5.46 [95% [CI: 3.36-7.56]) and clinic C (OR: 3.42 [95% CI: 2.33-4.52]). The increase in case detection was 392% across all 3 clinics. Referral rates of suicidal youth to outpatient behavioral health care centers increased at a rate equal to that of the detection rates. CONCLUSIONS Standardized screening for suicide risk in primary care can detect youth with suicidal ideation and prompt a referral to a behavioral health care center before a fatal or serious suicide attempt is made.
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Affiliation(s)
- Matthew B Wintersteen
- Department of Psychiatry and Human Behavior, Thomas Jefferson University/Jefferson Medical College, Philadelphia, PA 19107, USA.
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Engin E, Gurkan A, Dulgerler S, Arabaci LB. University students' suicidal thoughts and influencing factors. J Psychiatr Ment Health Nurs 2009; 16:343-54. [PMID: 19383013 DOI: 10.1111/j.1365-2850.2008.01377.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This research was planned as a descriptive study for the purpose of examining the suicidal thoughts of first-year university students and the factors that might affect them. The research was conducted with the participation of first-year students (class of 1992) at Ege University between January 2003 and October 2004. The research data were collected on a form prepared by the researcher to determine the university students' socio-demographic characteristics and their suicidal thoughts, the trait anger, expression of anger inventory and the brief symptom inventory. It was determined that 2.4% of the students had suicidal thoughts, and 11.2% of the students had previously attempted suicide. The risk factors of the students' suicidal thoughts were determined to be issues of gender, school problems, family relationships, anger expression, somatization, hostility, psychotic symptoms, phobic anxiety, anxiety disorder and interpersonal sensitivity.
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Affiliation(s)
- E Engin
- Department of Psychiatric Nursing, Ege University School of Nursing, Izmir, Turkey.
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Abstract
BACKGROUND The aim with this article is to provide an introduction to self-harm as a clinical phenomenon, with phenomenological descriptions and definitions, and by presenting risk factors, epidemiological data and functions of self-harm. MATERIAL AND METHOD The basis for the article is a non-systematic literature search of the electronic databases Medline, PsychInfo and EMBASE (1985 - 2008). and our own archive of literature on self-harm. RESULTS There is some evidence for an increase in the prevalence of self-harm. Among possible risk factors are childhood abuse, abandonment, neglect, trauma and separation, and the affective quality of the attachment bonds in childhood. A common factor is self-harm as a bodily practice for affect regulation, and as such, it can be understood as a dysfunctional competence. INTERPRETATION To search for understanding of self-harm in individual, familiar and cultural contexts contributes to meet individuals with such tendencies with empathy and beneficial interventions.
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Affiliation(s)
- Bente Sommerfeldt
- Poliklinikk for spiseforstyrrelser, Oslo universitetssykehus, Aker 0320 Oslo.
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Belik SL, Stein MB, Asmundson GJG, Sareen J. Relation between traumatic events and suicide attempts in Canadian military personnel. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2009; 54:93-104. [PMID: 19254440 DOI: 10.1177/070674370905400207] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine whether exposure to particular types of traumatic events was differentially associated with suicide attempts in a representative sample of active military personnel. METHOD Data came from the Canadian Community Health Survey: Mental Health and Well-Being Canadian Forces Supplement (CCHS-CFS), a cross-sectional survey that provided a comprehensive examination of mental disorders, health, and the well-being of currently active Canadian military personnel (n = 8441; aged 16 to 54 years; response rate 81.1%). Respondents were asked about exposure to 28 traumatic events that occurred during their lifetime. Suicide attempts were measured using a question about whether the person ever "attempted suicide or tried to take [his or her] own life." RESULTS The prevalence of lifetime suicide attempts for currently active Canadian military men and women was 2.2% and 5.6%, respectively. Sexual and other interpersonal traumas (for example, rape, sexual assault, spousal abuse, child abuse) were significantly associated with suicide attempts in both men (adjusted odds ratios [AORs] ranging from 2.31 to 4.43) and women (AORs ranging from 1.73 to 3.71), even after adjusting for sociodemographics and mental disorders. Additionally, the number of traumatic events experienced was positively associated with increased risk of suicide attempts, indicating a dose-response effect of exposure to trauma. CONCLUSIONS The current study is the first to demonstrate that sexual and other interpersonal traumatic events are associated with suicide attempts in a representative sample of active Canadian military men and women.
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Affiliation(s)
- Shay-Lee Belik
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba.
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Marks DM, Park MH, Ham BJ, Han C, Patkar AA, Masand PS, Pae CU. Paroxetine: safety and tolerability issues. Expert Opin Drug Saf 2009; 7:783-94. [PMID: 18983224 DOI: 10.1517/14740330802423168] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Paroxetine is a selective serotonin re-uptake inhibitor (SSRI) available in immediate release and controlled release (CR) formulations. Paroxetine is the most potent inhibitor of serotonin re-uptake among the now available SSRIs. Paroxetine has been approved for the treatment of major depressive disorder (MDD), obsessive-compulsive disorder, panic disorder (PD), generalised anxiety disorder, post traumatic stress disorder (PTSD), and social anxiety disorder (SAD) in adults, whereas paroxetine CR is approved for the treatment of MDD, SAD, PD and premenstrual dysphoric disorder in adults. The overall efficacy of paroxetine seems to be comparable to other SSRIs in the treatment of approved indications, although paroxetine treatment induces more sedation, constipation, sexual dysfunction, discontinuation syndrome and weight gain than other SSRIs. Recent data suggest that paroxetine treatment leads to increased rates of congenital malformations, although this evidence is not conclusive. Paroxetine and paroxetine CR are not indicated for use in the paediatric population and are categorised as Pregnancy Class D. In conclusion, whether the tolerability profile of paroxetine differs substantially from other new antidepressants (including other SSRIs) needs to be determined in adequately powered well-designed randomised controlled comparative clinical trials.
