A step forward in conceptualizing psychological closeness/distance to suicide methods: A qualitative approach

INTRODUCTION

Suicide is a leading cause of death, making suicide prevention a major public health priority. Increasing understanding of factors influencing suicidal behavior is paramount. Previous research has implicated psychological closeness, characterized by perceptions of how close/distant or attached/detached one feels to a particular object, as a cognitive factor that influences suicidal behavior. However, a better understanding of how psychological closeness to suicide methods is conceptualized by relevant populations is needed to improve its assessment and understand how it may confer risk for suicide.

METHODS

The goal was to refine the conceptualization of psychological closeness to suicide methods by incorporating feedback from relevant populations. We conducted 30 interviews with those primarily identifying as having lived experience of suicide (n = 10), clinicians who work with suicidal patients (n = 11), and suicide researchers (n = 9). A rigorous thematic approach using NVivo software was used to uncover common themes.

RESULTS

Primary themes included familiarity, comfort, and attachment, with one emerging theme of symbolism. We define these themes, provide context to their meaning, and share exemplary quotes across diverse participants.

CONCLUSION

We consider clinical, research, and policy implications from an interdisciplinary lens and discuss the strengths and limitations of this study.

'My safety depends on everyone else feeling safe and good': emotion work among transgender and gender diverse Texans

Emotion work is a regulatory method used to change the degree or quality of one's own or another's emotions. Among sexual minority people, emotion work is a regulatory method utilised to maximise identity expression while maintaining harmony in interpersonal connections. However, little is known about the utilisation of emotion work among transgender and gender diverse (TGD) people. We sought to address this gap by qualitatively exploring emotion work among members of this population. We conducted semi-structured focus groups and interviews with 11 TGD adults. Eligibility criteria included (1) English speaking, (2) at least 18 years old, (3) currently living in Texas, and (4) identifying as TGD. Interviews explored identity-related experiences of discrimination and affirmation in different social environments, and emotional, physiological and behavioural responses. Interview transcripts were analysed by four researchers using thematic analysis. Four superordinate themes were developed: 1) feeling rules, 2) intrapersonal processes, 3) identity management strategies, and 4) psychophysiological strain. We found transgender and gender diverse participants feel responsible for emotion work to maintain comfort in social interactions often at the expense of authentic identity expression and psychosocial wellbeing. Findings are interpreted using the existing literature on identity management and emotion regulation. Implications for clinical practice are also provided.

Sensitivity and specificity of the CRAFFT to identify heavy cannabis use: Evidence from a large statewide adolescent sample

BACKGROUND AND AIM

Screening adolescents at risk for cannabis use disorders is critical. The CRAFFT is a screening tool designed to address both alcohol and drug use among youth. Current study tests the psychometric properties of the CRAFFT and attempts to modify one of the screening items to compare the efficiency.

DESIGN

We examined the ideal cut-off point of the CRAFFT for identifying persons with heavy cannabis use and compared the utility of the original and revised CRAFFT.

PARTICIPANTS

Sample (N = 132,555) averaged 16.19 (±1.21) years of age; 51.0% were female, 59.7% were White, 15.2% were Latino/Latina, and 6.7% were African-American. Majority resided in non-rural area and 34.5% were receiving free or reduced lunch at school.

MEASUREMENTS

Heavy cannabis use was defined as using cannabis 10 or more times in the past 30 days. Sensitivity, specificity, the area under the receiver operating characteristic curve, and Youden value were analyzed to determine the ideal cut-off point.

FINDINGS

Maximum overall predictive accuracy was at a cutoff score of 2 or higher when using the original CRAFFT questions. At a cutoff score of 2, sensitivity was 82.0%, specificity was 83.7%, with an AUC of 0.880. On the contrary, when an alternative CAR question was used, maximum predictive accuracy was at a cutoff score of 1 or higher when predicting heavy cannabis use. At a cutoff score of 1, sensitivity was 92.7%, specificity was 75.5%, with an AUC of 0.900.

CONCLUSIONS

The results provide evidence that the CRAFFT is a promising brief diagnostic instrument for heavy cannabis use among youth. Modification to Car item may have potential in reducing disparities in sensitivity among different racial ethnic groups, as well as those who with low socioeconomic status.