Suicidal Patients Research Articles

The rapid anti-suicidal ideation effect of ketamine: A systematic review

In many countries suicide rates have been trending upwards for close to twenty years–presenting a public health crisis. Most suicide attempts and deaths are associated with psychiatric illness, usually a depressive disorder. Subanesthetic ketamine is the only FDA-approved antidepressant that works in hours not weeks—thus potentially transforming treatment of suicidal patients. We reviewed all randomized controlled trials of the effect of ketamine on suicidal ideation to determine if ketamine rapidly reduces suicidal ideation [SI] in depressed patients and how long the benefit persists after one dose and if the route of administration or dose affects the outcome. A systematic review was conducted as per PRISMA [preferred reporting items for systematic reviews and meta-analyses] criteria. PubMed search inclusive of “ketamine” and “suicide” yielded 358 results. Papers (N = 354) were then read by at least two authors, identifying 12 meeting eligibility requirements and eleven RCTs examining whether ketamine treatment ameliorated SI. Four of five RCTs examined racemic ketamine (0.5 mg/kg) given intravenously and found an advantage for ketamine over control for rapid reduction in SI in acutely depressed patients. Two studies examined intranasal esketamine in depressed suicidal patients and found no advantage over saline. One study examined outcome six weeks after a single intravenous dose of ketamine and found benefit for SI sustained relative to 24 h post-dose. Further research is warranted into: optimal dosing strategy, including number and frequency; and long-term efficacy and safety. Ultimately, it remains to be shown that ketamine's benefit for SI translates into prevention of suicidal behavior.

Medium term religious support program applied to suicidal psychiatric patients

Medium term religious support program applied to suicidal psychiatric patients

An Emotion Regulation Tablet App for Middle-Aged and Older Adults at High Suicide Risk: Feasibility, Acceptability, and Two Case Studies

The unique features of technological applications may improve the treatment of people at risk of suicide. In this article, we present feasibility and acceptability data as well as two case studies demonstrating the use of WellPATH, a tablet app that aims to help suicidal patients during emotionally-charged situations outside of therapy sessions. The WellPATH app was part of a 12-week psychotherapy intervention (CRISP - Cognitive Reappraisal Intervention for Suicide Prevention) for middle-aged and older adults after their discharge from a suicide-related hospitalization. The use of WellPATH includes three stages: preparation and practice, incorporation, and actual use. Feasibility was measured by the overall use of WellPATH during 12 weeks, and acceptability was measured with the three items of the Client Satisfaction Questionnaire. Twelve study participants were administered WellPATH as part of CRISP. The results provide preliminary evidence of feasibility and acceptability of WellPATH. Study participants and therapists reported high satisfaction with WellPATH and provided feedback for future research and development. The patients in the case studies reported a reduction in negative emotions and an increase in emotion regulation (i.e., cognitive reappraisal ability) after using techniques on the WellPATH app. Our preliminary findings suggest that use of technology applications such as the WellPATH app is feasible and accepted among middle-aged and older adults at high suicide risk. Further research with an adequately powered sample is needed to further evaluate WellPATH's feasibility and accessibility, and test its efficacy with this high-risk population.

Emergency psychiatric assessment, treatment, and healing (EmPATH) unit decreases hospital admission for patients presenting with suicidal ideation in rural America.

