Suicide Prevention Interventions Research Articles

Early onset marijuana use and suicidal ideation among African American college students

Between 2013 and 2019 the suicide rate for African American young persons 15–24 years of age rose by 47% for males and 59% for females. Presently, little is known about factors that contribute to the suicidal behavior of African Americans in late adolescence and emerging adulthood. However, considering the coinciding increase in high potency marijuana use among African American young persons and literature suggesting a potential link between marijuana use and suicidal behavior, we examined early onset marijuana use as a risk factor for suicidal ideation. The sample included 221African American students (70% female and M age = 20.3, SD = 1.97) attending an HBCU between 2019 and 2020. We employed multivariable logistic regression analysis that included suicidal ideation as the outcome variable and early onset marijuana use as the explanatory variable, while controlling for demographic factors and mental health treatment status. Approximately 19% of the sample reported suicidal ideation. Early onset marijuana use was reported by 28% of students. Compared to students who never used marijuana, early onset users were three times as likely to report suicidal ideation (AOR = 3.33, 95% CI = 1.06–10.44). In conclusion, early onset marijuana use may place African American young persons at increased risk for suicidal ideation. Marijuana use may be an important malleable risk factor that can be targeted in suicide prevention interventions designed for African American college students. More research is warranted.

Assessing Detection of Children With Suicide-Related Emergencies: Evaluation and Development of Computable Phenotyping Approaches.

Although suicide is a leading cause of death among children, the optimal approach for using health care data sets to detect suicide-related emergencies among children is not known. This study aimed to assess the performance of suicide-related International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and suicide-related chief complaint in detecting self-injurious thoughts and behaviors (SITB) among children compared with clinician chart review. The study also aimed to examine variations in performance by child sociodemographics and type of self-injury, as well as develop machine learning models trained on codified health record data (features) and clinician chart review (gold standard) and test model detection performance. A gold standard classification of suicide-related emergencies was determined through clinician manual review of clinical notes from 600 emergency department visits between 2015 and 2019 by children aged 10 to 17 years. Visits classified with nonfatal suicide attempt or intentional self-harm using the Centers for Disease Control and Prevention surveillance case definition list of ICD-10-CM codes and suicide-related chief complaint were compared with the gold standard classification. Machine learning classifiers (least absolute shrinkage and selection operator-penalized logistic regression and random forest) were then trained and tested using codified health record data (eg, child sociodemographics, medications, disposition, and laboratory testing) and the gold standard classification. The accuracy, sensitivity, and specificity of each detection approach and relative importance of features were examined. SITB accounted for 47.3% (284/600) of the visits. Suicide-related diagnostic codes missed nearly one-third (82/284, 28.9%) and suicide-related chief complaints missed more than half (153/284, 53.9%) of the children presenting to emergency departments with SITB. Sensitivity was significantly lower for male children than for female children (0.69, 95% CI 0.61-0.77 vs 0.84, 95% CI 0.78-0.90, respectively) and for preteens compared with adolescents (0.66, 95% CI 0.54-0.78 vs 0.86, 95% CI 0.80-0.92, respectively). Specificity was significantly lower for detecting preparatory acts (0.68, 95% CI 0.64-0.72) and attempts (0.67, 95% CI 0.63-0.71) than for detecting ideation (0.79, 95% CI 0.75-0.82). Machine learning-based models significantly improved the sensitivity of detection compared with suicide-related codes and chief complaint alone. Models considering all 84 features performed similarly to models considering only mental health-related ICD-10-CM codes and chief complaints (34 features) and models considering non-ICD-10-CM code indicators and mental health-related chief complaints (53 features). The capacity to detect children with SITB may be strengthened by applying a machine learning-based approach to codified health record data. To improve integration between clinical research informatics and child mental health care, future research is needed to evaluate the potential benefits of implementing detection approaches at the point of care and identifying precise targets for suicide prevention interventions in children.

Machine learning approaches for predicting suicidal behaviors among university students in Bangladesh during the COVID-19 pandemic: A cross-sectional study.

