Recent Suicide Research Articles

THE ILLUSIONS OF SUCCESS

AbstractThe author reflects on life lessons drawn from a varied career in business, government service, and education. Examples of meaning and purpose are drawn from interactions with individuals ranging from a Morgan Stanley banker to Mother Teresa. Topics such as loneliness and isolation are explored, and statistics are cited about recent suicide rates. The author notes that “after four decades of working closely with leaders, observing them and listening to their deepest thoughts and concerns, I have distilled the pursuit of meaning and purpose into eight practices.” In brief, those practices are (1) know and live your own story, (2) maintain deep connections in your core relationships, (3) regularly express gratitude, (4) learn to forgive and serve, (5) define success and failure for yourself, (6) make sure risk continues to play a role in your life, (7) integrate your life, rather than compartmentalizing it, and (8) work to leave a legacy for others. Solitude is also essential and provides the space to reflect upon our lives, relationships, challenges, and blessings. Solitude differs from loneliness. Solitude fills our hearts with gratitude and renewed energy for living. Loneliness kills our very souls and often spirals into sadness and despair.

Does social support moderate between depression and suicidal ideation in low-income African Americans?

Historically rates of death by suicide in African Americans have been lower than in other communities, although no ethno-racial differences have emerged in rates of suicidal ideation. Despite the fact that suicidal ideation impacts millions of people every year and is commonly reported by individuals who have attempted suicide, it has not been a focus of investigation among African American adults. One major predictor of suicidal ideation is depressive symptoms, although this association in African Americans has received little empirical attention. This study examines the impact of one potential culturally relevant moderator, social support, on the link between depressive symptoms and suicidal ideation in a sample of low income, African American adults with a recent suicide attempt (n = 267). Correlational analyses confirmed a positive, significant relation between depressive symptoms and suicidal ideation among the entire sample and separately for women and men. Linear regression analyses revealed that friend, but not family, support moderated the association between depressive symptoms and suicidal ideation, when controlling for homelessness. This moderating effect, however, was only found for the women (n = 152) in the sample. The results highlight the value of social support from friends in fostering resilience against suicidal ideation in high-risk low-income African American women. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Correlates of Grief: Prevalence of Anxiety Symptoms, Drug Consumption and Associated Factors Among Mexican Adults Seeking Psychological Support for Grief During COVID-19 Pandemic: A Cross-Sectional Study

Background: The coronavirus 2019 disease (COVID-19) illness pandemic is one of the highest challenges in modern history, with nearly four million deaths confirmed, generating with this a serious psychological impact on the loved ones of the deceased. So far, the evidence regarding the impact of the COVID-19 pandemic on the grievers is scarce, and urgent evidence needs to be developed, especially for developing countries, such as Mexico, where the deaths caused by the COVID-19 are high.Methods: A cross-sectional study was conducted through the Duelo (Grief) COVID platform, a self-applied online treatment. The response of 5,224 participants, which was fully completed, included measurements of anxiety, depression, sleep quality, activation, PTSD related factors (avoidance and activation), and drugs consumed. Independent sample t tests, Cohen´s d, Chi-Square and ANOVA tests were conducted along with multinomial logistic regression.Outcomes: The results indicated that 90·4% of the participants showed a clinical symptomatology of depression, anxiety, and sleep affectations, 513 individuals informed they consumed substances. Antidepressants and Anxiolytics were the most common drugs reported. The most affected participants were young unemployed women, that consumed medicines, had a recent suicide attempt in the last 3 months, and lost someone due to COVID-19, or for some other reason in less than one month prior (all pInterpretation: Due to these results, an urgently implementation of broad psychological treatments on the general population is suggested in order to reduce the impact on mental health.Clinical Trial Registration Details: Registered in Clinical trials (NCT04638842).Funding Information: This study was funded by the Autonomous University of Ciudad Juárez (UACJ).Declaration of Interests: We declare no competing interests.Ethics Approval Statement: The Research Ethics Committee of the Autonomous University of Ciudad Juárez, México, provided the approval for this study. Reference code: CEI-2020-2-226. Before proceeding to answer the questionnaires, the participants needed to read the informed consent that is also available on the register study in Clinical Trials (NCT04638842). In order to receive the intervention, the participants needed to read and accept the informed consent. Only adults aged 18 or older were allowed to register, and their data will be protected, such as their email. No sensible data was required by the participants such as their name, telephone, address, socioeconomic status or location. Any modification of the trial protocol will be communicated to the Research Ethics Committee of the Autonomous University of Ciudad Juárez and Clinical Trials.

