Life-threatening Behavior Research Articles

The impact of austerity on the delivery of an NHS mentalisation-based therapy service

Historically, a group of people experiencing distress were largely viewed by health services as untreatable, because of a chronic sense of mistrust and difficulties in being cared for. This group of people have attracted labels such as ‘Emotionally Unstable Personality Disorder’ and ‘Complex Emotional Needs’. However, the recent developments in so-called evidenced-based psychological treatments offer hope that these patients can ‘recover’, or what one therapy has called ‘a life worth living’. It follows that these newer psychological treatments hold the promise of keeping hope alive, that even the most traumatised and disturbed people may be coached into functioning, and, perhaps more cynically, to reduce their burden on already-stretched health services. This cultural shift towards optimism is not the target of the paper. Instead, this paper offers an insider clinician’s perspective to outline how austerity has negatively affected the capacity to offer care and containment to patients presenting with life-threatening behaviours.

Retraction: Suicidal thoughts and behaviors among gender and sexual minorities: Adults ages 25-44 show highest rates of past month suicidal thoughts. Suicide and Life-Threatening Behavior.

Manges, M. E., Bryan, C. J., Bryan, AB. O., Bauder, C. R., Wastler, H. M. (2023). Suicidal thoughts and behaviors among gender and sexual minorities: Adults ages 25-44 show highest rates of past month suicidal thoughts. Suicide and Life-Threatening Behavior. https://doi.org/10.1111/sltb.13029. The above article, published online on 15 December 2023 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors, the journal Editor in Chief, Thomas Joiner, PhD, and Wiley Periodicals LLC on behalf of the American Association of Suicidology. The retraction has been agreed due to errors in the interpretation of the chi-square analysis comparing sexual and gender minorities. Following discovery of the error in interpretation, the authors informed the editorial office and have revised the article with the intent of sharing the corrected results. The correction needed to amend the version of record requires significant alterations to the published article, which requires the journal to issue a retraction. An updated version of this article has been submitted for peer review at Suicide and Life-Threatening Behavior."

Adolescents’ Relational Resources and Health Risky Behaviours during the COVID-19 Pandemic: Online School Burnout and Psychological Well-Being as Mediators

The study aimed to examine whether the students’ psychological well-being and online school burnout are mediators in the association between relational resources and engaging in risky behaviour by adolescents. 186 primary and secondary school students took part in an online survey. Students’ psychological well-being was a mediator in the association between relational resources and socially unacceptable stimulating behaviours, while e-learning burnout mediated the relationship between relational resources and health and life-threatening behaviours. The findings emphasise the critical role of strengthening the students’ potential and stress resilience and building a support social network.

Hurting myself to cope: Using network analysis to understand the association between perceived stigma and non-suicidal self-injury functions among men who have sex with men in China

Prior studies have demonstrated that perceived stigma is robustly associated with risky and life-threatening behaviors, including non-suicidal self-injury (NSSI), among men who have sex with men (MSM). However, studies regarding the relationship between perceived stigma and NSSI are limited. The present study aimed to investigate the network structure of perceived stigma and NSSI functions, along with bridge nodes, to elucidate how they co-exist. A sample of 2610 Chinese MSM (mean age = 23.99, age range: 18–68 years) was recruited from an online survey platform. All participants completed a web-based survey with measures of perceived stigma and NSSI functions. Results indicated that ‘negative attitudes towards homosexuality’ and ‘disappointment in gay son’ were identified as the most central nodes in the perceived stigma network, whereas ‘seeking attention’ and ‘influencing others to change’ ranked highest on centrality in the NSSI network. Two bridge connections were exhibited within the combined perceived stigma and NSSI network model: ‘unwelcoming in public’ and ‘avoiding unpleasant tasks’ from perceived stigma and NSSI communities, respectively. This is among the first studies investigating the co-occurrence between perceived stigma and NSSI from the network approach. Our findings provide an empirically-based perspective on the importance of family- and community-based interventions, with potential clinical implications for reducing NSSI among sexual and gender minority groups.