Psychological and behavioral stress has increased enormously during Coronavirus Disease 2019 (COVID-19) pandemic. However, early prediction and intervention to address psychological distress and suicidal behaviors are crucial to prevent suicide-related deaths. This study aimed to develop a machine algorithm to predict suicidal behaviors and identify essential predictors of suicidal behaviors among university students in Bangladesh during the COVID-19 pandemic. An anonymous online survey was conducted among university students in Bangladesh from June 1 to June 30, 2022. A total of 2391 university students completed and submitted the questionnaires. Five different Machine Learning models (MLMs) were applied to develop a suitable algorithm for predicting suicidal behaviors among university students. In predicting suicidal behaviors, the most crucial background and demographic features were relationship status, friendly environment in the family, family income, family type, and sex. In addition, features related to the impact of the COVID-19 pandemic were identified as job loss, economic loss, and loss of family/relatives due to COVID-19. Moreover, factors related to mental health include depression, anxiety, stress, and insomnia. The performance evaluation and comparison of the MLM showed that all models behaved consistently and were comparable in predicting suicidal risk. However, the Support Vector Machine was the best and most consistent performing model among all MLMs in terms of accuracy (79%), Kappa (0.59), receiver operating characteristic (0.89), sensitivity (0.81), and specificity (0.81). Support Vector Machine is the best-performing model for predicting suicidal risks among university students in Bangladesh and can help in designing appropriate and timely suicide prevention interventions.

Systems resilience in the implementation of a large-scale suicide prevention intervention: a qualitative study using a multilevel theoretical approach

BackgroundResilience, the capacity to adapt and respond to challenges and disturbances, is now considered fundamental to understanding how healthcare systems maintain required levels of performance across varying conditions. Limited research has examined healthcare resilience in the context of implementing healthcare improvement programs across multiple system levels, particularly within community-based mental health settings or systems. In this study, we explored resilient characteristics across varying system levels (individual, team, management) during the implementation of a large-scale community-based suicide prevention intervention.MethodsSemi-structured interviews (n=53) were conducted with coordinating teams from the four intervention regions and the central implementation management team. Data were audio-recorded, transcribed, and imported into NVivo for analysis. A thematic analysis of eight transcripts involving thirteen key personnel was conducted using a deductive approach to identify characteristics of resilience across multiple system levels and an inductive approach to uncover both impediments to, and strategies that supported, resilient performance during the implementation of the suicide prevention intervention.ResultsNumerous impediments to resilient performance were identified (e.g., complexity of the intervention, and incompatible goals and priorities between system levels). Consistent with the adopted theoretical framework, indicators of resilient performance relating to anticipation, sensemaking, adaptation and tradeoffs were identified at multiple system levels. At each of the system levels, distinctive strategies were identified that promoted resilience. At the individual and team levels, several key strategies were used by the project coordinators to promote resilience, such as building relationships and networks and carefully prioritising available resources. At the management level, strategies included teambuilding, collaborative learning, building relationships with external stakeholders, monitoring progress and providing feedback. The results also suggested that resilience at one level can shape resilience at other levels in complex ways; most notably we identified that there can be a downside to resilience, with negative consequences including stress and burnout, among individuals enacting resilience.ConclusionsThe importance of considering resilience from a multilevel systems perspective, as well as implications for theory and future research, are discussed.

Evaluating the efficacy of a community participatory intervention to prevent suicide in Thailand: a randomised controlled trial protocol

IntroductionThe age-standardised suicide mortality rate in Thailand has been stable at a high level in recent years, highlighting the need for suicide prevention interventions. In Thailand, community involvement plays a...

Moral Injury and Suicide Attempts in Nigerian Military Veterans

Military suicide prevention and control has become a priority to military authorities due to its increasing rates and consequences. However, there is still paucity of research examining associated factors that put veterans at risk for suicidal attempts. This study examined association between moral injury, mental health outcomes, contextual factors (pre-deployment ideation, post-deployment duration) and suicidal attempts by rank in Nigerian military veterans. A total of 582 purposively sampled military veterans who were exposed to insurgency completed a cross-sectional survey and standardised instruments were utilised to assess study variables. To examine associations of exposure to potentially morally injurious events (PMIEs; witnessing, perpetrating, and betrayal), control variables and suicidal attempts, we estimated two series of multivariable binary logistic regressions stratified by rank, with suicide attempt as the dependent variable. Results indicated that potentially morally injurious events, particularly due to perpetration was the greatest risk factor for suicidal attempts for both enlisted and officers. Enlisted veterans who reported perpetration (OR1.9, 95%CI; 1.1-2.8) and betrayal (OR-1.7,95%CI; 1.2-2.6) were more likely to report suicidal attempts than those who denied perpetration and betrayal. Witnessing morally injurious events emerged as a significant risk factor for suicidal attempts in military officers (AOR = 1.54, 95% CI 1.2-1.8) but not in the enlisted veterans. The fully adjusted model revealed no significant association between moral injury due to betrayal and suicide attempts after post-deployment other factors were controlled. Military authorities should give more attention to moral injury when assessing and designing intervention for suicide prevention, especially among enlisted veterans.

