Prior Suicidal Ideation Research Articles

Suicidal ideation among medical and surgical inpatients at South Gondar Public Hospitals, Northwest Ethiopia, 2023: a multicenter institution-based cross-sectional study.

Suicide is a significant global public health issue impacting individuals, families, and communities across the world. People with medical and surgical conditions are at an elevated risk of experiencing suicidal thoughts. However, to the best of our knowledge, in Ethiopia, there has not been any published research that examines the magnitude and associated factors of suicidal ideation in this context. The objective of this study was to assess the prevalence of suicidal ideation among medical and surgically admitted patients in South Gondar public hospitals, Northwest Ethiopia, 2023. A multi-center institutional-based cross-sectional study was conducted in South Gondar public hospitals. A systematic random sampling technique was used to select 616 individuals with a response rate of 98.2%. Suicidal ideation was measured using the World Health Organization's Composite International Diagnostic Interview suicide module. Descriptive, bivariate, and multivariate binary logistic regressions were employed, with odds ratios and 95% confidence intervals. The significance of the association was determined with a p-value of less than 0.05. The prevalence of suicidal ideation in this study was 24.7% (95% CI: 20.8, 27.7). Poor life satisfaction (AOR = 2.64, 95% CI, 1.63, 4.3), poor social support (AOR: 3.38; 95% CI; 1.97, 5.8), being female (AOR: 1.98; 95% CI; 1.19, 3.3), depression (AOR: 2.67; 95% CI; 1.67, 4.22), prior suicidal ideation and/or attempt (AOR = 2.73, 95% CI; 1.47, 5.1), having high perceived threat (AOR = 3.0; 95% CI; 1.69, 5.29), and having poor sleep quality (AOR: 2.54; 95% CI 1.5, 4.25) were significantly associated with suicidal ideation at p-value < 0.05. The prevalence of suicidal ideation is notably high among patients hospitalized in surgical and medical wards. Effective screening, timely intervention, and enhanced support systems are essential for individuals, particularly for females, with poor social support, high perceived threat, prior suicidal ideation and/or attempt, poor sleep quality, depression, and low life satisfaction.

Risk Factors and Clinical Predictors of Suicidal Behaviors and Non-Suicidal Self-Injury Among Pediatric Psychiatry Emergency Admissions Pre- and Post-Pandemic: A Retrospective Cohort Study.

Suicidal behavior (SB) and non-suicidal self-injury (NSSI) are significant public health concerns among adolescents. The COVID-19 pandemic may have exacerbated these issues. This retrospective cohort study analyzed data from 341 adolescents (aged 6-18 years) presenting to a Romanian pediatric psychiatry emergency department during the years 2019 (pre-pandemic) and 2022 (post-pandemic). All participants underwent a thorough psychiatric assessment, and, together with their caregivers, were questioned on a wide range of potentially relevant issues, such as family, social, school, and life history factors. Logistic regression and random forest models were used to identify predictors of SB and NSSI. SB was significantly predicted in regression models based on a prior suicidal ideation (OR = 68.410; p < 0.001), having a parent living abroad (OR = 11.438; p = 0.020), depression (OR = 6.803; p < 0.001), and conflicts with peers (OR = 0.325, p = 0.042), teachers (OR = 0.119, p = 0.024), or both (OR = 0.166, p = 0.012). The random forest model featured a slightly different order of the main predictors and highlighted the importance of additional predictors, such as prior suicide attempts, gender, and past non-suicidal self-injury. NSSI was mainly predicted by a history of self-harm (OR = 52.437; p < 0.001), the number of comorbid psychiatric disorders (OR = 1.709; p = 0.003), and conduct disorder (OR = 0.184; p < 0.001), to which are added, according to random forest models, new predictors, such as borderline personality disorder, suicidal ideation, and school performance. Post-pandemic increases were observed in depression, suicidal ideation, and possible psycho-traumatic negative life event exposure. This study underscores the complex interplay of individual, familial, and societal factors influencing adolescent self-harm. Comprehensive interventions are needed, with early intervention crucial for those with a history of self-harm. Further research using prospective designs is recommended.

Multi-environment prediction of suicidal beliefs.

