Communication Of Suicidal Intent Research Articles

An analysis of risk factors for child suicide in three centres from 2008 to 2017.

As a part of a study of suicide in children aged 17 years and under in three centers-Hennepin County in the United States (US), Auckland in New Zealand (NZ), and South Australia in Australia (AUS) from 2008 to 2017 it was decided to characterize potential risk factors and to determine whether these differed by jurisdiction. Reviewed data included a history of psychiatric illness, symptoms prior to suicide, events preceding suicide, previous suicidal ideation or suicide attempts, and communication of suicidal intent. The most common events preceding suicide were arguments with family/friends and relationship issues; in addition depression with or without expressed suicidal ideation, self-harming behavior, sadness, distress, drug/substance abuse, and anorexia were documented. Suicidal intent was on occasion communicated via technological means. In 79.5% of cases in South Australia decedents had a previously diagnosed psychiatric illness, with 62% in Hennepin County. This compared to a much lower proportion of cases in Auckland (23.8%). Whether this reflects more limited access to psychiatric services or a reluctance to seek support and therapy in Auckland is unclear. It does, however, demonstrate that risk factors for child suicide are not uniform among communities and so extrapolation of data from one area to another may not be appropriate. Disturbingly parents/carers were not aware of the decedent's suicidal intent in 84-87.2% of cases.

Measurement Properties of the Suicidal Behaviour Questionnaire-Revised in Autistic Adults

We explored the appropriateness and measurement properties of a suicidality assessment tool (SBQ-R) developed for the general population, in autistic adults—a high risk group for suicide. 188 autistic adults and 183 general population adults completed the tool online, and a sub-sample (n = 15) were interviewed while completing the tool. Multi-group factorial invariance analysis of the online survey data found evidence for metric non-invariance of the SBQ-R, particularly for items three (communication of suicidal intent) and four (likelihood of suicide attempt in the future). Cognitive interviews revealed that autistic adults did not interpret these items as intended by the tool designers. Results suggest autistic adults interpret key questions regarding suicide risk differently to the general population. Future research must adapt tools to better capture suicidality in autistic adults.

Youth Suicide in Korea Across the Educational Stages

Background: Youth suicides have diverse characteristics according to the young people's developmental stages. Warning signs and communication of suicidal intent can be vague among early adolescents, while mental health problems may be more evidently related to suicidal ideation in older adolescents. Understanding the developmental characteristics of youth suicide is necessary for effective suicide prevention. Aims: We explored the differences between children and adolescents who died by suicide and the characteristics of these young people as observed by their school teachers. Method: We analyzed teachers' mandatory postmortem reports of suicides among 308 Korean students. We compared: suicide-related information including personal, familial, and school factors; stressful life events; and participation in interventions among elementary, middle, and high school students who died by suicide. We also assessed the distribution of student suicides per month. Results: Suicide among elementary school students increased during school vacations, and suicide among middle and high school students increased during the school semester. According to the teachers' reports, elementary school students who died by suicide were more extroverted and had better academic achievements than their high school peers, and had significantly lower levels of substance/tobacco use. Elementary school students who died by suicide showed significantly less academic stress and use of external professional help than did other groups. Limitations: Because this research is based on mandatory teacher reports, the subjective opinions of teachers may have affected the reliability of the data. Suicide by out-of-school youth was not included. Conclusion: School-based suicide prevention should be implemented in accordance with young people's developmental characteristics.