Simulation Models for Suicide Prevention: A Survey of the State-of-the-Art.

Suicide is a leading cause of death and a global public health problem, representing more than one in every 100 deaths in 2019. Modeling and Simulation (M&S) is widely used to address public health problems, and numerous simulation models have investigated the complex, dependent, and dynamic risk factors contributing to suicide. However, no review has been dedicated to these models, which prevents modelers from effectively learning from each other and raises the risk of redundant efforts. To guide the development of future models, in this paper we perform the first scoping review of simulation models for suicide prevention. Examining ten articles, we focus on three practical questions. First, which interventions are supported by previous models? We found that four groups of models collectively support 53 interventions. We examined these interventions through the lens of global recommendations for suicide prevention, highlighting future areas for model development. Second, what are the obstacles preventing model application? We noted the absence of cost effectiveness in all models reviewed, meaning that certain simulated interventions may be infeasible. Moreover, we found that most models do not account for different effects of suicide prevention interventions across demographic groups. Third, how much confidence can we place in the models? We evaluated models according to four best practices for simulation, leading to nuanced findings that, despite their current limitations, the current simulation models are powerful tools for understanding the complexity of suicide and evaluating suicide prevention interventions.

Relationship of stress-reactive cortisol to suicidal intent of prior attempts in major depression

Higher intent suicide attempts carry elevated risk of future suicidal behavior. Abnormal functioning of the hypothalamic-pituitary-adrenal (HPA) axis is both linked to nonfatal suicidal behavior and suicide deaths in major depressive disorder. Few studies, however, have identified biological markers of a high-intent suicidal subgroup. We examined HPA axis output and reactivity to the Trier Social Stress Test (TSST) via salivary cortisol in depressed individuals (N=68) with a suicide attempt (SA) history. A median split of higher and lower suicidal intent scores was used to define groups. Individuals with high intent SA had attenuated total cortisol output (AUCg), F(1,60)=10.04, SE=5.095, p=.003, and lower HPA-axis stress responsivity to the TSST (AUCi), F(1,60)=4.50, SE=4.604, p=.039, compared with the low intent SA group. The high intent group also reported more pronounced negative affect than the low intent group (F[1,61]=6.413, SE=10.55, p=.014) both at baseline (meandiff=22.32, p=.038) and in response to the stressor task (meandiff=37.62, p=.003). Vulnerability to suicidal behavior in high-intent individuals may be related to the combined profile of impaired physiological responses to stress and greater negative affectivity. This clinical and biologic subgroup may benefit from targeted suicide prevention interventions.

Efficacy of a digitally supported regional systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands

ObjectiveWe evaluated the effect of a digitally supported systems intervention for suicide prevention (SUPREMOCOL) in Noord-Brabant, the Netherlands. MethodNon-randomized stepped wedge trial design (SWTD). Stepwise implementation in the five subregions of the systems intervention. Pre-post analysis for the whole province (Exact Rate Ratio Test, Poisson count). SWTD Hazard Ratios of suicides per person-years for subregional analysis of control versus intervention conditions over five times three months. Sensitivity analysis. ResultsSuicide rates dropped 17.8% (p = .013) from 14.4 suicides per 100,000 before the start of implementation of the systems intervention (2017), to 11.9 (2018) and 11.8 (2019) per 100, during implementation; a significant reduction (p = .043) compared to no changes in the rest of the Netherlands. Suicide rates dropped further by 21.5% (p = .002) to 11.3 suicides per 100,000 during sustained implementation in 2021. Sensitivity analysis confirmed the reduction (p = .02). The SWTD analysis over 15 months in 2018–2019 did not show a significant association of this reduction with implementation per subregional level, probably due to insufficient power given the short SWTD timeframe for implementation and low suicide rates per subregion. ConclusionsDuring the SUPREMOCOL systems intervention, over four years, there was a sustained and significant reduction of suicides in Noord-Brabant.

