Short-term Suicide Risk Research Articles

Validity, Reliability, and Factor Structure of the Suicide Crisis Scale in Turkish.

In our study, we aimed to adapt the Suicide Crisis Inventory (SCI), which can be used specifically to assess the acute phase of suicide, to the Turkish population by examining its Turkish validity and reliability in a non-clinical sample. In this cross-sectional study, a total of 300 university students aged 18-24 years were evaluated online using the Socio-demographic and Clinical Data Form, the SCI, and the Suicide Behavior Questionnaire (SBQ). Criterion validity, discriminative validity, and factor analyses (exploratory and confirmatory) were conducted for the validity of the SCI, and internal consistency and item-total correlations were examined for reliability analyses. Additionally, a linear regression model was constructed to assess the predictive validity of the SCI. The predictive validity of past SCI scores was evaluated using a simple regression model. When the linear regression model was tested with SCI scores as the independent variable and SBQ scores as the dependent variable [F(1-298) = 203.625; P = .000], it was found that the independent variable explained 41% of the variance in the dependent variable (r = 0.637; r 2 = 0.406). SCI scores significantly predicted SBQ scores (t = 14.270; B = 0.047; Bsth = 0.003; β = 0.647; P = .000). In the validity analysis, the items removed from the scale could be evaluated for the total score, as they did not belong to any factor as originally specified. When items were removed, the total item reliability was Cronbach's alpha = 0.981. We believe that the SCI will be a useful tool in assessing short-term suicide risk in a Turkish sample and in conducting scientific research. The SCI was found to be sufficient for use in a Turkish sample for the evaluation of short-term suicide risk, considering some limitations.

Modeling the associations between emotion regulation, suicide crisis syndrome and suicidal behavior: Results in community and clinical samples.

Emotion Regulation (ER) and Suicide Crisis Syndrome (SCS) are psychological processes involved in suicide. Within ER, both the use of rumination and dysfunctional emotion beliefs are associated with suicide. SCS, a pre-suicidal mental state involving cognitive and affective dysregulation, is related to short-term suicide risk. Here, we first examined associations between ER (beliefs about the uncontrollability of emotions and rumination), SCS and suicide behavior, and second, we test a multistep model in which ER factors are linked to suicide behavior through SCS. We conducted two cross-sectional studies to address this issue by self-reports. Study 1 used a community sample (N = 421). Study 2 used a clinical sample (N = 70). Results from both studies showed that beliefs about the uncontrollability of emotions and rumination were associated with higher levels of SCS symptoms and suicide behavior, and that SCS was associated with suicide behavior. In addition, path analyses showed that uncontrollability beliefs were linked to rumination, which in turn was associated with SCS, and this variable mediated the association between ER factors and suicide ideation (in both community and clinical samples) and suicide attempts (in the community sample). As we expected, in both samples, uncontrollability of emotions and rumination were positively related with SCS and suicide behavior. We emphasize the importance of addressing uncontrollability beliefs and rumination in suicide prevention.

Association of 7-Day Follow-Up With 6-Month Suicide Mortality Following Hospitalization for Suicidal Thoughts or Behaviors Among Older Adults

To evaluate whether timely follow-up outpatient mental health care is associated with reduced short-term suicide risk following hospitalization for suicidal thoughts or behaviors. Retrospective cohort analysis using 2015 Medicare data for adults aged ≥ 65 years who were hospitalized for suicidal ideation or behaviors (n=36,557) linked with the National Death Index. Adjusted risk ratios (ARR) estimated the association between 7-day follow-up and suicide risk at 30-, 90-, and 180-days, adjusted for confounding by indication using inverse probability of treatment weights of observable covariates. Overall, 39.3% of patients received 7-day follow-up, which was associated with 41% higher risk of suicide within 180 days. Follow-up care was associated with higher suicide risk for Medicare Advantage enrollees, patients with no recent prior mental health care, and those admitted for suicidal behaviors. Results suggest 7-day follow-up care was not associated with lower post-discharge suicide risk. For this high-risk group, suicide-specific interventions may be needed during the critical postdischarge period.

