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Pitman A, Logeswaran Y, McDonald K, Cerel J, Lewis G, Erlangsen A. Investigating risk of self-harm and suicide on anniversaries after bereavement by suicide and other causes: a Danish population-based self-controlled case series study. Epidemiol Psychiatr Sci 2023; 32:e53. [PMID: 37551142 PMCID: PMC10465319 DOI: 10.1017/s2045796023000653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/28/2023] [Accepted: 07/13/2023] [Indexed: 08/09/2023] Open
Abstract
AIMS To investigate mechanisms of suicide risk in people bereaved by suicide, prompted by observations that bereaved people experience higher levels of distress around dates of emotional significance. We hypothesised that suicide-bereaved first-degree relatives and partners experience an increased risk of self-harm and suicide around dates of (i) anniversaries of the death and (ii) the deceased's birthday, compared with intervening periods. METHODS We conducted a self-controlled case series study using national register data on all individuals living in Denmark from 1 January 1980 to 31 December 2016 and who were bereaved by the suicide of a first-degree relative or partner (spouse or cohabitee) during that period, and who had the outcome (any episode of self-harm or suicide) within 5 years and 6 weeks of the bereavement. We compared relative incidence of suicidal behaviour in (i) the first 30 days after bereavement and (ii) in the aggregated exposed periods (6 weeks either side of death anniversaries; 6 weeks either side of the deceased's birthdays) to the reference (aggregated unexposed intervening periods). As an indirect comparison, we repeated these models in people bereaved by other causes. RESULTS We found no evidence of an elevated risk of suicidal behaviour during periods around anniversaries of a death or the deceased's birthdays in people bereaved by suicide (adjusted incidence rate ratio [IRRadj] = 1.00; 95% confidence interval [CI] = 0.87-1.16) or other causes (IRRadj = 1.04; 95% CI = 1.00-1.08) compared with intervening periods. Rates were elevated in the 30 days immediately after bereavement by other causes (IRRadj: 1.95, 95% CI: 1.77-2.22). CONCLUSIONS Although people bereaved by suicide are at elevated risk of self-harm and suicide, our findings do not suggest that this risk is heightened around emotionally significant anniversaries. Bereavement care should be accessible at all points after a traumatic loss as needs will differ over the grief trajectory.
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Affiliation(s)
- Alexandra Pitman
- UCL Division of Psychiatry, University College London (UCL), London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | | | - Keltie McDonald
- UCL Division of Psychiatry, University College London (UCL), London, UK
| | - Julie Cerel
- College of Social Work, University of Kentucky, Lexington, KY, USA
| | - Gemma Lewis
- UCL Division of Psychiatry, University College London (UCL), London, UK
| | - Annette Erlangsen
- Danish Research Institute for Suicide Prevention, Psychiatric Centre Copenhagen, Hellerup, Copenhagen, Denmark
- Copenhagen Research Centre for Mental Health, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Hellerup, Copenhagen, Denmark
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
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Ernst M, Zwerenz R, Michal M, Wiltink J, Tuin I, Beutel ME. Ambivalent toward life, ambivalent toward psychotherapy? An investigation of the helping alliance, motivation for treatment, and control expectancies in patients with suicidal ideation in inpatient psychotherapy. Suicide Life Threat Behav 2023; 53:557-571. [PMID: 37102497 DOI: 10.1111/sltb.12964] [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: 12/27/2022] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Research has found that patients with suicidal ideation (SI) are at high risk for unfavorable outcomes. The present work aimed to expand the knowledge about their characteristics and treatment success. METHODS Data were drawn from a routine assessment of N = 460 inpatients. We used patients' self-report data as well as therapists' reports covering baseline characteristics, depression and anxiety symptoms (at the start and end of therapy), psychosocial stress factors, helping alliance, treatment motivation, and treatment-related control expectancies. In addition to group comparisons, we conducted tests of associations with treatment outcome. RESULTS SI was reported by 232 patients (50.4% of the sample). It co-occurred with higher symptom burden, more psychosocial stress factors, and negation of help. Patients reporting SI were more likely to be dissatisfied with the treatment outcome (although their therapists were not). SI was related to higher levels of anxiety symptoms after treatment. In regression models of depression and anxiety symptoms, interactions of SI with the external control expectancy powerful others were observed, suggesting that in patients with frequent SI, this control expectancy hindered recovery. DISCUSSION/CONCLUSION Patients reporting SI are a vulnerable group. Therapists could support them by addressing (potentially conflicting) motivations and control expectancies.
