High Prevalence Of Suicide Research Articles

The Effect of Cognitive Therapy on Psychosis Clients with Suicide Risk: Literature Review

Psychosis is a mental or psychiatric disorder characterized by hallucinations, delusions, chaotic behavior, and accompanied by poor insight. A systematic review and meta-analysis study showed that individuals with a diagnosis of psychosis have a high prevalence of suicide. One of the psychotherapies given to psychosis clients with suicide risk is cognitive therapy (CT). Objective: To determine the effect of cognitive therapy (CT) on psychosis clients with suicide risk Articles discussed in this literature review were obtained through article searches in electronic journal databases, namely Science Direct, ProQuest, Wiley Online Library, EBSCOhost, Sage Journals, and ClinicalKey. The inclusion criteria of this journal review were human studies, English, and free fulltext. The results showed that CT in clients at risk of suicide has a significant effect in reducing suicide risk through mechanisms to correct thought distortions and build positive thoughts and beliefs to produce adaptive coping mechanisms. This study has implications for the importance of applying cognitive therapy as part of psychotherapeutic interventions for clients with psychosis who are at risk of suicide. This therapy not only helps reduce symptoms associated with psychosis, but also plays a role in reducing suicidal tendencies by correcting maladaptive thoughts and beliefs.

Bereavement-Related Needs and Their Relation to Mental Health Symptoms Among Adults Bereaved by Suicide and Fatal Overdose

Despite the high prevalence of suicide and fatal overdose, and the morbidity associated with these forms of bereavement, little is known about the loss-related needs of adults bereaved by these two causes, including whether survivors’ needs differ from those losing significant persons to other forms of sudden death and how these needs may relate to psychiatric symptomatology. Using a newly validated measure (the Sudden Bereavement Needs Inventory) and an online survey design, the purpose of this study was to examine the needs of adults (N = 403) who have experienced the suicide or fatal overdose of a close other within the past five years, to compare these needs with those of individuals bereaved by a sudden natural death, and to explore how the importance of specific need categories relates to psychiatric symptomatology. Results showed great overlap between adults bereaved by suicide and fatal overdose across all bereavement need categories, with notable differences between these two groups and those bereaved by a sudden-natural loss (e.g., cardiac arrest). Further, among the suicide and overdose bereaved, the self-rated importance of specific need categories accounted for much of the variation in symptoms of prolonged grief, posttraumatic stress, and depression, with relational needs and meaning-based needs emerging as most strongly related to psychiatric symptoms. Study results may suggest the importance of addressing specific needs in therapy among overdose and suicide bereaved individuals to promote adaptive outcomes.

Suicidal ideation, plan, and attempt among men who have sex with men in Nepal: Findings from a cross-sectional study.

Men who have sex with men (MSM) are at increased risk for suicide, with a much higher prevalence of suicidality than the general population. While there is a growing interest in the identification of risk factors for suicidal behaviors globally, the understanding of the prevalence and risk factors for suicidal behaviors among MSM in the context of low- and middle-income countries is almost non-existent. Therefore, this study aimed to investigate suicidal ideation, plan, and attempts, and related factors among MSM in Nepal. A cross-sectional respondent driven survey was conducted on 250 MSM between October and December 2022. Bivariate and multivariable logistic regression was used to evaluate independent correlates of suicidal behaviors of MSM. Overall, the lifetime prevalence of suicidal ideation, plans, and attempts among MSM in this study were 42.4%, 31.2%, and 21.6%, respectively. MSM with depressive symptoms (aOR = 5.7, 95% CI = 2.4-14.1), advanced education (higher secondary and above; aOR = 2.9, 95% CI = 1.4-6.1), and smoking habit (aOR = 2.5, 95% CI = 1.2-5.3) were at increased risk for suicidal ideation. Similarly, those with depressive symptoms (aOR = 2.2, 95% CI = 1.1-4.8) and advanced education (aOR = 2.7, 95% CI = 1.2-5.7) were more likely to plan suicide, whereas young MSM were significantly more prone to attempting suicide (aOR = 2.7, 95% CI = 1.3-5.8). Interestingly, MSM with moderate to severe food insecurity were 2-3 times more likely to think about, plan, or attempt suicide (ideation: aOR = 3.5, 95% CI = 1.6-7.7; plan: aOR = 3.7, 95% CI = 1.6-8.3; attempt: aOR = 2.2, 95% CI = 1.1-4.6). The results suggest the importance of early assessment of suicidal behaviors among MSM and the need for tailored interventions to simultaneously address mental health problems and food insecurity to reduce suicide-related problems among Nepalese MSM.