Pleasure addiction via brain-manipulating technologies as a possible contributor to civilizational decline

Advances in new technologies create new ways to stimulate the pleasure center of the human brain: via new chemicals, direct application of electricity, electromagnetic fields, “reward hacking” in games, chat-bots and social networks, and, in the future, possibly via genetic manipulation, nanorobots and AI systems. This may have two consequences: a) human life may become more interesting, b) humans may stop participating in any external activities, including work, maintenance, reproduction, and even caring for their own health (potentially even harming themselves), which could contribute to a slow decline of the human population. Technological pleasure inducement, also known as “wireheading”, is not self-limiting and it may push the addict to his/her limits and ultimately result in life-threatening behavior. Mass unemployment and the provision of basic income would likely feed the industry of pleasures. Do-it-yourself (DIY) synthetic biology and computers may create the possibility of home production of very addictive drugs through various routes, like insertion of a morphine-producing gene in plants or stimulation of the brain via electromagnetic fields, which may not be possible to control by limiting the supply chain. Brain implant technologies like Neuralink open a route to widespread pleasure inducement. If “wireheading knowledge” becomes freely available, it could create a reward-hacking epidemic larger than the current U.S. opioid crisis and possibly contribute to a global civilizational decline.

A Suicide-Specific Diagnosis – The Case Against

A Suicide-Specific Diagnosis – The Case Against

A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

Suicidal behavior across a broad range of psychiatric disorders.

Suicide is a leading cause of death worldwide. In 2020, some 12.2 million Americans seriously contemplated suicide, 3.2 million planned suicide attempts, and 1.2 million attempted suicide. Traditionally, the approach to treating suicidal behavior (SB) has been to treat the "underlying" psychiatric disorder. However, the number of diagnoses associated with SB is considerable. We could find no studies describing the range of disorders reported to be comorbid with SB. This narrative review summarizes literature documenting the occurrence of SB across the lifespan and the full range of psychiatric diagnoses, not only BPD andthose that comprise MDE, It also describes the relevance of these observations to clinical practice, research, and nosology. The literature searches contained the terms "suicid*" and each individual psychiatric diagnosis and identified 587 studies. We did not include case reports, case series, studies only addressing suicidal ideation or non-suicidal self-injury (NSSI), studies on self-harm, not distinguishing between SBand NSSI and studies that did not include any individuals that met criteria for a specific DSM-5 diagnosis (n = 366). We found that SB (suicide and/or suicide attempt) was reported to be associated with 72 out of 145 diagnoses, although data quality varied. Thus, SB is not exclusively germane to Major Depressive Episode (MDE) and Borderline Personality Disorder (BPD), the only conditions for which it is a diagnostic criterion. That SB co-occurs with so many diagnoses reinforces the need to assess current and past SB regardless of diagnosis, and supports the addition of charting codes to the DSM-5 to indicate current or past SB. It also comports with new data that specific genes are associated with SB independent of psychiatric diagnoses, and suggests that SB should be managed with specific suicide prevention interventions in addition to treatments indicated for co-occurring diagnoses. SB diagnostic codes would help researchers and clinicians document and measure SB's trajectory and response to treatment over time, and, ultimately, help develop secondary and tertiary prevention strategies. As a separate diagnosis, SB would preclude situations in which a potentially life-threatening behavior is not accounted for by a diagnosis, a problem that is particularly salient when no mental disorder is present, as is sometimes the case.

Optimizing the dynamics of bone turnover with genetic algorithm.

Control systems and the modeling strategies are not only limited to engineering problems. These approaches can be used in the field of bio-mathematics as well and modern studies have promoted this approach to a great extent. The computational modeling and simulation of bone metastasis is painful yet critical after cancer invades the body. This vicious cycle is complex, and several research centers worldwide are devoted to understanding the dynamics and setting up a treatment strategy for this life-threatening behavior of cancer. Cancerous cells activation and the corresponding process of metastasis is reported to boost during the periodic waves of COVID-19, due to the inflammatory nature of the infection associated with SARS-2 and its variants. The bone cells are comprised of two types of cells responsible for bone formation and resorption. The computational framework of such cells, in spatial form, can help the researchers forecast the bone dynamics in a robust manner where the impact of cancer is incorporated into the computational model as a source of perturbation. A series of computational models are presented to explore the complex behavior of bone metastasis with COVID-19 induced infection. The finite difference algorithm is used to simulate the nonlinear computational model. The results obtained are in close agreement with the experimental findings. The computational results can help explore the vicious cycle's fate and help set up control strategies through drug therapies.

Being a deaf Bedouin young woman: suffering in silence

Deaf Bedouin young women must contend not only with the typical developmental tasks of young adulthood but also the traditional demands of Bedouin society. They aim to fulfill themselves and develop, but discrimination and institutional neglect, coupled with their society’s traditions, pose a complex challenge. This qualitative study of 14 deaf Bedouin young women in Israel found that they display self-esteem, apparently to cope with the challenges of being sidelined because they are young and deaf Bedouin women as well as members of the country’s Arab minority. Also, it is apparent that the hearing population has not invested sufficiently in the women’s development, making it more difficult for them to function as adults on various levels. Given this background and the cultural characteristics of Bedouin society, in which young women are tightly controlled, their options appear to be suffering in silence or engaging in life-threatening behavior.