Руминативное мышление как когнитивный фактор хронификации депрессии: определение понятия и валидность инструментария

Despite large amount of empirical evidence in support of rumination as a risk factor of depression onset and chronification, theoretical foundations of ruminative thinking are still being discussed. This includes the issue of so-called constructive, or reflec¬tive, ruminations. Objective: This study gives a theoretical review of different views on rumination, empirically tests the idea of constructive and non-constructive rumi¬native thinking, and tests the validity of the Ruminative Response Scale (RRS, Rus sian version) [38]. Study design: We conducted a factor analysis of adapted RRS, as well as an intercorrelational analysis of this scale, Symptom Checklist-90-Revised (SCL-90-r), and the COPE Inventory; hypotheses were tested in a general population group (n=476) and two clinical groups (patients with depressive disorders, n=53, and patients with different diagnoses with recent suicide attempts, n=41). Results: Our theoretical review examines ruminative thinking as a dysfunctional coping strategy (E. Watkins) from the perspective of the structural-dynamic model of thinking in the course of creative problem-solving (V. Zaretsky, A. Kholmogorova). Rumination is conceptualized as getting stuck «in a loop» at certain levels of organization of cognitive processes, which substitutes motivation focus on actual problem solving. The resulting four-factor structure of RRS has good psychometric properties and strong correla¬tions with different psychopathological symptoms and dysfunctional coping strategies (namely, psychological and behavioral avoidance and venting negative emotions); these correlations are found in all resulting factors but one, which implies that it may have a special status. Conclusion: The Russian version of RRS shows good preliminary psychometric characteristics and is viable for practical purposes. The idea of construc¬tive rumination discussed in literature has not been confirmed empirically. ¬

Incorporating psychopathology into the interpersonal-psychological theory of suicidal behavior (IPTS).

The interpersonal-psychological theory of suicidal behavior (IPTS) posits that the joint presence of perceived burdensomeness (PB), thwarted belongingness (TB), and capability for suicide (CS) is necessary for suicide attempt. Emerging evidence demonstrates these effects are not consistently observed. Psychopathology may independently impact on the explanatory power of the IPTS constructs. The aims of the current study were to assess whether the inclusion of psychopathology indicators into the IPTS explains additional variance in recent suicide attempt and to assess the relative influence of interpersonal-psychological constructs versus mental illness on suicide attempt. Australian adults (N=1,323; 77% female) who reported suicidal ideation in the past year were recruited using social media advertising to complete an online cross-sectional survey. None of the predicted IPTS interactions was significantly associated with recent suicide attempt, although PB and CS had significant independent associations. The addition of psychopathology indicators to the IPTS model explained significant additional variation in suicide attempt (18% vs. 14%). The influence of psychopathology on suicide attempt may be insufficiently explained by interpersonal-psychological constructs. The IPTS may have greater explanatory power to identify transitions from suicidal ideation to suicide attempt after accounting for mental illness.

Common and Country-Specific Characteristics Associated With Suicidality in the Arab Region.

To explore the prevalence of recent (previous 2 weeks) suicide attempts and estimates of likelihood of future suicide attempts as well as demographic characteristics associated with such attempts among residents of the Arab region looking for depression information online. Google Ads were used to recruit 1,003 Arabic-speaking adults mostly from February 2014 to June 2014 to take part in a depression and suicidality screening study using a self-report questionnaire based on DSM-IV diagnostic criteria. Of the eligible participants (N = 900), 10.6% reported a suicide attempt in the previous 2 weeks, and 16.1% indicated a likelihood of making a suicide attempt in the following month. Men, those declining to state their sexual orientation, those from lower subjective social status (SSS), and unemployed individuals had higher odds of reporting a past suicide attempt (P = .001, P = .002, P < .001, P = .023, respectively). Younger individuals, those less religious, those with past suicide attempt, and those with lower SSS had higher odds of a likelihood of a future suicide attempt (P = .03, P = .02, P < .001, P = .001, respectively). Comparing the 4 countries with highest number of participants (Algeria, n = 148, Egypt, n = 260, Morocco, n = 118, and Saudi Arabia, n = 99), lower SSS was associated with higher odds of an attempt for Algeria, Morocco, and Saudi Arabia, but not for Egypt (P = .002). Lower religiosity was related to higher odds of estimates of future suicide for Algeria, Egypt, and Saudi Arabia, but not for Morocco (P = .014). Suicidality among residents of Arab-speaking countries warrants further exploration. Common predictors of risk may be less relevant for some populations.​.