Effective suicide prevention interventions and their significance for the Dutch work field and the National Agenda on Suicide Prevention

SamenvattingDit artikel geeft een overzicht van effectieve suïcidepreventie-interventies en hun betekenis voor het Nederlandse werkveld en de Landelijke Agenda Suïcidepreventie. We bespreken een in 2020 gepubliceerde systematische review die het effect van preventieve interventies op suïcides en suïcidepogingen evalueerde, en geven een update van de ontwikkelingen daarna. Zestien onderzoeken met 252.932 participanten lieten zien dat er effectieve suïcidepreventie-interventies bestaan, zowel voor het voorkómen van suïcides, als van suïcidepogingen. Multi-level-interventies hebben grotere effecten dan uni-level-interventies. Vooral keteninterventies die nadrukkelijk de verbinding tussen identificatie van mensen met suïciderisico op populatieniveau en toegang tot specialistische zorg leggen, verdienen landelijke prioriteit. Een digitaal beslissingsondersteunend instrument voor hulpverleners en ketenpartners van alle niveaus kan uitkomst bieden. Dit instrument werd ontwikkeld binnen SUPREMOCOL, een onderzoek naar de effectiviteit van een systeeminterventie voor suïcidepreventie, uitgevoerd in de provincie Noord-Brabant, dat significante resultaten had in het voorkómen van suïcide. Het is het enige wetenschappelijk onderzoek in Nederland dat expliciet suïcide en suïcidepogingen als uitkomsten van een suïcidepreventie-interventie evalueert. In Nederland is dat nodig in het kader van de Landelijke Agenda Suïcidepreventie.

HHS awards funding to states, tribes and colleges to prevent youth suicide

The U.S. Department of Health and Human Services (HHS) on June 1, through the Substance Abuse and Mental Health Services Administration, awarded $5.9 million to states, tribes and college campuses for youth suicide prevention programs. Of the total $5.9 million, $3.6 million was awarded to states and tribes under the Garrett Lee Smith (GLS) State/Tribal Youth Suicide Prevention and Early Intervention Program. The remaining $2.3 million was awarded to college campuses under the GLS Campus Suicide Prevention Program, which enhances mental health services for all college students, including those at risk for suicide, depression, serious mental illness/serious emotional disturbances, and/or substance use disorders that can lead to school failure.

Promoting Engagement With Smartphone Apps for Suicidal Ideation in Young People: Development of an Adjunctive Strategy Using a Lived Experience Participatory Design Approach.

Suicide among young people is a worrying public health concern. Despite this, there is a lack of suitable interventions aligned with the needs of this priority population. Emerging evidence supports the effectiveness of digital interventions in alleviating the severity of suicidal thoughts. However, their efficacy may be undermined by poor engagement. Technology-supported strategies (eg, electronic prompts and reminders) have been deployed alongside digital interventions to increase engagement with the latter. However, evidence of their efficacy is inconclusive. User-centered design approaches may be key to developing feasible and effective engagement strategies. Currently, no study has been published on how such an approach might be expressly applied toward developing strategies for promoting engagement with digital interventions. This study aimed to detail the processes and activities involved in developing an adjunctive strategy for promoting engagement with LifeBuoy-a smartphone app that helps young people manage suicidal thoughts. Development of the engagement strategy took place in 2 phases. The discovery phase aimed to create an initial prototype by synthesizing earlier findings-from 2 systematic reviews and a cross-sectional survey of the broader mental health app user population-with qualitative insights from LifeBuoy users. A total of 16 web-based interviews were conducted with young people who participated in the LifeBuoy trial. Following the discovery phase, 3 interviewees were invited by the research team to take part in the workshops in the design phase, which sought to create a final prototype by making iterative improvements to the initial prototype. These improvements were conducted over 2 workshops. Thematic analysis was used to analyze the qualitative data obtained from the interviews and workshops. Main themes from the interviews centered around the characteristics of the strategy, timing of notifications, and suitability of social media platforms. Subsequently, themes that emerged from the design workshops emphasized having a wider variety of content, greater visual consistency with LifeBuoy, and a component with more detailed information to cater to users with greater informational needs. Thus, refinements to the prototype were focused on (1) improving the succinctness, variety, and practical value of Instagram content, (2) creating a blog containing articles contributed by mental health professionals and young people with lived experience of suicide, and (3) standardizing the use of marine-themed color palettes across the Instagram and blog components. This is the first study to describe the development of a technology-supported adjunctive strategy for promoting engagement with a digital intervention. It was developed by integrating perspectives from end users with lived experience of suicide with evidence from the existing literature. The development process documented in this study may be useful for guiding similar projects aimed at supporting the use of digital interventions for suicide prevention or mental health.