Ecological Momentary Assessments and Passive Sensing in the Prediction of Short-Term Suicidal Ideation in Young Adults

Advancements in technology, including mobile-based ecological momentary assessments (EMAs) and passive sensing, have immense potential to identify short-term suicide risk. However, the extent to which EMA and passive data, particularly in combination, have utility in detecting short-term risk in everyday life remains poorly understood. To examine whether and what combinations of self-reported EMA and sensor-based assessments identify next-day suicidal ideation. In this intensive longitudinal prognostic study, participants completed EMAs 4 times daily and wore a sensor wristband (Fitbit Charge 3) for 8 weeks. Multilevel machine learning methods, including penalized generalized estimating equations and classification and regression trees (CARTs) with repeated 5-fold cross-validation, were used to optimize prediction of next-day suicidal ideation based on time-varying features from EMAs (affective, cognitive, behavioral risk factors) and sensor data (sleep, activity, heart rate). Young adult patients who visited an emergency department with recent suicidal ideation and/or suicide attempt were recruited. Identified via electronic health record screening, eligible individuals were contacted remotely to complete enrollment procedures. Participants (aged 18 to 25 years) completed 14 708 EMA observations (64.4% adherence) and wore a sensor wristband approximately half the time (55.6% adherence). Data were collected between June 2020 and July 2021. Statistical analysis was performed from January to March 2023. The outcome was presence of next-day suicidal ideation. Among 102 enrolled participants, 83 (81.4%) were female; 6 (5.9%) were Asian, 5 (4.9%) were Black or African American, 9 (8.8%) were more than 1 race, and 76 (74.5%) were White; mean (SD) age was 20.9 (2.1) years. The best-performing model incorporated features from EMAs and showed good predictive accuracy (mean [SE] cross-validated area under the receiver operating characteristic curve [AUC], 0.84 [0.02]), whereas the model that incorporated features from sensor data alone showed poor prediction (mean [SE] cross-validated AUC, 0.56 [0.02]). Sensor-based features did not improve prediction when combined with EMAs. Suicidal ideation-related features were the strongest predictors of next-day ideation. When suicidal ideation features were excluded, an alternative EMA model had acceptable predictive accuracy (mean [SE] cross-validated AUC, 0.76 [0.02]). Both EMA models included features at different timescales reflecting within-day, end-of-day, and time-varying cumulative effects. In this prognostic study, self-reported risk factors showed utility in identifying near-term suicidal thoughts. Best-performing models required self-reported information, derived from EMAs, whereas sensor-based data had negligible predictive accuracy. These results may have implications for developing decision algorithms identifying near-term suicidal thoughts to guide risk monitoring and intervention delivery in everyday life.

A Suicide-Specific Diagnosis – The Case Against

A Suicide-Specific Diagnosis – The Case Against

Implicit identification with death detects and predicts short-term suicide risk among adolescents discharged from the emergency room.

Implicit identification with death, measured by the Death-Suicide-Implicit Association Test (D/S-IAT), has been found to predict long-term suicide risk among adolescents. However, previous studies did not examine the predictive utility of D/S-IAT on short-term suicide risk trajectories among adolescents, especially during the critical period following discharge from the emergency room (ER) due to suicide behaviors. This study examined the ability of the D/S-IAT to discriminate and predict suicide risk trajectories during the month following initial suicide risk assessment, among adolescents recently discharged from the ER. One hundred and fifteen adolescents aged 9-18 years (77.4% female) were assessed at clinic intake. All participants completed D/S-IAT and self-report measures for suicide risk, depression, and anxiety during intake and 1-month follow-up. The D/S-IAT distinguished and predicted participants with continued heightened suicide risk at follow-up, above and beyond depression, anxiety, and suicide risk level at intake. Along with conventional measures, D/S-IAT may be utilized to predict short-term suicide risk during post-ER discharge.

Reducing short term suicide risk after hospitalization: A randomized controlled trial of the Collaborative Assessment and Management of Suicidality

