Suicide Risk Assessment Research Articles

Suicide among Veterans in Veterans Health Administration care: Differences in methods by tier of predicted suicide risk

Veterans' suicide rates exceed those of non-Veteran adults, and Veteran suicides more often involve firearms. However, the relationship between Veteran characteristics and suicide method is not well understood. Using the Veteran Health Administration suicide prediction algorithm, we assessed differences in suicide method by predicted risk among Veteran suicide decedents. Significant predictors of firearm involvement included lower algorithm-predicted suicide risk, no recent suicide attempts, male sex, and older age. Non-firearm methods were most common at high tiers of suicide risk. Firearm safety counseling is important for all Veterans and non-firearm lethal means safety counseling may be particularly important for high-risk Veterans.

Revolutionizing Mental Health Nursing Education: Virtual Reality Simulation for Understanding and Intervening in Major Depressive Disorder and Suicidal Thoughts.

Utilizing Healthcare Simulation Standards of Best Practice™, a virtual reality (VR) platform was created to meet American Association of Colleges of Nursing Essential and Quad Council Public Health competencies. The scenario, involving major depressive disorder with suicidal ideation and alcohol dependency, engages learners in assessing suicide risk, recognizing symptoms, and recommending treatment. Eighty-four prelicensure nursing students have taken part in this mental health VR simulation since spring 2023. Although no significant difference was observed between pre-post knowledge, learners appreciated the VR experience. Student ratings were lowest for how physically demanding the task was and highest for their focus and interest in successfully doing the simulation.

Last general practitioner consultation during the final month of life: a national medical record review of suicides in Sweden

ObjectivesIndividuals who die by suicide often consult their general practitioners (GPs) in their final weeks of life. The aim of this study was to gain a deeper knowledge of the clinical characteristics and GP assessments and treatments among individuals who consulted their GPs during the month preceding suicide. Further, we compared these features in those with and without contact with psychiatric services (PC and NPC, respectively) during the two years that preceded the suicide.DesignA nationwide retrospective explorative study investigating medical records.SettingPrimary care in Sweden.ParticipantsIndividuals who died by suicide in Sweden in 2015 with a GP visit within 30 days of death.ResultsThe study cohort corresponds to one fifth (n = 238) of all suicides that occurred in Sweden in 2015 (n = 1179), representing all those with available primary care records showing contact with a GP during the final 30 days of life (NPC: n = 125; PC: n = 113). The mean age was 58 years ± 19. Patients in the NPC group were older (NPC: 63 years ± 19 vs. PC: 53 years ± 18, p < 0.0001) and presented psychiatric symptoms less often (NPC: 50% vs. PC: 67%, p < 0.006). Somatic symptoms were as common as psychiatric symptoms for the whole sample, being present in more than half of individuals. Suicide risk was noted in only 6% of all individuals. Referral to psychiatric services occurred in 14%, less commonly for the NPC group (NPC: 6% vs. PC: 22%, p < 0.001). Cardiovascular or respiratory symptoms were noted in 19%, more often in the NPC group (NPC: 30% vs. PC: 6%, p < 0.001), as were diagnoses involving the circulatory system (all 10%, NPC:14% vs. PC: 5%, p < 0.020).ConclusionA high level of somatic symptoms was observed in primary care patients both with and without psychiatric contact, and this might have influenced GPs’ management decisions. Psychiatric symptoms were noted in two thirds of those with psychiatric contact but only half of those without. While GPs noted psychiatric symptoms in over half of all individuals included in the study, they seldom noted suicide risk. These findings highlight the need for increased attention to psychiatric symptoms and suicide risk assessment, particularly among middle-aged and older individuals presenting with somatic symptoms.Strengths and limitations of this studyThe National Cause of Death Register has excellent coverage of suicide deaths and access to medical records was very good. The medical record review provided detailed information regarding primary care utilization before death by suicide. Because of the lack of statistical power, due to the limited number of persons with GP contact during the last month of life, we chose not to correct for multiple comparisons. Our study approach did not capture the reasons behind GPs’ documentation of elevated suicide risk. No systematic inter-rater reliability (IRR) testing was made, however, reviewers received training and continuous support from the research group.

The Emotional Impact of Suicide Assessment: A Qualitative Study of Military Family Medicine Residents.