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Affiliation(s)
- Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Department of Clinical Psychology, Psychotherapy and Psychoanalysis, Institute of Psychology, University of Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Inka Tuin
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Assessment of Contributing Factors and Treatment Practices for Therapeutic Efficacy and Drug-Related Problems in Suicidal Psychotic Patients. Brain Sci 2022; 12:brainsci12050543. [PMID: 35624930 PMCID: PMC9138544 DOI: 10.3390/brainsci12050543] [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: 01/28/2022] [Revised: 04/09/2022] [Accepted: 04/21/2022] [Indexed: 01/27/2023] Open
Abstract
Suicide, a deliberate act of self-harm with the intention to die, is an emerging health concern but, unfortunately, the most under-researched subject in Pakistan, especially in Khyber Pukhtunkhwa (KPK). In this study, we aimed to identify risk factors that can be associated with suicidal behavior (SB) and to evaluate the prevailing treatment practices for therapeutic efficacy and drug-related problems (DRPs) in psychotic patients among the local population of KPK. A prospective, multicenter study was conducted for suicidal cases admitted to the study centers by randomized sampling. Socio-demographics and data on suicidal behavior were assessed using the Columbia-Suicide Severity Rating Scale (C-SSRS), socioeconomic condition by Kuppuswamy socioeconomic scale (KSES) and treatment adherence by Morisky Medication-Taking Adherence Scale (MMAS-4). Drug-related problems and the therapeutic efficacy of prevailing treatment practices were assessed at baseline and follow-up after 3 months of treatment provided. Regarding suicidality (N = 128), females reported more ideations (63.1%), while males witnessed more suicidal behavior (66.6%, p < 0.001). Suicide attempters were mostly married (55.6%, p < 0.002); highly educated (53.9%, p = 0.004); dissatisfied with their life and had a previous history (p < 0.5) of suicide attempt (SA) (20.6%), self-injurious behavior (SIB) (39.7%) and interrupted (IA) or aborted attempts (AA) (22.2%). A greater improvement was observed in patients receiving combination therapy (p = 0.001) than pharmacotherapy (p = 0.006) or psychotherapy (p = 0.183), alone. DRPs were also detected, including drug-selection problems (17.88%), dose-related problems (20.64%), potential drug−drug interactions (24.31%), adverse drug reactions (11.46%) and other problems like inadequate education and counseling (21.55%). Furthermore, it was also found that psychotic patients with suicidal ideations (SI) were significantly (p = 0.01) more adherent to the treatment as compared to those with suicidal attempts. We concluded that suicide attempters differed significantly from patients with suicidal ideations in psychotic patients and presented with peculiar characteristics regarding socio-demographic factors. A combination of therapies and adherence to the treatment provided better outcomes, and targeted interventions are warranted to address drug-related problems.
