High Risk Of Suicide Research Articles

Prevalence of Suicidal Ideation in Patients With COVID-19 Admitted to a Hospital in Qazvin, Iran

Background and Objectives: Many patients with COVID-19 show long-term physical and mental symptoms. This study aims to determine the prevalence of suicidal ideation in patients with COVID-19 hospitalized in a hospital in Qazvin, Iran. Methods: This is a cross-sectional study. The study population consists of all patients with COVID-19 admitted to Bou Ali Sina Hospital in Qazvin city. A two-part questionnaire was used to collect data; the first part surveys demographic characteristics, history of death due to COVID-19 in relatives, history of underlying disease, days of hospitalization, history of intubation, and history of hospitalization in intensive care units. The second part was the Beck Scale for Suicide Ideation. The collected data were analyzed in SPSS software, version 23 using ANOVA and logistic regression analysis. Results: Participants were 206 patients with COVID-19. The data showed that 12.8% of patients had high suicidal ideation. Younger patients were at a high risk of suicide (Mean age: 31.96±12.59 years) (P<0.001). In addition, patients who were single (P<0.001) and had a history of death due to COVID-19 in relatives or friends had higher suicidal ideation (P=0.005). Conclusion: About 12.8% of patients with Covid-19 admitted to the study hospital had a high suicidal ideation. There is no considerable difference between the prevalence of suicidal ideation reported in this study and the data reported for the general population of Iran before the pandemic.

Domestic Violence Experience, Past Depressive Disorder, Unplanned Pregnancy, and Suicide Risk in the First Year Postpartum: Mediating Effect of Postpartum Depression.

This study aimed to examine the relationship between domestic violence, past depressive disorder, unplanned pregnancy, suicide risk, and postpartum depression among Korean women using a mediation model approach. A web-based, cross-sectional survey was performed from September 21 to September 30, 2022. Participants included 1,486 women in their first year postpartum from Chungnam Province, South Korea. The generalized linear model mediation was analyzed using the R-based Jamovi 2.3.21 version program. Of all participants, 8.7% had domestic violence experience, 7.5% had been diagnosed with depressive disorder by the doctor in the past, 33.0% had reported that the last pregnancy was unplanned, 39.9% had postpartum depression, and 11.2% of the participants had a suicide risk. Among the participants with a high risk of suicide, 34.4%, 37.5%, 53.1%, and 96.9% reported experiencing domestic violence, past depressive disorder, an unplanned pregnancy, and postpartum depression, respectively. Postpartum depression partially mediated the relationship between domestic violence, past depressive disorder, and suicide risk and completely mediated the relationship between unplanned pregnancy and suicide risk. Our findings highlight the necessity for screening and early intervention for suicide risk and postpartum depression from pregnancy to the first year postpartum.

Development of an AI-Based Suicide Ideation Prediction Model for People with Disabilities

South Korea has one of the highest suicide rates among countries in the Organisation for Economic Co-Operation and Development, and the suicide rate among people with disabilities is more than twice that of the general population. This study aimed to develop an artificial intelligence-based suicide ideation prediction model for people with disabilities in order to provide a proactive approach for managing high-risk groups and offer evidence for establishing suicide prevention policies. The support vector machine, adaptive boost (AdaBoost), and bidirectional long short-term memory (Bi-LSTM) models were used in this study. Data from the Disability and Life Dynamics Panel for 2018–2021 were used. The performance of the models was evaluated based on the accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). All the prediction models demonstrated excellent performance, with AUC > 0.80 (0.83–0.87). The best-performing models were AdaBoost (0.87) for accuracy, Bi-LSTM (0.90) for sensitivity, and AdaBoost (0.90) for specificity. This study is the first to develop an artificial intelligence-based suicide ideation prediction model for disabled people and is significant in that it suggests ways to pre-emptively manage groups at high risk for suicide, providing evidence for the establishment of suicide prevention policies.