Assessing suicide risk in primary care settings has become standard practice; however, the emotional toll on medical providers remains understudied. This qualitative study examines the emotional impact of suicide assessments among family medicine residents. We conducted one-on-one, semistructured, in-depth interviews with a convenience sample of residents enrolled in a family medicine residency program at a US military installation. Employing an exploratory, qualitative research approach, we iteratively coded transcribed interviews for content and themes. For this study, we interviewed 15 family medicine residents spanning all three postgraduate year groups. The primary objective of the comprehensive study was to evaluate the confidence levels of family medicine residents in suicide risk screening, with the intent to identify educational gaps for improvement. However, unexpectedly, participants revealed their profound negative emotional responses during these assessments. The emotional impact of suicide risk assessment was the most frequently coded theme in the study, with participants noting six main emotional reactions to assessing suicide risk among their patients: fear, weariness, anxiety, shock, overwhelm, and inadequacy. Despite claims of emotional detachment, participants often expressed surprise and vulnerability when faced with suicidal patients. With suicide screening becoming increasingly vital in primary care, understanding and mitigating the emotional impact on physicians is essential. Future research should explore strategies to support medical providers in navigating these challenging interactions effectively for both the patients and themselves.

Beyond prediction: a new paradigm for understanding suicide risk

Recent meta-studies have shown that there are no known risk factors for suicidal behavior that could be used for behavior prediction, rendering the classic understanding of high and low risk for suicide questionable. The aim of this manuscript is to propose a new understanding of suicide risk that does not depend on predictive powers. In contrast, the developed Normic account of suicide risk, which is based on a possible world framework rather than probability calculations, suggests that the normalcy of an event determines whether the risk for the event’s occurrence is high or low. I suggest that this normalcy stems from the norms of practical rationality for agents who consider self-killing. The more difficult it is to make sense of possible intentional self-killing, the more abnormal the event is, which renders the event less risky. Consequently, from the Normic account of suicide risk, an individual who has weak or no life-sustaining reasons is at high risk for suicide. In conclusion, although the prediction of suicide is beyond the current scope of clinical psychology, there are still reasonable options for understanding what distinguishes individuals at high risk from those at low risk for suicide.

Improving assessment and management of suicide risk among people who inject drugs: A mixed methods study conducted at the Medically Supervised Injecting Centre, Sydney.

People who inject drugs are 13 times more likely to die by suicide than the general population. Guidelines for responding to risk in this population are limited. Harm reduction services attended by people who inject drugs require targeted strategies to address the complexities of suicide risk among this population. Co-design, engaging health professionals and people with lived experience informed the study. Mixed methods were used to understand the experience of managing suicide risk among clients attending the Medically Supervised Injecting Centre (MSIC) in Sydney. A survey was administered to assess staff confidence in managing risk. Focus groups were conducted with health professionals and MSIC clients to explore experiences of suicide management, response and opportunities for improvement. Half (N = 17) the MSIC staff surveyed reported over 10 years' experience working with this population. Confidence in managing suicide risk was low. Three key themes emerged from focus groups (N = 17): (i) Autonomy and the need to involve clients in the assessment process; (ii) Trust between clients and health professionals, and transparency in decision-making; and (iii) System barriers, described by health professionals as inadequate referral pathways for clients in distress, and by clients as negative experiences of care, including involuntary admission and not receiving medication (e.g. methadone). Revised assessment guidelines and a tailored safety plan were developed. These resources are also suitable for other alcohol and other drug services. The challenge in managing suicide risk in harm reduction services is balancing duty of care with staff-client relationships and client engagement.

Understanding Internalized Stigma's Role in Sex-Specific Suicidal Ideation among Individuals with Bipolar Disorder.