The objective was to evaluate the impact of an emergency psychiatric assessment, treatment, and healing (EmPATH) unit in the emergency department (ED) on hospital admissions, ED length of stay, and 30-day follow-up for patients presenting with suicidal ideation or attempt. This study was a before-and-after analysis of introducing the EmPATH unit within a Midwestern academic medical center on outcomes of adult patients (≥18years) presenting with suicidal ideation or suicidal attempt. The primary outcome in this study was the change in proportion of inpatient psychiatric admission of suicidal patients presenting to the ED before and after implementation of the EmPATH unit. Secondary outcomes compared were changes in proportion of any admission, incomplete admission defined as discharge from the ED after admission request placed, outpatient follow-up, return ED visits within 30days of admission, and ED boarding time. Association between the EmPATH unit implementation and categorical outcomes were determined using log-binomial regression to estimate relative risks (RRs) and 95% confidence intervals (CIs). Continuous outcomes were log-transformed and generalized estimating equations were used to examine as the mean difference by time period. There were 962patients presenting with suicidal ideation (n=435 before EmPATH unit, n=527 after EmPATH unit). Compared to the pre-EmPATH-unit period, there was a reduction in psychiatric admission (RR= 0.48, 95% CI= 0.40 to 0.56), any admission (RR= 0.65, 95% CI= 0.58 to 0.73), incomplete admission (RR= 0.22, 95% CI= 0.11 to 0.43), and 30-day return to the ED (RR= 0.74, 95% CI= 0.56 to 0.98). ED boarding time among admitted patients was reduced by approximately two-thirds both in admitted patients (RR= 0.34, 95% CI= 0.30 to 0.39) and among those with incomplete admissions (RR= 0.37, 95% CI= 0.23 to 0.61). There was a 60% increase in a 30-day follow-up care established at the time of discharge (RR= 1.60, 95% CI= 1.40 to 1.82). The introduction of the EmPATH unit has improved management of patients presenting to the ED with suicidal attempts/ideation by reducing ED boarding and unnecessary admissions and establishing post-ED follow-up care.

Characteristics of Dimensional Psychopathology in Suicidal Patients With Major Psychiatric Disorders and Its Association With the Length of Hospital Stay: Algorithm Validation Study.

BackgroundSuicide has emerged as a serious concern for public health; however, only few studies have revealed the differences between major psychiatric disorders and suicide. Recent studies have attempted to quantify research domain criteria (RDoC) into numeric scores to systematically use them in computerized methods. The RDoC scores were used to reveal the characteristics of suicide and its association with major psychiatric disorders.ObjectiveWe intended to investigate the differences in the dimensional psychopathology among hospitalized suicidal patients and the association between the dimensional psychopathology of psychiatric disorders and length of hospital stay.MethodsThis retrospective study enrolled hospitalized suicidal patients diagnosed with major psychiatric disorders (depression, schizophrenia, and bipolar disorder) between January 2010 and December 2020 at a tertiary hospital in South Korea. The RDoC scores were calculated using the patients’ admission notes. To measure the differences between psychiatric disorder cohorts, analysis of variance and the Cochran Q test were conducted and post hoc analysis for RDoC domains was performed with the independent two-sample t test. A linear regression model was used to analyze the association between the RDoC scores and sociodemographic features and comorbidity index. To estimate the association between the RDoC scores and length of hospital stay, multiple logistic regression models were applied to each psychiatric disorder group.ResultsWe retrieved 732 admissions for 571 patients (465 with depression, 73 with schizophrenia, and 33 with bipolar disorder). We found significant differences in the dimensional psychopathology according to the psychiatric disorders. The patient group with depression showed the highest negative RDoC domain scores. In the cognitive and social RDoC domains, the groups with schizophrenia and bipolar disorder scored higher than the group with depression. In the arousal RDoC domain, the depression and bipolar disorder groups scored higher than the group with schizophrenia. We identified significant associations between the RDoC scores and length of stay for the depression and bipolar disorder groups. The odds ratios (ORs) of the length of stay were increased because of the higher negative RDoC domain scores in the group with depression (OR 1.058, 95% CI 1.006-1.114) and decreased by higher arousal RDoC domain scores in the group with bipolar disorder (OR 0.537, 95% CI 0.285-0.815).ConclusionsThis study showed the association between the dimensional psychopathology of major psychiatric disorders related to suicide and the length of hospital stay and identified differences in the dimensional psychopathology of major psychiatric disorders. This may provide new perspectives for understanding suicidal patients.

The Relationship Between Suicide Attempt and Gonadotropins, Gonadal Hormones, and Cortisol in Females.