Bipolar Disorder and Suicide

Suicide is a dramatic and frequent consequence of bipolar disorder. Prevention of suicidal behavior involves an assessment of suicidal vulnerability factors (history of suicidal behavior, impulsive personality, etc.), characteristics of depression (agitated depression, a subtype of bipolar disorder, etc.), psychiatric comorbidities, and stress factors. Psychosocial at the same time with the characteristics of suicidal behavior in a depressed subject (severe or repeated gestures in particular) make it possible to direct the diagnosis towards a bipolar disorder rather than a major depressive disorder. In addition to training caregivers to screen for bipolar disorder and assess suicidal behavior, the withdrawal of lethal means, networking, and treatment of depression reduce the risk of suicidal behavior. At the medicinal level, the use of lithium salts could be of particular interest in subjects at high risk of suicide.

Exploring Patient Empowerment in Major Depressive Disorder: Correlations of Trust, Active Role in Shared Decision-Making, and Symptomatology in a Sample of Italian Patients.

Background/Objectives: Empowerment in medicine and psychiatry involves patients gaining control over health-related decisions, improving treatment adherence, outcomes, and satisfaction. This concept is especially significant in psychiatric care due to the complex challenges of mental health conditions, including stigma and impairment of emotional and cognitive functioning. We aim to investigate the correlations between patient trust, decision-making involvement, symptom severity, and perceived empowerment among individuals with Major Depression. Methods: Patients with Major Depressive Disorder were recruited in the "Policlinico G. Rodolico" psychiatry outpatient clinic from November 2022 to June 2023. Inclusion criteria: ages 18-65, ability to consent, stable condition, psychiatric medication history, and recent consultation. Exclusion criteria: psychotic features, bipolar disorder, substance abuse, high suicide risk, and severe comorbidities. Measures included the User Scale for Measuring Empowerment in Mental Health Services (SESM), Trust in Oncologist Scale (TiOS), Clinical Decision-Making Style for Patients (CDMS-P), and Hamilton Depression Rating Scale (HAM-D). Analysis used Kendall's Tau correlation and Two-One-Sided Tests procedure. Results: Seventy-three patients completed the study. No relationship was found between decision-making involvement and perceived empowerment (τ = -0.0625; p = 0.448), or between trust in psychiatrists and empowerment (τ = 0.0747; p = 0.364). An inverse correlation existed between patient involvement in therapy management and trust (τ = -0.2505; p = 0.002). Depression severity inversely correlated with empowerment (τ = -0.2762; p = <.001), but not with trust or decision-making involvement. Conclusions: The lack of significant correlations suggests that decision-making involvement and trust alone may not suffice to enhance empowerment. Trust may encourage patient passivity, while skepticism might drive active involvement. Higher empowerment is associated with less depressive symptoms, highlighting its potential connection with patient outcomes.

Factors Influencing Suicidal Ideation in Persons with Physical Disabilities.

Suicidal ideation is a leading indicator of suicide risk, particularly among persons with disabilities, a population at high risk of suicide. This study aimed to identify factors affecting suicidal ideation among persons with physical disabilities in Korea. Data for this cross-sectional study were obtained from the Disability and Life Dynamics Panel. Eight hundred and twenty-eight persons with physical disabilities were extracted from the data, and seven hundred seventy people who responded to the suicidal ideation question were included in the analysis. Chi-square and multivariate logistic regression analyses were employed. The results show a high percentage of suicidal ideation among persons with physical disabilities (18.5%). Among the general characteristics, more women were found to have suicidal ideation than men, and people in their 40s and 60s had a higher rate of suicidal ideation than other age groups. A lower educational level was found to be related to suicidal ideation. After controlling for general characteristics, depression increased the likelihood of suicidal ideation among individuals with physical disabilities. Economic difficulties and disability acceptance did not relate to suicidal ideation. Based on the results of this study, continuous observation of suicidal ideation in people with physical disabilities and early intervention programs for preventing depression and increasing disability acceptance are considered necessary.

Is too much insight bad for you?