Background: The experience of stigma can exert a profound impact on the mental health and well-being of individuals with bipolar disorder (BD). Our study explores which factors of internalized stigma are associated with suicidal ideation and how they differ between the two sexes in a clinical sample of BD patients. Methods: The study follows a cross-sectional study design, employing the Clinical Global Impression for Bipolar Patients (CGI-BP) to evaluate the overall severity of illness and the alteration in patients affected by bipolar disorder, the Internalized Stigma of Mental Illness (ISMI) assessing self-stigma among individuals experiencing mental disorders, and the Columbia Suicide Severity Rating Scale (C-SSRS) identifying and assessing individuals vulnerable to suicide. Descriptive analyses, analysis of variance (ANOVA), and logistic regression analysis were conducted, and 344 BD subjects were recruited. Results: Our ANOVA results revealed a significant association between sex and suicide across ISMI sub-items (p = 0.000). Logistic regression analysis comprised three phases: Discrimination was consistently significant across all phases (p < 0.001), while Alienation and Stereotype emerged as additional predictors of suicide in later phases of the analysis (p < 0.001). Conclusions: Our study contributes to the growing body of literature on internalized stigma, sex, and suicidality among individuals with bipolar disorder. Early intervention programs and prevention strategies are needed.

Assessment of Suicide Risk and Cultural Considerations in Forcibly Displaced Migrant Youth

Migrant youth who face forced displacement from their home countries have an emergent mental health burden, placing them at increased suicide risk. As such, it is crucial for pediatric providers to include suicide screening and assessment in their care for this population. Migrant families seek safety but, in many cases, encounter adverse events and psychosocial inequities in the migration journey and in the host community. Factors such as trauma, acculturative stress, and intersectionality influence suicide risk in migrants. Summative traumatic events contribute to the mental health load and worsen suicidal outcomes in migrant youth. Acculturative stress can lead to social marginalization in the host country, further adding to the existing mental health burden. Finally, intersectionality encompasses complex sociocultural influences, which shape the development of cultural identity in migrant youth and influence suicide risk. By examining these factors, the author advances cultural considerations in screening and assessment for suicide risk in migrant youth through evidence-based tools in pediatric clinical practice. Barriers to access to mental health services, stigma, and distrust of the health care system within the host community are also addressed. The author establishes recommendations for early suicide screening and prevention within this population through trauma-informed care, active advocacy, and cultural sensitivity.

Issues Faced by General Practitioners in Managing Mental Health Disorders in Basic Health Units: a Cross-Sectional Study

ObjectivesThis study aimed to investigate the main issues faced by general practitioners when managing mental health disorders in the primary care setting and evaluate their interest in continued medical training on mental health. MethodsWe carried out a cross-sectional survey which included general practitioners (n=94) working in primary care in São Bernardo do Campo, SP, Brazil. ResultsParticipants reported challenging issues to be as follows: psychiatric emergency (44.7%), alcohol and drug use disorders (35.1%), psychopharmacology (29.9%), and suicide risk assessment (27.6%). About a third of the sample reported a lack of knowledge on criteria regarding referral to psychiatric services. Almost the entire sample reported the need for better interaction between general practitioners and psychiatrists and interest in continued medical training. ConclusionsOur findings support the evidence that a network between general practitioners and psychiatrists is needed as well as the improvement of continued medical training on mental health.

Representación del riesgo suicida y su exploración en una simulación realizada por estudiantes de Medicina

IntroductionExploring suicide risk is a fundamental skill for medical professionals. However, university medical education typically does not include enough formal training in this area. Simulation has been used as a method for learning this skill, although most studies using this pedagogic tool focus on analysing changes in self-perceived capabilities and attitudes after receiving specific training on suicide. MethodsA formative assessment task was carried out, consisting of recording a video in which groups of final-year medical students conducted a general psychiatric assessment with a simulated patient. The patient's diagnosis, suicide risk assessment, and exploratory questions were chosen by the students. Videos recorded over one term were studied. The chosen suicide risk assessment and exploratory questions regarding suicide risk were analysed independently and in relation to the chosen diagnosis. ResultsOut of 34 videos recorded, in 70% of those where suicide risk was explored, there was no suicidal ideation, and none had active suicidal ideation. Suicide risk was explored in 88% of the videos, but only 23.5% directly asked about the presence of suicidal ideation. ConclusionsThe task helped students integrate the importance of exploring suicide risk. The proportion of suicidal risk represented, and the exploratory questions, highlight the need to implement additional training interventions that focus on knowledge and stigma towards suicide.

Which Types of Providers Have Firearm Discussions in a Pediatric Primary Care Clinic?