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Affiliation(s)
- David M Marks
- Duke University Medical Center, Department of Psychiatry and Behavioural Sciences, 2218 Elder Street, Durham 27705, USA
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21
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Abstract
This analysis drew from decades of published research to evaluate the Suicide Intent Scale (SIS), the dominant research tool for assessing intent to die in apparent suicide attempts. The review sought to 1) synthesize findings related to the scale's normative scores, reliability, and validity (factorial, convergent, and predictive), and 2) examine the objective and subjective subscales' performance. A literature search yielded 158 studies reporting findings for the SIS. Psychometric properties were summarized. Studies supported the scale's reliability, especially that of the subscale assessing self-reported (versus circumstantial indicators) of intent. Mixed findings emerged regarding convergent and predictive validity. The review identified shortcomings in factorial validity and the subscales' performance, especially for adolescents. The Suicide Intent Scale has some strengths, but the weaknesses require further investigation into how to better measure intent to die in attempted suicide.
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Affiliation(s)
- Stacey Freedenthal
- Graduate School of Social Work, University of Denver, Denver, Colorado 80210, USA.
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Silverman MM, Berman AL, Sanddal ND, O'carroll PW, Joiner TE. Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 1: Background, rationale, and methodology. Suicide Life Threat Behav 2007; 37:248-63. [PMID: 17579538 DOI: 10.1521/suli.2007.37.3.248] [Citation(s) in RCA: 332] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Morton M Silverman
- Clinical Associate Professor of Psychiatry at the University of Chicago, Chicago, IL 60615, USA.
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Silverman MM, Berman AL, Sanddal ND, O'carroll PW, Joiner TE. Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 2: Suicide-related ideations, communications, and behaviors. Suicide Life Threat Behav 2007; 37:264-77. [PMID: 17579539 DOI: 10.1521/suli.2007.37.3.264] [Citation(s) in RCA: 610] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Morton M Silverman
- Clinical Associate Professor of Psychiatry at the University of Chicago, Chicago, IL 60615, USA.
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Daigle MS, Côté G. Nonfatal suicide-related behavior among inmates: testing for gender and type differences. Suicide Life Threat Behav 2006; 36:670-81. [PMID: 17250471 DOI: 10.1521/suli.2006.36.6.670] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Suicide-related behavior (SRB) is significantly more prevalent among female (40.8%) than among male (28%) inmates, although suicide risk is higher among the latter. When instrumental behavior (IB) is excluded and only suicidal acts (SA) considered, rates for the two groups are more comparable (11.9% and 16%, respectively). Compared with other female inmates, the SRB group is more suicidal, hostile, and impulsive and more likely to have been previously victimized and to be diagnosed with Axis I and II disorders. Women with IB are not significantly different from those with SA, except that their behavior provides significantly greater tension release.
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Affiliation(s)
- Marc S Daigle
- Université du Québec à Trois-Rivières, the Centre for Research and Intervention on Suicide and Euthanasia, Montreal, Canada.
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Abstract
This 2005 Louis I. Dublin Award Address explores some of the basic difficulties and controversies inherent in the development and universal acceptance of a nomenclature for suicidology. Highlighted are some of the unresolved challenges with agreeing upon a mutually exclusive set of terms to describe suicidal thoughts, intentions, motivations, and self-destructive behaviors.
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Antretter E, Dunkel D, Osvath P, Voros V, Fekete S, Haring C. Multilevel modeling was a convenient alternative to common regression designs in longitudinal suicide research. J Clin Epidemiol 2006; 59:576-86. [PMID: 16713520 DOI: 10.1016/j.jclinepi.2005.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Revised: 10/17/2005] [Accepted: 10/20/2005] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVE The prospective investigation of repetitive nonfatal suicidal behavior is associated with two methodological problems. Due to the commonly used definitions of nonfatal suicidal behavior, clinical samples usually consist of patients with a considerable between-person variability. Second, repeated nonfatal suicidal episodes of the same subjects are likely to be correlated. We examined three regression techniques to comparatively evaluate their efficiency in addressing the given methodological problems. STUDY DESIGN AND SETTING Repeated episodes of nonfatal suicidal behavior were assessed in two independent patient samples during a 2-year follow-up period. The first regression design modeled repetitive nonfatal suicidal behavior as a summary measure. The second regression model treated repeated episodes of the same subject as independent events. The third regression model represented a hierarchical linear model. RESULTS The estimated mean effects of the first model were likely to be nonrepresentative for a considerable part of the study subjects. The second regression design overemphasized the impact of the predictor variables. The hierarchical linear model most appropriately accounted for the heterogeneity of the samples and the correlated data structure. CONCLUSION The nonhierarchical regression designs did not provide appropriate statistical models for the prospective investigation of repetitive nonfatal suicidal behavior. Multilevel modeling provides a convenient alternative.
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Affiliation(s)
- Elfi Antretter
- Unit for Clinical Research and Evaluation, Psychiatric State Hospital Hall, Thurnfeldgasse 14, A-6060 Hall, Tyrol, Austria.
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