BackgroundThis study compared the “next day appointment” (NDA) use of the Collaborative Assessment and Management of Suicidality (CAMS) to treatment as usual (TAU) for individuals discharged from the hospital following a suicide-related crisis. We hypothesized that CAMS would significantly reduce suicidal thoughts and behaviors as well as improve psychological distress, quality of life/overall functioning, treatment retention and patient satisfaction. MethodsParticipants were 150 individuals who had at least one lifetime actual, aborted, or interrupted attempt and were admitted following a suicide-related crisis. There were 75 participants in the experimental condition who received adherent CAMS and 75 participants who received TAU. Suicidal thoughts and behaviors, psychological distress, and quality of life/overall functioning were assessed at baseline and at 1, 3, 6, and 12 months post-baseline. Treatment retention and patient satisfaction were assessed at post-treatment. ResultsParticipants in both conditions improved from baseline to 12 months but CAMS was not superior to TAU for the primary outcomes. A small but significant improvement was found in probability of suicidal ideation at 3 months favoring TAU and amount of suicidal ideation at 12 months favoring CAMS. CAMS participants experienced less psychological distress at 12 months compared to baseline. LimitationsThe study was limited by only one research clinic, lower than expected recruitment, and imbalance of suicidal ideation at baseline. Conclusions: All participants improved but CAMS was not more effective than TAU. The NDA clinic was feasible and acceptable to clients and staff in both conditions and future research should investigate its potential benefit.

Proximal Risk for Suicide: Protocol for an Ecological Momentary Assessment Study.

BackgroundSuicide is a prevalent public health concern in the United States across all age groups. Research has emphasized the need to identify risk markers that prevent suicide along shorter timeframes, such as days to weeks. Furthermore, little has been done to explore the relative significance of factors that can predict short-term suicide risk or to evaluate how daily variability in these factors impacts suicidal ideation or behavior. This proposed project aims to identify risk factors that best predict near-time changes in suicidal ideation and examine potential interactions between these factors to predict transitions into suicidal thinking or behaviors.ObjectiveThe aim of this proposed study is threefold: (1) To identify which psychological risk factors are most strongly associated with proximal changes in suicide risk across days and weeks. (2) To evaluate theoretical assumptions of the Integrative-Motivational-Volitional Theory of Suicide. (3) To determine how disruptions in physiological arousal interact with theoretical mechanisms of risk to predict concurrent and short-term prospective increase in suicidal thoughts and behaviors.MethodsA daily diary or ecological momentary assessment design will be utilized with 200 participants. Participants will complete 2 in-person visits separated by 3 weeks during which they will complete 3 brief daily assessments within their natural environments using the ilumivu research app on a smart device. Research will occur at the Mayo Clinic Health System (MCHS) Eau Claire site. Participants will be recruited through chart review and standard care delivery assessment.ResultsThis manuscript outlines the protocol that will guide the conduct of the forthcoming study.ConclusionsThe proposed project aims to lead efforts using technological advances to capture microchanges in suicidal thinking/behavior over shorter timeframes and thereby guide future clinical assessment and management of suicidal patients. Results of this study will generate robust evidence to evaluate which risk factors predict proximal changes in suicidal ideation and behaviors. They will also provide the ability to examine potential interactions with multiple theoretically derived risk factors to predict proximal transitions into worsening suicidal thinking or behaviors. Such information will provide new targets for intervention that could ultimately reduce suicide-related morbidity and mortality.International Registered Report Identifier (IRRID)PRR1-10.2196/37583

Predicting short-term suicidal thoughts in adolescents using machine learning: developing decision tools to identify daily level risk after hospitalization.

Mobile technology offers unique opportunities for monitoring short-term suicide risk in daily life. In this study of suicidal adolescent inpatients, theoretically informed risk factors were assessed daily following discharge to predict near-term suicidal ideation and inform decision algorithms for identifying elevations in daily level risk, with implications for real-time suicide-focused interventions. Adolescents (N = 78; 67.9% female) completed brief surveys texted daily for 4 weeks after discharge (n = 1621 observations). Using multi-level classification and regression trees (CARTSs) with repeated 5-fold cross-validation, we tested (a) a simple prediction model incorporating previous-day scores for each of 10 risk factors, and (b) a more complex model incorporating, for each of these factors, a time-varying person-specific mean over prior days together with deviation from that mean. Models also incorporated missingness and contextual (study week, day of the week) indicators. The outcome was the presence/absence of next-day suicidal ideation. The best-performing model (cross-validated AUC = 0.86) was a complex model that included ideation duration, hopelessness, burdensomeness, and self-efficacy to refrain from suicidal action. An equivalent model that excluded ideation duration had acceptable overall performance (cross-validated AUC = 0.78). Models incorporating only previous-day scores, with and without ideation duration (cross-validated AUC of 0.82 and 0.75, respectively), showed relatively weaker performance. Results suggest that specific combinations of dynamic risk factors assessed in adolescents' daily life have promising utility in predicting next-day suicidal thoughts. Findings represent an important step in the development of decision tools identifying short-term risk as well as guiding timely interventions sensitive to proximal elevations in suicide risk in daily life.