Suicidality and protective factors among sexual and gender minority youth and adults in Canada: a cross-sectional, population-based study

BackgroundSexual and gender minority populations experience elevated risks for suicidality. This study aimed to assess prevalence and disparities in non-fatal suicidality and potential protective factors related to social support and health care access among sexual and gender minority youth and adults and their heterosexual and cisgender counterparts in Canada. The second objective was to examine changes in the prevalence of suicidal ideation and protective factors during the COVID-19 pandemic.MethodsPooled data from the 2015, 2016 and 2019 Canadian Community Health Surveys were used to estimate pre-pandemic prevalence of suicidal ideation, plans and attempts, and protective factors. The study also estimated changes in the prevalence of recent suicidal ideation and protective factors in fall 2020, compared with the same period pre-pandemic.ResultsThe prevalence of suicidality was higher among the sexual minority populations compared with the heterosexual population, and the prevalence was highest among the bisexual population, regardless of sex or age group. The pre-pandemic prevalence of recent suicidal ideation was 14.0% for the bisexual population, 5.2% for the gay/lesbian population, and 2.4% for the heterosexual population. The prevalence of lifetime suicide attempts was 16.6%, 8.6%, and 2.8% respectively. More than 40% of sexual minority populations aged 15–44 years had lifetime suicidal ideation; 64.3% and 36.5% of the gender minority population had lifetime suicidal ideation and suicide attempts. Sexual and gender minority populations had a lower prevalence of protective factors related to social support and health care access. The prevalence of recent suicidal ideation among sexual and gender minority populations increased in fall 2020, and they tended to experience longer wait times for immediate care needed.ConclusionsSexual and gender minority populations had a higher prevalence of suicidality and less social support and health care access compared to the heterosexual and cisgender populations. The pandemic was associated with increased suicidal ideation and limited access to care for these groups. Public health interventions that target modifiable protective factors may help decrease suicidality and reduce health disparities.

The Impact of Transgender Minority Stress and Emotion Regulation on Suicidality and Self-Harm

Transgender and gender diverse (TGD) individuals experience high levels of minority stress, as well as a high prevalence of suicidality and self-harm. The current study investigates if emotion regulation mediates the relationships of minority stressors with self-harm and suicidality. TGD adult primary care patients (N = 115) completed a survey including measures of minority stressors, emotion dysregulation, self-harm, and suicidality. Emotion regulation mediated the relationship between victimization and suicidality. Emotion regulation did not mediate the relationship between victimization and self-harm. TGD individuals’ suicide risk may be increased when they experience victimization through increased emotion dysregulation.

Suicide Risk Among Adolescents With ADHD: An Overview From the National Inpatient Sample Data Set.

Studies have shown an association between attention deficit hyperactivity disorder (ADHD) and suicide; however, it has not been studied from inpatient hospitalization data among adolescents. For this study, data from the National Inpatient Sample data set were used. Based on the diagnosis of ADHD, the patient sample was stratified into two groups. Study group was composed of patients with ADHD, and control group was selected by propensity score matching (1:1), which composed of patients without ADHD. The primary outcome was suicidal ideation/attempt between the groups. Prevalence of SI was 25.1% in patients with ADHD versus 10.3% among patients without ADHD. Prevalence of SA was also very high (8.0% vs 3.9%) among patient with ADHD compared with non-ADHD group. After controlling for covariates, ADHD was a strong predictor of suicidal ideation/attempt with an odds ratio of 2.18. It is important to screen for suicidality in patient with ADHD given the high prevalence of suicidality.

Associations of Suicidality Trends With Cannabis Use as a Function of Sex and Depression Status