The aim of this study was to examine the relationship between suicidal behavior and gonadotropins, gonadal hormones, and cortisol in females. The study included 3 groups of 23 females each, aged 18-45 years; one group comprising those who had attempted suicide, another group of females matched for age, menstrual phase, and body mass index, with depression but no suicidal tendencies, and a control group of 23 healthy females. For all participants, a sociodemographic information form was completed, and the Beck Depression Inventory, the Beck Anxiety Inventory, and the Beck Hopelessness Scale were used. Blood samples were taken at 8 am (in the attempted-suicide group, within 24 hours of the attempt), and follicle-stimulating hormone, luteinizing hormone, estradiol, testosterone, progesterone, and cortisol levels were measured. No statistically significant differences were observed between the groups with respect to gonadotropin and gonadal hormone levels. There were statistically significant differences in the cortisol levels between the attempted suicide and control groups and between the depression and control groups (P < .05). The cortisol levels negatively correlated with all scale scores. Studies on suicidal patients should pay more attention to the potential role of hypocortisolism. More studies with larger samples are needed to investigate the relationship between gonadotropins, gonadal hormones, and suicidal behavior.

Suicide Screening and Risk Assessment in the Emergency Department: Case Review of a Suicide Attempt Survivor

One in 10 of those who die by suicide are seen in an emergency department within the 2 months before their death. Despite national guidelines and resources (including from the Joint Commission and Emergency Nurses Association) for suicide screening, risk assessment, and follow-up care, suicidal ideation and behavior continue to go undetected in emergency departments, leading to gaps in care. This case review was conducted as part of a larger electronic medical record review of emergency department practices and aims to highlight potential gaps in care and identify missed opportunities for suicide screening and risk assessment. In addition to highlighting these missed opportunities, this case review provides recommendations for suicide screening and risk assessment resources with options for evidence-based follow-up care for suicidal patients.

Suicide in primary care: How to screen and intervene.

Suicide is significant public health concern within the United States. Research results are mixed about the effectiveness of universal screening and interventions with patients who are at-risk for suicide. Primary care is a logical intervention point to mitigate risk among patients in each of these areas. The Department of Veterans Affairs and Department of Defense have developed comprehensive guidelines for the assessment and management of suicidal patients. This approach involves specific screening tools, risk stratification by categories and interventions used by clinicians to help reduce risk levels in their patients. This article aims to provide a model, built on the principles of these guidelines, which primary care physicians can use to identify, assess and intervene with patients who are at-risk for suicide.

The influence of religious/spiritual beliefs on Malaysian hospital healthcare workers' attitudes towards suicide and suicidal patients: a qualitative study.

There has been mixed findings on whether a healthcare workers' religious beliefs contribute positively or negatively to their attitudes towards suicidal patients. This study aims to explore qualitatively the influence of religious/spiritual beliefs on healthcare workers' attitudes towards suicide and suicidal patients in the culturally heterogeneous Malaysian population. Thirty-one healthcare workers from diverse religious backgrounds, professions and medical disciplines were interviewed. Thematic analysis revealed the centrality of religion in determining healthcare workers' acceptability of suicide, specific religious beliefs that influenced their views on the right-to-die issue, perceptions of the suicidal patient's religiousness/spirituality, and the aspects and extent of religious relevance in professional philosophy and practice. Healthcare workers who could perceive the multifactorial nature of suicide causation had a more empathetic response. There were high levels of paternalism in the care of suicidal patients, involving unsolicited religious/spiritual advice practised as a form of suicide deterrent and social support. The formal integration of religious/spiritual practices into the professional care of suicidal patients was indicated.

Commentary: The influence of religious/spiritual beliefs on Malaysian hospital healthcare workers' attitudes toward suicide and suicidal patients: a qualitative study.

Commentary: The influence of religious/spiritual beliefs on Malaysian hospital healthcare workers' attitudes toward suicide and suicidal patients: a qualitative study.

Increased C-reactive protein concentration and suicidal behavior in people with psychiatric disorders: A systematic review and meta-analysis.