Relationships between inflammatory markers and suicide risk status in major depression

Pro-inflammatory status has been implicated in depression and suicidal behaviors. Polyunsaturated fatty acids (PUFAs) and cytokines, two types of inflammatory biomarkers, have been associated with suicide, independent of depression severity. How these biomarkers relate to each other is less clear. We measured plasma phospholipid levels of arachidonic acid (AA%), docosahexaenoic acid (DHA%), and eicosapentaenoic acid (EPA%) as a percentage of total phospholipids, as well as serum interleukin-6 (IL-6), interleukin-1β (IL-1β) and tumor necrosis factor α (TNF-α), in 80 patients with major depressive disorder (MDD) and 24 healthy controls (HC). Individual PUFA and cytokine species were compared using ANOVA across four suicide risk-stratified groups: 1) highest-risk, recent (within 5 years) suicide attempters (n = 20); 2) high-risk, severe current suicidal ideators (having intent or plan) with no recent attempt history (n = 22); 3) low-risk, current non-ideators who were also lifetime non-attempters (n = 38); and 4) HC (n = 24). None of the participants were enrolled following an acute suicide attempt. Of biomarkers studied, only DHA% (p = 0.012) and IL-1β (p = 0.002) differed between groups. In post-hoc testing, DHA% was lower in attempters than ideators (p = 0.018) or MDD non-ideators (trend level, p = 0.073). IL-1β was lowest in attempters, differentiating them from ideators (p = 0.009) and HC (p = 0.004). Recent suicide attempt, one of the most powerful predictors of suicide risk, was also most closely tied to inflammatory indices in this study. Low DHA% as an indicator of suicide risk is consistent with previous reports; however, lower IL-1β was unexpected and may relate to acuity/chronicity of inflammation. There is a need for prospective studies of immune status with respect to suicidal behaviors.

Protocol of a Multi-centric Randomized Controlled Trial to Evaluate Efficacy of Telephone-Based Psychosocial Interventions on Future Suicide Risk in Suicide Attempters.

Background:Persons with previous history of a suicide attempt are at increased future risk of death by suicide. These vulnerable individuals, however, do not seek receive or seek help from mental health services. Telephone-based psychosocial interventions are potential strategies in augmenting mental health care in such persons.Methods:We aim to compare the efficacy of telephone-based psychosocial interventions (TBPI) with routine telephone reminders in persons with recent suicide attempts using a multi-site, parallel group, rater-blind, two-arm randomized controlled trial design in 362 participants. In the first group, participants will receive three sessions of TBPI comprising of brief supportive interventions, problem-solving strategies, and reminders for adherence to prescribed mental health treatment at weekly intervals. In the second group, participants will receive three telephone reminders for adherence to prescribed mental health treatment at weekly intervals. We will follow up participants for 6 months. Primary outcomes are suicidal ideation scores on Beck’s Scale for Suicide Ideation and number of repeat suicide attempts. Secondary outcomes are scores on Beck’s Hopelessness Scale, Beck’s Depression Inventory, Connor–Davidson Resilience Scale and Visual Analogue Rating Scales for acceptability of interventions. Outcomes will be assessed at 1, 3, and 6 months after receiving telephone interventions or reminders.Results:The trial is currently underway after prospective registration under Clinical Trials Registry of India and has recruited 260 participants till August 15, 2020.Conclusion:This study has potential to generate evidence on additional strategies for use along with standard mental health treatments in management of high-risk suicide behaviors.

Detection of Suicidality Among Opioid Users on Reddit: Machine Learning-Based Approach.

