Ongoing Suicidal Ideation Research Articles

Gambling Disorder Symptoms, Suicidal Ideation, and Suicide Attempts.

Objective Gambling disorder (GD) patients have a higher suicide risk compared to the general population. The present study investigates the suicide-related risk factors of GD patients by analyzing GD diagnosis-related symptoms and suicide-related behaviors of subjects. Methods This study investigated which symptoms among GD diagnosis criteria are related to suicide risk in 142 patients diagnosed with GD. To analyze the relationship between GD symptoms and suicidal ideation and suicide attempt, the odds ratio (OR) was determined through multivariate logistic regression. Results The number of symptoms was significantly higher in the subjects who had suicidal ideation group and attempt group. In the cases of past suicide attempts, responses to withdrawal and escape questions were significantly higher; in the cases of ongoing suicidal ideation, responses to negative consequences and bailout questions were significantly higher. When depression was corrected, the ‘bailout’ item was, indicating that ‘bailout’ increased suicidal ideation (OR=4.937, 95% CI=1.009–24.164). In the suicide attempt group, ‘relieve’ item may increase suicide attempt (OR=6.978, 95% CI=1.300–35.562). Conclusion Past suicide attempts in GD patients correlated with withdrawal symptoms, and financial problem correlated with suicidal ideation. This suggests that evaluating suicide risk is important when evaluating GD patients, and evaluation of financial problems is important for GD patients with suicide risks.

“Some guidance and somewhere safe”: Caregiver and clinician perspectives on service provision for families of young people experiencing serious suicide ideation and attempt

BackgroundPrevious research has recommended the involvement of caregivers in the treatment of young people with depressive illness, but the best form and type of involvement remains largely unknown. This qualitative study aimed to explore clinician and caregiver perspectives on service provision for family members of young people (15–25 years) attending a specialist clinic for moderate–severe mood disorder.MethodsEight caregivers, and eight specialist clinicians were interviewed via a semi‐structured interview. Thematic analysis was used to interpret qualitative findings.ResultsThematic analysis revealed four key themes related to caregivers initial needs, crisis needs, discharge needs and broad challenges. Recurrent subthemes included the need for both information and support, especially at times of heightened suicide risk, or preceding a suicide attempt. Caregivers sought greater information, specific to their young person, and more support and guidance in their role managing the safety of the young person in their care.ConclusionsResults highlight that addressing the unmet support and information needs of caregivers may be of benefit to all (both the caregivers and the young person in their care). The lived experience of caregivers in this study indicates the significant stressors placed on them (especially when the young person they are supporting is at high risk of suicide), and the need to develop efficient and cost‐effective ways to enhance their perceived competence and skills. Implications are discussed for practitioners working with young people experiencing ongoing suicidal ideation.

Japanese university students' difficulty in living and its association with suicidal ideation.

In this study, we investigated (1) Japanese university students' actual "difficulty in living" and (2) its association with suicidal ideation. The Difficulty in Living Questionnaire was administered to 547 Japanese university students. Results revealed that 37.5% of the students felt difficulty in living, and 21.0% had ongoing suicidal ideation. An exploratory factor analysis resulted in a three-factor model, and multiple regression analysis showed that factors "external self-insufficiency" and "feeling of emptiness" significantly predicted suicidal ideation. To prevent young Japanese adults from committing suicide, increasing their self-affirmation and feelings of value among other people is crucial.

A Cry for Help: Suicide Attempts by an Iraqi Refugee and the Role of Community Service Learning


 
 
 Community Service Learning (CSL) is a method of teaching where students learn through active participation in thoughtfully organized community service. CSL has emerged as a promising training method to address the changing needs of medical students and to improve their social accountability (1,2). Medical schools are beginning to incorporate community service learning into their curriculums as a way to introduce students to the complicated world of delivering care to vulnerable populations.
 Mr. A, a refugee from Iraq, immigrated to Canada in June 2015 with his family. Five months later, during a CSL medical intake interview with two medical students and an Arabic interpreter, he revealed to have ongoing suicidal ideation and multiple suicide attempts. Due to significant cultural taboos and stigma around mental illness, Mr. A was initially very hesitant to seek medical help. However, with the help of the CSL program he was able to get much needed medical care.
 
 

Between-visit changes in suicidal ideation and risk of subsequent suicide attempt.

While clinicians are expected to routinely assess and address suicide risk, existing data provide little guidance regarding the significance of visit-to-visit changes in suicidal ideation. Electronic health records from four large healthcare systems identified patients completing the Patient Health Questionnaire or PHQ9 at outpatient visits. For patients completing two questionnaires within 90 days, health system records and state vital records were used to identify nonfatal and fatal suicide attempts. Analyses examined how changes in PHQ9 item 9 responses between visits predicted suicide attempt or suicide death over 90 days following the second visit. Analyses included 430,701 pairs of item 9 responses for 118,696 patients. Among patients reporting thoughts of death or self-harm "nearly every day" at the first visit, risk of suicide attempt after the second visit ranged from approximately 2.0% among those reporting continued thoughts "nearly every day" down to 0.5% among those reporting a decrease to "not at all." Among those reporting thoughts of death or self-harm "not at all" at the first visit, risk of suicide attempt following the second visit ranged from approximately 0.2% among those continuing to report such thoughts "not at all" up to 1.2% among those reporting an increase to "nearly every day". Resolution of suicidal ideation between visits does imply a clinically important reduction in short-term risk, but prior suicidal ideation still implies significant residual risk. Onset of suicidal ideation between visits does not imply any special elevation compared to ongoing suicidal ideation. Risk is actually highest for patients repeatedly reporting thoughts of death or self-harm.

