From hell and back: the experience of being a dialectical behavior therapy clinician with a personal history of self-harm and suicidal ideation

Independent and Cumulative Effects of Recent Maltreatment on Suicidal Ideation and Thoughts of Self-harm in a National Sample of Youth

There are conflicting reports with regard to the relationship between suicidal ideations and tinnitus and hyperacusis. Audiology departments play a major role in offering therapy and support for patients experiencing tinnitus and hyperacusis. If suicidal and self-harm ideations among patients seen in audiology clinics are high, then it would be important to screen for them to make onward referrals to mental health services. The aim of this study was to assess the prevalence of and factors related to suicidal and self-harm ideations in patients with tinnitus and hyperacusis seen at an audiology outpatient service. This study was a part of a service evaluation survey using a correlational design. All patients who sought help concerning their tinnitus or hyperacusis from an audiology clinic of the National Health Service in the United Kingdom in a 1-yr period were asked to complete the survey questionnaires (n = 402). The focus of this article is on analysis of the patients' responses about suicidal and self-harm ideations as measured via the Patient Health Questionnaire, item 9, and their associated factors. A total of 150/402 of patients answered the question about suicidal and self-harm ideations. Of these, 13% indicated that they had suicidal or self-harm ideations in the past 2 weeks. Suicidal and self-harm ideations were moderately correlated with scores on the anxiety and depression subscales of the hospital anxiety and depression scale. Suicidal and self-harm ideations decreased with increasing age. There were small statistically significant correlations between suicidal and self-harm ideations and tinnitus handicap, hyperacusis handicap, insomnia, and scores on the visual analog scale (VAS) of effect of tinnitus on life. The correlations between suicidal and self-harm ideations and gender, pure-tone average of the worse and better ears, uncomfortable loudness levels of the worse ears, and VAS of tinnitus loudness and annoyance were not statistically significant. A regression model showed that abnormal depression scores increased the chance of suicidal and self-harm ideations by a factor of 6.2 (95% confidence interval = 1.13-34.1, p = 0.036). Audiologists offering tinnitus and hyperacusis rehabilitation should screen for suicidal and self-harm ideations among patients, especially for those with comorbid depression, and make onward referral to appropriate services when needed.

Increasing research has been conducted on individuals presenting with self-harm at emergency departments (EDs). However, less is known about individuals presenting to EDs with only self-harm ideation. We aimed to describe the characteristics of those attending Irish hospitals with self-harm ideation and investigate any differences in comparison to those presenting with suicide ideation. A prospective cohort study was conducted on Irish ED presentations due to suicidal and self-harm ideation. Data were obtained from the service improvement data set of a dedicated nurse-led National Clinical programme for the assessment of those presenting to Irish emergency departments due to Self-harm and Suicide-related Ideation (NCPSHI). A total of 10 602 anonymized presentation data were analysed from 1 January 2018 to 31 December 2019. Descriptive analysis was conducted to compare those with suicidal and self-harm ideation on sociodemographic and care interventions. Being female and aged <29 were more prevalent among the self-harm ideation presentations. Compared to the self-harm ideation group, a higher proportion of those with suicidal thoughts received an emergency care plan (63% vs 58%, p = 0.002) and General Practitioner letter sent within 24 h of presentation (75% vs 69%, p = 0.045). Little variation was found between hospitals for self-harm ideation in both years. Our study suggests that females and younger populations are more prevalent in hospital presentations due self-harm ideation, while presentations related to suicidal ideation are more often made by males and involving substance use. Attention should be given to the relationship between clinicians' attitudes towards care provision and the content of suicide-related ideation ED disclosure.