Suicide disproportionately affects the military and veteran population, yet the task of identifying those at an increased risk of suicidal behavior remains challenging. In the face of this complex issue, novel machine learning methods have been applied to study the relationship between suicide and potential risk factors, but are often not generalizable to new and unseen samples. Herein, we examine the problem of prediction on unknown environments, commonly known as environment-wise domain adaptation, as it relates to the prediction of suicidal beliefs, measured with items from the Suicide Cognitions Scale (SCS). We adapt several recently invariance-based models trained using a sample consisting of people without any prior suicidal ideation (SI) to the prediction of suicidal beliefs of those with prior SI. In addition, we examine the possible causal relations regarding the SCS. Using a prospective sample of 2744 primary care patients with 17 risk and protective factors, we show that, to some extent, these methods are able to generalize to a new environment, namely, a sample with prior SI. Additionally, our results indicate suicidal ideation and suicidal behavior are likely to be causal children of SCS.

Suicide Death Prediction Using the Maryland Suicide Data Warehouse: A Sensitivity Analysis

Objective Nearly 50,000 Americans die each year from suicide, despite suicide death being a rare event in the context of health risk assessment and modeling. Prior research has underscored the need for contextualizing suicide risk models in terms of their potential uses and generalizability. This sensitivity analysis makes use of the Maryland Suicide Data Warehouse (MSDW) and illustrates how results inform clinical decision support. Method A cohort of 1 million living control patients were extracted from the MSDW in addition to 1,667 patients who had died by suicide between the years 2016 and 2019 according to the Maryland Office of the Medical Examiner (OCME). Data were extracted and aggregated as part of a 4-year retrospective design. Binary logistic and two penalized regression models were deployed in a repeated fivefold cross-validation. Model performances were evaluated using sensitivity, positive predictive value (PPV), and F1, and model coefficients were ranked according to coefficient size. Results Several features were significantly associated with patients having died by suicide, including male sex, depressive and anxiety disorder diagnoses, social needs, and prior suicidal ideation and suicide attempt. Cross-validated binary logistic regression outperformed either ridge or LASSO (least absolute shrinkage and selection operator) models but generally achieved low-to-moderate PPV and sensitivity across most thresholds and a peak F1 of 0.323. Conclusions Suicide death prediction is constrained by the context of use, which determines the best balance of precision and recall. Predictive models must be evaluated close to the level of intervention. They may not hold up to different needs at different levels of care.

Substance Use Disorder and Suicidal Ideation in Rural Maryland

Background Rural areas in the United States have been disproportionately burdened with high rates of substance use, mental health challenges, chronic stress, and suicide behaviors. Factors such as a lack of mental health services, decreased accessibility to public health resources, and social isolation contribute to these disparities. The current study explores risk factors to suicidal ideation, using emergency room discharge data from Maryland. Methods The current study used data from the Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) from the State of Maryland. Logistic regression was used to assess the association between ICD-10 coded opioid use disorder, alcohol use disorder, cannabis use disorder, major depressive disorder, and the outcome variable of suicidal ideation discharge. We controlled for income, race, age, and gender. Results Lifetime major depressive disorder diagnosis (odds ration [OR] = 79.30; 95% confidence interval [CI] 51.91-121.15), alcohol use disorder (OR = 6.87; 95% CI 4.97-9.51), opioid use disorder (OR = 5.39; 95% CI 3.63-7.99), and cannabis use disorder (OR = 2.67; 95% CI 1.37-5.18) were all positively associated with suicidal ideation. Conclusions The study highlights the strong link between prior substance use disorder, depression, and suicidal ideation visit to the emergency room, indicating the need for prevention and intervention, particularly among those in rural areas where the burden of suicidal ideation and chronic stress are high. As health disparities between rural and urban areas further widened during the COVID-19 pandemic, there is an urgent need to address these issues.

Mortality and Suicide Among Persons Experiencing Homelessness: A Seven-Year Follow-up Study.

There is a significant gap in scientific understanding about suicide among people experiencing homelessness (PEHs). This seven-year longitudinal study examined a cohort of 154 PEHs. In 2015, clinical assessments were conducted, including an evaluation of suicide risk, with data on causes of death collected from public health service records in 2022. Over the course of seven years, 14.3% of the sample passed away at an average age of 52.6 years. The leading causes of death were cancer, suicide, and accidental overdose. Participants who experienced violence had a higher number of suicide attempts and scored higher on the suicidal ideation scale. The most significant factors associated with mortality were prior suicide attempts and suicidal ideation. This study underscores the importance of suicide risk scale scores as the primary predictor of mortality. It emphasizes the need for further longitudinal research on suicide among PEHs and the development of specific programs to prevent suicide within this population. An approach combining structural and individual perspectives is suggested, considering appropriate housing policies and mental health care.

