Suicide Assessment Research Articles

2.100 Identifying Gaps in Provider Knowledge: Trainees Less Comfortable With Suicide Assessment in Youth with ASD and Intellectual Disability

Suicide is the second leading cause of death in adolescents, but training in suicide assessment and care is often insufficient. Additionally, there are limited data regarding the effects of training. Safe Alternatives for Teens and Youths Acute (SAFETY-A) is an intervention designed to increase safety in youth presenting to emergency departments. We examined changes in confidence level in assessing and addressing suicidal thoughts and behaviors (STBs) before and after SAFETY-A training in an urban public hospital.

A Veterans Affairs' perspective in response to Best Practice Model Subcommittee attribute statements for outpatient psychiatric pharmacists.

We applaud the work published by Lee et al1 and the best practice model subcommittee in their attribute statements for defining the optimal recommendations for outpatient psychiatric pharmacy practice. This serves as an excellent foundation in standardizing the expectations for clinical pharmacist practitioners (CPP) within outpatient mental health (MH) settings and our group believes these defined statements are being applied at the Department of Veterans Affairs (VA).2 Measurement-based care, suicide assessment, and comprehensive medication management (CMM) are all standards of care for VA outpatient MH CPP.3 The goal of our letter is to highlight the VA MH CPP model and the advancements in access, quality impact, and standardization.Integrating the MH CPP into the team-based care model significantly improves access to care, primarily when the CPP is utilized as a primary MH provider. Many strong CPP practices within the VA have been identified, including CPP integration into primary care MH services, outpatient MH clinics, specialty MH, and residential rehabilitation programs. Other strategies utilized by VA MH CPP to optimize access include utilizing analytics to target specific clinical interventions (population management), posthospital discharge appointments, and enhanced patient care in suicide risk stratification.In October 2017, the VA Pharmacy Benefits Management (PBM) partnered with the Office of Rural Health to increase access to care for veterans by utilizing MH CPPs as MH prescribers. Within 2½ years from its inception, 40 MH CPPs were hired, which increased direct patient care access and quality by providing CMM for 51 210 rural-residing patients.4 Due to the initiative's positive impact on patient care, an additional 46 MH CPP were hired in FY20/21, which demonstrates the importance of optimizing the MH CPP role in the team-based care model.MH CPP within the VA have established guidance for how to create a positive impact in the VA's internal performance metrics, including population management, continuity of care, experience of care, behavioral health screenings, and suicide risk management. They are also instrumental in serving as facility champions for psychotropic stewardship and safety. One of the attribute statements proposed by Lee et al1 recommends prescriptive authority and/or a collaborative practice agreement. In collaboration with VA PBM, a care coordination agreement (CCA) was created for MH CPP and establishes a partnership between MH and pharmacy services. This CCA covers many of the attribute statements, including attribute statements 14-24 and 27. The CCA is approved by service leadership and the chief of staff to ensure these attribute statements are being upheld. The PBM has also developed a business rules document to guide standardization of MH CPP practice within the VA. This includes in-depth descriptions defining clinical pharmacy practice, patient care delivery, optimizing access and integration, and documentation of workload.Overall, the VA has taken great strides to advance the practice of MH CPPs. Current practice by VA MH CPPs incorporates many of the attribute statements. We are hopeful that these well-developed attribute statements will help foster all psychiatric pharmacists to practice at the highest level of care, achieve reimbursement for clinical services, and bolster patient and provider satisfaction.

2.21 Equipercentile Linking of Suicidal Ideation Questionnaire-Junior and the Clinical Global Impression Scale for Treatment of Adolescent Depression

The efficient and valid assessment of suicidality is a challenge for clinical practice and research studies. The Suicidal Ideation Questionnaire-Junior (SIQ-Jr) is a widely used screening instrument to assess suicidal ideation and suicide risk. The Clinical Global Impression-Improvement scale (CGI-I) is a practical clinician-rated instrument that has been used in clinical research over the years. We aimed to investigate the benchmarks of clinically significant change of the SIQ-Jr absolute score by equipercentile linking with CGI-I scores.

Clozapine Reduces Recurrent Suicidal and Self-Injurious Behavior in Treatment-Refractory Incarcerated Individuals.