Impact of different interventions on preventing suicide and suicide attempt among children and adolescents in the United States: a microsimulation model study.

Despite considerable investment in suicide prevention since 2001, there is limited evidence for the effect of suicide prevention interventions among children and adolescents. This study aimed to estimate the potential population impact of different interventions in preventing suicide-related behaviors in children and adolescents. A microsimulation model study used data from national surveys and clinical trials to emulate the dynamic processes of developing depression and care-seeking behaviors among a US sample of children and adolescents. The simulation model examined the effect of four hypothetical suicide prevention interventions on preventing suicide and suicide attempt in children and adolescents as follows: (1) reduce untreated depression by 20, 50, and 80% through depression screening; (2) increase the proportion of acute-phase treatment completion to 90% (i.e., reduce treatment attrition); (3) suicide screening and treatment among the depressed individuals; and (4) suicide screening and treatment to 20, 50, and 80% of individuals in medical care settings. The model without any intervention simulated was the baseline. We estimated the difference in the suicide rate and risk of suicide attempts in children and adolescents between baseline and different interventions. No significant reduction in the suicide rate was observed for any of the interventions. A significant decrease in the risk of suicide attempt was observed for reducing untreated depression by 80%, and for suicide screening to individuals in medical settings as follows: 20% screened: -0.68% (95% credible interval (CI): -1.05%, -0.56%), 50% screened: -1.47% (95% CI: -2.00%, -1.34%), and 80% screened: -2.14% (95% CI: -2.48%, -2.08%). Combined with 90% completion of acute-phase treatment, the risk of suicide attempt changed by -0.33% (95% CI: -0.92%, 0.04%), -0.56% (95% CI: -1.06%, -0.17%), and -0.78% (95% CI: -1.29%, -0.40%) for reducing untreated depression by 20, 50, and 80%, respectively. Combined with suicide screening and treatment among the depressed, the risk of suicide attempt changed by -0.27% (95% CI: -0.dd%, -0.16%), -0.66% (95% CI: -0.90%, -0.46%), and -0.90% (95% CI: -1.10%, -0.69%) for reducing untreated depression by 20, 50, and 80%, respectively. Reducing undertreatment (the untreated and dropout) of depression and suicide screening and treatment in medical care settings may be effective in preventing suicide-related behaviors in children and adolescents.

Implementing Peer Specialists in Suicide Prevention Efforts in the Veterans Health Administration.

The Veterans Health Administration (VHA) recognizes peer support as an underused intervention in suicide prevention. PREVAIL is a peer-based suicide prevention intervention that was designed and piloted with non-veteran patients recently hospitalized for suicidal thoughts or behaviors. The purpose of this study was to elicit veteran and stakeholder feedback to inform the adaptation of PREVAIL for piloting with veterans flagged for high suicide risk. Semi-structured interviews were conducted with multiple stakeholders from a VHA medical center in the northeast. Interviews focused on the perceived benefits and concerns of peer specialists directly addressing suicide risk with veterans. Interviews were recorded, transcribed, and analyzed using rapid qualitative analysis. Interviewees included clinical directors (n = 3), suicide prevention coordinators (n = 1), outpatient psychologists (n = 2), peer specialists (n = 1), and high-risk veterans (n = 2). Overall, peer specialists were viewed as possessing many distinct strengths in engaging and helping high-risk veterans as part of a team approach. Concerns included liability, adequate training, clinical supervision and support, and self-care for peer specialists. Findings indicated support and confidence that peer support specialists would be a valuable addition and could help fill existing gap in VHA's suicide prevention efforts.

