Future Suicide Risk Research Articles

Mental Defeat Predicts Increased Suicide Risk in Chronic Pain: A 12-Month Prospective Study.

Mental defeat is considered a potential risk factor for suicidal thoughts and behaviours in chronic pain. This study evaluated the role of mental defeat in predicting future suicide risk and examined whether depression influences this relationship. A total of 340 participants with chronic pain completed questionnaires at two time points, 12 months apart. Data collected included sociodemographic and pain characteristics, mental defeat, psychosocial risk factors including depression and health-related variables. Weighted univariate and multivariable analyses assessed the link between mental defeat and suicide risk, with a moderation analysis testing the role of depression. Higher levels of mental defeat and depression were linked to increased suicide risk at 12 months. Depression significantly amplified the effect of mental defeat on suicide risk, particularly in individuals with higher depression levels (B = 0.06, SE = 0.01, t = 6.21, p < 0.001) compared with moderate (B = 0.05, SE = 0.01, t = 5.20, p < 0.001) or low levels of depression (B = 0.04, SE = 0.01, t = 2.83, p = 0.004), indicating a dose-response relationship. Mental defeat is a significant risk factor for suicide in chronic pain, with depression intensifying this risk. Addressing both mental defeat and depression simultaneously in treatment may help reduce suicide risk in these patients. This study strengthens the evidence linking mental defeat with heightened suicide risk in chronic pain. By providing prospective data, it clarifies the temporality of this relationship. Given that suicide risk doubles in chronic pain patients, whereby comorbid depression is common, these findings have crucial clinical implications. Both mental defeat and depression are modifiable. Addressing them together in treatment may help reduce suicide risk in this population.

Association Between Adolescent Violence Exposure and the Risk of Suicide: A 15-Year Study in Taiwan.

According to the 2023 Ministry of Health and Welfare statistics, the suicide rate among adolescents aged 15 to 24 has steadily increased since 2018, from 3.7 to 5.5 per 100,000 populations, reaching a recent high. Although previous studies have pointed out that the future risk of suicide of those who had suffered from abuse was higher than that of the general population, researchers seldom focused on adolescent groups. Therefore, the aim of this study was to explore the risk of suicide after youth violence and the impact of subsequent comorbid mental illness and suicide risk. This retrospective matched cohort study analyzed data from the NHIRD, covering the period from 2000 to 2015. A total of 976 cases aged 10-18 who had experienced violence were included in this study. Controlled grouping was conducted by 1:10 matching based on gender, age, and the time of medical treatment, and a control group who had not experienced violence was selected for comparison. We used the Cox proportional hazards model to analyze the risk of suicide among adolescents after exposure to violence. The suicide rate among adolescents who have experienced violence was significantly higher than that of the control group after 15 years of follow-up (1.0% vs. 0.5%). The prevalence of mental illness or disorders in adolescents exposed to violence was significantly higher than in the control group (45.2% vs. 40.1%). Among adolescents who had experienced violence, the methods of suicide included poisoning (solid and liquid) (53.6% vs. 43.2%), hanging (1.2% vs. 0.6%), firearms (2.4% vs. 0%), and cutting instruments (27.4% vs. 22.8%), all of which were significantly higher than in the control group. After adjusting for gender, age, residential area, and mental health comorbidities, the risk of suicide in those who had experienced violence was 1.475 times that of the control group (95% CI = 1.125-1.933; p = 0.005). In this study, female, younger age, and comorbid mental disorders were identified as risk factors for suicide among the adolescent victims of violence. Exposure to youth violence was associated with an increased prevalence of emotional disorders, including depression and social isolation, which subsequently elevated the suicide risk. These findings underscore the urgent need for governmental attention to the mental health of adolescent victims of violence. Implementing targeted psychological support and intervention programs could play a crucial role in mitigating the risk of suicide among this vulnerable population.

Risk of admission to hospital for self-harm after admission to hospital for COVID-19: French nationwide longitudinal study.