BackgroundIn recent years, both suicide and overdose rates have been increasing. Many individuals who struggle with opioid use disorder are prone to suicidal ideation; this may often result in overdose. However, these fatal overdoses are difficult to classify as intentional or unintentional. Intentional overdose is difficult to detect, partially due to the lack of predictors and social stigmas that push individuals away from seeking help. These individuals may instead use web-based means to articulate their concerns.ObjectiveThis study aimed to extract posts of suicidality among opioid users on Reddit using machine learning methods. The performance of the models is derivative of the data purity, and the results will help us to better understand the rationale of these users, providing new insights into individuals who are part of the opioid epidemic.MethodsReddit posts between June 2017 and June 2018 were collected from r/suicidewatch, r/depression, a set of opioid-related subreddits, and a control subreddit set. We first classified suicidal versus nonsuicidal languages and then classified users with opioid usage versus those without opioid usage. Several traditional baselines and neural network (NN) text classifiers were trained using subreddit names as the labels and combinations of semantic inputs. We then attempted to extract out-of-sample data belonging to the intersection of suicide ideation and opioid abuse. Amazon Mechanical Turk was used to provide labels for the out-of-sample data.ResultsClassification results were at least 90% across all models for at least one combination of input; the best classifier was convolutional neural network, which obtained an F1 score of 96.6%. When predicting out-of-sample data for posts containing both suicidal ideation and signs of opioid addiction, NN classifiers produced more false positives and traditional methods produced more false negatives, which is less desirable for predicting suicidal sentiments.ConclusionsOpioid abuse is linked to the risk of unintentional overdose and suicide risk. Social media platforms such as Reddit contain metadata that can aid machine learning and provide information at a personal level that cannot be obtained elsewhere. We demonstrate that it is possible to use NNs as a tool to predict an out-of-sample target with a model built from data sets labeled by characteristics we wish to distinguish in the out-of-sample target.

Brief Cognitive-Behavioral Therapy for Suicidal Inpatients

Suicide risk is elevated in psychiatric patients following discharge from inpatient care. Despite this vulnerability, there has been limited research investigating suicide prevention protocols that take into account the unique system characteristics of this setting (e.g., short lengths of stay, crisis stabilization treatment model, multidisciplinary team coordination). Cognitive-behavioral therapy (CBT) has demonstrated efficacy for improving suicide risk in outpatients, but has not been validated with inpatients. The current study was a treatment development and pilot feasibility open trial that modified brief cognitive-behavioral therapy (BCBT) for an inpatient setting (BCBT-I). Key treatment modifications included administering up to 10 sessions (depending on patient length of stay), daily, and in a standardized order, with core crisis management skills introduced during the first three sessions. In addition, coordination with the inpatient treatment team was included in BCBT-I implementation. Six adult inpatients with a recent suicide attempt enrolled and completed an average of 4.67 BCBT-I sessions (SD = 1.36). The treatment was highly acceptable (Client Satisfaction Questionnaire total score M = 3.49, SD = 0.73). Pre- to posttreatment effect sizes demonstrated improvements in suicidal ideation (d = 0.97), depression (d = 1.33), and suicidal implicit associations (d = 1.28). All but one of the participants (83%) completed follow-up assessments 1-, 2-, and 3-months postdischarge. Over follow-up, two participants reported suicidal ideation (both without intent), and none reported suicide attempts, preparatory acts or behaviors, or nonsuicidal self-injury. This study provided preliminary evidence supporting the feasibility of CBT to treat suicidal inpatients. Future research is needed to validate BCBT-I in a larger, randomized controlled trial to determine whether BCBT-I reduces suicide risk beyond that afforded by inpatient treatment alone.

Verbal Response Latency as a Behavioral Indicator of Diminished Wish to Live in a Clinical Sample of Active Duty Army Personnel with Recent Suicidal Ideation

Objective Research on risk factors of suicide attempt has yielded little improvement in imminent risk detection for clinicians, due in part to the inherent limitations of self-report methodologies. Therefore, objective behavioral indicators of suicide risk that can be implemented practically with little cost in clinical settings are needed. Method The current study examined verbal response latency, measured as the length of time to answer a question asking about reasons for living (i.e., What are your reasons for living or not killing yourself?), as a potential indicator of suicide risk among 97 active duty Army personnel presenting to an emergency department or behavioral health clinic for current suicide ideation and/or a recent suicide attempt. Results Verbal response latency was significantly correlated with diminished wish to live at the participant level but was not significantly correlated with wish to die or overall severity of suicidal ideation. Conclusion Verbal response latency may serve as an objective indicator of suicide risk. Highlights Response latency to a life construct may be an objective indicator of suicide risk Delayed response latency is indicative of diminished wish to live Pathological mechanisms may manifest within dyadic interactions via verbal behaviors