Suicide-specific mortality among patients with treatment-resistant major depressive disorder, major depressive disorder with prior suicidal ideation or suicide attempts, or major depressive disorder alone.

The impact of treatment-resistant depression (TRD) or prior suicidal ideation/suicide attempt (SI/SA) on mortality by suicide among patients with major depressive disorder (MDD) is not well known. This retrospective, observational, descriptive cohort study characterized real-world rates of suicide-specific mortality among patients with MDD with or without TRD or SI/SA. Adult patients with MDD among commercially insured and Medicare enrollees in Optum Research Database were included and assigned to three cohorts: those with treatment-resistant MDD (TRD), those with MDD and SI/SA (MDD+SI/SA), and those with MDD without TRD or SI/SA (MDD alone). Suicide-specific mortality was obtained from the National Death Index. The effects of demographic characteristics and SI/SA in the year prior to the end of observation on suicide-specific mortality were assessed. For the 139,753 TRD, 85,602 MDD+SI/SA, and 572,098 MDD alone cohort patients, mean age ranged from 55 to 59 years and the majority were female. At baseline, anxiety disorders were present in 53.92%, 44.11%, and 21.72% of patients with TRD, MDD+SI/SA, and MDD alone, respectively. Suicide-mortality rates in the three cohorts were 0.14/100 person-years for TRD, 0.27/100 person-years for MDD+SI/SA, and 0.04/100 person-years for MDD alone. SI/SA during the year prior to the end of observation, younger age, and male sex were associated with increased suicide risk. Patients with TRD and MDD+SI/SA have a heightened risk of mortality by suicide compared with patients with MDD alone. Suicide rates were higher in patients with recent history versus older or no history of SI/SA, men versus women, and those of young age versus older age.

Predictors of suicide attempt within 30 days of first medically documented major depression diagnosis in U.S. army soldiers with no prior suicidal ideation

BackgroundUnderstanding mental health predictors of imminent suicide attempt (SA; within 30 days) among soldiers with depression and no prior suicide ideation (SI) can inform prevention and treatment. The current study aimed to identify sociodemographic and service-related characteristics and mental disorder predictors associated with imminent SA among U.S. Army soldiers following first documented major depression diagnosis (MDD) with no history of SI.MethodsIn this case-control study using Army Study to Assess Risk and Resilience in Servicemembers (STARRS) administrative data, we identified 101,046 active-duty Regular Army enlisted soldiers (2010–2016) with medically-documented MDD and no prior SI (MDD/No-SI). We examined risk factors for SA within 30 days of first MDD/No-SI using logistic regression analyses, including socio-demographic/service-related characteristics and psychiatric diagnoses.ResultsThe 101,046 soldiers with documented MDD/No-SI were primarily male (78.0%), < 29 years old (63.9%), White (58.1%), high school-educated (74.5%), currently married (62.0%) and < 21 when first entering the Army (56.9%). Among soldiers with MDD/No-SI, 2,600 (2.6%) subsequently attempted suicide, 16.2% (n = 421) within 30 days (rate: 416.6/100,000). Our final multivariable model identified: Soldiers with less than high school education (χ23 = 11.21, OR = 1.5[95%CI = 1.2–1.9]); combat medics (χ22 = 8.95, OR = 1.5[95%CI = 1.1–2.2]); bipolar disorder (OR = 3.1[95%CI = 1.5–6.3]), traumatic stress (i.e., acute reaction to stress/not PTSD; OR = 2.6[95%CI = 1.4–4.8]), and “other” diagnosis (e.g., unspecified mental disorder: OR = 5.5[95%CI = 3.8-8.0]) diagnosed same day as MDD; and those with alcohol use disorder (OR = 1.4[95%CI = 1.0-1.8]) and somatoform/dissociative disorders (OR = 1.7[95%CI = 1.0-2.8]) diagnosed before MDD were more likely to attempt suicide within 30 days. Currently married soldiers (χ22 = 6.68, OR = 0.7[95%CI = 0.6–0.9]), those in service 10 + years (χ23 = 10.06, OR = 0.4[95%CI = 0.2–0.7]), and a sleep disorder diagnosed same day as MDD (OR = 0.3[95%CI = 0.1–0.9]) were less likely.ConclusionsSA risk within 30 days following first MDD is more likely among soldiers with less education, combat medics, and bipolar disorder, traumatic stress, and “other” disorder the same day as MDD, and alcohol use disorder and somatoform/dissociative disorders before MDD. These factors identify imminent SA risk and can be indicators for early intervention.