ObjectiveSuicide is a leading cause of death worldwide. Identifying factors associated with suicidality (suicidal ideation [SI]/suicidal behavior) could increase our understanding of the pathophysiological underpinnings of suicide and improve its prevention.MethodsWe conducted a systematic review (PubMed/PsycInfo/Cochrane databases, up to September 2020) and random‐effect meta‐analysis including observational studies comparing peripheral C‐reactive protein (CRP) levels in suicidal versus non‐suicidal patients affected by any psychiatric disorder and healthy controls (HC). Primary outcome was the CRP standardized mean difference (SMD) between patients with high suicidality versus those with absent or low suicidality. Secondary outcomes were SMD of CRP levels between those with suicide attempt versus no suicide attempt, as well as between those with (high) versus low or absent SI. Quality of included studies was measured with Newcastle‐Ottawa scale.ResultsOut of initial 550 references, 21 observational studies involving 7682 subjects (7445 with mood disorders or first‐episode psychosis, 237 HC) were included. A significant association of CRP levels with suicidality (SMD 0.688, 95% CI 0.476–0.9, p < 0.001) emerged. CRP levels were higher in individuals with high SI (SMD 1.145, 95% CI 0.273–2.018, p = 0.010) and in those with suicide attempt (SMD 0.549, 95%CI 0.363–0.735, p < 0.001) than non‐suicidal individuals (either patients or HC). Main analyses were confirmed in sensitivity analysis (removing HC), and after adjusting for publication bias. The cross‐sectional design of included studies, and the high heterogeneity of diagnosis and treatment limit the generalizability of these results. Median quality of included studies was high.ConclusionCRP is associated with higher suicidality in patients with mental disorders. Large cohort studies longitudinally monitoring CRP levels are needed to explore its longitudinal association with suicidality.

Assessments in Psychotherapy with Suicidal Patients: The Precedence of Alliance Work

In this article the aim was to explore how therapists handle suicide risk assessment in connection with patient’s experience of alliance in psychotherapy. In a naturalistic, longitudinal study, 19 suicidal patients were interviewed three times: just before they started in therapy (T1), during the early phase (T2), and again after one year (T3). 17 therapists were interviewed separately at T2 and T3. The interviews explored the personal experiences of both patients and therapists, including their handling of suicidality and the quality of their relationships. An interpretative-phenomenological approach was used to analyze the research interviews case by case, as seen from the perspective of both therapist and patient in each dyad. Because of their duties within the Norwegian Healthcare System, all therapists are obliged to follow the National Guidelines in suicide risk assessment. The results indicate that there are two pitfalls for therapists: to avoid the topic of suicidality and using the suicide risk assessment in a rigid way. Both pitfalls have disturbing effects on the working alliance between therapist and patient. Most of the therapists were able to integrate personalized assessment procedures in the running dialogue. Our argument here is that in order to integrate assessment with therapeutic work, it is important for the therapist to establish ethical responsibility with patient. A modern philosophical perspective on ethics of closeness is discussed.

The Role of General Practitioners in Suicide Prevention—What You Said and Did then Actually Saved My Life

Background: General practitioners (GPs) have an important role in the prevention of suicidal behavior. The purpose of this study was to explore their views and experiences in identifying and assessing suicidal ideation. Methods: Ten GPs were recruited through convenience sampling based on accessibility, interest and willingness to participate. In-depth interviews were carried out, and the results were transcribed verbatim. Aspects of experiences with suicidal patients emerged through the thematic analysis process. Results: The GPs described the varied clinical picture when patients presented in their office. How they identified depressive symptoms apart from originally somatic complaints included forming a trusting relationship and addressing suicide ideation. They described customized interventions as well as obstacles and factors that facilitated communication, including time, their own personal traits, patient’s disclosure and organizational barriers. Conclusions: The levels of the suicidal process among patients in general practice vary greatly. GPs adjust their appraisals to profoundly understand and intervene to prevent a crisis of escalation into subsequent suicidal behavior.

Increasing Mental Health Literacy in Law Enforcement to Improve Best Practices in Policing-Introduction of an Empirically Derived, Modular, Differentiated, and End-User Driven Training Design.