Insight in psychosis is associated with reduced psychotic symptom severity, less coercive treatment and better functioning. Controversially, it has been suggested that insight may lead to depression, higher suicide risk and worse self-perceived quality of life. Future clinical trials are warranted to address this 'insight paradox', particularly the direction of causality.

Stressors and suicidal ideation in low-income adults in Malaysia: A serial mediation analysis of social support and mental health symptoms.

Studies have documented a heightened risk of suicidal ideation in response to stressors, especially among people from socioeconomically disadvantaged backgrounds. However, the mechanisms of this association remain elusive. Drawing on the social deterioration and counteractive models, this study aims to elucidate the pathways linking stressors to suicidal ideation through serial mediation of social support and mental health symptoms in Malaysia. Data were collected from 404 low-income adults (33.2% male and 66.8% female) receiving monthly financial assistance from Malaysia's social welfare department. We employed stressor measures (i.e. financial, family and work), the Oslo Social Support Scale, the Patient Health Questionnaire and the Suicidal Behaviour Questionnaire-Revised. A total of 46.8% of participants reported mild-to-severe anxiety and depressive symptoms, with 11.1% classified as high risk for suicide. Direct and indirect effects were found. After controlling for age and gender, social support and mental health symptoms mediated the link between stressors and suicidal ideation. The serial mediation analysis indicates that stressors are connected to heightened suicidal ideation through a sequence involving insufficient social support, followed by elevated levels of mental health symptoms. Understanding the multifaceted relationships among stressors, social support, mental health symptoms and suicide ideation expands the potential for developing targeted interventions and preventive strategies tailored for vulnerable populations. Clinical work with low-income individuals may include implementing early systematic efforts to develop accessible mental health and integrated care services.

Gender-specific correlates for suicide mortality in people with schizophrenia: a 9-year population-based study

BackgroundSchizophrenia is associated with a high mortality rate due to the high risk of suicide. However, there is still a lack of evidence on the gender-specific risk factors for suicide among people with schizophrenia. In this study, we aimed to measure the sociodemographic and clinical correlates of suicide deaths in different genders among people with schizophrenia.MethodsData on patients with schizophrenia from 2013 to 2021 in Guangzhou, China were obtained from the National Information System for Psychosis (NISP), involving a total of 33,080 patients. Cox regression and Fine-Gray models were used to explore the sociodemographic and clinical risk factors for suicide mortality in different genders.ResultsThe overall age-standardized mortality rates due to suicide were 133.89 (95% CI: 124.31-143.47) per 100,000 person-years for females and 163.25 (95% CI: 152.92-173.59) per 100,000 person-years for males. To be specific, lack of medical insurance, history of non-treatment, and history of suicidal behavior was associated with a higher risk for suicide mortality for females, while an age of 35–54, being hospitalized once, and the age of onset being > 28 years were linked to lower risk for suicide mortality for males. For both genders, a lower risk for suicide mortality was observed in patients at an older age (≥ 55 years) and with a history of hospitalization more than once, and a higher suicide mortality risk was found in married patients and those residing in rural areas.ConclusionThe present study found that gender differences should be taken into account in the development of suicide prevention programs for people with schizophrenia, and future research is still required to verify our preliminary results.

The association of pain screening and pain level with suicide among US veterans with comorbid musculoskeletal and bipolar disorder diagnoses

BackgroundHigh suicide rates are documented among persons with bipolar disorder diagnoses and pain diagnoses, but few studies have examined the association of pain with suicide mortality in individuals with comorbid pain and bipolar disorders. This study assessed the association of pain screening and pain severity with suicide mortality among veterans with comorbid bipolar and musculoskeletal disorder (MSD) diagnoses. MethodsA retrospective cohort study was conducted on 168,021 patients within the Veterans Health Administration (VHA) who received an MSD diagnosis from 2000 to 2015 and had a bipolar disorder diagnosis. Pain severity, comorbidities, demographics, and suicide mortality were extracted from VHA databases. Poisson regression examined relative risk of suicide by the presence pain screening and pain severity ratings. ResultsPain was assessed in 72.73 % of veterans. Suicide risk was greater in those not assessed (0.98 % versus 0.77 % in assessed group). However, this result did not persist after adjusting for covariates (RR = 1.06). Among those assessed, higher suicide risk was associated with moderate (RR = 1.10), severe pain (RR = 1.06), and no pain (reference) relative to mild pain (RR = 0.99). Major depression, substance use disorders, and prescribed opioids and benzodiazepines increased risk. LimitationsData were obtained from medical records; diagnoses were not confirmed via formal assessment, and no information was available on actual medication use or purpose. Over 25 % of the sample were missing pain severity ratings, which could have affected results. ConclusionsSuicide risk factors among persons with bipolar disorder are complex and multifactorial. Providers should prioritize suicide prevention efforts following new onset or worsening pain.