The revised suicide crisis inventory (SCI-2): Validation and assessment of prospective suicidal outcomes at one month follow-up

Background and AimThe Suicide Crisis Syndrome (SCS) is an evidence-based pre-suicidal cognitive and affective state predictive of short-term suicide risk. The most recent SCS formulation, proposed as a suicide-specific DSM diagnosis, features a feeling of Entrapment accompanied by four additional symptom clusters: Affective Disturbance; Loss of Cognitive Control; Hyperarousal; and Social Withdrawal. The aim of the present study was to revise the Suicide Crisis Inventory (SCI; Barzilay et al., 2020), a self-report measure assessing the presence of the SCS,in accordance with the current SCS formulation, as well as to assess the psychometric properties and clinical utility of its revised version, the Suicide Crisis Inventory—2 (SCI-2). MethodsThe SCI-2, a 61-item self-report questionnaire, was administered to 421 psychiatric inpatients and outpatients at baseline. Prospective suicidal outcomes including suicidal ideation, preparatory acts, and suicidal attempts were assessed after one month. Internal structure and consistency were assessed with confirmatory factor analysis, convergent, discriminant, and current criterion validity. Receiver-operating characteristic (ROC) curves with Area under the Curve (AUC) were used to examine the predictive validity of the SCI-2 to prospective outcomes. Exploratory analyses assessed the predictive validity of the five SCI-2 dimensions. ResultsThe SCI-2 demonstrated excellent internal consistency (Cronbach's α = 0.971), good convergent, discriminant, and current criterion validity. The SCI-2 significantly predicted all three outcomes, and was the only significant predictor of suicidal attempts with AUC = 0.883. DiscussionThe results of this study indicate that the SCI-2 is a valid and reliable tool to assess the presence and intensity of the Suicide Crisis Syndrome and to predict short-term prospective suicidal behaviors and attempts among psychiatric outpatients and inpatients regardless of patients’ readiness to disclose suicidal ideation.

Validity of the modular assessment of risk for imminent suicide in predicting short-term suicidality.

The Modular Assessment of Risk for Imminent Suicide (MARIS) is a clinical assessment tool, consisting of four modules assessing (1) a pre-suicidal cognitive-affective state (Module 1); (2) patients' attitudes toward suicide (Module 2); (3) clinicians' assessment of suicide risk factors (Module 3); and (4) clinicians' emotional responses to patients (Module 4) that assesses short-term suicide risk. Initial evidence provided evidence for its reliability and concurrent validity. The present study extended these findings by examining the MARIS's predictive validity in relation to suicidal thoughts and behaviors at one-month follow-up. A sample of 1039psychiatric patients (378 inpatients, 661 outpatients) and their clinicians (N=144) completed a battery of measures at baseline; 670 patients completed the one-month follow-up assessment. MARIS total scores predicted suicidal thoughts and behaviors at one-month follow-up, even after controlling for baseline suicidal thoughts and behaviors. Moreover, both Module 1 and the Distress subscale of Module 4 were uniquely associated with suicidal thoughts and behaviors at one-month follow-up, controlling for baseline suicidal thoughts and behaviors. Modules 2 and 3, on the other hand, exhibited poor internal consistency. Overall, both patient- and clinician-rated indices are uniquely predictive of suicidal thoughts and behaviors at one-month follow-up, highlighting the need for integrating clinicians' emotional responses into suicide risk assessment. Pending replication and extension of these findings in external samples, a briefer, two-module version of MARIS (MARIS-2) may be such an integrative, psychometrically sound, and clinically useful instrument that can be utilized to assess short-term suicide risk.