This retrospective review examines clozapine's effects on treatment-refractory incarcerated individuals (N = 23) with recurrent thoughts of self-harm and/or self-injurious behavior. Emergent suicide risk assessments and days on suicide watch were assessed for the 3 months pre- and post-clozapine treatment. Total suicide assessments fell from 73 pre- to 14 post-clozapine, with a median of 2 assessments (interquartile range [IQR]: 1,5) pre-clozapine compared with 0 (IQR: 0,1) post-clozapine (p < 0.0001). Total days on suicide watch decreased from 104 days pre- to 32 post-clozapine, with a median of 3 days (IQR: 0,9) pre-clozapine compared with 0 (IQR: 0,0) post-clozapine (p = 0.0012). Emergency room visits and medical hospitalizations decreased substantially for all months of treatment. Clozapine treatment was associated with marked reductions in self-injurious thoughts and behaviors in high-risk incarcerated individuals.

Reducing short term suicide risk after hospitalization: A randomized controlled trial of the Collaborative Assessment and Management of Suicidality

BackgroundThis study compared the “next day appointment” (NDA) use of the Collaborative Assessment and Management of Suicidality (CAMS) to treatment as usual (TAU) for individuals discharged from the hospital following a suicide-related crisis. We hypothesized that CAMS would significantly reduce suicidal thoughts and behaviors as well as improve psychological distress, quality of life/overall functioning, treatment retention and patient satisfaction. MethodsParticipants were 150 individuals who had at least one lifetime actual, aborted, or interrupted attempt and were admitted following a suicide-related crisis. There were 75 participants in the experimental condition who received adherent CAMS and 75 participants who received TAU. Suicidal thoughts and behaviors, psychological distress, and quality of life/overall functioning were assessed at baseline and at 1, 3, 6, and 12 months post-baseline. Treatment retention and patient satisfaction were assessed at post-treatment. ResultsParticipants in both conditions improved from baseline to 12 months but CAMS was not superior to TAU for the primary outcomes. A small but significant improvement was found in probability of suicidal ideation at 3 months favoring TAU and amount of suicidal ideation at 12 months favoring CAMS. CAMS participants experienced less psychological distress at 12 months compared to baseline. LimitationsThe study was limited by only one research clinic, lower than expected recruitment, and imbalance of suicidal ideation at baseline. Conclusions: All participants improved but CAMS was not more effective than TAU. The NDA clinic was feasible and acceptable to clients and staff in both conditions and future research should investigate its potential benefit.

Der assistierte Suizid

After the Federal Constitutional Court overturned the ban on business-like assisted suicide in 2020, politicians, society and the medical profession are discussing legal protective measures to prevent abuse. This survey among members of the DGPPN is the first to record the attitudes and experiences regarding assisted suicide of psychiatrists and other mental health workers in Germany, as suicidality and assisted suicide are highly relevant topics for medicine and especially for psychiatry and psychotherapy. The survey was conducted as an online survey with aspecially created questionnaire and aDSGVO-compliant data protection concept and sent to atotal of 9356 members. In addition to the descriptive analysis of the questionnaire, the free-text responses were subjected to an additional qualitative analysis. Finally, correlations between sociodemographic variables and relevant items were examined. A total of 2048 members participated in the survey (22%). Most participants (88%) considered a(new) legal regulation of assisted suicide to be necessary; the separation of counselling, assessment and execution of assisted suicide was mentioned most frequently (76%). The majority considered assisted suicide to be legitimate under certain circumstances when the suicide wish is freely made (72%), especially in cases of high suffering and near the end of life (67%). Age, gender, and religious beliefs were found to be significant influencing factors in several responses. Alarge majority of the DGPPN members consider it necessary to find alegal regulation that prevents abuse of assisted suicide; however, while most participants did not consider assisted suicide to be legitimate or illegitimate in principle, but rather made this dependent on the specific circumstances of the suicide wish, more than half ruled out to assist with suicide. The results represent an important contribution to the political debates about legal protective measures.

Psychiatric Treatment and Repeat Suicide Attempts Among Adults With Substance Use, by HIV Status, United States, 2014-2020.