The Relationship Between Attention and Suicidal Ideation Among Patients With Adult-Onset Chronic Schizophrenia.

Patients with chronic schizophrenia (SZ) have a high risk of suicide, and their cognition function is impaired. We aimed to explore the relationship between attention and suicidal ideation among patients with adult-onset chronic SZ. A total of 416 patients with adult-onset chronic SZ were enrolled in this study. We divided patients into suicidal ideation group and non-suicidal ideation group according to the evaluation results of the Beck Scale for Suicide Ideation. Psychotic symptoms were measured by Positive and Negative Syndrome Scale (PANSS), and cognitive function was measured by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Insomnia symptoms were measured by Insomnia Severity Index (ISI). Age was significantly different (44.28±10.58 vs. 48.46±12.23, t=10.64, p=0.001) between the two groups, and the patients with suicidal ideation were younger than patients without suicidal ideation. The positive symptom scores of the PANSS, the scores of ISI, and attention scores of RBANS were higher in patients with suicidal ideation than patients without suicidal ideation (17.30±5.67 vs. 15.58±4.90, t=9.633, p=0.002; 3.00 [1.00-6.00] vs. 2.00 [1.00-3.50], Z=-2.048, p=0.041; 81.80±14.99 vs. 76.91±13.88, t=10.101, p=0.002). In the logistic regression analysis, age (odds ratio [OR], 0.973; 95% confidence interval [95%CI], [0.955-0.992]; p=0.005), positive symptom scores of PANSS (OR, 1.063; 95%CI, [1.019-1.109]; p=0.005), ISI scores (OR, 1.098; 95%CI, [1.037-1.163]; p=0.001), and attention scores of RBANS (OR, 1.029; 95%CI, [1.013-1.047]; p=0.001) were independently associated with the occurrence of suicidal ideation among patients with adult-onset chronic SZ. High attention scores of RBANS were a risk factor for suicidal ideation among patients with adult-onset chronic SZ.

Validation of the Spanish Version of the Nurses' Global Assessment of Suicide Risk Scale (NGAR) in Nonclinical Settings.

To validate the Nurses' Global Assessment of Suicide Risk (NGASR) in Spanish for an early detection identification of the risk of suicide. A descriptive cross-sectional survey design was used for this work through face-to-face clinical interviews with each participant. Following EQUATOR TRIPOD checklist, the index was translated and administered to a sample of 30 mental health experts and 151 university students. To examine the psychometric properties of the NGASR, the questionnaires also included other standardised scales such as BDI, SBQ and SEEQ. The research was conducted between 2022 and 2023. The content validity index-scale (CVI-S) was 81% and the NGASR presented high reliability with a Kuder-Richardson coefficient of 0.83. Exploratory factor analysis (EFA) returned a six-factor structure for the NGASR items. The results showed that 21.7% of the students assessed had an intermediate to very high suicide risk. This study also revealed that people with mental health problems and depression had a higher risk of suicide. Beyond the sociolinguistic Spanish validation of the scale, it should be noted that it is carried out on a young population in a nonclinical environment, something that many authors have been requesting in their previous validations. The NGASR is a useful prevention tool in university educational settings.

The Social Determinants of Suicide among Female Service Members and Veterans : Running Title: Social Determinants of Suicide.