0655 Whose Mind after Midnight? Demographic and Clinical Variation in Nocturnal Suicide Risk

Abstract Introduction Although suicides are more prevalent during the day, the risk of suicide is highest at night when adjusted for population wakefulness. It is unclear how nighttime patterns of suicide risk vary by demographic and clinical subgroups. Methods Population wakefulness data were combined with time of fatal injury data for 78,647 suicides from 2003-2017. The primary outcome was number of suicides per hour with wakefulness as an offset/exposure term. Subgroups included sex, race, ethnicity, military service, blood alcohol category and marijuana positive on autopsy, current depressed mood or partner conflict, and prior suicidal ideation or suicide attempts. Formal interaction tests identified significant subgroup variations adjusted for age, sex, race, and ethnicity where appropriate. Groups with significant interactions were subsequently examined using robust Poisson regression models to measure incident risk ratios (IRRs). Results There were subgroup interactions for age (p &amp;lt; 0.001), ethnicity (p = 0.014), blood alcohol level on autopsy (p &amp;lt; 0.001), and current partner conflict at time of fatal injury (p &amp;lt; 0.001). There was a sharp peak in risk around 4AM for individuals aged 15 to 24 (aIRR: 3.11 [2.39, 4.05]) and 25-34 (aIRR 2.15 [1.63, 2.86]), and at 6AM for individuals aged 65 to 74 (aIRR: 1.78 [1.40, 2.25]) and 75+ (aIRR: 2.25 [1.69, 3.00]). Hispanic individuals had an elevated risk between 10PM and 3AM with a maximal 232% increase at 2am (aIRR: 2.32 [1.67, 3.23]). Current partner conflict increased risk from 8PM to11PM and from 1AM to 3AM with a peak risk at 11PM (aIRR: 1.53 [1.24, 1.89]). Individuals with a BAL &amp;lt; 0.08 mg/dL showed a sustained increased risk for suicide between 8PM and 4AM; individuals with a BAL of 0.08 mg/dL or more showed greater risk (aIRR 2.33 [1.88, 2.89] at 1AM) than those with a BAL &amp;lt; 0.08 mg/dL (aIRR: 1.68 [1.40, 2.01] at 12AM). Conclusion Nighttime suicide risk varied significantly by age, ethnicity, blood alcohol level on autopsy, and current partner conflict. Military service was not associated with greater nighttime risk, which contrasts with prior findings. Support (if any)

Heterogeneity in the Course of Suicidal Ideation and its Relation to Suicide Attempts in First-Episode Psychosis: A 5-Year Prospective Study.

Although the risk of suicide is high in first-episode psychosis (FEP), little is known about the course of suicidal ideation and its relation to suicide attempts. Therefore, we aimed to identify 5-year trajectories of suicidal ideation and associated factors in FEP and compare how suicide attempts were distributed across these identified trajectories. This 5-year prospective study assessed suicidal ideation, suicide attempts and potentially associated factors through research interviews, chart review and coroners' reports in 382 FEP patients [mean age = 23.53 (SD = 3.61)] admitted to 2 5-year early psychosis services in Montreal, Canada. Trajectories were identified using a semiparametric mixture model, and associated factors with multinomial logistic regression. Three suicidal ideation trajectories were identified: low and decreasing (n = 325, 85.08%); early decline, then increasing (n = 30, 7.85%), and persistent suicidal ideation (n = 27, 7.07%). Suicidal ideation prior to admission (OR = 2.85, 95% CI, 1.23 to 6.63, P < 0.05) and cocaine use disorder (OR = 6.78, 95% CI, 1.08 to 42.75, P < 0.05) were associated with the early decline, then increasing suicidal ideation trajectory. Persons with prior suicide ideation (OR = 4.33, 95% CI, 1.66 to 11.29, P < 0.05) and attempts (OR = 8.18, 95% CI, 2.39 to 27.97, P < 0.001) and alcohol use disorder (OR = 3.63, 95% CI, 1.4 to 9.42, P < 0.05) were more likely to belong to the persistent suicidal ideation trajectory, and to attempt suicide during follow-up. Our study highlights heterogeneity in the course of suicidal ideation over 5 years and the importance of ongoing assessment of suicidal risk in FEP patients, particularly for patients who persistently report suicidal ideation, as they are likelier to engage in suicide attempts. Patients with factors associated with increasing or persistent suicidal ideation trajectories should be targeted for suicide prevention interventions from the early phase of follow-up. Given the small number of persons in these trajectories and the wide CIs for some factors, larger studies are however needed to further characterize who belongs in each group.