Assessing the risk of subsequent self-harm after hospitalisation for COVID-19 is critical for mental health care planning during and after the pandemic. This study aims to compare the risk of admission to hospital for self-harm within 12 months following a COVID-19 hospitalisation during the first half of 2020, with the risk following hospitalisations for other reasons. Using the French administrative healthcare database, logistic regression models were employed to analyse data from patients admitted to hospitals in metropolitan France between January and June 2020. The analysis included adjustments for sociodemographic factors, psychiatric history and the level of care received during the initial hospital stay. Of the 96 313 patients hospitalised for COVID-19, 336 (0.35%) were subsequently admitted for self-harm within 12 months, compared to 20 135 (0.72%) of 2 797 775 patients admitted for other reasons. This difference remained significant after adjusting for sociodemographic factors (adjusted odds ratio (aOR) = 0.66, 95% CI: 0.59-0.73), psychiatric disorder history (aOR = 0.65, 95% CI: 0.58-0.73) and the level of care received during the initial hospital stay (aOR = 0.70, 95% CI: 0.63-0.78). History of psychiatric disorders and intensive care were strongly correlated with increased risk, while older age was inversely associated with self-harm admissions. Hospitalisation for COVID-19 during the early pandemic was linked to a lower risk of subsequent self-harm than hospitalisation for other reasons. Clinicians should consider psychiatric history and intensive care factors in evaluating the risk of future suicide.

Suicidal ideation and its associated factors among high school adolescents in Haiphong, Vietnam

Suicide is a serious and preventable public health issue. This study aimed to identify the prevalence and associated factors of suicidal ideation (SI) among high school students. This cross-sectional study was conducted among 1,270 high school students. The Global School Student Health Survey (GSHS) questionnaire examined SI and related factors. The participant was identified as having SI by the question, “During the past 12 months, did you ever seriously consider suicide ideation?”. Overall, 16.9% of the participants reported having SI during the last year (17.1% males and 16.7% females). Multivariable analysis indicated several factors positively associated with SI: being bullied during the last 30 days (AOR= 2.15, 95%CI: 1.23-3.77), often feeling lonely in the last 12 months (AOR= 1.95, 95%CI: 1.10-3.44), worried and could not sleep at night in the last 12 months (AOR= 4.40, 95%CI: 2.64-7.34), tobacco use in the last 30 days (AOR= 3.76, 95%CI: 1.66-8.54), alcohol use in the last 30 days (AOR= 1.83, 95%CI: 1.26-2.65), no close friends (AOR= 2.03, 95%CI: 1.30-3.17), parents/guardians did not regularly check homework in the last 30 days (AOR= 1.57, 95%CI: 1.09-2.25), parents/guardians did not understand problems and worries of students in the last 30 days (AOR= 3.32, 95%CI: 2.04-5.42) and parents/guardians often displayed disrespect in the last 30 days (AOR= 1.63, 95%CI: 1.13-2.36). SI is widely recognized as a significant predictor of future suicide risk. Therefore, schools, parents, and policymakers need to urgently take measures to prevent deaths from occurring.

Exploring the role of service dogs for Canadian military Veterans experiencing suicidality

Abstract Despite ample anecdotal evidence, there are limited meaningful studies speaking to the important role of the human-animal bond (HAB) in reducing suicidality. However, research is increasingly showing the viability of service dogs (SDs) as a complementary approach for military Veterans suffering from post-traumatic stress disorder (PTSD) and substance use harms – two of the strongest indicators of suicidality across any population. An original, exploratory study completed in 2020 focused on how SDs supported Canadian Veterans living with PTSD and substance use concerns. From this work, a secondary analysis was then undertaken: 28 transcripts were examined through thematic analysis to explore the experiences of the Veterans who were identified as being at high risk for suicide to better understand how SDs may assist with their suicidality. Our methodological approach for the secondary analysis employed affective coding to discover how the social support system enabled by the SDs reduced experiences of loneliness and hopelessness, as well as symptoms of PTSD, depression, and substance use concerns that are commonly associated with suicidality. The SDs were reported by the Veterans as being a catalyst in reducing self-harm and suicidality, as the HAB provided a unique and necessary form of social support for Veterans that was distinct from what other human-human interactions could provide. While acknowledgement of how context specificity and the lived experience of each individual remains crucial for making sense of suicidality, the significant finding from this research has been the identification of the critical impact that SDs have in the lives of Veterans when it comes to preventing suicide. The SD has been explained as a bridge to improve Veterans’ overall quality of life and reduce markers commonly recognized as precursors to suicide – a finding that may be critical in helping reduce future suicide risk among military Veterans, and warrants further investigation.