The Dynamic Relationship Between Alpha and Beta Power and Next-Day Suicidal Ideation in Individuals With Treatment-Resistant Depression

BackgroundNocturnal wakefulness has emerged as a potential predictor of short-term suicide risk. This analysis used dynamic temporal patterns in alpha and beta power and global sleep metrics to explore the possible link between next-day suicidal ideation (NDSI) and wakefulness measures in unmedicated participants with treatment-resistant depression. MethodsThirty-three medication-free participants with treatment-resistant depression completed overnight polysomnography. Alpha and beta spectral power as functions over time were used to represent arousal-related components of the dynamic sleep process. A functional data analytic approach (multilevel functional principal component analysis [MFPCA]) was used to preserve the oscillatory nature of the data; MFPCA PC scores were then associated with NDSI. Associations between NDSI and polysomnography-defined wakefulness after sleep onset, sleep efficiency, and total sleep time were also evaluated. ResultsNDSI had the strongest relationship with the second beta PC score (slope = 0.09 [90% credible interval, 0.03 to 0.14]), which represented an oscillating pattern that reflected disturbed sleep. The first PCs from both alpha and beta MFPCAs represented the overall magnitude of power and were most closely associated with traditional polysomnography metrics but were not related to NDSI. Results were equivocal for wakefulness after sleep onset with NDSI and did not support a relationship between NDSI and either sleep efficiency or total sleep time, highlighting the value of information contained in oscillating electroencephalogram patterns for identifying physiological links between nocturnal wakefulness and NDSI. ConclusionsThis study leveraged the dynamic nature of wakefulness-related electroencephalogram frequencies and provides a potential electrophysiological link between suicidal ideation and wakefulness during sleep in individuals with treatment-resistant depression.

Predicting short-term suicide risk: allowing for ongoing variation in severity of intent.

This article considers the role that assessment of suicidal ideation may have in short-term prediction of suicide. Suicide risk assessment is a multifactorial process and it is assumed that assessment of suicidal ideation is one component. Denial that suicidal ideation has any useful role in risk assessment fails to allow for the marked ongoing short-term variability in severity of intent, which is a common feature of the suicidal state of mind. It is concluded that the assessment of suicidal ideation, provided it is carried out correctly and applied appropriately, should continue to be regarded as a central component of the overall prediction process. A 'two-take' approach to short-term risk assessment and mitigation is proposed that takes variability in severity of intent into account and includes anticipatory treatment planning for any problems that may occur in the near future.