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Schechter M, Goldblatt MJ, Ronningstam E, Herbstman B. The Psychoanalytic Study of Suicide, Part II: An Integration of Theory, Research, and Clinical Practice. J Am Psychoanal Assoc 2022; 70:139-166. [PMID: 35451319 DOI: 10.1177/00030651221087158] [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: 11/16/2022]
Abstract
In Part I contemporary psychoanalytic concepts about suicide were synthesized with other theories and empirical research findings. Here the focus is on applying those principles and describing an integrative psychodynamic approach to treatment, one emphasizing the therapeutic alliance, unconscious and implicit processes, exploration of fantasy, and use of the therapeutic relationship as an implicitly interpretive vehicle for change. It is "integrative" because it draws on ideas and techniques described in dialectical behavioral therapy (DBT) and cognitive-behavioral therapy (CBT), as well on developmental and social psychology research. Psychotherapy with suicidal patients is inherently challenging, requiring the therapist to bear intense emotional pain while attending to potentially derailing countertransference pressures. The therapist plays an active role in helping the patient navigate affect storms and counter harsh self-attack, and instilling hope that treatment can lead to meaningful change. The integrative psychodynamic approach offers a pathway to a lessening of harsh self-judgment, greater connection with the body, improvement in continuity of experience, positive changes in narrative identity, emergence of the patient's genuine capacities, and more satisfying interpersonal relationships. These changes promote affect tolerance, improve life satisfaction, and decrease the likelihood of suicidal behavior.
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Park CHK, Lee JW, Moon J, Jeon DW, Lee SY, Shim SH, Kim SG, Lee J, Paik JW, Cho SJ, Kim MH, You S, Jeon HJ, Rhee SJ, Kim MJ, Kim J, Ahn YM. Early Trauma and Relationships among Recent Stress, Depressive Symptoms, Anxiety Symptoms, and Suicidal Ideation in Korean Women. J Korean Med Sci 2021; 36:e72. [PMID: 33724739 PMCID: PMC7961867 DOI: 10.3346/jkms.2021.36.e72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Evidence continues to accumulate that the presence or absence of early trauma (ET) implies unique characteristics in the relationships between suicidal ideation and its risk factors. We examined the relationships among recent stress, depressive symptoms, anxiety symptoms, and suicidal ideation in Korean suicidal women with or without such a history. METHODS Using data on suicidal adult females, 217 victims and 134 non-victims of ET, from the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior, we performed structural equation modeling to investigate the contribution of recent stress, depressive symptoms, and anxiety symptoms on suicidal ideation within each group according to the presence or absence of a history of ET. RESULTS Structural equation modeling with anxiety and depressive symptoms as potential mediators showed a good fit. Recent stress had a direct effect on both depressive symptoms and anxiety symptoms in both groups. Only anxiety symptoms for victims of ET (standardized regression weight, 0.281; P = 0.005) and depressive symptoms for non-victims of ET (standardized regression weight, 0.326; P = 0.003) were full mediators that increased suicidal ideation. Thus, stress contributed to suicidal ideation by increasing the level of anxiety and depressive symptoms for victims and non-victims, respectively. CONCLUSION Tailored strategies to reduce suicidal ideation should be implemented according to group type, victims or non-victims of ET. Beyond educating suicidal women in stress-management techniques, it would be effective to decrease anxiety symptoms for those with a history of ET and decrease depressive symptoms for those without such a history.
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Affiliation(s)
| | - Jae Won Lee
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Korea
| | - Jungjoon Moon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong Wook Jeon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Yeol Lee
- Department of Psychiatry, Wonkwang University Hospital, Iksan, Korea
| | - Se Hoon Shim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Shin Gyeom Kim
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jeewon Lee
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jong Woo Paik
- Department of Psychiatry, Kyung Hee University Medical Center, Seoul, Korea
| | - Seong Jin Cho
- Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Korea
| | - Min Hyuk Kim
- Department of Psychiatry, Wonju Severance Christian Hospital, Wonju, Korea
| | - Sungeun You
- Department of Psychology, College of Social Sciences, Chungbuk National University, Cheongju, Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Jin Rhee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Min Ji Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea
| | - Junghyun Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea.
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Psychoanalytische Supervision der Behandlung von suizidalen Patienten. FORUM DER PSYCHOANALYSE 2020. [DOI: 10.1007/s00451-020-00393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Donovan AL, Browne J, Freudenreich O, Cather C. Suicide in Schizophrenia Spectrum Disorders. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20200309-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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