Psychological Risk Factors among Transgender: The Mediating Role of Body Dissatisfaction between Quality of Life, Suicidal Ideation and Social Interaction Anxiety

Abstract
 Social attitudes, prejudice and stigmas towards transgender community vary around the world. Consequently, the prevalence of suicidal attempts, self-injurious behaviors, and associated psychological factors were very common among them. The current study aimed to examine the association between quality of life, suicidal ideation, social interaction anxiety and body image among trans genders. Two hundred trans genders of age between 18-45 years participated in this study. They were approached by using snow ball sampling technique from different cities of Pakistan. Four instruments, Body Image States Scale (BISS), World Health Organization Quality of Life Scale- (WHOQOL-BREF), Beck Scale for Suicidal Ideation (BSSI), Social Interaction Anxiety (SIA) were used in this research. The results showed no significant difference on demographic variables with regard to body image, social interaction anxiety, quality of life and suicidal ideation (p<0.05). Results of mediation analysis by using Smart-PLS showed that body image significantly mediates the association between quality of life and suicidal ideation (r=0.164, p<0.001) and it also mediates the relationship between quality of life and social interaction anxiety (r=0.184, p<0.001). The findings indicated that this population is at a high risk for psychological comorbidities and life-threatening behaviors. Efforts should be taken to reduce discrimination and psychological risk factors and bring positive attitude towards transgender community.

Risk management in dialectical behavior therapy: Treating life-threatening behaviors as problems to be solved.

Dialectical behavior therapy (DBT) is an empirically supported behavioral treatment for individuals with borderline personality disorder who frequently exhibit life-threatening behavior, such as suicide attempts, nonsuicidal self-injury urges and actions, and suicidal ideation. We provide an overview of the theoretical framework by which DBT conceptualizes these life-threatening behaviors and the principles by which safety planning measures are implemented and maintained throughout treatment. The importance of orienting clients to treatment and obtaining their commitment to decrease life-threatening behavior is reviewed. Relevant strategies associated with risk management and assessment, such as the diary card, chain analysis, solution analysis, phone coaching, and consultation team, are described. The overview concludes with a case example to illustrate the application of these techniques with a DBT client with a long-standing history of engaging in life-threatening behaviors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Screen for Nonsuicidal Self-Injury: Development and initial validation among veterans with psychiatric disorders.

Nonsuicidal self-injury (NSSI) is associated with significant impairment and is a robust predictor of suicidal ideation, attempts, and death by suicide; however, the present lack of a brief screening instrument for NSSI coupled with consistent underidentification of NSSI in male adults has led to concerning rates of missed identification of NSSI. The Screen for Nonsuicidal Self-Injury (SNSI) is a brief, 10-item screen designed to identify individuals currently engaging in NSSI with an emphasis on behaviors more frequently endorsed by male adults. The present study examined the development and validation of the SNSI. In a sample of veterans (N=124) with complex psychiatric presentations, SNSI scores demonstrated good internal consistency and strong construct validity with area under the curve (AUC) estimates of 0.85-0.93 for the identification of NSSI disorder. SNSI scores also demonstrated good convergent (rs 0.59-0.90) and external validity (rs=0.25-0.42), and excellent predictive validity identifying future NSSI Suicide and Life-Threatening Behavior disorder (AUC=0.88) and NSSI behaviors (AUC=0.90). Importantly, SNSI performance was not affected by participants' race, sex assigned at birth, or age. The SNSI is an efficient screen to identify patients engaging in NSSI who are likely to benefit from more comprehensive assessment and treatment programs.

T1 bladder carcinoma with variant histology: pathological features and clinical significance

The aim of the study was to stratify high-grade T1 (HGT1) bladder urothelial carcinoma into risk categories based on the presence of variant histology when compared to conventional urothelial carcinoma. The clinicopathological features of 104 HGT1 cases of urothelial carcinoma of the bladder with variant histology present in 34 (37%) were assessed. The endpoint of the study was disease-free survival and cancer-specific survival. Overall, variant histology was identified as a significant predictor of disease-free survival (P = 0.035). The presence of any specific variant histology (squamous, glandular, micropapillary, nested, microcystic, inverted growth, villous-like, basaloid, and lymphoepithelioma-like) was identified as a significant predictor of disease-free survival (P = 0.008) and cancer-specific survival (P = 0.0001) in HGT1 bladder cancer. Therefore, our results support including micropapillary HGT1 urothelial carcinoma within the aggressive high-risk category, as suggested by some recent clinical guidelines, but also favor nested, glandular, and basaloid to be placed in the high-risk category due to their potential of aggressive, life-threatening behavior and their limited response to bacillus Calmette-Guerin therapy. Conversely, the low-risk category would include urothelial carcinomas with squamous, inverted growth, or microcystic morphology, all with limited life-threatening potential and good response to current therapy. A very low-risk category would finally include patients whose tumors present villous-like or lymphoepithelioma-like morphology. In conclusion, our findings support the value of reporting the variant histology as a feature of variable aggressiveness in HGT1 urothelial carcinoma of the bladder.