During the past decade, cannabis use among US adults has increased markedly, with a parallel increase in suicidality (ideation, plan, attempt, and death). However, associations between cannabis use and suicidality among young adults are poorly understood. To determine whether cannabis use and cannabis use disorder (CUD) are associated with a higher prevalence of suicidality among young adults with or without depression and to assess whether these associations vary by sex. This survey study examined data from 281 650 adults aged 18 to 34 years who participated in the National Surveys on Drug Use and Health. Data were collected from January 1, 2008, to December 31, 2019. Prevalence of past-year daily or near-daily cannabis use (≥300 days in the past year), CUD, and major depressive episode (MDE). Past-year CUD and MDE were based on DSM-IV diagnostic criteria. Past-year suicidal ideation, plan, and attempt. Among the 281 650 adults aged 18 to 34 (men, 49.9% [95% CI, 49.6%-50.2%]; women, 50.1% [95% CI, 49.8%-50.4%]) included in the analysis, past-year suicidal ideation and plan along with daily cannabis use increased among all examined sociodemographic subgroups (except daily cannabis use among current high-school students), and past-year suicide attempt increased among most subgroups. National trends in adjusted prevalence of past-year suicidal ideation, plan, and attempt varied by daily and nondaily cannabis use and CUD among adults with or without MDE. After controlling for MDE, CUD, cannabis use status, and potential confounding factors, the adjusted prevalence of suicidal ideation, plan, and attempt increased 1.4 to 1.6 times from the 2008-2009 to 2018-2019 periods (adjusted risk ratio [ARR] for suicidal ideation, 1.4 [95% CI, 1.3-1.5]; ARR for suicide plan, 1.6 [95% CI, 1.5-1.9]; ARR for suicide attempt, 1.4 [95% CI, 1.2-1.7]), with 2008 to 2009 as the reference period. Past-year CUD, daily cannabis use, and nondaily cannabis use were associated with a higher prevalence of past-year suicidal ideation, plan, and attempt in both sexes (eg, among individuals without MDE, prevalence of suicidal ideation for those with vs without CUD was 13.9% vs 3.5% among women and 9.9% vs 3.0% among men; P < .001), but significantly more so in women than men (eg, suicide plan among those with CUD and MDE was 52% higher for women [23.7%] than men [15.6%]; P < .001). From 2008 to 2019, suicidal ideation, plan, and attempt increased 40% to 60% over increases ascribed to cannabis use and MDE. Future research is needed to examine this increase in suicidality and to determine whether it is due to cannabis use or overlapping risk factors.

Prevalence of suicidality, depression, post-traumatic stress disorder, and anxiety among female sex workers: a systematic review and meta-analysis.

The purpose was to assess prevalence of suicidality, depression, post-traumatic stress disorder (PTSD), and anxiety among female sex workers (FSW). A systematic review and meta-analysis was performed. Search strategy was performed in MEDLINE, Scopus, Web of Science, EMBASE, Ovid and Cochrane Central Database from inception until March 2020. Considered for inclusion were cross-sectional studies performed on FSW that assessed prevalence of any of the following: suicide attempt or suicidal ideation, depression, PTSD, or anxiety. Five reviewers, independently and in duplicate, selected all eligible articles in an abstract and full-text screening phase and, moreover, extracted information from each study. A binomial-normal generalized linear mixed model was employed to estimate prevalence of the conditions. From 8035 studies yielded in the search strategy, 55 were included for analysis. The overall prevalence of suicidal ideation and attempt was 27% (95% C.I. 18-39%) and 20% (95% C.I. 13-28%), respectively. Furthermore, overall prevalence of depression and PTSD was 44% (95% C.I. 35-54%) and 29% (95% C.I. 18-44%), respectively. Eleven studies were classified as high quality. Findings indicate that there is an overall high prevalence of suicidality, depression, and PTSD among FSW. Development of accessible large-scale interventions that assess mental health among this population remains critical.

Quality of life in patients of corrosive esophageal stricture treated with endoscopic dilatation.

Background and AimCaustic ingestion is associated with long‐term sequelae in the form of esophageal and/or gastric cicatrization requiring endoscopic or surgical intervention. Quality of life (QoL) and disability in patients with caustic‐induced sequelae is less explored.MethodsIn this prospective study, we included consecutive patients with symptomatic caustic‐induced esophageal stricture undergoing endoscopic dilatation. QoL was measured using the World Health Organization Quality of Life questionnaire (WHOQoL‐BREF). Disability was measured using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Subjective dysphagia score was calculated by Likert scale.ResultsA total of 42 patients were included in the study; 25 (59.5%) patients were male. Patients had poor WHOQoL‐BREF and WHODAS scores compared to normality data in all domains of the scores among both the genders. A majority (66.7%) of patients had a current psychiatric diagnosis, with the most common being mood disorder (50%) followed by suicidality (45.2%). Males had a higher prevalence of a previous psychiatric diagnosis compared to females, while females had a higher prevalence of suicidality. Dysphagia score had strong correlation with the WHOQoL (r = −0.66; P < 0.01) and WHODAS (r = 0.71; P < 0.01).ConclusionPatients with esophageal stricture due to caustic ingestion on long‐term endoscopic dilatation have poor QoL, high prevalence of psychological morbidity, and disability.