Child, Adolescent and Young Adult Suicides: A Comparison Based on the Queensland Suicide Registry

Objective: The incidence of suicides increases rapidly up to the age of 20 years. Despite major developmental changes, only a limited number of studies has compared characteristics of child, adolescent and young adult suicides. The aim of the current study was to compare demographic, psychosocial and psychiatric characteristics of suicides in three youngest age groups - 10-14 years, 15-19 years and 20-24 years - in Queensland, Australia, between 2002 and 2011. Methods: The Queensland Suicide Register (QSR) contains information from a variety of sources, including: police report of death to a Coroner, post-mortem autopsy report, toxicology report and Coroner’s findings. Annual suicide rates were calculated by gender and age group. Odds Ratios (OR) with 95% confidence intervals (95% CI), Chi2 test are presented. Results: Between 2002 and 2011, there were 850 youth suicides recorded in the QSR - 43 aged 10-14 years, 295 aged 15-19 years and 512 aged 20-24 years. The proportion of males increased with age (51.2%, 69.5% and 76.6%). However, the proportion of Indigenous people decreased significantly with age (45.2%, 18.1% and 14.5%). Hanging was the most frequent suicide method for all age groups and for both genders, decreasing significantly with age for both genders. Prevalence of a diagnosed psychiatric disorder, substance use and psychiatric treatment increased with age. Evidence of untreated mental health problems was reported without significant differences between age groups. Similarly, there were no significant differences in history of previous suicide attempts and communication of suicide intent. Suicide in social group and attention to suicide in media, family conflict, school/ work-related problems and childhood trauma decreased significantly with age while relationship problems increased. Conclusion: Suicides in early adolescence were characterised by higher prevalence of family conflicts, schoolrelated problems and suicides in social groups. Suicides in young adults had significantly higher prevalence of psychiatric disorders and were much more impacted by relationship problems. The characteristics of suicides in late adolescents fell in between the other age groups.

Miseries Suffered, Unvoiced, Unknown? Communication of Suicidal Intent by Men in “Rural” Queensland, Australia

It has long been argued that suicide prevention efforts in rural locations face not only structural barriers, such as a lack of accessible health care and specialized mental health services, but also a range of cultural barriers. A commonly discussed cultural factor that may contribute to higher rural suicide rates is low levels of help-seeking behavior, which in turn act as a barrier to accessing and receiving care. However, the assumption that suicide by rural men is more likely to be accompanied by low help-seeking behavior, relative to urban men, has not been well tested. Using data from the Queensland Suicide Register, this study evaluates one form of help-seeking behavior--communication of suicidal intent--among men who died by suicide. Contrary to the expectation that suicide in rural areas would be associated with lower levels of help-seeking behavior than suicide in urban areas, it was found that communication of suicidal intent was broadly comparable across rural and urban settings. The implications for suicide prevention policies and service delivery strategies are discussed.

Mental Disorders and Communication of Intent to Die in Indigenous Suicide Cases, Queensland, Australia

In comparing Indigenous to non‐Indigenous suicide in Australia, this study focussed on the frequency of the association between some psychiatric conditions, such as depression and alcohol abuse, and some aspect of suicidality, in particular communication of suicide intent. Logistic regression was implemented to analyze cases of Indigenous (n = 471) versus non‐Indigenous suicides (n = 6,655), using the Queensland Suicide Register as a data source. Compared to non‐Indigenous suicides, Indigenous cases had lower odds of being diagnosed with unipolar depression, seeking treatment for psychiatric conditions or leaving a suicide note. Indigenous suicides had greater odds of verbally communicating suicide intent and having a history of alcohol and substance use. The magnitude of these differences is remarkable, underscoring the need for culturally sensitive suicide prevention efforts.

Communication of suicide intent, fact or myth?

Communication of suicide intent, fact or myth?

A Chronological Perspective on Suicide—The Last Days of Life

A combined psychological autopsy and narrative approach was used to study the completed suicides of 67 Israeli soldiers. Three issues were addressed. First, the authors examined the typology of the life narratives of suicide completed during active army duty. Second, focusing on the last 3 weeks of the soldiers' lives, they sought to examine their triggers for suicide, emotional state of mind, army duty functioning, and communication of suicidal intent. Finally, they examined military responses to communication of intent, help provision, and help acceptance. Four types of narratives were identified: regressive, stable, tragic (progression and sudden collapse), and romantic (ups and downs). During the last days of life, suicide completers exhibited a split between an emotional state of mind (evidencing an emotional deterioration) and a behavioral military functioning, which was mostly stable. The analysis also revealed a resistance to receive help and a resistance to provide help, both of which impeded intervention. The gap between functioning and emotional distress in suicidal individuals and the incongruence between crisis and help are highlighted. The need to educate military personnel to look beyond duty functioning and the need to develop clear guideline about referrals to professional helps are discussed.