ObjectiveSafe firearm storage decreases self-inflicted and unintentional firearm injury in youth. Medical providers are well-positioned to discuss safe firearm storage with families. The primary objective of this study was to determine which providers are most likely to discuss firearms with their patients. Our secondary objective was to determine whether providers were more likely to discuss firearms with patients at elevated suicide risk. MethodsThis was a retrospective chart review of primary care well-child visits occurring January to December 2019 in a large, urban academic clinic. We documented provider type and training level (exposure); any documentation of firearms in the chart (counseling, screening) was considered as having a firearm discussion (outcome). We also collected demographics, patient mental health history, and Patient Health Questionnaire-9 scores and assessed suicide risk. ResultsOf the 743 charts reviewed, firearms were discussed in 9% (n = 66). Medical students were most likely to discuss firearms (15%), and attending physicians were least likely (1%, P < 0.001). Providers did not discuss firearms more frequently among youth at elevated suicide risk. ConclusionsThough providers do not frequently discuss and document firearm discussions overall, the higher rates among medical students are promising. Given the lethality of firearms in a suicide attempt, the lack of firearm safety discussions with those at elevated suicide risk was concerning. Further study should evaluate factors that facilitate discussions in this cohort and identify strategies to improve counseling among more senior providers.

Suicide among Indian Medical Students and Professionals: A 3-year Exploratory Study Using Online Google Database (2020–2022)

Abstract Background and Aims: Medical students and professionals are particularly susceptible to psychological distress due to various factors especially after COVID 19 pandemic. However, there is currently no robust reporting system for suicides among medical professionals in India. We aimed to explore the characteristics of suicide deaths among medical students and professionals in India over three years (2020–2022). Materials and Methods: We conducted a two-level retrospective analysis of online news report on suicide deaths among medical students and professionals from January 2020 to December 2022. Results: A total of 118 fatal suicides among MBBS students, postgraduates and working medical professionals were reported. More than 50 percent of the reported suicides were before the age of 30 years. The most common method used was hanging (49%) and the presence of mental illness (12%) was the commonest predictor of suicide among medical students and professionals. Conclusion: There is pressing need for a national suicide reporting system for medical students and professionals to formulate a stringent policy on suicide prevention for medical community.

Psychometric Properties of a Persian Version of the Columbia Suicide Severity Rating Scale (C-SSRS) in Iranian Soldiers.

Objective: Suicide is an important health issue nearly all over the world. The Columbia Suicide Severity Rating Scale (C-SSRS) is a well-known instrument for suicide risk assessment. Our purpose in this study is to provide a Persian version of the C-SSRS and evaluate its psychometric properties in the Iranian military population, particularly suicide risk leveling characteristic of the C-SSRS. Method : For linguistic adaptation, we gathered opinions of an expert panel consisting of 23 professionals in mental health sciences. Furthermore, this version was administered to two groups of soldiers, one representing a sample of normal population (N = 338), while the other group comprised a sample of clinical population from a referral psychiatric hospital (N = 348) in Tehran, capital of Iran, from July 2021 until one year later. Besides the C-SSRS, the Beck Scale for Suicidal Ideation (BSSI), Beck Hopelessness Scale (BSS), and General Health Questionnaire 28 (GHQ28) were obtained from the participants. Correlation coefficients, internal consistency, and factor analysis were evaluated using the Statistical Package for the Social Sciences (version 23) software. Results: All items of the Persian version of the C-SSRS had acceptable content validity and face validity. This tool demonstrated high correlation coefficients with the BSSI (r = 0.73, P < 0.001) and BHS (r = 0.64, P < 0.001), but a low correlation coefficient with the GHQ28 (r = 0.22, P < 0.001). Specifically, the suicide risk level based on the C-SSRS had a high correlation with both the BSSI and BHS. Also, its internal consistency was satisfactory (Cronbach's alpha = 0.89). Furthermore, factor analysis revealed two factors that is consistent with suicidal ideation and suicidal behavior factors. Conclusion: Our results indicated acceptable validity and reliability for the Persian version of the C-SSRS, demonstrating its capability to classify suicide risk. It can be concluded that the ordinal suicide risk level (as red, orange, yellow and green) is a valid index for the application of the C-SSRS.

Predicting inmate suicidal behavior with an interpretable ensemble machine learning approach in smart prisons.