Understanding suicide

Suicide remains a significant public health challenge globally, requiring comprehensive approaches for prevention and treatment. Almost 90% of individuals who commit suicide suffer from mental health disorders at the time of death, emphasizing the central role of psychiatry in understanding and preventing suicide. Suicidal thoughts, planning, attempts, and completed suicides exist on a continuum, with the highest suicide rates occurring within six months after an attempt and more severe attempts increasing the risk of future suicide. History plays a significant role in shaping the perception of suicide, from considering it a sin to recognizing it as a mental illness. Emile Durkheim's ground-breaking work on suicide as a social phenomenon furthered our understanding. Knowledge regarding the complexities surrounding suicide is paramount to developing effective strategies. Early detection through clinical interviews and screening tools and creating safe spaces for discussion are critical prevention measures. Pharmacological and non-pharmacological interventions are essential for addressing underlying psychiatric disorders and reducing suicidal thoughts and behaviors. While significant progress has been made in understanding suicide risk factors and implementing prevention strategies, continued research and community engagement are imperative. Destigmatizing mental health discourse and fostering supportive environments are essential steps toward reducing the incidence of suicide and supporting individuals in distress. By embracing a holistic approach that integrates pharmacological and nonpharmacological interventions, along with societal engagement, we can strive towards a future where suicide is increasingly rare, and individuals feel valued, supported, and connected.

DSM-5 suicidal behavior disorder: a systematic review of research on clinical utility, diagnostic boundaries, measures, pathophysiology and interventions.

It has been a decade since Suicidal Behavior Disorder (SBD) was introduced in Section III of the DSM-5 under "Conditions for Further Study". SBD is chiefly characterized by a self-initiated sequence of behaviors believed at the time of initiation to cause one's own death and occurring in the last 24 months. To systematically review empirical studies on SBD to identify primary research themes and promising future research directions. A search of empirical articles on SBD published between May 2013 and March 2023 was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Screening of 73 records by two independent raters yielded 14 eligible articles. The primary research themes identified from these articles included clinical utility of SBD to predict future suicide risk, association of SBD with closely related disorders, psychometric properties of SBD measures, pathophysiology of SBD, and the effectiveness of interventions for people with SBD. Understanding of SBD has slowly progressed since its introduction a decade ago and has mainly been applied in research to define study groups displaying suicidal behavior. The clinical utility of SBD for predicting future suicide risk is low and more research is needed to understand measurement of the diagnosis and its distinctiveness from related disorders and other self-harming behaviors.

Lower levels of social support are associated with risk for future suicide attempts in a clinical sample of transgender and gender diverse adults.

Transgender and gender diverse (TGD) adults are disproportionately affected by suicide. Social support and connection to the broader TGD community may help lower TGD adults' odds of having a suicide attempt (SA). The current study examined whether baseline levels of social support and community connectedness were associated with TGD adult's prospective odds of having a SA over 12months of follow-up. Longitudinal data for the current study came from a patient cohort of TGD adults enrolled in the LEGACY Project. Descriptive statistics and an attrition analysis were used to examine characteristics of the cohort and missingness over time. Logistic generalized estimating equation models were used to examine factors associated with patients' odds of having a past 6-month SA at 6- or 12-month follow-up. During the 12-month follow-up period, a total of 26 patients (3.1%; N = 830) reported having a SA. The 6-month incidence of SAs was approximately 2% at both 6- and 12-months of follow-up (6 months: N = 830; 12 months: N = 495). Baseline factors associated with increased odds of a future SA included gender identity (transfeminine vs. transmasculine: adjusted odds ratio [aOR] = 3.73, 95% confidence interval [CI] = 1.26-11.08; nonbinary vs. transmasculine: aOR = 3.09, 95% CI = 1.03-9.21), having a prior SA (aOR = 6.44, 95% CI = 2.63-15.79), and having moderate vs. high perceived social support (aOR = 4.25, 95% CI = 1.65-10.90). Lower levels of social support are associated with risk for future suicide attempts among TGD adults. Findings may inform screening practices for future suicide risk and the development of interventions to improve mental health outcomes for TGD adults.