Evaluate the social determinants of health (SDOH) associated with suicidality among female Service Members and Veterans (SMV) in Arizona. Used data from a statewide Arizona Veteran Survey (n = 1,134) to analyze SDOH associated with suicidality (any self-report of suicidal ideation, suicide attempt, or calling a crisis line). Response data were cross-tabulated and analyzed for statistical significance using a chi-square test with a p-value of p < 0.05. Depression, disability, barriers to treatment, housing instability, feelings of loneliness, and more were associated with increased suicidality among respondents. Substance use within the last 30 days, social support, and Veteran social support were not found to be significantly associated with suicidality. Female SMV populations experiencing social, economic, and health disparities appear to be at higher risk for suicide. These findings suggest that future suicide prevention efforts may be more effective if tailored towards populations in need of additional support and social services.

Latent profile analysis of transdiagnostic emotional distress, suicidality, and resilience in first responders

BackgroundFirst responders (i.e., law enforcement officers, firefighters, and emergency medical technicians/paramedics), experience significantly higher occupational trauma exposure than U.S. adult workers outside these fields, leading to increased risks of comorbid mental health disorders. Repeated and intense trauma exposure may combine with personal factors to place them at higher risk for suicide. Conversely, first responders may show higher levels of psychological resilience in the face of occupational trauma experiences. Some research exists on resilience, though little is known about suicide resilience in first responder populations. MethodsWe used latent profile analysis (LPA) on a treatment-seeking sample of first responders (N = 340) with measures of posttraumatic stress disorder (PTSD), generalized anxiety, depression, suicidality, and resilience. ResultsWe determined the best fit was a five-class solution, including the following emotional distress categories: minimal (19 %), mild (33 %), moderate (8 %), moderately severe (27 %), and severe (13 %) emotional distress. In this study, all multivariate analyses of variance (MANOVAs) were statistically significant and had large effect sizes ranging from the lowest (resilience) to the largest (depression). LimitationsWe used self-report assessments and not a clinical interview. Also, we did not have data on measures of substance use, emotional dysregulation (e.g., attachment), or trauma exposure. ConclusionsThis study underscores the critical need for developing and implementing transdiagnostic interventions that not only address the spectrum of emotional distress and suicidality but also actively enhance resilience among treatment-seeking first responders.

The Impact of Pain, Threat Perception and Emotional Distress on Suicide Risk in Individuals with Colorectal Cancer.

Colorectal cancer (CRC) can significantly impact mental health, increasing suicide risk. Variables such as pain and threat perception may be crucial. This study aims to identify predictors of suicide risk in individuals with CRC. A total of 71 participants (76.06% men) aged 27 to 88 years (M = 65.18, SD = 12.02) were assessed using the SF-36 for pain, the Brief Illness Perception Questionnaire (B-IPQ) for threat perception, the Hospital Anxiety and Depression Scale (HADS) for emotional distress, and the Plutchik suicide risk scale for suicide risk. Descriptive, comparative, and correlational analyses were performed, followed by a linear regression analysis. Nearly 20% of participants exhibited high suicide risk. There was a moderate-to-high association between suicide risk and the perception of threat, pain, and emotional distress. The linear regression model explained 39% of the variance in suicide risk, with threat perception, pain, and emotional distress as significant predictors. These results indicate the need for multidisciplinary care for individuals with CRC, including emotional support from health psychologists, and holistic, human-centered care from nursing and medical professionals. Future research is necessary to further explore these relationships and improve patient care strategies.