Communication of suicide intent by schizophrenic subjects: data from the Queensland Suicide Register

BackgroundSuicide in mentally ill subjects, like schizophrenics, remains unbearably frequent in Australia and elsewhere. Since these patients are known to constitute a high-risk group, suicide in them should be amongst the most preventable ones. The objective of this study is to investigate the frequency of suicide communication in subjects with reported history of schizophrenia who completed suicide.MethodThe Queensland Suicide Register (QSR) was utilised to identify suicide cases. Frequency of suicide communication was examined in subjects with schizophrenia, and compared with persons with other psychiatric conditions and with subjects with no reported diagnosis. Socio-demographic variables, history of suicidal behaviour, pharmacological treatment and mental health service utilisation were also compared among the three groups.Results and discussionSubjects with a reported diagnosis of schizophrenia comprised 7.2% (n = 135) of the 1,863 suicides included in this study. Subjects with schizophrenia and those with other psychiatric disorders communicated their suicide intent more frequently than those with no psychiatric diagnosis, and persons with schizophrenia communicated their intent more than those with other psychiatric diagnoses. Seventy one per cent of schizophrenia subjects had contact with a mental health professional within the three months prior to suicide.ConclusionThe fact that subjects with schizophrenia had the highest prevalence of suicide intent communication could offer concrete opportunities for suicide prevention.

Antecedents of suicide in people with schizophrenia.

Suicides among people with schizophrenia are commonly believed to be impulsive and to occur unexpectedly. As part of the National Suicide Prevention Project in Finland, a nationwide psychological autopsy study, suicide victims with DSM-III-R schizophrenia (n = 86; n = 64 in the active illness phase) and others (n = 1109; n = 666 without any evidence for psychosis) were compared for communication of suicidal intent (CSI), as well as previous suicide attempts known by the next of kin and/or an attending health care professional during the latest treatment relationship. More victims with schizophrenia (84%) had a history of previous CSI, and/or had made previous suicide attempt(s) than others (70%). Also, victims with active illness schizophrenia (56%) had more CSI and/or had made suicide attempts during their last three months than victims with no psychosis (41%). CSI and/or suicide attempts occur at least as often in people with schizophrenia as in those without schizophrenia, even in the active phase of the illness.

Suicide among subjects with personality disorders.

There have been few psychological autopsy studies of suicide among individuals with personality disorders. The possible specificity of characteristics of suicide among such individuals has been little investigated. A random sample of 229 subjects who committed suicide, representing all suicide victims in Finland within a 12-month period, were comprehensively examined by using the psychological autopsy method and were diagnosed according to DSM-III-R criteria. Within this random sample the authors investigated all subjects with axis II personality disorders (N = 67) and divided them into clusters B (N = 43), C (N = 23), and A (N = 1). Individuals with clusters B and C personality disorders were separately compared with sex- and age-matched suicide victims without personality disorder, in terms of sociodemographic characteristics, comorbid axis I and III syndromes, treatment histories, previous suicide attempts, communication of suicide intent, and suicide methods. All suicide victims with a personality disorder received at least one axis I diagnosis. In 95% this included a depressive syndrome, a psychoactive substance use disorder, or both. Individuals with cluster B personality disorders were more likely than comparison subjects to have psychoactive substance use disorders (79% versus 40%) and previous nonfatal suicide attempts (70% versus 37%) and were less likely to have axis III physical disorders (29% versus 50%). Subjects with cluster C personality disorders were not found to differ from the control subjects in any of the variables examined. Suicide victims with personality disorders were almost always found to have had current depressive syndromes, psychoactive substance use disorders, or both. Suicide victims with cluster B personality disorders differed from other suicide victims in several characteristics, while those with cluster C personality disorders did not.