Causes and Motivations of Non-Suicidal Self-Injury in Everyday Life Scenarios

Non-suicidal self-injury (NSSI) is a behavior in which a person purposefully injures himself or herself without suicidal intent. NSSI is most common in teens and young adults and has been linked to a number of mental diseases. The risk of future suicide is increased among people who participate in repetitive self-harming practices. Medication and psychotherapy, such as cognitive behavioral therapy, are treatment possibilities. The study conducted a literature review to better understand NSSI among adolescents aged 10 to 29 years. NSSI is motivated both inside and externally. Interventions of NSSI include immediate medical attention for persons suffering from mental illnesses and self-harm. Psychological therapies aim to improve coping skills and emotional regulation. Support and early intervention should be provided by parents, teachers, and healthcare experts.

Neural responses to decision-making in suicide attempters with youth major depressive disorder

An improved understanding of the factors associated with suicidal attempts in youth suffering from depression is crucial for the identification and prevention of future suicide risk. However, there is limited understanding of how neural activity is modified during the process of decision-making. Our study aimed to investigate the neural responses in suicide attempters with major depressive disorder (MDD) during decision-making. Electroencephalography (EEG) was recorded from 79 individuals aged 16–25 with MDD, including 39 with past suicide attempts (SA group) and 40 without (NSA group), as well as from 40 age- and sex- matched healthy controls (HCs) during the Iowa Gambling Task (IGT). All participants completed diagnostic interviews, self-report questionnaires. Our study examined feedback processing by measuring the feedback-related negativity (FRN), ΔFN (FRN-loss minus FRN-gain), and the P300 as electrophysiological indicators of feedback evaluation. The SA group showed poorest IGT performance. SA group and NSA group, compared with HC group, exhibited specific deficits in decision-making (i.e., exhibited smaller (i.e., blunted) ΔFN). Post hoc analysis found that the SA group was the least sensitive to gains and the most sensitive to losses. In addition, we also found that the larger the value of ΔFN, the better the decision-making ability and the lower the impulsivity. Our study highlights the link between suicide attempts and impaired decision-making in individuals with major depressive disorder. These findings constitute an important step in gaining a better understanding of the specific reward-related abnormalities that could contribute to the young MDD patients with suicide attempts.

Optimism, Sociability, andthe Risk ofFuture Suicide Attempt among U.S. Army Soldiers.

Most research on suicide attempts among U.S. service members has been focused on risk factors that occur during service. There is an important gap in our understanding of premilitary factors, such as personality characteristics, that may be associated with future suicide attempt risk during service. Of particular importance is identifying risk factors for the 1/3 of suicide attempters who never receive a mental health diagnosis (MH-Dx)-and therefore are not identified as having a mental health problem in the military healthcare system-prior to their suicide attempt. Using two components of the Army Study to Assess Risk and Resilience in Servicemembers, we examined the association of personality facets from the Tailored Adaptive Personality Assessment System, a computerized instrument administered prior to entering service, with medically documented suicide attempts during service. A 2010-2016 sample of historical administrative records from U.S. Regular Army enlisted soldiers with complete data on 11 commonly administered Tailored Adaptive Personality Assessment System facets was examined using a series of logistic regression analyses to identify the facets associated with future suicide attempt. Significant facets were then applied to data from a longitudinal cohort study of 11,288 soldiers surveyed upon entering basic combat training and followed via administrative records for their first 48 months of service. This research was approved by the Institutional Review Boards at the collaborating institutions. Analysis of the historical administrative data (87.0% male, 61.6% White non-Hispanic), found that low Optimism (odds ratio (OR) = 1.2 [95% CI = 1.0-1.4]) and high/low (vs. moderate) Sociability (OR = 1.3 [95%CI = 1.1-1.6]) were associated with suicide attempt after adjusting for other univariable-significant facets and socio-demographic and service-related variables. When examined in the longitudinal survey cohort, low Optimism (OR = 1.7 [95% CI = 1.1-2.4]) and high/low (vs. moderate) Sociability (OR = 1.7 [95% CI = 1.1-2.5]) were still associated with increased odds of documented suicide attempt during service, even after adjusting for each other, socio-demographic and service-related variables, and medically documented MH-Dx. Mental health diagnosis had a significant two-way interaction with Optimism (F = 5.27, p = 0.0236) but not Sociability. Stratified analyses indicated that low Optimism was associated with suicide attempt among soldiers without, but not among those with, a MH-Dx. Interactions of Optimism and Sociability with gender were nonsignificant. In the full model, population attributable risk proportions for Optimism and Sociability were 15.0% and 18.9%, respectively. Optimism and Sociability were differentially associated with suicide attempt risk across time in service. Optimism and Sociability, assessed prior to entering U.S. Army service, are consistently associated with future suicide attempt during service, even after adjusting for other important risk factors. While Sociability is equally associated with suicide attempt among those with and without a MH-Dx, Optimism is specifically associated with suicide attempt among soldiers not identified in the mental healthcare system. Risk differences across time in service suggest that Optimism and Sociability interact with stressors and contextual factors in particular developmental and Army career phases.