The convergence of smart technologies and predictive modelling in prisons presents an exciting opportunity to revolutionize the monitoring of inmate behaviour, allowing for the early detection of signs of distress and the effective mitigation of suicide risks. While machine learning algorithms have been extensively employed in predicting suicidal behaviour, a critical aspect that has often been overlooked is the interoperability of these models. Most of the work done on model interpretations for suicide predictions often limits itself to feature reduction and highlighting important contributing features only. To address this research gap, we used Anchor explanations for creating human-readable statements based on simple rules, which, to our knowledge, have never been used before for suicide prediction models. We also overcome the limitation of anchor explanations, which create weak rules on high-dimensionality datasets, by first reducing data features with the help of SHapley Additive exPlanations (SHAP). We further reduce data features through anchor interpretations for the final ensemble model of XGBoost and random forest. Our results indicate significant improvement when compared with state-of-the-art models, having an accuracy and precision of 98.6% and 98.9%, respectively. The F1-score for the best suicide ideation model appeared to be 96.7%.

Risk factors and methods in suicides of elderly patients connected to mental health services from 1999-2024.

Suicide prevention is an important aspect of psychiatric care, with older men being a population identified at especially high suicide risk and a recent increase in suicides among older women. Using data collected by the region's quality assurance team, we examined all suicide deaths occurring between March 1999 and February 2024 in patients aged 60 years or older who were connected to the region's Addiction and Mental Health Program at the time of death. Data were analyzed to describe which factors were most commonly identified in suicides in older adults receiving mental healthcare. We also compared male and female cases to determine whether certain factors were more commonly observed in one gender. We identified 48 cases of suicide occurring in patients aged 60 or over. 60% of suicides occurred in males. Overdose and hanging were the most common suicide methods used, and all suicides occurring on inpatient units occurred via hanging. Depression was the most common diagnosis, and was diagnosed more frequently in suicides of female older adults. A greater proportion of suicides in older women were associated with previous history of suicide attempts. Our findings support many current best practices for suicide prevention in psychiatric care, including minimizing ligatures and anchor points on inpatient settings, assessing for and limiting access to means in individuals at-risk, and assessing suicide risk in hospitalized patients prior to passes and discharge. Recognition and treatment of depression remain important aspects in the treatment of older adults to prevent suicide.

Emerging Themes and Research Frontiers in Suicide Prediction: A Scientometric Analysis.

Suicide remains a critical global health issue despite advancements in mental health treatment.The purpose of this analysis is to emphasize the development, patterns, and noteworthy outcomes of suicide prediction research. It also helps to uncover gaps and areas of under-researched topics within suicide prediction. A scientometric analysis was conducted using Biblioshiny and VOSviewer. To thoroughly assess the academic literature on suicide prediction, various scientometric methodologies such as trend analysis and citation analysis were employed. We utilized the temporal features of the Web of Science to analyze publication trends over time. Author affiliation data were used to investigate the geographic distribution of research. Cluster analysis was performed by grouping related keywords into clusters to identify overarching themes within the literature. A total of 1,703 articles from 828 different sources, spanning from 1942 to 2023, were collected for the analysis. Machine learning techniques might have a big influence on suicide-related event prediction, which would enhance attempts at suicide prevention and intervention. The conceptual understanding of suicide prediction is enhanced by scientometric analysis, which further uncovers the research gap and literature in this area. Suicide prediction research underscores that suicidal behavior is not caused by a single factor but is the result of a complex interplay of multiple factors. These factors may include biological, psychological, social, and environmental factors. Understanding and integrating these factors into predictive models is a theoretical advancement in the field. Unlike previous bibliometric studies in the field of suicide prediction that have typically focused on specific subtopics or data sources, our analysis offers a comprehensive mapping of the entire landscape. We encompass a wide range of suicide prediction literature, including research from medical, psychological, and social science domains, thus providing a holistic overview.