Objective: Law enforcement officers often have contact to persons who show symptoms of mental disorders. Adequately designed training is necessary for developing the best possible practices in policing when coming into contact with mentally ill people, and may help to expand their general knowledge on mental disorders. To achieve a sustainable implementation of training content in daily policing work, the acceptance and proactive integration of methods by the training participants is essential.Method: This study investigates an exemplary modular training curriculum based on a survey with 2,228 German police officers (28.2% female, 71.8% male) concerning their needs and challenges when coming into contact with persons with mental disorders. This empirical end-user driven approach was used to adapt existing training concepts to the current needs and interests of law enforcement personnel in order to maximize compliance.Results: The training program draft includes basic modules which are intended to be of direct interest to all police officers, such as mental disorders with high policing relevance, encountering suicidal patients, (non-directive) communication and de-escalation skills, and mental hygiene in policing. They are arranged in more specialized modules that address specific target group audiences within police forces and the training curriculum provides information about genuine risks and self-protection, trauma sensitivity, and interaction with children and victims among other contents. The self-selectable, modular, and empirically-based continued training program also includes an introduction to local mental health service professionals and networks, trialogue sequences, and situational role play scenarios.Conclusion: Due to frequent contact law enforcement officers have to mentally ill people, improved training designed to maximize knowledge and the integration of trained methods is necessary. Gaining acceptance and proactive support by trainees is ensured through end-user driven implementation of specialized and differentiated up-to-date training programs. Our results showcase how police officers' perspectives on persons with mental illnesses is a main aspect that can and should be used to encourage training course designs.

A survey of Midwest physicians' experiences with patients in psychiatric distress in the emergency department.

Emergency medicine (EM) physicians commonly stabilize patients with acute psychiatric distress, such as suicidal ideation. Research has shown that suicidal ideation is difficult to manage in emergency department (ED) settings and that patients in psychiatric distress are often "boarded" in the ED while awaiting more definitive care. To examine the attitudes and experiences of emergency physicians regarding the care of patients in psychiatric distress. Special attention is given to suicidal ideation due to its prevalence in the United States. A 19 question anonymous survey was sent via email to 55 emergency medicine residency directors throughout Michigan, Ohio, Indiana, and Illinois, who were identified using an Internet search of residency programs in the region. The program directors were asked to distribute the survey to their colleagues and residents. The intent of this procedure was to generate as many survey responses as possible, while obscuring the identities of the respondents. Responses were gathered from October 29, 2019 until January 16, 2020. The survey was designed to assess respondents' self-reported demographic data as well as their experiences with the boarding process, initial examination, final disposition, reevaluation of the patient, physician training and resources, and follow up care. Statistical analysis was performed using a Mann-Whitney U test, significance was set at p<0.01. In total, 47EM physicians responded to the survey; however, not all of the respondents completed all 19 questions. Ten of 44 respondents (22.7%) reported that they do not perform the initial psychiatric examination themselves and instead defer to a nurse or social worker. Twenty-two of 44 respondents (50.0%) reported that they defer to a social worker when determining the final disposition of psychiatric patients. Respondents reevaluated patients in psychiatric distress statistically significantly less often (p=0.01) compared with patients with cardiac pathology. Additionally, 15 of 38 respondents (39.5%) reported that they did not feel adequately trained to handle psychiatric emergencies, and 36 of 39 respondents (92.3%) of physicians felt that their facility would benefit from additional mental health resources. Thirty five of 39 respondents (89.7%) reported that their facility did not have a system in place to follow up with suicidal patients upon discharge. Caring for patients who are acutely suicidal or in psychiatric distress is complex and more research is needed to optimize treatment strategies. The results of this study indicate that EM physicians may regularly defer to nonphysician providers when evaluating and treating patients in psychiatric distress. A perceived lack of training in psychiatry may contribute to this practice. The results of this study are in accord with previous research that indicated a need for additional psychiatry training in EM residencies.