Research on Psychache in Suicidal Population: A Bibliometric and Visual Analysis of Papers Published During 1994-2020.

Background: Psychache is a negative introspective experience, which is positively associated with the risk of suicide, independently of depression. It is undeniable that psychache is an important influencing factor to trigger suicide, which can also mediate the effect between depression and suicide variables. Nevertheless, the research tendency and current hotspots on psychache of suicide population have not been systematically investigated based on bibliometric analysis.Aim: The aim of the study was to analyze the research status, hotspots, and frontiers of psychological pain in the field of suicidology, so as to provide reference for domestic clinical research.Methods: The literature related to psychache in suicide individuals published from 1994 to 2020 was included and selected from the Web of Science Core Collection database on May 28, 2021. CiteSpace (version 5.7.R2) software was used to visualize and analyze highly cited journals, authors, and articles as well as co-occurrence analysis for countries, institution, authors, and keywords.Results: A total of 230 articles from the WoS database were included. The number of papers over the years showed an overall upward trend. The United States has made the largest contribution, with the majority of publications (89, 38.70%), followed by Canada (48, 20.87%), Israel (31, 13.48%), China (20, 8.80%), and Portugal (17, 7.39%). The most productive institution was Queen's University. Edwin S. Shneidman has the largest achievement and profound influence, and the most prolific author is Ronald R. Holden. However, the cooperation between institutions and authors was comparatively weak. The current hotspots in this field focus on the studies on the relationships between depression, despair, psychache, and suicide, the risk assessments of psychological pain, and the development of psychological pain scales. Suicide and Life-Threatening Behavior was the most frequently cited journal in this field.Conclusions: This analysis not only reveals the current research trend and hotspots but also provides some instructive suggestions on the development of psychache in the suicidology. Future work should pay more attention to develop effective psychological pain intervention programs for diverse suicide population. Additionally, longitudinal study can also be conducted to grasp the trajectory changes of psychological pain among suicide individuals.

Operative Management of Neonatal Lymphatic Malformations: Lesson Learned From 57 Consecutive Cases.

Aim of the study: Lymphatic malformations (LMs) are rare entities, sometimes difficult to treat, that may be life-threatening when intricately connected to airway structures. Invasive treatments are occasionally required, with sclerotherapy considered the treatment of choice and surgery as a second-line approach. The aim of the present study was to evaluate our multidisciplinary team experience in treating newborns affected by LMs requiring operative management, while defining early outcomes.Methods: Retrospective review of all consecutive patients admitted for LMs requiring operative management between January 2000 and January 2019. Patients were mainly characterized based on anatomical district of the LM (and further stratified based on the development of respiratory distress), need for tracheostomy, number of sclerotherapies, indication for surgery, and residual disease beyond the 1st year. Morbidity and mortality were also evaluated. Fisher exact test and Mann–Whitney test were used as appropriate. Statistical significance was set at p < 0.05.Results: Fifty-seven patients were included in the study, 36 with cervicofacial and/or mediastinal LMs and 21 with LMs of other anatomical districts. Due to the risk of developing respiratory distress at birth, patients with cervicofacial and/or mediastinal LMs were divided into two groups (8/36 group A vs. 28/36 group B). Group A patients are at higher risk for tracheostomy (7/8 group A vs. 1/28 group B, p = 0.0001) and more often require surgical reduction of the residual lymphatic abnormality (5/8 group A vs. 4/28 group B, p = 0.013). They also require sclerotherapies more often, but the difference is not statistically significant (8/8 group A vs. 19/28 group B, p = 0.15). Patients with cervicofacial/mediastinal LMs frequently suffer from persistent residual disease beyond the 1st year of life, significantly more often in group A (7/8 group A vs. 12/28 group B, p = 0.043).Conclusion: LMs are rare conditions with potential life-threatening behavior. Their intrinsic clinical complexity requires a multidisciplinary approach to the affected patients. Planning a long-term follow-up is essential because of the late-term problems those patients may experience.

Clinical Characteristics and Self-Harm in Forensic Psychiatric Patients.