Strategies to Prevent Suicide and Attempted Suicide in New South Wales (Australia): Community-Based Outreach, Alternatives to Emergency Department Care, and Early Intervention

Background: This study describes the development of a system dynamics model to project the potential impact of a series of proposed suicide prevention interventions in New South Wales (NSW, Australia) over the period 2016 to 2031. Methods: A system dynamics model for the NSW population aged ≥ 20 years which represented the current incidence of suicide and attempted suicide in NSW was developed in partnership with a consortium of stakeholders, subject matter experts, and consumers with lived experience. Scenarios relating to current suicide prevention initiatives were investigated to identify the combination of interventions associated with the largest reductions in the projected number of attempted suicide and suicide cases for a 5-year follow-up period (2019–2023). Results: The largest proportion of cases averted for both suicide and attempted suicide over the intervention period was associated with community-based suicide prevention outreach teams and peer-led drop-in facilities (6.8% for attempted suicide, 6.4% for suicide). A similar proportion of potential cases averted of both attempted suicide and suicide (6.4%) was evident for targeted interventions focusing only on those in the population with suicidal thoughts and a previous history of attempted suicide. Conclusion: Initiatives that are characterised by the short-term stabilisation of suicidal distress at the point of crisis, averting the need for a hospital encounter, and the referral of individuals to non-acute community-based care were associated with the largest potential reductions in suicidal behaviour in NSW.

Interventions for Adolescent Suicide Ideation and Suicide Attempts in Latin America and Spain: A Systematic Review

Purpose: Adolescents are particularly vulnerable to suicide attempts, which is a major risk factor for completed suicide in this age group. However, most research on suicide prevention interventions comes from high-income countries with predominantly white participants and English protocols. This study examines interventions that have been tested in Latin America and Spain. Methods: A systematic review was conducted to include interventions aimed at reducing suicide ideation, attempts, and increasing knowledge about it in these regions. Results: Sixteen articles were selected, and Dialectical Behaviour Therapy, Problem Solving Therapy, and Trauma-Focused Cognitive Behavioural Therapy were found to be more effective than standard treatments or wait-list conditions in reducing the outcomes. Discussion: This review highlights the need for more research on preventive interventions in Latin America and Spain. While all interventions evaluated were effective, further research and replication studies are necessary to strengthen the evidence base for these interventions.

Qualitative Evaluation of a Caring Letters Suicide Prevention Intervention for the Veterans Crisis Line.

Suicide is a leading cause of death in the United States. This has prompted the U.S. surgeon general to issue a report describing actionable items to reduce suicide rates, including a recommendation to increase the use of the caring letters intervention. This intervention involves mailing brief, nondemanding messages of care. As part of the Department of Veterans Affairs' (VA's) efforts to reduce suicide rates among veterans, a caring letters project was developed for veterans who contact the Veterans Crisis Line (VCL). This article describes the results of qualitative interviews conducted to better understand the experiences of veterans who received caring letters. Beginning in 2020, all identifiable veterans who used Veterans Health Administration services and contacted the VCL received nine letters over 1 year, along with a list of mental health resources. Semistructured interviews (N=23) were conducted, and content analysis was used to identify veterans' perspectives and suggestions for improving the intervention. Sixteen men and seven women participated (mean age=53 years). Feedback varied, with most participants reporting that receiving caring letters had a positive impact and others noting aspects that could be improved to enhance the intervention's caring intent. Some also reported that the letters helped them engage with community resources and made them more likely to seek VA care. The caring letters intervention, received after contact with the VCL, was well received by participants. They described feeling appreciated, cared for, encouraged, and connected. The results of this study will inform future evaluation examining veteran outcomes.