The importance of oxidative stress in the pathogenesis and treatment of bipolar affective disorder: a review of the literature

Introduction: Bipolar affective disorder (BD), also known as manic-depressive illness, is a chronic and recurrent psychiatric disorder characterised by significant mood disturbances. It is one of the leading causes of disability worldwide and is associated with a high risk of suicide. Recent studies highlight the role of oxidative stress (OS) in the pathogenesis of BD. The body's pro/antioxidant imbalance adversely affects cellular and molecular processes. Aim: The aim of this review is to synthesise the current state of knowledge on the role of OS in the aetiology and course of BD, including key biomarkers and potential therapeutic interventions. Methods: A review of the scientific literature was conducted, including articles published between 2000 and 2024. Searches were conducted in PubMed, Scopus and Web of Science databases, using the following keywords: 'bipolar disorder', 'oxidative stress', 'antioxidants', 'biomarkers', 'mitochondrial dysfunction', 'redox homeostasis', 'treatment'. Results: Results indicate that patients with BD have elevated levels of OS markers, including increased lipid peroxidation, altered antioxidant enzyme activity and impaired redox homeostasis. Treatment with lithium and other mood stabilisers may modulate levels of OS markers, which is one potential mechanism of drug action. However, inconclusive data suggest the need for further research to clarify the relationship between OS and BD. Conclusions: OS plays an important role in the pathophysiology of BD, offering potential directions for therapeutic interventions. Understanding the complex interactions between OS and BD may lead to the development of more targeted therapies aimed at reducing oxidative damage and improving patient health. Keywords: oxidative stress, bipolar affective disorder, redox, lipid peroxidation, protein damage, antioxidants, lithium

The BRIDGE project: a feasibility randomised controlled trial of brief, intensive assessment and integrated formulation for young people (age 14-24) with features of borderline personality disorder (Protocol).

Borderline personality disorder (BPD) is a severe mental disorder that is characterised by a pervasive pattern of instability of interpersonal relationships, self-image, and mood as well as marked impulsivity. BPD has its peak incidence and prevalence from puberty through to emerging adulthood. BPD is a controversial diagnosis in young people. Commonly, young people with BPD are under-diagnosed, untreated, are not in employment or training and are estranged from their families. Yet, they have complex needs and are at high suicide risk. To assess the feasibility of conducting a randomised controlled trial (f-RCT) of a BRIDGE, a brief intervention programme for young people (age 14-24) with BPD symptoms (sub-threshold or threshold) in a community sample from Scotland, UK. Forty young people (age 14-24) meeting criteria for BPD symptoms, will be randomised in a 1:1 ratio to receive either a) the BRIDGE intervention plus service-as-usual or b) service-as-usual alone. Follow up will be 12 weeks and 24 weeks post-intervention. The study is carried out between 2021 to 2024. The two primary outcomes of the MQ funded, BRIDGE project (f-RCT) are i. recruitment rates and ii. retention rates. The study will present the acceptability and appropriateness of our putative outcome measures for a future definitive randomised controlled trial (d-RCT). Young people with BPD benefit from good clinical care and targeted intervention, however are regularly missed or mislabelled. The community based feasibility trial would provide initial evidence of variable needs of young people with complex needs, who maybe missed or excluded from services as they don't "fit" a model/diagnosis. Workable multi-agency service model proposed in the trial would be a major advance in understanding care pathways regardless of trial outcome. ClinicalTrial.gov, identifier NCT05023447.

Negative and positive urgency as pathways in the intergenerational transmission of suicide risk in childhood.