Childhood adversity and severity of positive symptoms as predictors of suicidality controlling for sociodemographics among hospitalized patients diagnosed with schizophrenia in Jordan

Childhood adversity and severity of positive symptoms as predictors of suicidality controlling for sociodemographics among hospitalized patients diagnosed with schizophrenia in Jordan

Collaboration matters: A randomized controlled trial of patient-clinician collaboration in suicide risk assessment and intervention

BackgroundClinician collaboration can help high-risk individuals to manage their suicidal crises. However, limited research has directly examined how higher patient-clinician collaboration during assessment and intervention can effectively reduce suicidal ideation. This novel randomized clinical trial compared a high vs. low level of patient-clinician collaboration by pairing commonly used assessment (Structured Interview vs. Narrative Assessment) and intervention approaches (Safety Planning Intervention vs. Crisis Response Planning). We hypothesized that the interventions involving higher (than lower) patient-clinician collaboration during assessment (Narrative Assessment) or intervention (Crisis Response Planning) would lead to larger reductions in suicidal ideation. MethodsEighty-two participants with a history of suicide ideation and/or attempts were randomly assigned to one of the four interventions varying in patient-clinician collaboration. After attrition, sixty-six participants completed the study. Suicidal ideation via ecological momentary assessment was measured 14 days before and 14 days after treatment. ResultsAlthough the severity of suicidal ideation decreased in all groups, the two groups that included highly collaborative assessment had larger pre-post reductions in suicidal ideation (Narrative Assessment+Safety Plan; dwithin = 0.26, and Narrative Assessment+Crisis Response Plan; dwithin = 0.19) than the groups that included a checklist-based assessment (Structured Interview). LimitationsLonger follow-up periods with a larger sample would have provided an understanding of the durability of intervention effects. ConclusionResults suggest that the inclusion of higher patient-clinician collaboration techniques during suicide risk assessment can effectively reduce suicidal thoughts. Thus, clinician-led collaborative risk assessment approaches can enhance the effects of safety planning-type interventions among patients with elevated risk for suicide versus checklist-based assessment approaches.

Clinicians' perspectives of barriers and facilitators of suicide screening in head and neck cancer care.

e18023 Background: Patients with head and neck cancer (HNC) face a heightened risk of suicide, surpassing rates in other cancers and the general population. Unfortunately, there are currently no suicide-specific clinical guidelines in oncology, and it is unclear what barriers and facilitators impact suicide screening initiatives in HNC care. This qualitative study explored experiences, barriers and facilitators of suicide screening and management of mental health concerns in a diverse group of HNC clinicians. Methods: We conducted qualitative interviews with 16 HNC clinicians at a single healthcare system, including head and neck surgeons, radiation oncologists, medical oncologists, and nurses/nurse practitioners/physician assistants. Interviews covered topics such as clinicians’ perspective of the impact of HNC on patients’ mental health, experience with suicide risk assessment, existing protocols, and overall experiences related to managing mental health concerns in patients with HNC. Using rapid analysis techniques, we identified common challenges, facilitators, and training needs. Results: Our study uncovered distinct barriers faced by HNC clinicians. Key themes included the notable absence of formal suicide and mental health training among HNC clinicians; critical gaps in clinician education and the lack of established protocols for appraising and managing mental health concerns, particularly those related to suicide risk. Other barriers identified included clinicians’ uncertainties in recognizing and addressing suicidal thoughts, limited familiarity with available screening tools, and insufficient resources for patient support. Some key facilitators also emerged, including longer clinic visit times, mental health discussions in interdisciplinary conferences, and greater accessibility of mental health services for comprehensive patient support. Conclusions: In this qualitative study, we observed important barriers in mental health support and service delivery for HNC patients, especially gaps in clinician training, and lack of knowledge of existing suicide-related protocols. Given the suicide burden in HNC, it is important to address these challenges and begin developing initiatives for clinician training and formalized protocols to enhance mental health care for HNC patients.

Improving Emergency Department Care for Suicidality in Autism: Perspectives from Autistic Youth, Caregivers, and Clinicians.

In this pilot study, we conducted semi-structured interviews with 17 key members of the autism community (i.e., autistic youth with a history of suicidality, caregivers of autistic youth with a history of suicidality, autism specialist clinicians, ED clinicians) to inform the development of recommendations for modifying ED care for autistic patients, with a focus on suicide risk screening and management. Participants reported on challenges they encountered receiving or providing care and/or recommendations for improving care. Participant perspectives were aligned, and four main categories emerged: accounting for autism features, connection and youth engagement in care, caregiver and family involvement, and service system issues. As research continues in the development of autism-specific suicide risk assessment tools and management strategies, it is essential we better equip providers to address suicide risk in autistic patients, particularly in ED settings.