A latent class analysis of physical, emotional, and sexual abuse history among suicidal inpatients

ObjectivePhysical, emotional, and sexual abuse are subtypes of childhood abuse that may persist into adulthood. This study applied latent class analysis to describe the pattern of co-occurrence of these three abuse subtypes during childhood and adulthood and examined latent class differences in psychosocial characteristics and three types of suicide attempt history (aborted, interrupted, and actual). MethodsData were drawn from a high-risk sample of 115 military service members and adult beneficiaries who were psychiatrically hospitalized following a suicide-related crisis. ResultsThree latent classes were identified: Multiple and Persistent Abuse (Class One: 29.6%), Childhood Physical and Persistent Emotional Abuse (Class Two: 27.0%), and Minimal Abuse (Class Three: 43.5%). Females were more likely than males to report a history of Multiple and Persistent Abuse. After controlling for gender, the Multiple and Persistent Abuse Class had higher scores of depressive symptoms and hazardous drinking, poorer sleep quality, and increased social stress than the Minimal Abuse Class. Moreover, the Multiple and Persistent Abuse Class was associated with increased likelihood of lifetime interrupted suicide attempt (Odds Ratio [OR] = 3.81, 95% CI = 1.20, 12.07) and actual suicide attempt (OR = 3.65, 95% CI = 1.23, 10.85), and had the greatest number of total actual suicide attempt (1.82 times on average). ConclusionCo-occurrence of multiple subtypes of abuse across development is associated with higher psychosocial risk and history of suicide attempt. The assessment of specific subtypes of abuse and their timing may inform case conceptualization and the management of suicide risk among psychiatric inpatients.

Suicide prevention training: self-perceived competence among primary healthcare professionals

Objective: The aim is to report the outcomes of the suicide prevention training in terms of the self-perceived impact on the participants. Design: The three-hour training consisted areas of risk and protective factors, screening and evaluating suicide risk, raising concerns and confronting suicidal patients, and treating suicidal ideation in primary healthcare and the associated referral processes. Subjects: The studied participants consisted of general practitioners, nurses, public health nurses and social work professionals. Main outcome measures: Participants assessed their own competence on online form regarding four training areas prior to and two weeks after the training. Results: The response rate was 25%. The self-perceived competence of the healthcare professionals increased in all training areas and in all occupational groups. The healthcare professionals’ competence regarding the risk and protective factors training area saw the greatest increase across all professional groups except nurses. There were, however, differences between the groups. Conclusion: Suicide prevention training for primary healthcare professionals did increase the self-perceived competence of the participants in all areas covered by the training. Regular follow-up training is required in order for these improvements to be further developed and retained. Key points After the suicide prevention training all participants self-perceived increase in their competence in all training areas. The GPs self-perceived most increase in risk and protective factors and nurses in raising concerns and confronting suicidal patients. The GPs’ lowest increase was in the area of treating suicidal ideation in primary health care and the referral processes.

What are Canadian emergency physicians' attitudes and self-perceived competence toward patients who present with suicidal ideation?

Suicide is the 9th leading cause of death in Canada, and a common reason for patients to present to Canadian emergency departments (ED). Little knowledge exists around Canadian emergency physicians (EPs) attitudes toward and understanding of individuals with suicidal ideation. We developed a web-based survey on suicide knowledge, which was pilot tested by two EPs and one psychiatrist for clarity and content. The survey was distributed via email to attending physician members of the Canadian Association of Emergency Physicians. Data were described using counts, means, medians and interquartile ranges. The Understanding of Suicidal Patients (USP) Scale is an 11-point questionnaire to assess healthcare providers' attitudes toward individuals with suicidal ideation. Other questions pertaining to suicidal ideation, self-perceptions on ability to treat suicidal patients, and personal experiences with suicide were asked in Likert format. One hundred eighty-eight Canadian EPs responded to the survey (15% response rate), with a median age of 49 (IQR 39-55), academic practice reported by 55% of respondents, and 65% of respondents identified as male. The mean USP score was 21.8 (95% CI 21.1-22.5), which indicates a generally positive attitude and willingness to provide care for suicidal patients. Only 17% of respondents had participated in specific training for treatment of suicidal patients in the last five years, while the majority of respondents estimate treating 5-15 patients with suicidal ideation a month. Sixty four percent of respondents indicated they had the skills to screen patients for suicidal ideation, but less than one-third felt they could create a personalized safety plan for patients. Respondents have a generally positive attitude toward treating individuals with suicidal ideation. Respondents scored highly on the USP scale that measured willingness to provide care for and empathize with suicidal patients. Respondents felt they had the skills to adequately screen patients for suicidal ideation. Key gaps in knowledge were identified suggesting improved residency and ongoing medical education opportunities are needed to better improve care for this vulnerable population.