Preferences for a potential therapist's suicide lived experience and use of therapy.

The present study is an examination of laypersons' preferences regarding therapists with lived mental health experiences. Specifically, we investigated participants' preferences for a treatment with a therapist who has sought personal therapy, experienced suicidal ideation, or made a suicide attempt. Additionally, we explored how participants' personal experiences may impact these preferences. Three hundred ninety-eight community members were recruited to complete an online survey through Amazon's Mechanical Turk. Participants completed delayed discounting paradigms which involve choices between a therapist with the experience (e.g., suicidal ideation) and a therapist without the experience providing treatment with varied levels of therapeutic efficacy (i.e., average percentage of client recovery). Overall, participants were willing to lose therapeutic efficacy in order to work with a therapist who has not been in prior mental health treatment (9.36% efficacy loss), experienced suicidal ideation (19.43% efficacy loss), and engaged in suicide attempts (20.18% efficacy loss). Across these therapist options, the strongest preference was for therapists with prior treatment compared to the other two conditions. Preferences differed somewhat depending on the participant's social stigma, history of suicide attempts, and prior suicidal ideation; however, these effects were small in size. Overall, participants preferred less effective therapists without a history of personal therapy, suicidal ideation, and suicide attempts, compared to more effective therapists with a history of these experiences. Findings from this study highlight the pervasiveness of negative attitudes toward suicidal thoughts and behaviors and lived experience. If replicable, these results emphasize a need for destigmatization of these experiences in mental health care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

S2168 The Use of Rituximab for IgG4–Related Sclerosing Mesenteritis

Introduction: Sclerosing mesenteritis (SM) is an uncommon fibro-inflammatory disease affecting the abdominal mesentery. Although some patients are asymptomatic or have minimal symptoms, SM can present with complications such as bowel obstruction, chylous ascites, and mesenteric ischemia. First-line therapy includes glucocorticoids in combination with tamoxifen in those who are symptomatic. Case Description/Methods: An 82-year-old man with a history of prostate cancer and melanoma in remission and lymphocytic colitis presented with 4-months of poor appetite and 40-pound unintentional weight loss. Computed tomography (CT) abdomen showed an irregular 8.6 cm mesenteric mass with surrounding misty mesentery (Figure, Panel 1). CT-guided biopsy demonstrated fibro-adipose tissue with increased IgG4-positive plasma cells, supporting a diagnosis of IgG4-related SM. Follow-up CT abdomen 6 months later demonstrated enlargement of the mass with new encasement of the jejunal and ileal branches of the superior mesenteric artery and vein. Given impending mesenteric ischemia, he was treated with rituximab, a monoclonal anti-CD20 antibody, with 2 infusions 2 weeks apart without side-effects. He had contraindications to first-line therapy with glucocorticoids given prior suicidal ideation while on budesonide for microscopic colitis. Three months following treatment, his erythrocyte sedimentation rate improved from 52 to 25 (reference range, 3-28 mm/h) and IgG4 level from 851 to 267 (2.4-121 mg/dL). CT abdomen demonstrated a 50% decrease in the volume of the mesenteric mass without significant vascular involvement (Figure, Panel 2) and he had regained 30 pounds. Discussion: Although rituximab has been studied for IgG4-related disease in general, the use of rituximab specifically for IgG4-related SM is not well-known. We report a case of a patient with IgG4-related SM treated effectively with rituximab, suggesting this may be a suitable medication for those who have contraindications or do not respond to current first-line therapy, especially if IgG4-related. Whether this drug would also work in patients with SM not related to IgG4 disease is unknown. Patients treated with rituximab should be closely monitored for infections, as well as allergic and infusion-related reactions.Figure 1.: CT abdomen pelvis of sclerosing mesenteritis before (1) and after (2) rituximab treatment.

Temporal exploration of the interpersonal theory of suicide among adolescents during treatment.