Parental suicide attempts and suicide death increase suicide risk in their offspring. High levels of impulsivity have been observed in families at high risk for suicide. Impulsivity, a highly heritable trait that is especially elevated in childhood, is frequently measured with the UPPS-P Impulsive Behavior Scale, which includes negative urgency, positive urgency, sensation seeking, premeditation, and perseverance. Our study examined the association between the UPPS-P facets and suicide ideation (without suicide attempts) and suicide attempts at baseline and first-time endorsement within the next two years in childhood. We also examined how the UPPS-P facets mediated the association between parental suicide attempts and suicide death and offspring first-time suicide ideation and attempts at follow-up. The sample was 9,194 children (48.4% female; 9-10 years old) from the Adolescent Brain Cognitive Development (ABCD) study, assessed yearly three times. At Time 1 (T1), caregivers reported on suicide attempts and suicide deaths (combined) of the biological parents. Caregivers and children reported on suicide ideation and attempts in the KSADS-PL DSM-5 at each time point, T1 and follow-up (T2 and/or T3). The Short UPPS-P Scale (child-report) assessed the impulsivity facets at T1, which were computed as latent variables. At T1, 6.7% of children had a parent who had attempted or died by suicide. Most UPPS-P facets were associated with suicide ideation and attempts at T1 and T2/T3. In adjusted models, parental suicide attempts and suicide death were associated with offspring negative and positive urgency. In mediation models, parental suicide attempts and suicide death had an indirect effect on offspring first-time suicide ideation at T2/T3 through negative urgency (OR = 1.04; 95% CI, 1.01-1.08) and positive urgency (OR = 1.03, 95% CI, 1.01-1.05). Similar results were found for first-time suicide attempts at T2/T3. Our findings support an impulsive pathway in the familial transmission of suicide risk. For all youth, interventions that target multiple UPPS-P facets may help prevent or reduce suicide risk. For offspring whose parents have attempted or died by suicide, clinicians should pay particular attention to children who impulsively act on extreme emotions, as they may be at higher suicide risk.

Measuring psychache as a suicide risk variable: A Mokken analysis of the Holden's Psychache Scale

BackgroundThe Psychache Scale (PAS) is a questionnaire measuring trait-level psychological pain with satisfactory internal consistency and a strong correlation with suicidal ideation severity. However, inconsistent results have been reported for the PAS dimensionality. In the present study we used a non-parametric item response theory model, called Mokken Scale Analysis (MSA), to refine an unidimensional version of the PAS. MethodsThe sample was composed of 400 Italian adults (312 females and 88 males) nonrandomly recruited from the general population. ResultsA final set of 10 items satisfied the unidimensionality, local independence, and monotonicity assumptions, although it did not satisfy the double monotonicity assumption. The internal consistency of the PAS-10 was satisfactory (ordinal alpha = 0.98, ω = 0.97, and AVE = 0.82), and ROC curves analysis indicated good discriminant validity when differentiating participants with higher suicide risk from those with lower suicide risk. LimitationsStructural invariance between nonclinical and clinical samples was not investigated, and the presence of suicide ideation and behaviors was assessed with self-report measures with potential under-reporting of the phenomenon. ConclusionThe PAS-10 resulted to be a potentially valid and unidimensional measure of psychological pain (i.e., psychache) that could be used to screen adults at higher risk for suicide. Future studies are needed to investigate psychometric properties of the PAS-10 in clinical samples and to replicate results in independent samples.

Suicidality among clients in a network of coordinated specialty care (CSC) programs for first-episode psychosis: Rates, changes in rates, and their predictors

BackgroundPeople experiencing their first episode of psychosis have high risk of suicide, and programs specializing in early psychosis have not always achieved reduced risk. The present study analyzes patterns of suicide ideation, self-harm, and suicide attempts within the Connection Learning Healthcare System of 23 early psychosis programs in Pennsylvania and Maryland that follow the Coordinated Specialty Care treatment model. MethodPeople with first episode psychosis (n = 1101) were assessed at admission and every six months using a standardized battery that included self-reported past-month ideation and clinician-reported past-six-month ideation, self-harm, and suicide attempts. ResultsAt admission, there were 28 % rates of self-reported past-month suicide ideation and 52 % rates clinician-reported past-six-month suicide ideation, 23 % rate of clinician-reported self-harm, and 15 % rate of attempts. After the first six months of treatment there were significantly lower rates of clinician-reported suicidality (with reductions of at least 77 %), and after the first year of treatment there was significantly lower self-reported ideation (with approximately 54 % reporting lower past-month ideation). Changes were not accounted for by differential early discharge. A range of psychosocial variables predicted within- and between-subject variability in suicidality. Social and role functioning, depressive symptom severity, and a sense of recovery were significant within-subject predictors of all four measures of suicidality. ConclusionsCompared to admission, we observed substantially lower rates of suicidality within the first year of treatment for clients with first episode psychosis in Coordinated Specialty Care. Reductions were predicted by some of the variables targeted by the treatment model.