Prevalence of suicidality among the adolescents of a rural municipality of Eastern Terai of Nepal

Introduction: Suicidality is a mental health condition that includes suicidal ideation, plan, and attempt. Prevalence of Suicidality from the pilot study conducted in 2018 in Nepal shows 8.7% among adolescents aged 13 to 17years. The study aimed to determine the prevalence of suicidality among adolescents of a rural municipality of eastern Terai of Nepal.&#x0D; Method: A cross-sectional study was conducted among 443 adolescents from the randomly selected households of a rural municipality of Eastern Terai of Nepal. Validated self-administered tools; suicidal action and plan tools were used to assess the prevalence of suicidality.&#x0D; Result: The study revealed that 30.93% of the adolescent's respondents had developed suicidal thought in the last one year. Similarly, 22.12% of them had made suicidal plan and 12.42% had attempted suicide.&#x0D; Conclusion: High prevalence of suicidality among adolescents indicates need for scaling of mental health awareness programs and services in the rural municipality. Concerned authorities should take an intervention to decrease preventable death among adolescents.

Race Differences in Opioid Misuse and Adolescent Suicidality.

The rise of the opioid epidemic coincided with the increased risk of suicide as the leading causes of death among adolescents in the United States. Past research has linked non-medical prescription opioid use (NMPOU) with adolescent suicide. Less focus has been placed on race and ethnic differences among adolescents impacted by the opioid epidemic. This study examined the relationship of adolescent NMPOU and suicidality, stratified by race. The 2016 National Survey on Drug Use and Health (NSDUH) was used for this study. Weighted multivariate logistic regression analyses were conducted on a sample of 11,489 adolescent respondents to examine the effect of past-year NMPOU with the odds for serious thoughts of suicide, having a suicide plan, and making a suicide attempt. Findings indicated a higher prevalence of suicidality among adolescents who engaged in NMPOU compared to non-users. Adolescent opioid misuse was associated with 68% higher odds for having a suicide plan in the past year (OR = 1.68, 95% CI: [1.07, 2.63], p < 0.05). Interaction analysis found that among Asian adolescents, NMPOU was associated with higher odds for having a suicide plan compared to other race groups (OR=1.53, 95% CI: [1.04, 2.23], p < 0.05). Results indicated that adolescent opioid misuse is a risk factor for suicide, and Asians compared to other race groups were at greater risk. Social workers can serve as a nexus point in effectively engaging at-risk adolescents in substance use and mental health prevention and recovery services.

Distress, Grief, and Functionality following Military Unit Suicide Exposure

Given the high prevalence of suicide within the military context, there is a need to understand the impact of suicide within the military unit and assess factors that mitigate unfavorable outcomes. The aim of this study was to describe characteristics of military service members exposed to unit suicide and to examine demographic and psychosocial factors associated with military suicide exposure. Demographic, psychosocial, and exposure data were collected from 1,555 service members and veterans using an online survey. Additional data on exposure to trauma, closeness to the decedent, and unit social support were collected and analyzed as potential factors influencing grief, psychological distress, and functioning in those exposed to suicide. Service members and veterans who lost more than three unit members to suicide experienced significantly greater psychological distress than participants who lost one unit member to suicide. Lifetime trauma exposure was significantly related to greater distress and functional impairment. Perceived closeness was significantly related to greater grief, while increased unit social support was significantly related to less functional impairment. These findings suggest that suicide postvention efforts should focus on unit members most at risk for negative psychological and functional outcomes.

Adult Suicidal Behaviour of Native Psychiatric Inpatients: A Retrospective, Record-Based Study

Suicidal behaviour is seen in the context of a variety of mental disorders and while many believe that, in general, first episode psychosis is a particularly high-risk period for suicide, no general agreement regarding higher prevalence of suicide in first episode psychosis is achievable. In the present study, suicides and suicide attempts among psychiatric in-patients has been evaluated to assess the general profile of suicidal behaviour among native psychiatric inpatients and probing any relationship between serum cholesterol level and suicidal behaviour