The interpersonal theory of suicide (ITS) predicts perceived burdensomeness, thwarted belongingness, and hopelessness lead to suicidal ideation and recommends burdensomeness and belongingness should be the targets of treatment. Limited research has tested if burdensomeness and belongingness temporally predict suicidal ideation during treatment. This study examined the bidirectional relationships between burdensomeness, belongingness, hopelessness, depression, and suicidal ideation in young people seeking treatment for suicide-related behaviors. A sample of 638 Australian young people (69.3% females, Mage = 16.61 [SD = 2.99]) completed measures of burdensomeness, belongingness, hopelessness, depression, and suicidal ideation at each session of treatment (Msessions = 5.24 [SD = 2.16]). A random-intercept cross-lagged panel model examined the within-person direction of effects across the first five occasions of treatment. Autoregressive paths showed hopelessness had carryover effects across all time points. All other variables had carryover effects at four time points. Cross-lagged paths varied, with suicidal ideation predicting depression, burdensomeness, and hopelessness. Belongingness, burdensomeness, and hopelessness predicted suicidal ideation on one occasion. Hopelessness predicted burdensomeness and depression at three time points and predicted belongingness on one occasion. Results are partially consistent with the ITS, but in contrast to the theory, the most consistent predictor of suicidal ideation was prior suicidal ideation. Prior levels of hopelessness, belongingness, and burdensomeness did influence suicidal ideation at some time points, but the most consistent effects were from hopelessness toward burdensomeness. Theoretical and treatment implications for these findings are discussed, particularly the need to directly address hopelessness in treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Predictive models for first-onset and persistence of depression and anxiety among university students

BackgroundDepression and anxiety are both prevalent among university students. They frequently co-occur and share risk factors. Yet few studies have focused on identifying students at highest risk of first-onset and persistence of either of these conditions. MethodsMulticenter cohort study among Spanish first-year university students. At baseline, students were assessed for lifetime and 12-month Major Depressive Episode and/or Generalized Anxiety Disorder (MDE-GAD), other mental disorders, childhood-adolescent adversities, stressful life events, social support, socio-demographics, and psychological factors using web-based surveys; 12-month MDE-GAD was again assessed at 12-month follow-up. ResultsA total of 1253 students participated in both surveys (59.2% of baseline respondents; mean age = 18.7 (SD = 1.3); 56.0% female). First-onset of MDE-GAD at follow-up was 13.3%. Also 46.7% of those with baseline MDE-GAD showed persistence at follow-up. Childhood/Adolescence emotional abuse or neglect (OR= 4.33), prior bipolar spectrum disorder (OR= 4.34), prior suicidal ideation (OR=4.85) and prior lifetime symptoms of MDE (ORs=2.33-3.63) and GAD (ORs=2.15-3.75) were strongest predictors of first-onset MDE-GAD. Prior suicidal ideation (OR=3.17) and prior lifetime GAD symptoms (ORs=2.38-4.02) were strongest predictors of MDE-GAD persistence. Multivariable predictions from baseline showed AUCs of 0.76 for first-onset and 0.81 for persistence. 74.9% of first-onset MDE-GAD cases occurred among 30% students with highest predicted risk at baseline. LimitationsSelf-report data were used; external validation of the multivariable prediction models is needed. ConclusionMDE-GAD among university students is frequent, suggesting the need to implement web-based screening at university entrance that identify those students with highest risk.

Nighttime Sleep Quality and Daytime Sleepiness Predicts Suicide Risk in Adults Admitted to an Inpatient Psychiatric Hospital

ABSTRACT As sleep problems have been identified as an important, yet understudied, predictor of suicide risk, the present study analyzed the relationship between daytime sleepiness and nighttime sleep disturbance in a high-risk population of adults admitted to an inpatient psychiatric hospital. Objectives were to (1) examine the time course of subjective daytime sleepiness, nighttime sleep disturbance, and suicide risk throughout inpatient psychiatric treatment, (2) examine pre- to post-treatment changes in sleep disturbance with treatment as usual in an inpatient psychiatric setting, and (3) investigate whether daytime sleepiness and nighttime sleep disturbance predicted suicide risk above and beyond anxiety and depression. Participants were 500 consecutively admitted adults admitted to an intermediate length of stay (4–6 weeks) inpatient psychiatric hospital (47% female; 18–87 years of age). Measures of sleep, suicide risk, depression, and anxiety were completed at admission, weeks 1 through 4, and at discharge. Latent growth curve modeling (LGM) and hierarchal linear modeling (HLM) were conducted. The LGM analysis demonstrated that daytime sleepiness, nighttime sleep disturbance, and suicide risk all improved throughout inpatient treatment. Further, HLM showed that daytime sleepiness predicted suicide risk above and beyond symptoms of anxiety, depression, major sleep medications, and prior suicidal ideation and attempts, while nighttime sleep disturbance predicted suicide risk above and beyond symptoms of anxiety, major sleep medications, and prior suicidal ideation and attempts. Findings indicate the need to reevaluate safety protocols that may impact sleep, particularly that may increase daytime sleepiness, and to develop evidence-based sleep interventions for individuals admitted to inpatient psychiatric hospitals.