Motivations for Suicide Attempts amongst Psychiatric Inpatients: Associations with Risk Factors and Recent Suicide Attempt Characteristics

Suicide is a major and preventable public health issue and research has identified several distal risk factors for determining individuals at risk for a suicide attempt. However, understanding imminent processes could enhance individualized safety plan formulations and interventions. Motivation for suicide attempt (MfSA) reflects why an individual engages in a specific attempt. Research indicates such motives can be organized into major factors, but consensus on the number, and their correlates, has not been reached. The sample consisted of 190 patients who attempted suicide within 24 hours of hospitalization and completed the MfSA within the Suicide Attempt-Self Injury Interview. Exploratory factor and correlational analyses were conducted to identify the factors that underlie MfSA. Regression analyses were conducted to examine the relations of MfSA factors to distal suicide risk factors and suicide-related attempt characteristics. Two underlying MfSA factors were identified. Interpersonal MfSA was associated with lower age and higher problematic alcohol use. Intrapersonal MfSA was related to having previous suicide attempts, more past year negative life events, and higher depressive symptoms. The modified MfSA is easy to administer, and its factors show unique associations with important suicide-related constructs. The results could inform safety planning procedures to prevent future death by suicide.

Elucidating the chronic, complex nature of suicidal ideation: A national qualitative study of veterans with a recent suicide attempt

• The lived experience of suicidal ideation was examined in qualitative interviews. • Suicidal ideation was chronic, non-linear, with periodic increases in severity. • For some, severity increases are perceived as a result of negative self-evaluation. • For some, severity increases are perceived as random and uncontrollable. • Treatment and assessment should emphasize functioning and symptom management. Understanding the nature of suicidal ideation, or how suicidal ideation is experienced by the individual in its course and development, is important for informing suicidal ideation assessment and treatment. In this study, we conducted qualitative interviews with a national sample of fifty United States (U.S.) military veterans with recent suicide attempts to elucidate the nature of suicidal ideation from the perspective of those with lived experience. We interviewed 25 women and 25 men veterans from Veterans Health Administration healthcare facilities across the U.S. who made a recent (prior 6 months) suicide attempt. Data were analyzed using a thematic analysis approach. Suicidal ideation was characterized as chronic, varying in severity and duration. Two typologies characterized increases in suicidal ideation severity: those whose ideation increases due to negative self-evaluations and those whose ideation increases without clear warning. Additionally, participants described needing help recovering from severe episodes of suicidal ideation, which often disrupted their lives and everyday functioning. This was a study of U.S. military Veterans with a recent suicide attempt; our findings may differ from studies of nonveterans or those with suicidal ideation but have never attempted suicide. Our findings align with prior research that suicidal ideation is often experienced as chronic, fluctuating, and nonlinear. Suicide risk assessment may benefit from use of a combination of ideation severity and functional measures. Future work should investigate treatment of suicidal ideation that targets active symptom management and ameliorates the negative impacts that suicidal ideation has on patients’ functioning.

Using the GAD-7 and GAD-2 Generalized Anxiety Disorder Screeners With Student-Athletes: Empirical and Clinical Perspectives

With the aim of supporting anxiety screening of student-athletes, this study examined the psychometric performance of the GAD-7 and GAD-2 for assessing anxiety and other clinical mental health concerns (depression, past-year and recent suicidality) in student-athletes. Data from intercollegiate varsity athletes (N = 7,584) were drawn from the Healthy Minds Study. Reliability estimates were good in the sample. Area under the curve values were excellent for anxiety and fair to good for depression and suicidality. Across all clinical indicators, a cutoff of 6 (GAD-7) and 2 (GAD-2), respectively, yielded the most balanced sensitivity and specificity rates. Both measures positively correlated with functional impairment, academic impact, and perceived mental health and negatively correlated with positive mental health. Overall, results supported the reliability, accuracy, and construct validity of the GAD-7 and GAD-2 in a national student-athlete sample. Discussion focuses on clinical implications and practical usage of the GAD-7 and GAD-2 with student-athletes.