The association among psychiatric treatment history, HIV, and suicide reattempts among people starting treatment for substance use is not well understood. The objective of this study was to describe, by HIV status, the risk and protective factors associated with suicide reattempts among adults seeking treatment for substance use. The study included 340 390 US adult residents aged ≥18 years in the Addiction Severity Index-Multimedia Version network from January 1, 2014, through December 31, 2020. We used adjusted logistic regression models to estimate strength of association between prior psychiatric treatment, HIV status, and sociodemographic factors and suicide reattempts within 30 days of treatment evaluation. Adults who had been prescribed psychiatric medication were less likely to have a recent suicide reattempt (adjusted odds ratio [aOR] = 0.8; 95% CI, 0.7-0.8) than adults with no prescription history. Adjusted models found similar protective effects between psychiatric treatment and suicide reattempts among adults reporting abuse, mental illness, injection drug use, and limited activity because of a medical condition. Conversely, the following were associated with recent suicide reattempts: being male (aOR = 1.4; 95% CI, 1.3-1.5), having a high school education/GED (General Educational Development) or less (aOR = 1.2; 95% CI, 1.1-1.2), being single (aOR = 1.2; 95% CI, 1.1-1.3), experiencing a pain problem (aOR = 1.2; 95% CI, 1.2-1.3), and not being referred to substance use treatment by court (aOR = 3.4; 95% CI, 3.2-3.7). A history of prescribed psychiatric medication is significantly associated with a reduced risk for suicide reattempts among adults seeking substance use treatment. Clinicians should consider incorporating mental health and suicide assessments into substance use treatment plans.

A systematic investigation of the short and long term experiences of taking part in research about suicidal thoughts and acts in the context of a randomised controlled trial

Partaking in studies about suicide can be a positive experience. There is also evidence of some negative impacts in the days immediately following participation. No research has examined both the short and longer term effects of repeated assessment of an individual's suicidal thoughts/behaviours. Clinical trials can involve multiple suicide assessments over several months. The current study investigated whether participants experienced any brief or lasting effects from this kind of intense suicide focused research. Participants had recent suicidal experiences, and were participating in a randomised controlled trial evaluating a psychological therapy targeting suicidal experiences for people with non-affective psychosis. Multiple measures of suicidal thoughts/acts were completed at baseline, 6 and 12-month follow-up time-periods. For the current study, participants (N ​= ​100 ​at baseline and n ​= ​32 ​at follow-up) undertook a semi-structured qualitative interview about their experiences of taking part in suicide research, and completed a checklist of adjectives to describe how it felt to talk about suicide during the assessments. They rated their current mood before and after completing the trial assessments using a visual analogue scale. A convergent mixed methods approach indicated that participation was positive in both the short and longer term. Mood improved or did not change over the course of assessments. More positive than negative adjectives were selected, regardless of the severity of suicidal thoughts experienced by participants. Thematic analysis of the qualitative data revealed many benefits of participating, including catharsis, being able to help others and being part of a wider endeavour to understand suicidal experiences. Both short and longer term feelings of distress arising from participation were offset by the expectation and acceptance of this occurring, together with the application of participant-initiated coping strategies. These findings lend reassurance that inviting people with severe mental health problems to participate in suicide research is not detrimental in either the short or long-term.

Knowledge, attitudes, and experiences in suicide assessment and management: a qualitative study among primary health care workers in southwestern Uganda

BackgroundSuicide is one of the leading causes of death globally, with over 75% of all suicides occurring in low-and middle-income Countries. Although 25% of people have contact with their health care workers before suicide attempts, most never receive proper suicide assessment and management. We explored primary care health workers' knowledge, attitudes, and experiences in evaluating and managing suicidality in structured primary healthcare services in Uganda.MethodsThis was a cross-sectional qualitative study among health workers in southwestern Uganda from purposively selected health facilities. A semi-structured interview guide was used, and data were analyzed using thematic analysis.ResultsThe in-depth interviews were conducted with 18 individuals (i.e., five medical doctors, two clinical officers, two midwives, and nine nurses) from 12 health facilities in the five selected districts. Four themes emerged from the discussions: a) Knowledge and attitudes of primary healthcare workers in the assessment and management of suicidality, b) Experiences in the assessment and management of suicidality, c) challenges faced by primary healthcare workers while assessing and managing suicidality, and d) Recommendations for improving assessment and management of suicidality in PHC.Most participants were knowledgeable about suicide and the associated risk factors but reported challenges in assessing and managing individuals with suicide risk. The participants freely shared individual experiences and attitudes in the assessment and management of suicide. They also proposed possible ways to improve the evaluation and management of suicidality in PHC, such as setting up a system of managing suicidality, regularizing community sensitization, and training health workers.ConclusionSuicidality is commonly encountered by primary health care workers in Uganda who struggle with its assessment and management. Improving the knowledge and attitudes of primary health care workers would be a big step towards ensuring equitable services.