Suicidality Risk Factors Across the CARE-HD, 2CARE, and CREST-E Clinical Trials in Huntington Disease.

Suicidality is a common concern in the routine care of persons with Huntington disease (HD) and for the many participants in HD clinical trials. In a previous analysis, we identified baseline and time-dependent factors associated with suicidal ideation and attempts from 2CARE, a large, randomized, double-blind clinical trial. The present analysis extends our prior methodology to 2 other large interventional HD clinical trials, CARE-HD and CREST-E. We observed relationships across studies between suicidality events and prior suicidal ideation at baseline, antidepressant/anxiolytic use, chorea, increasing age, and several domains in the Unified Huntington Disease Rating Scale (UHDRS) Behavioral Assessment (depressed mood, low self-esteem, aggression, and active suicidality). These data may form the basis for a subscale of demographic and UHDRS items with the potential for prospectively identifying suicidality risk in HD clinics and clinical trials. 2CARE and CREST are registered at clinicaltrials.gov. 2CARE NCT00608881, registered February 6, 2008; first enrollment March 2008. CREST-E NCT00712426, registered July 10, 2008; first enrollment September 2009. CARE-HD, not registered; first enrollment July 1997.

Preferences regarding therapists' history of personal therapy or suicidal ideation: A comparison of undergraduates and mental healthcare providers.

A majority of mental health care providers seek personal therapy (i.e., are prosumers), and many providers experience suicidal ideation. Although mental health care providers may have more awareness of mental health than undergraduates, stigma is prevalent across both mental health care professionals and within universities. Furthermore, suicidality is a particularly stigmatized aspect of mental health. Stigma may affect a client's willingness to work with therapists who are prosumers. Although client preferences have implications for treatment engagement, retention, and outcomes (Swift & Callahan, 2009, 2010; Swift, Callahan, & Vollmer, 2011), we are unaware of any research that considers clients' preferences regarding a prosumer therapist. The current study used a delay discounting paradigm to compare undergraduates' and mental health care providers' preferences of a prosumer therapist (i.e., with or without prior treatment history or prior suicidal ideation). We hypothesized that mental health care providers would be more accepting of a prosumer therapist, compared to undergraduates. Across both samples we expected a therapist with prior personal therapy to be more preferred than a therapist who has experienced prior suicidal ideation. Results were as expected, which may indicate a greater degree of mental health stigma among undergraduates compared to the mental health profession and greater stigma toward suicide in comparison to therapy experience in general. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Differential Predictors of Suicidal Ideation and Suicide Attempts: Internalizing Disorders and Substance Use in a Clinical Sample of Adolescents

Objective: Dually diagnosed adolescents are a high-risk population for experiencing suicidal thoughts and behavior. Given that research suggests risk factors for suicidal ideation and suicide attempts may be different, this study examined whether internalizing disorder severity, frequency of substance use, and the interaction between them differentiated adolescents who attempted suicide from those who ideated. Methods: Baseline data from 287 adolescents who received formal substance use disorder (SUD) treatment were used in this analysis. Major depressive disorder (MDD) and generalized anxiety disorder (GAD) severity as well as past-3 month use of alcohol, cannabis, and other illicit drugs were considered. The outcome of interest was a three-category measure of suicide risk: no reported suicidal ideation or attempts, suicidal ideation only, and suicide attempts. Results: Over half of the sample disclosed prior suicidal ideation (30.0%) or attempts (27.9%). Multinomial logistic regression models indicated more severe MDD and GAD symptomology differentiated ideators from non-suicidal adolescents, but internalizing disorder severity did not differ between ideators and attempters. Substance use frequency did not differ between suicide risk groups. MDD severity and frequency of alcohol use interacted to increase the risk of attempts, yet the effects were minimal. Instead, prior weapon violence victimization and sexual abuse were the largest differentiators between attempters and ideators. Conclusions: Findings suggest that internalizing disorder severity and prior traumatic experiences put adolescents with SUD histories at higher risk of suicidal thoughts and behaviors. Thus, integrating evidence-based suicide prevention and intervention efforts into SUD treatment is critical, particularly for dually diagnosed adolescents who meet these risk profiles. Psychotherapy and medication may help curtail the development of ideation by reducing symptoms of MDD and GAD, whereas adolescents with prior traumatic experiences may benefit from additional treatments shown to lower risk of suicide attempts.