Veteran Perspectives of Barriers and Facilitators to Campaigns Promoting Help Seeking During Crisis.

The objective of this paper is to characterize barriers and facilitators reported by U.S. military veterans related to campaigns promoting help seeking during suicidal crisis. Individual telephone interviews (N = 40) were conducted from August 2018-April 2019 with a sample of veterans who had a recent non-fatal suicide attempt. Interview transcripts were analyzed using a constant comparison analytic strategy. Participants reported the four facilitators to message effectiveness: (a) potential reach of specific channels; (b) interruption of suicidal thoughts; (c) normalizing the suicidal experience and help seeking; and (d) modeling desired behavior change. Barriers that hindered campaigns were also identified and include (a) broad messages, (b) challenges in cognitive processing, (c) media avoidance and (d) a boomerang effect. This study underscores the significance of involving those with lived experience to identify factors that may improve or hinder message effectiveness.

Prevalence and risk factors of COVID-19 suicidal behavior in Bangladeshi population: are healthcare professionals at greater risk?

BackgroundCurrent COVID-19 researches suggest that both general population and health-care providers (HCPs) are at risk of elevated psychological sufferings including suicidality. However, suicidality has not been addressed properly, although mental health problems are studied globally. Besides, the extreme fear of COVID-19 infection is being existed among the Bangladeshi HCPs, that is reported by a recent patients' suicide because of HCPs treatment negligence. MethodsA web-based cross-sectional study was administered through the social media platforms. A total 3,388 respondents took part in the survey (mean age 30.1 ± 6.4 years) among them 834 were frontline HCPs (30.7 ± 5.6 years). The measures included socio-demographics, PPE-related and patient-care related information and a question concerned with the COVID-19 suicidal behavior. ResultsAbout 6.1% of the total participants had suicidal behavior, with no detectable differences within the groups (i.e., general population and HCPs). Regression analysis showed that being female, being divorced, and having no child were emerged as independent predictors for suicidality. There was no significant association between the PPE-related or patient-care related variables and suicidal behavior of the HCPs. Majority of the participants sometimes had fear of death although no significant relation of the factor was found with suicidality. LimitationsThe study can be limited because of its nature (i.e., cross-sectional self-reporting online survey) and not considering non-COVID-19 related suicide risk factors etc. ConclusionsThe present findings identified the substantial proportion of the HCPs and general population had COVID 19 related suicidal behavior. It can be used to advocate a large-scale suicide safety plan using a multidisciplinary approach herein.

Early Life Trauma, Suicide Ideation, and Suicide Attempts: The Role of Rumination and Impulsivity

Suicide is the second leading cause of death for young adults in the United States. One of the many risk factors for suicide includes exposure to early life trauma. The present study examined whether rumination and impulsivity play a role in the relationship between early life trauma and increased risk for suicidal behavior (i.e., suicide ideation and suicide attempts) among 426 young adults. Early life trauma was associated with brooding, reflective rumination, and impulsivity in the form of negative urgency. Current or recent suicide ideators self-reported greater early life trauma, ruminative thinking, and impulsivity than non-ideators and non-attempters. Further, a multinomial logistic regression found that early life trauma, reflection, lack of premeditation, and lack of perseverance were associated with higher odds of reporting suicide ideation in the previous 6 months. We also found indirect relationships between early life trauma and suicide ideation through brooding or reflection and lack of perseverance in serial mediation analyses. These findings suggest that early life trauma may increase risk of suicide ideation to the degree that it leads to ruminative thinking and lack of follow-through with difficult tasks. How early life trauma might increase risk for ruminative thinking, impulsivity, and subsequent suicidal behavior is discussed.

PEPSUI, a Psychoeducational Program for the Management of Suicidal Patients: A Qualitative Study From a Randomized Controlled Trial.