Zero Suicide Quality Improvement: Developmental and Pandemic-Related Patterns in Youth at Risk for Suicide Attempts

ABSTRACT The Zero Suicide (ZS) approach to health system quality improvement (QI) aspires to reduce/eliminate suicides through enhancing risk detection and suicide prevention services. This first report from our randomized trial evaluating a stepped care for suicide prevention intervention within a health system conducting ZS-QI describes (1) our screening and case identification process, (2) variation among adolescents versus young adults, and (3) pandemic-related patterns during the first COVID-19 pandemic year. Between April 2017 and January 2021, youths aged 12–24 years with elevated suicide risk were identified through an electronic health record (EHR) case-finding algorithm followed by direct assessment screening to confirm risk. Eligible/enrolled youth were evaluated for suicidality, self-harm, and risk/protective factors. Case finding, screening, and enrollment yielded 301 participants showing suicide risk indicators: 97% past-year suicidal ideation, 83% past suicidal behavior; and 90% past non-suicidal self-injury (NSSI). Compared to young adults, adolescents reported more past-year suicide attempts (47% vs. 21%, p < .001) and NSSI (past 6 months, 64% vs. 39%, p < .001); less depression, anxiety, posttraumatic stress, and substance use; and greater social connectedness. Pandemic onset was associated with lower participation of racial-ethnic minority youths (18% vs. 33%, p < .015) and lower past-month suicidal ideation and behavior. Results support the value of EHR case-finding algorithms for identifying youths with potentially elevated risk who could benefit from suicide prevention services, which merit adaptation for adolescents versus young adults. Lower racial-ethnic minority participation after the COVID-19 pandemic onset underscores challenges for services to enhance health equity during a period with restricted in-person health care, social distancing, school closures, and diverse stresses.

Veteran Experiences With Suicide Ideation, Suicide Attempt, and Social Support in Safety Planning Within the Department of Veterans Affairs.

This evaluation examined the role of safety plans, one of a host of clinical suicide prevention interventions available for veterans through the United States Department of Veterans Affairs' national network of health care facilities managed by the Veterans Health Administration (VHA). Interviews were conducted with veterans who had experienced suicidal ideation or a suicide attempt since enrolling in the Department of Veterans Affairs health care system (N = 29). Topics included negative life experiences, triggers for suicidal ideation or a suicide attempt, ability to recall and utilize safety plans in crisis, safety plan elements found most and least useful, and improvements to safety planning. Eighteen (62.07%) of the veterans in the sample had attempted suicide. Drug use was by far the most triggering and overdose was the most negative life event to subsequent ideation or attempt. Although all at-risk veterans should have a safety plan, only 13 (44.38%) created a safety plan, whereas 15 (51.72%) could not recall ever creating a safety plan with their provider. Among those who did recall making a safety plan, identifying warning signs was the most remembered portion. The most useful safety plan elements were: recognizing warning signs, supportive people and distracting social settings, names and numbers of professionals, giving the veteran personal coping strategies, options for using the plan, and keeping their environment safe. For some veterans, safety plans were seen as insufficient, undesirable, not necessary, or lacking a guarantee. The suggested improvements included involving concerned significant others, specific actions to take in a crisis, and potential barriers and alternatives. Safety planning is a critical component in suicide prevention within VHA. However, future research is needed to ensure safety plans are accessible, implemented, and useful to veterans when in crisis.

“Keep up the messages, sometimes it was a lifesaver”: Effects of cultural adaptation on a suicide prevention clinical trial in American Indian/Alaska Native communities

Suicide disproportionately affects many American Indian/Alaska Native (AI/AN) communities. Caring Contacts is one of the few suicide prevention interventions with demonstrated success in diverse populations, but its acceptability and effectiveness have not been evaluated in AI/AN communities. Using community-based participatory research (Phase 1), we conducted focus groups and semi-structured interviews with AI/AN adults, healthcare providers, and leaders in four communities to improve study design and maximize intervention acceptability and effectiveness for implementation in a randomized controlled trial (Phase 2). This paper describes how adaptations made during Phase 1 affected the acceptability, fit, and responsiveness of the study features to the communities’ needs. Acceptability of the study procedures and materials in this community appears to be high, with 92% of participants indicating the initial assessment interview was a positive experience. Broadening eligibility criteria with regard to age and possession of a cellular device resulted in the recruitment of an additional 48% and 46% of participants, respectively. Inclusion of locally-informed methods of self-harm allowed us to capture a wider range of suicidal behavior than would have otherwise been identified. Clinical trials would benefit from community-engaged, cultural adaptation studies with populations in which the interventions would eventually be applied.