AimsSuicidal ideation constitutes a central element of most theories of suicide and is the defining facet separating suicide from other causes of death such as accidents. However, despite a high worldwide prevalence, most research has focused on suicidal behaviours, such as completed suicide and suicide attempts, while the greater proportion who experienced ideation, which frequently precedes suicidal behaviour, have received much less attention. This study aims to examine the characteristics of those presenting to EDs with suicidal ideation and quantify the associated risk of suicide and other causes of death.MethodsRetrospective cohort study was performed based on population-wide health administration data linked to data from the Northern Ireland Registry of Self-Harm and centrally held mortality records from April 2012 to December 2019. Mortality data, coded as suicide, all-external causes and all-cause mortality were analysed using Cox proportional hazards. Additional cause-specific analyses included accidental deaths, deaths from natural causes and drug and alcohol-related causes.ResultsThere were 1,662,118 individuals aged over 10 years, of whom 15,267 presented to the ED with ideation during the study period. Individuals with ideation had a 10-fold increased risk of death from suicide (hazard ratio [HRadj] = 10.84, 95% confidence interval [CI] 9.18, 12.80) and from all-external causes (HRadj = 10.65, 95% CI 9.66, 11.74) and a threefold risk of death from all-causes (HRadj = 3.01, 95% CI 2.84, 3.20). Further cause-specific analyses indicated that risk of accidental death (HRadj = 8.24, 95% CI 6.29, 10.81), drug-related (HRadj = 15.17, 95% CI 11.36, 20.26) and alcohol-related (HRadj = 10.57, 95% CI 9.07, 12.31) has also significantly increased. There were few socio-demographic and economic characteristics that would identify which of these patients are most at risk of suicide or other causes of death.ConclusionsIdentifying people with suicidal ideation is recognized to be both important but difficult in practice; this study shows that presentations to EDs with self-harm or suicide ideation represent an important potential intervention point for this hard-to-reach vulnerable population. However, and unlike individuals presenting with self-harm, clinical guidelines for the management and recommended best practice and care of these individuals are lacking. Whilst suicide prevention may be the primary focus of interventions aimed at those experiencing self-harm and suicide ideation, death from other preventable causes, especially substance misuse, should also be a cause of concern.

Self-harm and suicidal ideation in children and adolescents in contact with child protection services.

Self-harm and suicidal thoughts and behaviours among young people are significant global public health concerns. Although most young people with thoughts of self-harm or suicide do not act on their thoughts, it is important to identify factors that distinguish thoughts of self-harm and suicide from behaviours. To date, there are no reviews distinguishing self-harm and suicidal behaviours from thoughts of self-harm and suicide in young people or that have synthesised factors distinguishing self-harm behaviours from self-harm ideation. The current review addresses these gaps in the literature. We systematically searched: CINAHL, Embase, Medline, PsycINFO, Psychology and Behavioural Sciences Collection, and Web of Science Core Collection for articles published between 2011 and April 2024. Ninety-nine studies met inclusion criteria, with 92 articles examining risk and protective factors that distinguished suicide attempts from suicidal ideation and seven articles examining factors that distinguished self-harm behaviours from self-harm ideation. Using a narrative synthesis approach, studies were grouped by their outcome variable (e.g., self-harm or suicide) and then by risk and protective factors. While findings were inconsistent, the presence of non-suicidal self-injury, physical, emotional, or sexual abuse, violence, and family factors (e.g., family conflict) distinguished suicidal attempts from suicidal ideation. By contrast, the presence of parental factors (e.g., parental connectedness) and greater academic achievement were protective and distinguished suicidal ideation from suicide attempts. Being female, exposure to self-harm/suicide, and impulsivity distinguished self-harm behaviours from self-harm ideation. There was no evidence of protective factors that distinguished self-harm behaviours from self-harm ideation. The current review highlights important risk and protective factors that distinguish suicidal and self-harm behaviours from suicidal and self-harm ideation in young people. Our review has important implications for intervention and prevention efforts as identifying key risk and protective factors can improve risk assessment for young people experiencing thoughts of self-harm and suicide and enable more targeted interventions.