Ecological Momentary Assessment and Machine Learning for Predicting Suicidal Ideation Among Sexual and Gender Minority Individuals

Suicidality poses a serious global health concern, particularly in the sexual and gender minority population. While various studies have focused on investigating chronic stressors, the precise prediction effect of daily experiences on suicide ideation remains uncertain. To test the extent to which mood fluctuations and contextual stressful events experienced by sexual and gender minority individuals may predict later short- and long-term suicide ideation. This diagnostic study collected twice-daily data on mood states and stressful events from sexual and gender minority individuals over 25 days throughout 3 waves of the Chinese Lunar New Year (before, during, and after), and follow-up surveys assessing suicidal ideation were conducted 1, 3, and 8 months later. Online recruitment advertisements were used to recruit young adults throughout China. Eligible participants were self-identified as sexual and gender minority individuals aged 18 to 29 years. Those who were diagnosed with psychotic disorders (eg, schizophrenia spectrum or schizotypal disorder) or prevented from objective factors (ie, not having a phone or having an irregular sleep rhythm) were excluded. Data were collected from January to October 2022. To predict short-term (1 month) and longer-term (3 and 8 months) suicidal ideation, the study tested several approaches by using machine learning including chronic stress baseline data (baseline approach), dynamic patterns of mood states and stressful events (ecological momentary assessment [EMA] approach), and a combination of baseline data and dynamic patterns (EMA plus baseline approach). A total of 103 sexual and gender minority individuals participated in the study (mean [SD] age, 24.2 [2.5] years; 72 [70%] female). Of these, 19 (18.4%; 95% CI, 10.9%-25.9%), 25 (24.8%; 95% CI, 16.4%-33.2%), 30 (29.4%; 95% CI, 20.6%-38.2%), and 32 (31.1%; 95% CI, 22.2%-40.0%) reported suicidal ideation at baseline, 1, 3, and 8 months follow-up, respectively. The EMA approach showed better performance than the baseline and baseline plus EMA approaches at 1-month follow-up (area under the receiver operating characteristic curve [AUC], 0.80; 95% CI, 0.78-0.81) and slightly better performance on the prediction of suicidal ideation at 3 and 8 months' follow-up. In addition, the best approach predicting suicidal ideation was obtained during Lunar New Year period at 1-month follow-up, which had a mean AUC of 0.77 (95% CI, 0.74-0.79) and better performance at 3 and 8 months' follow-up (AUC, 0.74; 95% CI, 0.72-0.76 and AUC, 0.72; 95% CI, 0.69-0.74, respectively). The findings in this study emphasize the importance of contextual risk factors experienced by sexual and gender minority individuals at different stages. The use of machine learning may facilitate the identification of individuals who are at risk and aid in the development of personalized process-based early prevention programs to mitigate future suicide risk.