Structural brain alterations associated with suicidal thoughts and behaviors in young people: results from 21 international studies from the ENIGMA Suicidal Thoughts and Behaviours consortium

Identifying brain alterations associated with suicidal thoughts and behaviors (STBs) in young people is critical to understanding their development and improving early intervention and prevention. The ENIGMA Suicidal Thoughts and Behaviours (ENIGMA-STB) consortium analyzed neuroimaging data harmonized across sites to examine brain morphology associated with STBs in youth. We performed analyses in three separate stages, in samples ranging from most to least homogeneous in terms of suicide assessment instrument and mental disorder. First, in a sample of 577 young people with mood disorders, in which STBs were assessed with the Columbia Suicide Severity Rating Scale (C-SSRS). Second, in a sample of young people with mood disorders, in which STB were assessed using different instruments, MRI metrics were compared among healthy controls without STBs (HC; N = 519), clinical controls with a mood disorder but without STBs (CC; N = 246) and young people with current suicidal ideation (N = 223). In separate analyses, MRI metrics were compared among HCs (N = 253), CCs (N = 217), and suicide attempters (N = 64). Third, in a larger transdiagnostic sample with various assessment instruments (HC = 606; CC = 419; Ideation = 289; HC = 253; CC = 432; Attempt=91). In the homogeneous C-SSRS sample, surface area of the frontal pole was lower in young people with mood disorders and a history of actual suicide attempts (N = 163) than those without a lifetime suicide attempt (N = 323; FDR-p = 0.035, Cohen’s d = 0.34). No associations with suicidal ideation were found. When examining more heterogeneous samples, we did not observe significant associations. Lower frontal pole surface area may represent a vulnerability for a (non-interrupted and non-aborted) suicide attempt; however, more research is needed to understand the nature of its relationship to suicide risk.

What Kinds of Support are Alaska Native Youth and Young Adults Reporting? An Examination of Types, Quantities, Sources, and Frequencies of Support.

American Indian and Alaska Native (AI/AN) youth, particularly males, experience disproportionately high rates of suicide compared to other young people in the United States. Therefore, enacting suicide prevention efforts for AI/AN youth is especially important. Since research shows that strengthening social, cultural, and emotional support can reduce suicide risk, many recent prevention efforts focus on these strategies. Yet, to reinforce and to extend the positive impact of these strategies for suicide risk reduction, we argue it is useful to identify baseline levels and other features of already-existing support. Toward this end, we describe the types (i.e., category), quantities (i.e., distribution and average number), sources (i.e., from whom), and frequencies (i.e., how often) of social support that AN young people report receiving, and we examine if these "support profiles" differ by age and sex. We use survey data from 165 ANs under age 30, collected as part of a participatory intervention study focused on Promoting Community Conversations About Research to End Suicide (PC CARES). We find that: 1) most ANs reported receiving nearly all supports, 2) compared with females, males reported receiving fewer supports on average, 3) family was the most selected support source, followed by close friends and service providers, and 4) family (e.g., parents, siblings, and grandparents) provided support regularly (i.e., monthly or more). Though our findings may suggest fruitful avenues for interventions targeted toward AN males, we discuss these findings in relation to the gendered nature of suicide prevention and assessment.

Correlates of suicidality among standard rating scales and the Columbia-Suicide Severity Rating Scale (C-SSRS) in adolescents undergoing transcranial magnetic stimulation