Development of practice principles for the management of ongoing suicidal ideation in young people diagnosed with major depressive disorder.

Objectives:There is a lack of clear guidance regarding the management of ongoing suicidality in young people experiencing major depressive disorder. This study utilised an expert consensus approach in identifying practice principles to complement relevant clinical guidelines for the treatment of major depressive disorder in young people. The study also sought to outline a broad treatment framework for clinical intervention with young people experiencing ongoing suicidal ideation.Methods:In-depth focus groups were undertaken with a specialist multidisciplinary clinical team (the Youth Mood Clinic at Orygen Youth Health Clinical Program, Melbourne) working with young people aged 15–25 years experiencing ongoing suicidal ideation. Each focus group was audio recorded and transcribed verbatim using orthographic conventions. Principles of grounded theory and thematic analysis were used to analyse and code the resultant data.Results:The identified codes were subsequently synthesised into eight practice principles reflecting engagement and consistency of care, ongoing risk assessment and documentation, individualised crisis planning, engaging systems of support, engendering hopefulness, development of adaptive coping, management of acute risk, and consultation and supervision.Conclusions:The identified practice principles provide a broad management framework, and may assist to improve treatment consistency and clinical management of young people experiencing ongoing suicidal ideation. The practice principles may be of use to health professionals working within a team-based setting involved in the provision of care, even if peripherally, to young people with ongoing suicidal ideation. Findings address the lack of treatment consistency and shared terminology and may provide containment and guidance to multidisciplinary clinicians working with this at-risk group.

Sociodemographic and Clinical Differences Between Suicide Ideators and Attempters: A Study of Mood Disordered Patients 50 Years and Older

Our study sought to characterize mood disordered suicide ideators and attempters 50years and older admitted to a psychiatric ward either for a recent suicide attempt or for ongoing suicidal ideation. We enrolled 50 patients with suicide ideation consecutively admitted to an inpatient department and 50 patients admitted for a suicide attempt made in the last 48hours. Suicide attempters more frequently had low social support and an age of onset of mood disorder of 46years and older, and less frequently had a history of suicidal behaviors in the family members and pharmacological treatment, despite the fact that the groups did not differ with regard to antidepressants prescribed. The groups were not distinguishable based on several variables assumed to be risk factors for suicide behavior, such as proximal life events and stressors or alcohol use disorders. In both samples, comorbidity with organic diseases, the presence of stressful life events in the past 12months, and a diagnosis of major depression were frequently reported. In conclusion, the presence of low social support and the absence of a pharmacotherapy may increase suicidal behaviors in patients at risk.

Suicide Risk: Navigating the Failure Modes

Suicide Risk: Navigating the Failure Modes

Clinical Topics in Cultural Psychiatryedited by BhattacharyaRahul, CrossSean, and BhugraDinesh. London, United Kingdom, RCPsych Publications, 2010, 432 pp., £30.00.

Clinical Topics in Cultural Psychiatryedited by BhattacharyaRahul, CrossSean, and BhugraDinesh. London, United Kingdom, RCPsych Publications, 2010, 432 pp., £30.00.

Suicide Attempters in the Emergency Department Before Hospitalization in a Psychiatric Ward

The study aims to compare the current suicidal risk of mood disorder patients who had just attempted suicide, as compared with those who had not attempted suicide, admitted to an emergency department (ED), and then hospitalized in a psychiatric unit. One hundred sixty-one mood disorder patients admitted to the ED were studied. A total of 22.4% of the participants were admitted for a suicide attempt. Patients were assessed for psychopathology and diagnosis. Suicide attempters were nearly 12 times more likely to report ongoing suicidal ideation during the psychiatric evaluation in the ED than nonattempters. Men and women did not differ for current and previous suicide attempts or for ongoing suicidal ideation. It is important to conduct a suicide risk assessment when individuals are admitted to an ED.

Borderline Personality Disorder: Inpatient Psychiatric Nursing Management

Geri is a 42-year-old single woman who has been a recurring patient of an inpatient unit specializing in care of patients with personality disorders. She was diagnosed with borderline personality disorder (BPD) in her late teens. Her history includes tumultuous relationships, self-destructive behaviors such as cutting and burning herself, and inability to maintain consistent employment. Geri went to the emergency department (ED) following the breakup of her most recent relationship. While in the ED, Geri revealed three significant cigarette burns on her arm that she had made earlier that day while in a depersonalized state and verbalized ongoing suicidal ideation. She was admitted to the unit and immediately gravitated to the other patients with similar histories. Her demeanor rapidly changed from a picture of depression and suicidal ideation to one of “being at home” as the social director of the unit.

Management of the suicidal adolescent on a nonpsychiatric adolescent unit

Suicide attempts by adolescents far outnumber suicide fatalities, yet there is lack of agreement regarding the optimal approach to their immediate care. Since 1968, we have admitted all such patients to a general adolescent in-patient unit. A review of the first 100 admissions of adolescents who had attempted suicide was undertaken to determine the safety, economy, and efficacy of this practice. During an average six-day hospitalization, 12 patients required constant nursing observation for more than one day, and six received tranquilizers. No major disruption on the unit, suicide attempts, or self-abusive acts occurred. Twelve patients required subsequent transfer to in-patient psychiatric facilities because of on-going suicidal ideation or psychosis or both. Hospitalization on a general unit for adolescent survivors of suicide attempts is safe, usually adds minimal cost to ordinary hospital care, permits meticulous medical attention for poisoning, and provides a stabilizing influence following a major life crisis.