Early maladaptive schema domains and suicide risk in major depressive disorder: the mediating role of patients’ illness-related self-regulation processes and symptom severity

AbstractEarly maladaptive schemas (EMS), illness representations, and coping are associated with clinical outcomes of patients with major depressive disorder (MDD). However, the pathways that link these factors are largely unknown. The present prospective study aimed at investigating the possible mediating role of illness representations and coping in the associations among schema domains, symptom severity, and suicide risk in MDD. Participants were 135 patients diagnosed with MDD, aged 48.13 ± 14.12 (84.4% females). The Young Schema Questionnaire-Short Form 3 was used to measure schema domains at baseline. Illness representations and coping were measured at approximately five months later (mean = 5.04 ± 1.16 months) with the Illness Perception Questionnaire-Mental Health and the Brief COPE Inventory, respectively. MDD outcomes were measured about 10 months after the baseline assessment (mean = 9.44 ± 2.36 months) with the Beck Depression Inventory and the Risk Assessment Suicidality Scale. SPSS AMOS 27 was used to conduct path analysis. Serial mediation Structural Equation Modelling, controlling for age, education, marital status, working status, MDD duration, pharmacotherapy, and psychotherapy, revealed that Impaired Autonomy and Performance was positively linked to suicide risk. Negative MDD impact representations and symptom severity serially mediated the aforementioned association. Finally, problem-focused coping was negatively related to symptom severity and suicide risk. This study’s main limitation was modest sample size. Representations regarding the impact and severity of MDD mediate the effects of Impaired Autonomy and Performance on future suicide risk in MDD. Healing Impaired Autonomy and Performance domain of EMS, restructuring patients’ representations of high MDD impact, and enhancing problem-focused coping could significantly reduce symptom severity and suicide risk in Schema Therapy with MDD individuals.

Inter-relationships of depressive and anxiety symptoms with suicidality among adolescents: A network perspective

BackgroundPersons with suicidality including suicidal ideation (SI), suicide plans (SP) and/or suicide attempts (SA) are at higher risk for future suicide than those without suicidality. To reduce the risk of future suicide, it is important to understand symptoms of emotional distress that have the strongest links with SI, SP and SA. This network analysis examined item-level relations of depressive and anxiety symptoms with suicidality among adolescents during the COVID-19 pandemic. MethodsAdolescents between 12 and 20 years of age were assessed with the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and individual binary reponse (no/yes) items assessing SI, SP, and SA during the pandemic. The structure of depressive symptoms, anxiety symptoms and suicidality was characterized using “Expected Influence” and “Bridge Expected Influence” as centrality indices in the symptom network. Network stability was tested using a case-dropping bootstrap procedure. Node-specific predictive betweenness was computed to examine short paths of anhedonia, other depressive symptoms and anxiety symptoms with suicidality. A Network Comparison Test (NCT) was conducted to examine whether network characteristics differed based on gender. ResultsPrevalence rates of depressive symptoms, anxiety symptoms, and suicidality were 44.60 % (95% confidence interval (CI) = 41.53–47.67 %), 31.12 % (95%CI = 28.26–33.98 %), and 16.95 % (95%CI = 14.63–19.26 %), respectively, in the study sample. The network analysis identified GAD3 (“Worry too much”) as the most central symptom, followed by GAD6 (“Irritability”) and PHQ6 (“Guilt”) in the sample. Additionally, PHQ6 (“Guilt”), GAD6 (“Irritability”), and PHQ2 (“Sad mood”) were bridge nodes linking depressive and anxiety symptoms with suicidality. A flow network indicated that the connection between S (“Suicidality”) and PHQ6 (“Guilt”) reflected the strongest connection, followed by connections of S (“Suicidality”) with GAD2 (“Uncontrollable worrying”), and S (“Suicidality”) with PHQ2 (“Sad mood”). Finally, PHQ2 (“Sad mood”) was the main bridge node linking anhedonia with other depressive and anxiety symptoms and suicidality in the sample. ConclusionsFindings highlight the potential importance of reducing specific depressive and anxiety symptoms as possible means of reducing suicidality among adolescents during the pandemic. Central symptoms and key bridge symptoms identified in this study should be targeted in suicide prevention for at-risk adolescents.