Background: Suicide is a leading cause of death in adolescents and young adults.1 This study sought to examine correlations among suicide items of standard rating scales for depression and Columbia-Suicide Severity Rating Scale (C-SSRS)2 scores in adolescents participating in a transcranial magnetic stimulation study. Methods: This study examined data from adolescent patients (N=103) enrolled in a double-blind randomized control trial of transcranial magnetic stimulation (TMS). Total scores and respective individual items assessing suicidality from the Hamilton Depression Rating Scale (HAM-D)3, Montgomery-Asberg Depression Rating Scale (MADRS)4, and Children’s Depression Rating Scale-Revised scale (CDRS-R)5 were compared with C-SSRS total severity and total intensity scores using Pearson correlation coefficients at the end of acute treatment. Results: The suicidality item of the HAM-D scores showed a positive association with C-SSRS total severity and intensity scores at the end of acute treatment for ITT sample (n=103) (r = 0.83; p-value= <0.0001, r = 0.86; p-value=<0.0001), respectively. Similarly, associations were demonstrated with the CDRS-R Item 13 scores and the MADRS scores. Conclusions: Accurate and reliable assessments of suicidality are an ongoing challenge for clinical trials and practice. Suicidality measures of HAM-D and CDRS-R correlated with the C-SSRS suicide assessment scale. These measures can potentially contribute to assessing suicidal risk and be helpful as an outcome measure to monitor treatment response in various clinical settings. Further studies should compare the sensitivity and specificity of suicidality items of HAM-D and CDRS-R. Conflicts of Interests: Dr. Croarkin has received research support from the National Institute of Mental Health, Magventure, Neuronetics, NeoSync, and Pfizer. He has received material support from and provided consultation to Myriad Neuroscience. He has consulted for Procter & Gamble Company. Dr. Elmaadawi receives research support from Duke University and the University of North Western. He receives research funding from Neurocrine, Inc, and Neuronetics. Dr. Aaronson has received research support from Compass Pathways and Neuronetics and serves as a consultant to LivaNova, Neuronetics, Janssen, Genomind, and Sage Therapeutics. He serves on speaker boards for Janssen and Sunovion. Dr. Holbert has received material support (equipment) from Neuronetics. He is also a speaker for Neuronetics. Dr. Demitrack is a consultant to Neuronetics, Inc. and a full-time employee of Trevena, Inc. Dr. Strawn has received research support from Allergan, Neuronetics, Otsuka, the National Institute of Mental Health, National Institute of Child Health and Development, and National Institute of Environmental Health Sciences as well as the Yung Family Foundation. He receives royalties from Springer Publishing and received honoraria from CMEology and Neuroscience Educational Institute. He receives royalties from UpToDate. Finally, he received material support from and provided consultation to Myriad Genetics, Intracellular Therapeutics, and the FDA. The other authors have no disclosures. Funding: This study was funded by Neuronetics, Inc.

Collaboration is key: School psychologists' experience in suicide intervention

AbstractSchool psychologists are key school‐based personnel when responding to suicidal thoughts and behaviors. The present paper explored the experiences and attitudes of school psychologists, with a special focus on collaborating during suicide intervention activities. Using a descriptive phenomenological approach, a purposive sample procedure identified 10 school psychologists. Data were collected via in‐person, semi‐structured interviews. Most participants were female (n = 9) and all were practicing within the school setting and had delivered suicide intervention activities. Experiences described through interviews suggested collaboration while responding to suicide was a common activity that enhances the quality of services, external collaboration—though beneficial for students—can be a barrier to the provision of services, school psychologists cope through collaboration, and suicide intervention services would benefit from increased collaboration. Implications for practice include working to develop stable partnerships with external stakeholders and increasing collaboration during suicide assessment and response.

A Deeper Dive Into the Relation Between Psychotic-like Experiences and Suicidal Ideation and Behaviors in Children Across the United States.

Children who endorse psychotic-like experiences (PLEs) appear to be at a greater risk for suicidal ideation and behavior (SI/SB) compared to their peers who do not endorse PLEs. Despite evidence of differential relations among subtypes of PLEs and SI/SB, the research on which PLE subtypes produce the strongest associations remains mixed. Further, though there is evidence that general psychological distress may help explain the relation between PLEs and SI/SB, no research has investigated the role of distress specific to PLEs in this association. The present study sought to assess the associations among individual Prodromal Questionnaire-Brief Child Version (PQ-BC) items and SI/SB, as well as to explore the role of distress associated with PLEs as a mediator and/or moderator in a demographically diverse sample of children across the United States (N = 11 875). Results revealed that individual items of the PQ-BC may be differentially predictive of lifetime SI (ßs = 0.000-0.098) and SB (ßs=0.002-0.059), even when controlling for sociodemographic variables, internalizing symptoms, and traumatic experiences, with particularly strong associations observed among items indexing thought control, auditory hallucinations, suspiciousness, and nihilistic thinking/dissociative experiences. Item 13, nihilistic thinking/dissociative experiences, displayed the strongest effect sizes. Findings from moderation and mediation models provided evidence consistent with distress as both a partial mediator and moderator of the relation between total PLEs and individual PQ-BC items with SI and SB. Distress specific to PLEs may be an important modifiable risk factor to target in suicide assessment, prevention, and intervention efforts.