BackgroundSelf-harm and suicidal thoughts and behaviours among young people are significant global public health concerns. Although most young people with thoughts of self-harm or suicide do not act on their thoughts, it is important to identify factors that distinguish thoughts of self-harm and suicide from behaviours. To date, there are no reviews distinguishing self-harm and suicidal behaviours from thoughts of self-harm and suicide in young people or that have synthesised factors distinguishing self-harm behaviours from self-harm ideation. The current review addresses these gaps in the literature.MethodsWe systematically searched: CINAHL, Embase, Medline, PsycINFO, Psychology and Behavioural Sciences Collection, and Web of Science Core Collection for articles published between 2011 and April 2024. Ninety-nine studies met inclusion criteria, with 92 articles examining risk and protective factors that distinguished suicide attempts from suicidal ideation and seven articles examining factors that distinguished self-harm behaviours from self-harm ideation. Using a narrative synthesis approach, studies were grouped by their outcome variable (e.g., self-harm or suicide) and then by risk and protective factors.ResultsWhile findings were inconsistent, the presence of non-suicidal self-injury, physical, emotional, or sexual abuse, violence, and family factors (e.g., family conflict) distinguished suicidal attempts from suicidal ideation. By contrast, the presence of parental factors (e.g., parental connectedness) and greater academic achievement were protective and distinguished suicidal ideation from suicide attempts. Being female, exposure to self-harm/suicide, and impulsivity distinguished self-harm behaviours from self-harm ideation. There was no evidence of protective factors that distinguished self-harm behaviours from self-harm ideation.ConclusionsThe current review highlights important risk and protective factors that distinguish suicidal and self-harm behaviours from suicidal and self-harm ideation in young people. Our review has important implications for intervention and prevention efforts as identifying key risk and protective factors can improve risk assessment for young people experiencing thoughts of self-harm and suicide and enable more targeted interventions.

<h3>Statement of Purpose</h3> The causes of suicide attempts or ideation are complex and multifaceted. This study analyzes physical traumatic injury as a risk factor for suicide ideation and intentional self-harm. <h3>Methods/Approach</h3> A retrospective analysis of an all-inclusive inpatient dataset, comparing the one-year hospital readmission rate, involving intentional self-harm or suicide ideation, of two groups of injured patients: (a) those classified as trauma alerts (TAs) at a Level I or II trauma center or (b) individuals who were treated as emergencies without activation (EMWA) of trauma services. We compared readmission rates (per 1000) of TAs and EMWAs using t-tests. Logistic regression further examined the probability of readmission with suicide ideation or intentional self-harm, controlling for patient demographics, pre-existing mental health conditions, injury type, and socioeconomic status. <h3>Results</h3> Rates of readmission with intentional self-harm and suicide ideation were, on average, 60 and 45 percent higher for the TA compared to the EMWA patient group (P &lt; 0.001). Compared to the population at large, the post-trauma hospitalization rate for self-harm and suicide ideation was, respectively, 8.7 and 7.6 times greater (P &lt; 0.001). Over 80% of patients readmitted with intentional self-harm or suicide ideation had a pre-existing mental health condition. Logistic regression results indicate these patients had an odds-ratio of near six, predicting the readmission. Examining the subset of patients without a documented history of a mental health condition, trauma alert patients were significantly more likely to commit initial and intentional self-harm (OR=1.26, 95% CI 1.03–1.53) or develop suicide ideation (OR=1.28, 95% CI 1.08–1.42), diagnosed during an inpatient readmission within one year of the signature event. Gender, race, insurance status, socioeconomic status, and injury type were also significant. <h3>Conclusions</h3> There is a significant difference between trauma alerts versus emergencies without trauma services as it pertains to the post-hospitalization development of suicide ideation or engagement in intentional self-harm. <h3>Significance</h3> Mental health support must be made available to survivors of major trauma, particularly those with a preexisting mental health condition and traumatic brain injury.

Background and aimsInternet addiction (IA) is common among young students. This study aimed to examine the influence and mechanisms of IA and susceptible personality traits on the impact of suicidal ideation in adolescent students in China.MethodsThis cross-sectional study (09/2012–09/2015) used stratified cluster sampling with “school type” for stratification; 136,266 students from 63 schools completed the questionnaire. Logistic regression analysis was performed to estimate the effect of IA (Young's Internet Addiction Test) and susceptible personality (Barratt impulsiveness scale, Buss & Perry Aggression Questionnaire; and Eysenck Personality Questionnaire-R Short Scale) on suicidal ideation (Scale of Suicidal Ideation).ResultsSuicidal ideation was observed in 20,218 (14.77%) of the students, and IA was detected in 28,836 (21.16%) subjects. Compared with those without IA, students with IA had a higher prevalence of suicidal ideation (P < 0.0001). No planning impulsiveness had a predictive effect on suicidal ideation in the impulsive personality trait, while in the aggressive personality trait, hostility and self-aggression had a predictive effect on suicidal ideation (all P < 0.0001). High psychoticism and neuroticism were impact factors for suicidal ideation, but extroversion was a protective factor (all P < 0.0001).DiscussionThese results highlight the importance of assessing personality traits and reducing IA as a possible means of lessening suicidal ideation. Susceptible personality (such as high psychoticism, high neuroticism, and low extroversion) play a prominent role in influencing the probability of having suicidal behavior among those recently exposed to IA.ConclusionsIA and susceptible personality traits were significantly correlated with suicidal and self-harm ideation among adolescent students.