Suicide in Older Adult Men Is Not Related to a Personal History of Participation in Football.

Introduction: It is reasonable to estimate that tens of millions of men in the United States played high school football. There is societal concern that participation in football confers risk for later-in-life mental health problems. The purpose of this study is to examine whether there is an association between a personal history of playing high school football and death by suicide.Methods: The subjects were obtained from the Lieber Institute for Brain Development (LIBD) brain donation program in collaboration with the Office of the Medical Examiner at Western Michigan University Homer Stryker MD School of Medicine. Donor history was documented via medical records, mental health records, and telephone interviews with the next-of-kin.Results: The sample included 198 men aged 50 or older (median = 65.0 years, interquartile range = 57–75). There were 34.8% who participated in contact sports during high school (including football), and 29.8% participated in high school football. Approximately one-third of the sample had suicide as their manner of death (34.8%). There was no statistically significant difference in the proportions of suicide as a manner of death among those men with a personal history of playing football compared to men who did not play football or who did not play sports (p = 0.070, Odds Ratio, OR = 0.537). Those who played football were significantly less likely to have a lifetime history of a suicide attempt (p = 0.012, OR = 0.352). Men with mood disorders (p < 0.001, OR = 10.712), substance use disorders (p < 0.020, OR = 2.075), and those with a history of suicide ideation (p < 0.001, OR = 8.038) or attempts (p < 0.001, OR = 40.634) were more likely to have suicide as a manner of death. Moreover, those men with a family history of suicide were more likely to have prior suicide attempts (p = 0.031, OR = 2.153) and to have completed suicide (p = 0.001, OR = 2.927).Discussion: Suicide was related to well-established risk factors such as a personal history of a mood disorder, substance abuse disorder, prior suicide ideation, suicide attempts, and a family history of suicide attempts. This study adds to a steadily growing body of evidence suggesting that playing high school football is not associated with increased risk for suicidality or suicide during adulthood.

PMH31 Universal Screening for Suicidal Thoughts and Behaviors in a Large Healthcare System's Hospital and Emergency Departments

The Joint Commission recently revised its National Patient Safety Goal requirements to include standardizing suicide screening. Sutter Health launched system-wide standardized use of the Columbia Suicide Severity Rating Scale (C-SSRS) in acute care facilities in July 2019. Describe and compare characteristics of adult patients screening positive for suicidal thoughts or behaviors (STB) including those with major depressive disorder (MDD). Electronic health record-based observational cohort study describing and comparing sociodemographic and clinical characteristics of adult patients screening positive for STB (7/1/2019-10/4/2020), including those with MDD. MDD+STB were compared to those with STB without MDD (STB-MDD) and on risk categories (no risk v any risk). Wilcoxon rank-sum tests for continuous variables and χ2 tests for categorical variables were used. Results reported are statistically significant at 0.05. 410,302/478,143 (85.8%) of adults were screened by C-SSRS, 8,416 (2.05%) had STB, 914 (10.9%) had MDD+STB, 7,502 (89.1%) had STB without MDD. Of those with STB, 3,278 (38.9%) were low risk, 1,314 (15.6%) moderate risk, and 3,824 (45.4%) high risk. Any risk vs no risk: males (46.6% v 42.3%), White (55.5% v 47.9%), mean age 41.6 v 50.3 years, homeless in last 12 months (12.0% v 2.5%), index encounter Psych unit (10.3% v 0.2%), mental health diagnoses (22.2% v 4.9%), MDD (10.9% v 1%). MDD+STB patients vs MDD-STB: mean age 38.8 v 41.9 years, female (58.6% v 52.8%), Asian (9.7% v 6.6%), income $75,000+ (45.5% v 34.0%), index encounters in Psych units (46.5% v 5.9%), substance abuse (12.1% v 3.9%), anxiety (16% v 2.2%) and documented prior suicidal ideation (3.7% v 0.5%). Screening for STB identified 2.05% with any STB and 10.9% with MDD+STB. Characteristics differed based on risk and MDD status. Highlighting demographic and clinical differences between these patient groups can guide efforts to provide mental health consultation and referrals.