Suicides and Suicide Attempts Among Psychiatric Hospital Inpatients in Iran

Background: Suicidal behavior is seen in the context of a variety of mental disorders. While many believe that, in general, first-episode psychosis is a particularly high-risk period for suicide, no general agreement regarding higher prevalence of suicide in first-episode psychosis is achievable. Objective: In the present study, suicides and suicide attempts among psychiatric in-patients have been evaluated to assess the general profile of suicidal behavior among native psychiatric inpatients and any relationship between serum cholesterol level and suicidal behavior. Methods: Five acute academic wards, which have been specified for admission of first episode adult psychiatric patients, and five acute non-academic wards, which have been specified for admission of recurrent episode adult psychiatric patients, were selected for the current study. All inpatients with suicidal behavior (successful suicide and attempted suicide, in total), during the last five years (2013-2018), were included in the present investigation. Also, the assessment of serum lipids, including triglyceride, cholesterol, low-density lipoprotein and high-density lipoprotein, was done , for comparing the suicidal subjects with non-suicidal ones. Results: Among 19160 psychiatric patients hospitalized in Razi psychiatric hospital during a sixtymonths period, 63 suicidal behaviors, including one successful suicide and sixty-two suicide attempts, were recorded by the safety board of hospital. The most frequent mental illness was bipolar I disorder, which was significantly more prevalent in comparison with other mental disorders (p&lt;0.04, p&lt;0.02, p&lt;0.007, and p&lt;0.003 in comparison with schizophrenia, depression, personality disorders and substance abuse, respectively). Self-mutilation, self-poisoning and hanging were the preferred methods of suicide among 61.11%, 19.44% and 19.44% of cases, respectively. In addition, no significant difference was evident between the first admission and recurrent admission inpatients, totally and separately, particularly with respect to psychotic disorders. Besides, with respect to different components of serum lipids, no specific or significant pattern was evident. Conclusion: While in the present study, the suicidal behavior was significantly more evident in bipolar disorder in comparison with other psychotic or no-psychotic disorders, no significant difference was evident between the first admission and recurrent admission of psychiatric inpatients. Moreover, no significant relationship between suicidal behavior and serum lipids was found .

Making a symbolic gesture: a qualitative examination of self-immolation in Iran

Self-immolation is one of the most dramatic methods of committing suicide. Some regions in Iran have a high prevalence of suicide by this method. This study aims to understand and explore the experience of self-immolated women in Iran. Twenty women have interviewed in the burns centers of three different cities immediately the following hospitalization due self-immolation, and the data was analyzed using conventional content analysis. The results were categorized in three main categories: Cultural background and preparing the stage, making a symbolic gesture and events of the day of the incident. Making a symbolic gesture consists of the critical elements of self-immolation, including the presence of significant others, dramatic presentation of misery, bringing an end to misfortune, proof of innocence, creating a sense of compassion or guilt and inspiration from similar cases. The social situation of women in Iran is contributing to self-immolation through feelings of anger and helplessness.

The Suicidal Patient

Suicidal ideation is a common psychiatric emergency seen across a broad range of patients. Although admission to a dedicated psychiatric unit is preferable, patients with suicidal ideation are often admitted to internal medicine or family medicine services, either for management of comorbid medical conditions or because of a lack of available psychiatry beds. Primary care physicians and emergency physicians are particularly likely to encounter suicidal patients, given their high clinical volume and the relatively high prevalence of suicidality in their community of patients. In addition, many patients who present with nonpsychiatric complaints will also have concurrent suicidal ideation. This review discusses the approach to the patient, and definitive treatment, disposition, and outcomes. Figures show suicide in 2010 was the 10th leading cause of death in the United States, accounting for 38,364 deaths, men are more likely to use firearms and hanging, while women are more likely to attempt suicide by poisoning, and suicide is more common in whites and Native Americans compared to Hispanics or Asians. This review contains 3 figures, 6 tables, and 45 references. Keywords: Suicide, suicidal ideation, depression, overdose, suicidal management, mental health

Stigma in the bereavement experiences of gay men who have lost a partner to suicide

Despite the high prevalence of suicide in gay communities, the impact of suicide on surviving male partners is poorly understood. This article presents a qualitative case study of two gay men who lost a partner to suicide and explores how stigma may shape gay men’s bereavement experiences. Data were collected using photovoice methods and analysed using a thematic approach. Five themes were inductively derived: (1) trying to prevent the inevitable; (2) guilty of keeping secrets; (3) dreams shattered by suicide; (4) abandoned and alone in grief; and (5) a lonesome road to recovery. Within each theme, the article indentifies how stigma-related challenges associated with suicide, mental illness and minority sexual identity shaped gay men’s bereavement experiences. Practice and policy implications are discussed, including how the provision of tailored clinical and peer supports can assist gay men in the bereavement of a same-sex partner to suicide. The findings detailed in this study highlight the need for interventions to de-stigmatise mental illness and suicide within and outside the gay community.