Internet addiction (IA) is common among young students. This study aimed to examine the influence and mechanisms of IA and susceptible personality traits on the impact of suicidal ideation in adolescent students in China. This cross-sectional study (09/2012-09/2015) used stratified cluster sampling with "school type" for stratification; 136,266 students from 63 schools completed the questionnaire. Logistic regression analysis was performed to estimate the effect of IA (Young's Internet Addiction Test) and susceptible personality (Barratt impulsiveness scale, Buss & Perry Aggression Questionnaire; and Eysenck Personality Questionnaire-R Short Scale) on suicidal ideation (Scale of Suicidal Ideation). Suicidal ideation was observed in 20,218 (14.77%) of the students, and IA was detected in 28,836 (21.16%) subjects. Compared with those without IA, students with IA had a higher prevalence of suicidal ideation (P < 0.0001). No planning impulsiveness had a predictive effect on suicidal ideation in the impulsive personality trait, while in the aggressive personality trait, hostility and self-aggression had a predictive effect on suicidal ideation (all P < 0.0001). High psychoticism and neuroticism were impact factors for suicidal ideation, but extroversion was a protective factor (all P < 0.0001). These results highlight the importance of assessing personality traits and reducing IA as a possible means of lessening suicidal ideation. Susceptible personality (such as high psychoticism, high neuroticism, and low extroversion) play a prominent role in influencing the probability of having suicidal behavior among those recently exposed to IA. IA and susceptible personality traits were significantly correlated with suicidal and self-harm ideation among adolescent students.

A Global Call for Action to Prioritize Healthcare Worker Suicide Prevention During the COVID-19 Pandemic and Beyond.

Comparison of paediatric emergency department visits for attempted suicide, self-harm, and suicidal ideation before and during the COVID-19 pandemic: a systematic review and meta-analysis

Autistic individuals experience significantly elevated rates of childhood trauma, self-harm and suicidal behaviour and ideation (SSBI). Is this purely the result of negative environmental experiences, or does this interact with genetic predisposition? In this study we investigated if a genetic predisposition for autism is associated with childhood trauma using polygenic scores (PGS) and genetic correlations in the UK Biobank (105,222 < N < 105,638), and tested potential mediators and moderators of the association between autism, childhood trauma and SSBI. Autism PGS were significantly associated with childhood trauma (max R2 = 0.096%, P < 2 × 10−16), self-harm ideation (max R2 = 0.108%, P < 2 × 10−16), and self-harm (max R2 = 0.13%, P < 2 × 10−16). Supporting this, we identified significant genetic correlations between autism and childhood trauma (rg = 0.36 ± 0.05, P = 8.13 × 10−11), self-harm ideation (rg = 0.49 ± 0.05, P = 4.17 × 10−21) and self-harm (rg = 0.48 ± 0.05, P = 4.58 × 10−21), and an over-transmission of PGS for the two SSBI phenotypes from parents to autistic probands. Male sex negatively moderated the effect of autism PGS on childhood trauma (β = −0.023 ± 0.005, P = 6.74 × 10−5). Further, childhood trauma positively moderated the effect of autism PGS on self-harm score (β = 8.37 × 10−3 ± 2.76 × 10−3, P = 2.42 × 10−3) and self-harm ideation (β = 7.47 × 10−3 ± 2.76 × 10−3, P = 6.71 × 10−3). Finally, depressive symptoms, quality and frequency of social interactions, and educational attainment were significant mediators of the effect of autism PGS on SSBI, with the proportion of effect mediated ranging from 0.23 (95% CI: 0.09–0.32) for depression to 0.008 (95% CI: 0.004–0.01) for educational attainment. Our findings identify that a genetic predisposition for autism is associated with adverse life-time outcomes, which represent complex gene-environment interactions, and prioritizes potential mediators and moderators of this shared biology. It is important to identify sources of trauma for autistic individuals in order to reduce their occurrence and impact.