BackgroundSuicide prevention after a recent suicide attempt remains a major issue for clinicians. Indeed, these patients are at risk of new attempts and also less prone to interact with mental health services. As psychoeducation-based interventions are strongly recommended for patients with severe or chronic disorders and poor adherence, we developed the first French program of suicide psychoeducation (PEPSUI).MethodsWe started a large multicenter randomized controlled trial in outpatients who attempted suicide in the last year (i.e., current suicidal behavior disorder) to assess the feasibility, acceptability, and effectiveness of a 10-week psychoeducational program (PEPSUI group: scientific information on suicidal behavior, and third-wave cognitive behavioral therapies) compared with a 10-week relaxation program (control condition), in a naturalistic setting. Here, we present the qualitative part of this study. Participants in both groups completed a narrative interview with questions on their general impressions about the therapy process and outcomes, specific areas of change in their life since inclusion, and knowledge and perceptions about suicide and mental health services. Interviews were audiotaped, transcribed, and coded using inductive and deductive thematic analysis with a constant comparative approach. Participants were consecutively included until data saturation.ResultsThe interviews of 18 patients (n=10 in the PEPSUI group, and n=8 in the relaxation group) were analyzed. Qualitative analyses revealed some common points, and many differences between groups that are relevant for suicide prevention. Patients in both groups were satisfied with the programs. Group modality and therapeutic alliance with the instructors were considered useful in both groups. Participation was related to improved perception of mental health units (particularly in the PEPSUI group). Both groups reported the acquisition of stress management skills and distress tolerance. Relaxation was an easy way to survive stress. Conversely, the PEPSUI program had deeper implications for daily life through effective positioning towards internal events (thoughts and emotions) as a consequence of mindfulness-derived practices, enhancement of value-based commitments, improvement of the meaning in life and internal locus of control, increased contact with the present moment, use of a matrix (a decision-making tool), and acquisition of scientific knowledge on suicidal behavior.ConclusionThrough specific processes for targeting suicidal risk and reducing the stigma, the PEPSUI program may represent a promising intervention for suicide prevention.

Slower perception of time in depressed and suicidal patients

Effective suicide prevention is hindered by a limited understanding of the natural progression and neurobiology of the suicidal process. Our objective was to characterize the duration of the suicidal process and its relation to possible determinants: time judgment and cognitive impulsivity. In four groups of adults of both sexes including recent suicide attempters (n = 57), suicidal ideators (n = 131), non-suicidal depressed controls (n = 51) and healthy controls (n = 48) we examined time estimation and production, impulsivity and other cognitive variables. Duration of the suicidal process was recorded in suicide attempters. The suicide process duration, suicide contemplation and action intervals, had a bimodal distribution, ∼40% of attempters took less than 5 min from decision to attempt. Time slowing correlated negatively with the suicidal action interval (time from the decision to kill oneself to suicide attempt) (p = .003). Individuals with suicide contemplation interval shorter than three hours showed increased time slowing, measured as shorter time production at 35 s (p = .011) and 43 s (p = .036). Delay discounting for rewards correlated with time estimation at 25 min (p = .02) and 90 s (p = .01). Time slowing correlated positively with suicidal ideation severity, independently of depression severity (p < .001). Perception of time slowing may influence both the intensity and the duration of the suicidal process. Time slowing may initially be triggered by intense psychological pain, then worsen the perception of inescapability in suicidal patients.

Network Changes in Insula and Amygdala Connectivity Accompany Implicit Suicidal Associations.

Limited knowledge exists regarding the neurobiology of suicidal thoughts, given that there are currently no direct probes of the suicidal state. This pilot study used magnetoencephalography (MEG) to evaluate correlates of the implicit association between the self and death compared to the self and life as objective markers of suicide risk. Healthy volunteers (HVs; n=21) completed a modified version of the Suicide Implicit Association Task (S-IAT) during MEG scanning. Gamma power—which is considered a proxy measure of excitation-inhibition balance—was directly compared in the self-death/self-life contrast. As a proof-of-concept, the ability of dynamic causal modeling to categorize HVs versus four individuals with recent suicide crisis (SC) was evaluated. In HVs, enhanced gamma power in both amygdala and anterior insula were found for the self-death compared with self-life contrast. In addition, connectivity estimates between early visual cortex, anterior insula, and amygdala correctly categorized SC participants with 77% to 82% sensitivity and 80% to 85% specificity. These findings, which implicate network-level changes in salience network and amygdala connectivity in mediating suicidal associations, require further replication in larger samples. Direct probing of suicidal thoughts with the S-IAT may provide foundational markers of neural circuits associated with suicide risk.