'Hiding their troubles': a qualitative exploration of suicide in Bhutanese refugees in the USA.

Suicide is a major global health concern. Bhutanese refugees resettled in the USA are disproportionately affected by suicide, yet little research has been conducted to identify factors contributing to this vulnerability. This study aims to investigate the issue of suicide of Bhutanese refugee communities via an in-depth qualitative, social-ecological approach. Focus groups were conducted with 83 Bhutanese refugees (adults and children), to explore the perceived causes, and risk and protective factors for suicide, at individual, family, community, and societal levels. Audio recordings were translated and transcribed, and inductive thematic analysis conducted. Themes identified can be situated across all levels of the social-ecological model. Individual thoughts, feelings, and behaviors are only fully understood when considering past experiences, and stressors at other levels of an individual's social ecology. Shifting dynamics and conflict within the family are pervasive and challenging. Within the community, there is a high prevalence of suicide, yet major barriers to communicating with others about distress and suicidality. At the societal level, difficulties relating to acculturation, citizenship, employment and finances, language, and literacy are influential. Two themes cut across several levels of the ecosystem: loss; and isolation, exclusion, and loneliness. This study extends on existing research and highlights the necessity for future intervention models of suicide to move beyond an individual focus, and consider factors at all levels of refugees' social-ecology. Simply focusing treatment at the individual level is not sufficient. Researchers and practitioners should strive for community-driven, culturally relevant, socio-ecological approaches for prevention and treatment.

Addiction and First Psychotic Episode: how to treat them together ?

1. Background Most of young adults or adolescents, when there are hospitalized for a first psychotic episode (FEP) has co-occurring addiction disorders. For the FEP, treating the psychotic trouble is often the first aim, addiction is considered as a second one, caregivers understand substance misuse as a first psychotic trouble consequence [3]. Treatment for FEP can reduced/cessation substance use for half patient [1]. So, there is an underestimation of addiction diagnosis in general psychiatric unit, and lack of integrated specialized addiction care. However, the follow up show that improvement in addictive behaviour is the first step to change the global perception of treatment for psychosis [4]. Adult people with schizophrenia are exposed for abuse, misuse of psychoactiv substance. Prevalence for substance abuse among schizophrenia patients reaches almost 50 % [5]. Without treatment, there is a bad prognostic for psychotic illness but also for addiction trouble. Studies show more relapse in addiction, severe symptoms of psychotic illness and more and longer hospitalisation. These patients present also more emergency admission, increased rate of medical comorbidity, higher prevalence of suicide, Greater rate of unemployement and marginalization [6]. Finally despite the common occurrence between psychotic spectrum illness and substance use disorders, they are often under-recognized and undertreated, leading to poor treatment outcomes [7]. Avoiding this evolution with treatments for addiction and for psychosis is a real challenge for these patients. 2. Method A scientific review was conducted 3. Results and conclusion 50% of patient with FEP, reduce or stop substance use with an Early Intervention only, without specific treatment for addictive behaviour. Nevertheless, during specific treatment for FEP (Early Intervention Service), there is a need for effective and early intervention for cannabis use because: – Use of cannabis during the early stage of psychosis is significantly associated with increased severity of psychotic symptoms, mania, depression and poorer psychosocial functioning. – Continued use of cannabis following the FEP is associated with poorer outcome, on negative and positive psychotic symptoms. For the FEP with a continued substance use after the onset, recommendations are similar to adults, in order to treat them with specialized integrated interventions.

"It's Awful When We Get It Wrong": An Exploratory Qualitative Study of Vocational Rehabilitation Counselors' Perspectives on Suicide.

Despite the high prevalence of suicide among people with disabilities, little research has explored suicide in the context of the vocational rehabilitation (VR) system. We analyzed the responses of 27 VR counselors who responded to an open-ended qualitative prompt regarding their experiences with suicide training and competency. Key themes included a desire for more training on suicide and the experience of seeking and receiving suicide training and experience outside of VR. Responses also underscored the heavy emotional impact of working with suicidal clients, especially when one feels unprepared to do so. These results suggest that it is important to provide VR counselors with resources and training for addressing suicide in their client populations.