Purpose The aim of this study was to explore the relationship between parental mental illness in childhood with suicidal and self-harm ideations in adults seeking help for their tinnitus and/or hyperacusis. Method This was a retrospective, cross-sectional study. The data for 292 consecutive patients who attended a Tinnitus and Hyperacusis Therapy Specialist Clinic in the United Kingdom were included. Results Forty-six of 292 patients, or 15.75% of the patients, expressed that they have been bothered by suicidal and self-harm ideations within the last 2 weeks. Furthermore, 38.7% of the patients (113/292) reported that, while they were growing up during the first 18 years of life, their parent(s) were suffering from a mental illness. Logistic regression analysis showed a significant relationship between suicidal and self-harm ideations and the history of parental mental illness after adjusting the model for (a) tinnitus disability as measured via the Tinnitus Handicap Inventory (Newman, Jacobson, & Spitzer, 1996), (b) hyperacusis as measured via the Hyperacusis Questionnaire (Khalfa et al., 2002), (c) anxiety as measured via the Generalized Anxiety Disorder Questionnaire (Spitzer, Kroenke, Williams, & Löwe, 2006), (d) depression as measured via the Patient Health Questionnaire (Kroenke, Spitzer, & Williams, 2001), and (e) age and gender. Adjusted odds ratio was 2.5 (95% CI [1.14, 5.6], p = .022). The only other variable that was significantly related to the risk of suicidal and self-harm ideations was depression; adjusted odds ratio was 7.7 (95% CI [2.6, 26.3], p = .001). Conclusions Clinicians who offer tinnitus and hyperacusis rehabilitation should screen for suicidal and self-harm ideations among patients, especially for those with symptoms of depression and a childhood history of parental mental illness. Patients with suicidal and self-harm ideations should be referred to mental health services for further diagnosis and treatment.

Globally, suicide is the second leading cause of death for adolescents/young people aged 15-30-years old. The mainstream care for these affected persons is mostly unsuccessful due to limited culturally appropriate care. This is a mixed-methods randomised controlled feasibility trial design. A culturally adapted manual-assisted psychological intervention (CaMaPI) was utilised to treat adolescents/young people with histories of self-harm and suicidal ideation. CaMaPI is a manualised intervention consisting of 10 sessions, grounded in psychoeducation and cognitive behavioural therapy. Participants aged 18-29 were screened for self-harm and suicidal ideation. N = 20 participants were randomised into CaMaPI (n = 10) or Treatment as Usual (TaU) (n = 10) groups. One focus group with n = 8 participants, and n = 3 individual interviews were conducted with the experimental group. Satisfaction with intervention (CaMaPI, 100%; TaU, 50%). Reduction in self-harm and suicidal ideation was higher in CaMaPI on the suicide and self-harm scale at Md = 1.00 with z = -2.264, compared to TaU, Md = 3.00 with z = -0.378. Both groups showed no significant reduction in hopelessness. Emerging themes from the qualitative findings showed acceptance of self-harm and suicidal ideation as a treatable condition, mood management and behaviour modification, alongside cultural appropriateness and positive experience of the CaMaPI. CaMaPI is feasible, culturally appropriate and acceptable in reducing self-harm and suicidal ideation in adolescents/young people with histories of self-harm and suicidal ideation in Nigeria. A fully powered randomised control trial is recommended to evaluate the clinical and cost-effectiveness of CaMaPI compared with TAU. ClinicalTrials.gov (No. NCT06440031) KEY PRACTITIONER MESSAGE: Suicide is one of the leading causes of death among 15- to 29-year-olds globally. Seventy-three percent of all suicides and self-harm happen in low- and middle-income countries, including Nigeria. CaMaPI is acceptable, culturally appropriate and feasible for treating suicidal ideation and self-harm behaviours in adolescents and young people. CaMaPI is manualised and delivered with minimal resources by trained clinical psychology researchers.