The Relationship Between Future Self-Continuity and Suicide Risk in Military Veterans with Traumatic Brain Injury

Veterans with Traumatic Brain Injury (TBI) have an increased risk for suicide. A lack of Future-Self Continuity (FSC), which refers to the sense of “psychological connectedness” that a person has between their present and future selves, has also been associated with suicide risk. For this study, 308 U.S. military veterans, 39 of whom self-reported a TBI, completed a series of questionnaires to assess future self-continuity and suicidality. The results replicated previous findings in that TBI and low future self-continuity were individually associated with increased suicidality. Additionally, future self-continuity was found to have a moderating effect on TBI, in that TBI was associated with increased suicide risk only when future self-continuity was low or moderate. When future self-continuity was high, TBI was not associated with increased suicide risk. Examination of the three subcomponents of future self-continuity revealed that FSC-Vividness and FSC-Positivity moderated the TBI-suicidality relationship, while FSC-Similarity had no significant moderating effect. These results suggest that high future self-continuity may be a protective factor for suicide risk among veterans with a TBI diagnosis. Understanding this relationship between TBI, future self-continuity, and suicidality could help enhance suicide prevention efforts.

Factors influencing the length of stay in a unit with mixed rehabilitation and psychiatric care after a suicide attempt by jumping: a cohort observational retrospective study.

Persons who have attempt suicide by jumping often require intensive treatment for their somatic injuries and the high risk of future completed suicide. The FSEF (French Student Health Foundation) developed a Transdisciplinary unit specifically designed for these people. The aim of this study was to investigate psychiatric and somatic factors associated with Length Of Stay (LOS) in this unit. Cohort observational retrospective study. The Transdisciplinary unit provide a dual approach, combining rehabilitation (physiotherapy, balneotherapy, occupational therapy, speech therapy, cognitive rehabilitation, social and family support) and psychiatric care. Men and women admitted into the Transdisciplinary unit, after a suicide attempt by jumping from a height with severe somatic injuries. We examined the associations between potential predictors and LOS with Stepwise regressions: model 1 included all variables assessed at admission (age, sex, occupational status, psychiatric disorder history, height of the fall, type of injury, LOS in acute care units and dependences at admission); model 2: all variables at discharge (main psychiatric diagnosis, orientation at discharge, psychotropic treatments, pain treatments, arms mobility limitation, legs mobility limitation, sphincter disorders and dependences at discharge); final model: all significant variables in models 1 and 2. One hundred ninety-seven subjects were included (49.7% of men; mean age: 25.6 years, ±6.21). Most factors associated with LOS were related to injuries due to the suicide attempt. LOS in the Transdisciplinary unit increased with longer LOS in acute care (β=0.589; P=0.003), higher dependence for continence at admission (β=44.640; P<0.001) and sphincter disorders at discharge (β=78.034; P<0.001). LOS was also longer with higher dependence for behavior at discharge (β=30.182; P=0.042) and unemployed status (β=59.496; P=0.008), which could reflect psychiatric disorders severity. LOS was shorter when subjects had arms mobility limitation at discharge (β=-42.591; P=0.018). The persons admitted into this unit have serious physical injuries due to their fall. These injuries require intensive rehabilitation and their severity is the largest contributing factor to the LOS. Some findings also advocate for influence of psychiatric factors on LOS, underlying the need for both concomitant psychiatric and somatic care for these people. People should ideally receive both psychiatric and rehabilitation care after a suicide attempt by jumping.

Long-term suicide risk of children and adolescents with attention deficit and hyperactivity disorder – a systematic review

IntroductionSeveral studies showed the high suicide risk of patients with attention deficit and hyperactivity disorder (ADHD), however most of these studies had cross-sectional design.ObjectivesThe aim of the current study was to review systematically those studies which investigated the suicide risk among ADHD patients with longitudinal design.MethodsThe systematic search was made on OVID Medline, PsychInfo, PubMed, Scopus, and Web of Science. The search terms were (ADHD OR attention deficit hyperactivity disorder) AND (suicide OR suicidal OR suicidality) AND (follow-up OR longitudinal study OR prospective study). Inclusion criteria were: written in English; participants under 18 years at the baseline; longitudinal, prospective studies; ADHD population at the baseline and at the follow-up; suicide behavior as primary outcome. Exclusion criteria were: the study did not contain empirical data, and reviews/meta-analyses and studies which aimed to investigate the drug treatment efficacy of ADHD.Results18 papers were included in the systematic review. 10 articles were published in the last 5 years. 9 studies enrolled children aged under 12 at baseline. The follow-up periods varied between 2 and 17 years. 17 studies found a significant positive association between ADHD diagnosis at baseline and the future suicidal behavior and/or attempts at the follow-up. The affective comorbidity showed an association with the future suicide risk.ConclusionsThese results highlight the importance of screening suicidality in patient with ADHD and consider it during treatment. Further studies are needed to clarify the role of the treatment and comorbidities of ADHD in the increased suicide risk.DisclosureNo significant relationships.