Randomized, Double-Blind, Placebo-Controlled, Fixed-Dose Study to Evaluate the Efficacy and Safety of Amphetamine Extended-Release Tablets in Adults With Attention-Deficit/Hyperactivity Disorder.

Objective: To evaluate the efficacy and safety of amphetamine extended-release tablets (AMPH ER TAB) in adults with attention-deficit/hyperactivity disorder (ADHD).Methods: In a 5-week forced-dose titration phase, subjects were randomized to either oral double-blind AMPH ER TAB 5-mg starting dose or matching placebo, once daily in the morning. Safety and efficacy assessments were completed weekly. After visit 3, subjects received 20 mg for 14 ± 3 days before visit 5. At visit 5, efficacy assessments included the administration of serial Permanent Product Measure of Performance (PERMP) tests predose and at 0.5, 1, 2, 4, 8, 10, 12, 13, and 14 hours postdose. The primary efficacy endpoint was the mean PERMP Total score (PERMP-T) across postdose time points during the visit 5 serial PERMPs. Safety was monitored by adverse events (AEs) assessed at each visit, Columbia Suicide Severity Rating Scale (C-SSRS), vital signs, weight, physical examination, and assessment of sleep, appetite, mood, and psychotic AEs. The study was conducted from February 2019 to October 2019.Results: Of 130 randomized subjects, 127 were in the intent-to-treat (ITT) population and 91 completed the study. The mean PERMP-T across all postdose time points at visit 5 was statistically significantly higher in the AMPH ER TAB group than in the placebo group (302.8 vs 279.6; P = .0043). Numerical differences favoring AMPH ER TAB were seen at all time points, with statistically significant improvements in the AMPH ER TAB group at 30 minutes and 1, 2, 4, 8, and 13 hours postdose, although the 10-, 12-, and 14-hour time points were not significant. Common AEs included decreased appetite, insomnia, and dry mouth. The majority of treatment-emergent AEs were mild to moderate in severity, and no serious AEs, as defined by the US Food and Drug Administration, were reported.Conclusions: AMPH ER TAB demonstrated efficacy in treatment of symptoms of ADHD in adults, with an anticipated safety profile.Trial Registration: ClinicalTrials.gov identifier: NCT03834766.

Motivational Interviewing and Self-Determination Theory in Suicide Assessment: A Practical Application to Aid Residents' Management of Suicide.

Suicide is a problem on the rise in the United States. One significant avenue to help reverse the trend is through family medicine and interventions within primary care clinics. This can be a significant stressor for many family medicine physicians to manage patients experiencing suicidal ideation within their busy schedule. Motivational Interviewing is an evidence-based method of interacting with patients in a healthy and collaborative manner. The literature is growing on how to use Motivational Interviewing in assessments of suicidal ideation. Additionally, Self-Determination Theory proposes that individuals have three basic needs: a sense of connection, a level of autonomy, and a degree of competence. These needs and the associated principles of intrinsic and extrinsic motivation help to explain why Motivational Interviewing can be so helpful in the change process. By examining the principles of Motivational Interviewing and Self-Determination Theory residents will be able to better create an environment conducive to collaborative sharing, honest discussion, and meaningful assessment to ensure safety for patients in primary care.

Suicide assessment and consultation in school settings

Risk of suicide among youth is a daunting public health concern that requires collaborative and coordinated prevention and intervention efforts. In recent years, suicide has been the second leading cause of death among children and youth aged 10–24 years in the U.S., with death by suicide totaling nearly 20% of total deaths among this combined age group in 2019 (Heron, 2021). Rates of suicidal thoughts have also increased significantly, particularly among middle and high school students. Identifying youth who have suicidal thoughts but not behaviors is critical. We know that suicide attempts greatly increase the risk that a person will end their life.