Application of a 5-item brief symptom rating scale to evaluate suicide risk in elderly inpatients.

Suicide rates among hospital inpatients increase with age. Choosing a simple and appropriate suicide risk assessment tool can assist medical staff to identify high-risk individuals in time, and reduce the inpatient suicide rates. A total of 1,841 elderly inpatients in the Renji Hospital South Campus, Shanghai Jiaotong University of Medicine from April to August 2020 were randomly selected as the participants for a cross-sectional study. Their conditions were assessed by BSRS-5, Barthel index (BI), and numeric rating scale (NRS). Then, the software SPSS 23.0 (IBM Corp., Armonk, NY, USA) was applied to create a database and statistically analyze the results. According to the BSRS-5 score, 1,825 participants (99.1%) had no suicide risk (0-3 points) and 16 participants (0.9%) had suicide risk (4-24 points). Subsequently, univariate analysis was performed with the BSRS-5 score as the dependent variable and participant gender, age, self-care ability, and pain intensity as independent variables. The results showed that self-care ability (F=3.195, P=0.000) and pain intensity (F=3.247, P=0.001) were the main risk factors for suicide. Finally, to investigate the relationship of suicide risk with self-care ability and pain intensity, the scores of the 3 scales (BSRS-5, BI, NRS) were assigned, and then the data were analyzed by logistic regression. The results showed that self-care ability assignment was statistically significant (P=0.009<0.05, B=-0.657), suggesting that self-care ability score affected the suicide risk in elderly inpatients. Specifically, the weaker their self-care ability, the higher the suicide risk. Suicide prevention strategies should take self-care ability into account, which is a crucial influencing factor of suicide risk in elderly inpatients. The BSRS-5 assessment tool is recommended to assess suicide risk in elderly inpatients, which can then contribute to the establishment of a 3-level safety system for suicide prevention in elderly inpatients.

Analysis of social factors influencing authenticity of suicide for patient who attempt to suicide in emergency department: Retrospective study based Post-suicidal Care Program data

Purpose: This study was conducted to analyze the social factors influencing the 'authenticity of suicidal ideation' based post-suicidal care programs in emergency departments (EDs). Methods: This retrospective study was an analysis using the data of patients who had attempted suicide and visited the ED in tertiary urban hospitals from January 1, 2016, to December 31, 2018. The variables examined included gender, age, history of previous psychiatric disease, suicide method, and the number of previous attempts. Univariate and multivariate logistic regression analyses were conducted to identify factors influencing the registration rate for the community-based post-suicide care program. Results: Overall,1,460 suicides were analyzed, 177 (1.16%) showed a high authenticity of suicide. The social factors influencing the authenticity of suicide intent were the unmarried status of men and women, joblessness, history of mental illnesses, more than two previous suicide attempts, the influence of alcohol, and an attempt to commit suicide after midnight more specifically between 24:00 to 6:00 hours in the morning (p&lt;.05). The factors influencing the severity of the condition of high authenticity suicide patients were low Glasgow coma scores (12 points or less), lactate levels, and oxygen saturation observed in the patients who were admitted to the intensive care unit for treatment and died (p&lt;.05). Conclusion: The need for evidence-based preventive measures and early assessment tools at the emergency medicine level is emphasized to reduce the rate of suicide attempts. If the results of this study are used in the management of suicide prevention, the evaluation of the authenticity of suicide intent will be more likely to be made at the emergency medicine level, allowing the severity to be assessed earlier.