Life problems in children and adolescents who self-harm: findings from the multicentre study of self-harm in England.

Self-harm, a significant and increasing global problem in children and adolescents, is often repeated and is associated with risk of future suicide. To identify potential interventions, we need to understand the life problems faced by children and adolescents, and by sub-groups of younger people who self-harm. Our aims were to include the following: (a) investigate the type and frequency of life problems in a large sample of children and adolescents who self-harmed. (b) Examine whether problems differ between those who repeat self-harm and those who do not. We analysed data for 2000 to 2013 (follow up until 2014) from the Multicentre Study of Self-harm in England on individuals aged 11 to 18 years who presented to one of the five study hospitals following self-harm and received a psychosocial assessment including questions about problems, which precipitated self-harm. In 5648 patients (12,261 self-harm episodes), (75.5% female, mean age 16.1 years) the most frequently reported problems at first episode of self-harm were family problems. Problems around study/employment/study and relationships with friends also featured prominently. The types of problems that precede self-harm differed between late childhood/early adolescence. Abuse, mental health problems and legal problems significantly predicted repeat self-harm for females. The most common problems reported by both genders were social/interpersonal in nature, indicating the need for relevant services embedded in the community (e.g. in schools/colleges). Self-harm assessment and treatment choices for children and adolescents must take age and gender into account. To prevent future self-harm, individualised supports and services are particularly needed for abuse, mental health and legal problems.

Utilising the Integrated Motivational Volitional (IMV) model to guide CBT practitioners in the use of their core skills to assess, formulate and reduce suicide risk factors

Abstract Cognitive behavioural therapists based in primary care are not usually expected to provide therapy to acutely suicidal individuals or work directly on suicidal thoughts. However, all practitioners should be vigilant about suicide risk and potentially help to reduce vulnerabilities to future suicide risk as part of their routine work. Many of the risk factors and processes hypothesised to play a role in the development of suicidal thinking and behaviours are likely to be evident within the usual content of standard evidence-based protocols for depression or anxiety disorders. In this paper we are suggesting that even within the current primary care remit, (i) an increased awareness of suicide risk vulnerability factors and (ii) using knowledge of a psychological model of suicidal behaviour to inform clinical care are likely to be extremely helpful in structuring clinical formulation and informing interventions. Key learning aims (1) To understand the IMV model and the factors associated with suicidal thoughts and suicidal behaviour. (2) To understand how core CBT skills and interventions can address these factors. (3) To support CBT practitioners in using their current CBT knowledge and skills in the service of reducing the risk of suicidal behaviour.

"A Sustained, Productive, Constructive Relationship with Someone Who Can Help"-A Qualitative Exploration of the Experiences of Help Seekers and Support Persons Using the Emergency Department during a Suicide Crisis.

For Australians experiencing a suicide crisis, the emergency department (ED) is the recommended point of contact for intervention and to ensure personal safety. However, negative ED experiences can deter individuals from returning, thus impacting future suicide risk. In order to improve the ED environment for individuals in suicidal crisis, an in-depth understanding of this experience is needed. In-depth semi-structured interviews with 17 help seekers and 16 support persons were conducted. A grounded theory approach uncovered a core organising concept—all participants wanted a “a sustained, productive, constructive relationship with someone who can help” during the ED visit—which guided analysis. Thematic analysis resulted in two themes and four subthemes exploring the systemic and interpersonal aspects of the ED visit and the roadblocks and pathways to development of the relationship. Interpersonal factors included aspects of staff interaction and presence of a support person. Systemic factors related to aspects controlled by the physical space and internal policies and procedures and included aspects such as the chaotic environment, long waiting times, and access to staff. Overwhelmingly, there were more roadblocks than pathways reported by participants. Improving the ED environment, increasing staff training and encouraging the presence of support persons may help mitigate some of these roadblocks.