Psychological well-being in US veterans with non-fatal suicide attempts: A multi-cohort population-based study

BackgroundMost people who survive suicide attempts neither re-attempt suicide nor die by suicide. Research on suicide attempt survivors has primarily focused on negative endpoints (e.g., increased suicide risk) rather than positive outcomes. One important outcome is psychological well-being (PWB), defined as positive functioning across emotional, intrapersonal, and interpersonal domains. We compared PWB among US military veterans with (i.e., attempt survivors) and without (i.e., non-attempters) a history of suicide attempt(s) using data from three nationally representative cohorts. MethodsEach US veteran cohort (Cohort1: N = 3148; Cohort2: N = 1474; Cohort3: N = 4042) completed measures of suicidality (e.g., attempt history), character strengths (e.g., curiosity, optimism), psychological symptoms (e.g., depression), and indicators of PWB (e.g., happiness). t-Tests were conducted to examine group differences in PWB; hierarchical regressions were conducted to examine suicide attempt status as a predictor of PWB controlling for symptoms and demographics. Multivariable regressions were conducted to identify predictors of PWB among attempt survivors. ResultsIn each cohort, reported PWB was markedly lower among suicide attempt survivors than non-attempters (ds = 0.9–1.2), even after adjusting for mental health symptoms. Individual differences in PWB were observed, with a subset of suicide attempt survivors reporting higher PWB levels than non-attempters (1.4–7.4 %). Curiosity and optimism were positively associated with PWB among suicide attempt survivors (rs = 0.60–0.78). LimitationsData were cross-sectional, limiting inferences about causation and directionality of associations. ConclusionsFindings highlight diminished PWB as an important and understudied concern among veteran attempt survivors. Collectively, our findings underscore the importance of considering PWB in the research, assessment, and treatment of suicidality.

Adolescent suicide assessment and management in primary care

BackgroundTo understand how suicide management occurs within the primary care setting in terms of follow-up assessments and referral practices.MethodsAt an initial primary care visit, adolescents (aged 12–20 years old) completed electronic screening. Data were focused on youth who endorsed a suicidal risk item while completing screening at two Midwestern primary care clinics. Data were collected through retrospective chart reviews to analyze actions taken by the primary care physician at the youth’s initial visit and follow-up visit within the next 12 months.ResultsAt initial visits 200 adolescents endorsed a suicidal risk item and 39 (19.5%) were considered to be concerning by their primary care physician. The average age was 14.7 years old (SD ± 2.0). Seventy-two percent (n = 144) were female, and 65% (n = 129) identified as Black. At initial visits, significant differences between suicidal concern groups were found in reporting active suicidal ideation, past suicide attempts, those who were referred to behavioral health counseling, and those who had a diagnosis of depression. Interestingly, only 13% (n = 25) of all patients who endorsed the suicide item were asked whether or not there were weapons in their home and primary care providers asked only 7% (n = 13) of all patients whether they had a safety plan.ConclusionsThere was inconsistent follow-up for adolescents with a history of suicide concerns. At this time, national guidelines do not exist regarding primary care follow-up of youth with suicide concerns. Guidelines are a necessary precursor for practice improvement.Trial RegistrationClinical Trials Registry: NCT02244138. Registration date, September 1, 2014.

Der Verlust des Sittlichen im Recht

The Federal Constitutional Court has derived from the general right of personality a right of the individual to end his or her life consciously and deliberately and to have recourse to outside help in carrying out the suicide. The paper examines whether autonomy actually gives human beings the right to dispose of themselves freely and without restraint or whether autonomy is subject to certain limitations. After outlining the reasons given by the Federal Constitutional Court for a right of suicide (B.), the author discusses whether the free pluralistic constitutional state is morally based (C.). In this respect the author emphasizes that human dignity as a moral value forms the basis of social coexistent. The moral foundation of law guarantees freedom, peace and justice. In a further section the author examines the freedom of the individual within the framework of the state (D.) In the author’s point of view human freedom is not arbitrary and limitless. It finds its basis and its limitation in the moral law. This is followed by a moral assessment of suicide from the angle of Christianity and the Philosophy of Enlightenment, which have had a significant influence on the legal system and the jurisprudence of the Federal Constitutional Court (E.). On this basis, the author analyses and evaluates the decision of the Federal Constitutional Court on assisted suicide (F.). According to the author neither human dignity, the right to live nor the general right of personality give the individual a right to suicide; rather freedom and autonomy of man, based on the angle of Christianity and the Philosophy of the Enlightenment, are limited by moral law. An outlook on the consequences of the decision of the Federal Constitutional Court concludes the article (G.).