Self-harm, comprising non-suicidal self-injury, and suicide attempts, is a serious and potentially life-threatening behavior that has been associated with poor life quality and an increased risk of suicide. In forensic populations, increased rates of self-harm have been reported, and suicide is one of the leading causes of death. Aside from associations between self-harm and mental disorders, knowledge on self-harm in forensic psychiatric populations is limited. The purpose of this study was to characterize the clinical needs of a cohort of forensic psychiatric patients, including self-harm and possible risk factors thereof. Participants (N = 98) were consecutively recruited from a cohort of forensic psychiatric patients in Sweden from 2016 to 2020. Data were collected through file information, self-reports, and complemented with semi-structured interviews. Results showed that self-harm was common among the participants, more than half (68.4%) of whom had at some point engaged in self-harm. The most common methods of non-suicidal self-injury were banging one's head or fist against a wall or other solid surface and cutting, and the most common method of suicide attempt was hanging. The most prominent functions of non-suicidal self-injury among the participants were intrapersonal functions such as affect regulation, self-punishment, and marking distress. Self-harm in general was associated to neurodevelopmental disorders (p = 0.014, CI = 1.23–8.02, OR = 3.14) and disruptive impulse-control and conduct disorders (p = 0.012, CI = 1.19–74.6, OR = 9.41), with reservation to very wide confidence intervals. Conclusions drawn from this study are that self-harm was highly prevalent in this sample and seems to have similar function in this group of individuals as in other studied clinical and non-clinical groups.

Bibliometric Analysis of Suicide Research Among Black Youth

Historically, Black youth have had lower rates of suicide attempts in comparison to their peers; however, in recent years this rate has changed, with self-reported suicide attempts for Black adolescents rising by 73%. The purpose of this study was to analyze the characteristics of research on Black youth and suicide using bibliometric techniques. To conduct our analysis, we developed a search strategy utilizing the Scopus database for the time period from 1980 to 2020. Results indicated an increasing trend in the number of articles published each year related to Black youth and suicide. The most highly productive journals were the Suicide and Life Threatening Behavior, Pediatrics, and Journal of Youth and Adolescence. Authors who frequently published in this area include Nadine Kaslow, Rheeda Walker, and Sean Joe. While this research area is growing, there is a lack of published articles focused on interventions for suicide prevention and non-comparative race specific research focused on Black youth.

Deconstructing witnessed suicide: A portrait of those who die by suicide in front of others

Witnessed suicides can have devastating effects on the individuals who observe them. McDowell et al. (Suicide and Life-threatening Behavior, 24(3), 213–223, 1994) have been the only researchers to create a taxonomy for the motivations of individuals who died by suicide in front of witnesses, and the role played by those witnesses. Their categories, based on 50 cases within a military population, included reciprocal abandonment, violent divorce, Russian roulette, and homicidal rage. The present study examines 100 witnessed suicides that occurred between the years 2000 and 2009 in a non-military population. In general, the taxonomy created by McDowell et al. was applicable to decedents in the present study, except for the category of Russian roulette. Some of the terminology was updated and a new category of legal entanglement was created. The creation of this new taxonomy of witnessed suicide permits further understanding of the characteristics of individuals who end their lives in front of a witnesses, and their communications behind the suicidal act.

Optimal PAI-A Cutoffs to Determine Risk for Non-Suicidal Self-Injury (NSSI) and Suicide-Related Behavior (SRB) among At-Risk Adolescents

Objective This study examines psychopathology and personality correlates of non-suicidal self-injury (NSSI) and suicide-related behavior (SRB) in an understudied sample of adolescents who have exhibited behaviors (e.g., delinquent acts, premature high school termination) that place them at-risk for poor psychosocial outcomes. Method Participants included a predominantly White male sample of 182 adolescents (Mage = 16.82 years). In addition to information about NSSI and SRB histories, participants self-reported various facets of personality and psychopathology on the Personality Assessment Inventory-Adolescent (PAI-A). Results Logistic regression analyses indicated that the Suicidal Ideation (SUI) scale on the PAI-A was the strongest predictor of both NSSI and SRB history, as it outperformed other relevant PAI-A scales and the Suicide Potential Index (SPI), an aggregate scale that was designed to assess for suicide risk using the PAI for adults. Receiver operating characteristic (ROC) curve analyses were also conducted to determine optimal cutoff scores for significant PAI-A predictors. Conclusions Findings from the current study can be used to identify NSSI and SRB risk and target these life-threatening behaviors when working with at-risk adolescents. Highlights PAI-A SUI outperformed other PAI-A variables in predicting NSSI and SRB risk. PAI SPI did not perform as well in adolescents compared to adult samples. Cutoff scores in the current sample were well below those in the PAI-A manual.