Suicide in bipolar disorder in Finland

The authors examined suicides of persons with bipolar disorder in aspects relevant to suicide prevention, including clinical features, treatment contacts, adequacy of treatment received, communication of suicidal intent, and suicide methods. All suicide victims with DSM-III-R bipolar I disorder among all 1,397 suicides in Finland within a 12-month period were carefully studied using the psychological autopsy method and were compared to suicide victims with unipolar major depression. Thirty-one bipolar I victims were identified. Most suicides of persons with bipolar disorder occurred during a major depressive episode (79%), but in some cases it occurred during a mixed state (11%) or even during or immediately after remission of psychotic mania (11%). Men had a higher rate of comorbid alcoholism, a lesser mean age, and shorter treatment histories than women. Although 74% of the victims were receiving psychiatric care at the time of suicide, and 39% had even explicitly communicated their intent to health care personnel during the last 3 months, only 11% of those who were depressed had received adequate doses of antidepressants and none had received ECT. Only 32% of the bipolar patients were prescribed lithium. In comparison to unipolar depressed suicide victims, the bipolar victims had more divorces, longer treatment histories, and more frequent hospitalizations. Although late suicides were common among both male and female bipolar victims, suicide seemed to occur earlier among males. Most bipolar victims had had a recent psychiatric treatment contact, but few had received adequate treatment immediately before death. Suicide victims with unipolar and bipolar disorders differed in marital status and treatment history.

Suicide in psychotic major depression

A sample of unipolar DSM-III-R major depressive suicide victims representing all suicides in current unipolar major depression within 1 year in Finland was carefully examined by psychological autopsy. The sample was divided into currently psychotic ( n=24) or non-psychotic ( n=46) subgroups, the psychotic subgroup was described and the two subgroups were compared. The majority (79%) of psychotic as well as nonpsychotic (87%) major depressive suicide victims were found to be complicated, comorbid cases. No major differences between the psychotic and nonpsychotic subgroups were found in sociodemographic features, comorbidity, clinical history or communication of suicide intent. However, the psychotic victims were more likely to have used violent suicide methods (88% vs. 59%).

Suicide behavior and depression in university student psychiatric referrals.

Two hundred and sixty four university students who were referred consecutively for psychiatric examination were evaluated by the author using a detailed, precoded questionnaire based on the Feighner et al., diagnostic criteria for psychiatric research. Histories including suicide behavior and affective symptoms were recorded. Four measures of suicide behavior: thoughts, wishes, threats, and attempts were all associated with the presence of affective disorders, but did not significantly in their association with specific affective disorders. Suicide attempts were more frequent than threats and did, in some cases, occur without the communication of suicide intent.

The Communication of Suicidal Intent by Completed Suicides

This article reviews the literature on the communication of suicidal intent by completed suicides. Research problems and methodological differences which limit knowledge about suicidal communications are discussed. Despite these difficulties, available data confirms that suicides frequently do communicate their intent. Furthermore, suicides identified as noncommunicators may, nevertheless, provide cues suggesting their intent. Although a few differences are indicated, attempts to distinguish communicators from noncommunicators according to such variables as sex, age, marital status, education, religion, social status, and clinical diagnosis have met with little success.

The communication of suicidal intent. A reexamination.

Verbal expressions and nonverbal indicators of suicidal intent have been frequently regarded as pleas for rescue and help. We investigated the clinical and empirical significance of verbalizations of suicidal ideas, putting one's affairs in order, and previous suicide attempts as forms of "communication of suicidal intent." The patient sample consisted of 211 suicide attempters: 71 "communicators" and 140 "noncommunicators." The results indicated the following: (1) there is no clear evidence that verbal communication, final acts, and previous suicide attempts are justifiably labeled together as ways of communicating suicidal intent; (2) prior verbalization of suicidal ideation or intent bears little relationship to the extent of the wish to die experienced at the time of the suicide attempt; and (3) "talking" or "not talking" about suicidal plans may be a manifestation of personal style rather than an index of despair or hidden motives.