Annual Meeting to Offer Sessions on Suicide From Many Dimensions

Back to table of contents Previous article Next article APA & MeetingsFull AccessAnnual Meeting to Offer Sessions on Suicide From Many DimensionsMichael Myers, M.D.Michael MyersSearch for more papers by this author, M.D.Published Online:4 Feb 2020https://doi.org/10.1176/appi.pn.2020.2a34AbstractSuicide will once again be a prominent topic at APA’s Annual Meeting in response to the rising numbers of deaths by suicide.APA’s Annual Meeting is always replete with state-of-the-art updates on psychiatric dimensions of suicide. This year is no exception. What follows is a list of some of the many offerings. It is far from exhaustive, so I urge anyone attending the meeting to keep abreast of the full program. (Please note that attendees must register for courses and pay an additional fee.)“Dissemination and Implementation of an Evidence-Based Care for Suicide Attempters in Japan” with APA President Bruce Schwartz, M.D., and his expert collaborators from Japan. This Presidential Session will have great appeal to many American and international psychiatrists attending the meeting.“Responding to the Impact of Suicide in Clinicians” with Eric Plakun, M.D., and Jane Tillman, Ph.D. This is a popular and annual interactive session by two seasoned clinicians.“Therapeutic Risk Management of the Suicidal Patient” with Hal Wortzel, M.D., and Bridget Matarazzo, Psy.D., and “Evidence-Based Treatment Approaches for Suicidal Adolescents” with Michele Berk, Ph.D., and Stephanie Clarke, Ph.D. These sessions are presented by APA Publishing authors, who always draw a large attendance.“What Do I Do Now? The Development of a Clinical Pathway for Children and Adolescents With Identified Suicide Risk” with Stephen Soffer, Ph.D., Jason Lewis, Ph.D., O’Nisha Lawrence, M.D., Yesenia Marroquin, Ph.D., and Tami D. Benton, M.D. The presenters will describe the rationale and need for a clinical pathway to support a practice with children and adolescents at risk for suicide, review the process for developing a clinical pathway, and guide the audience through the flow of the clinical pathway.“Data Versus Diatribe and the Depiction of Suicide in the News Media” with Mira Zein, M.D., M.P.H., Jessica Gold, M.D., M.S., Diana Robinson, M.D., Abhisek Chandan Khandai, M.D., M.S., and Laura Pientka, D.O. Attendees will meet in small groups to discuss the relationship between psychiatrists and the media, including safe reporting guidelines and reducing contagion.“Firearms and Suicide Prevention: Why We Should Ask About Guns and How to Do It” with Marian Rain, M.D., Meagan Patricia Whitney, M.D., Theresa Raquel De Freitas Nicholson, M.D., and “Suicide and Firearms: What Do We Know and What Do We Do” with Ahmad Hameed, M.D., Kathleen Clare Dougherty, M.D., and Usman Hameed, M.D. Over 22,000 people die by firearm suicide each year in the United States—a public health crisis in which psychiatrists can play a prominent role in the effort to end it.“Dynamic Therapy With Self-Destructive Borderline Patients: An Alliance-Based Intervention for Suicide” with Eric Plakun, M.D., and Samar Habl, M.D. This session will cover nine practical principles to establish and maintain a therapeutic alliance in the psychodynamic psychotherapy of self-destructive borderline patients.“Developing a Suicide-Specific Treatment Program in Your Health Care Setting” with Kathleen Crapanzano, M.D., and Raymond Tucker, Ph.D. They will focus on the importance of integrating a comprehensive suicide-specific treatment program into mental health care settings.“The Suicidal Patient: Principles and Practice of Assessment, Treatment, and Care Management” with Kirk Strosahl, Ph.D., John Chiles, M.D., and Laura Roberts, M.D., M.A. This master course is a comprehensive, day-long course that will appeal to attendees irrespective of career stage. Participants will learn about the difficulties inherent in both predicting and preventing suicide, with the aim of refocusing their clinical attention on aspects of the patient’s presentation that are more amenable to direct intervention.“Imminent Suicide Risk Assessment in High-Risk Individuals Denying Suicidal Ideation or Intent: Introduction and Training” with Igor Galynker, M.D., Ph.D., and his expert faculty. Dr. Galynker is a prominent suicide researcher/clinician and frequent presenter at APA Annual Meetings. The course aims to train clinicians in a novel framework for the assessment of short-term suicide risk: the Modular Assessment of Risk for Imminent Suicide (MARIS) and the Narrative-Crisis Model of suicidal behavior (NCM). ■More information on these and other Annual Meeting sessions can be found using the Session Search tool on APA’s website here.Michael Myers, M.D., is a consultant to APA’s Scientific Program Committee and a professor of clinical psychiatry at SUNY-Downstate Medical Center. He is a specialist in physician health and the author of numerous books including The Physician as Patient: A Clinical Handbook for Mental Health Professionals and Touched by Suicide: Hope and Healing After Loss. ISSUES NewArchived

Impulsivity and Suicidal Behavior.

Suicide is the leading cause of injury mortality in the United States and the second-leading cause of death in people aged 10-34years. While many long-term risk factors are known, the short-term prediction of suicidal behavior remains elusive. Many characteristics of suicidal behavior cut across diagnoses, but suicide is increased in recurrent psychiatric disorders, addictive disorders, and trauma-related disorders. Suicide results from the interaction of short-term and long-term behavioral regulation. The shorter the time-course of the mechanism, the closer it is to actual suicidal behavior, and the harder it is to prevent. We will discuss the manner in which impulsivity, a major determinant of short-term suicide risk, interacts with longer-term risk factors, especially sensitization to addictive or traumatic stimuli. Impulsivity predisposes to sensitization; in turn, impulsivity is a prominent component of sensitized behavior. Impulsivity can be described as a general pattern of behavior ("trait" impulsivity), as responses that are not conformed to their context (action-impulsivity), or as inability to delay reward or to take future consequences into account (choice-impulsivity). Each of these contributes to suicidal behavior. The neural mechanisms of impulsivity and sensitization are analogous, and sensitization can produce rapidly fluctuating patterns of impulsive behavior, arousal, and anhedonia. In order to recognize and prevent suicidal behavior, it is necessary to identify factors associated with susceptibility to bouts of impulsive behavior in people at elevated long-term risk.

Effects of suicide awareness materials on individuals with recent suicidal ideation or attempt: online randomised controlled trial.

Awareness materials featuring ways of coping with suicidal ideation can reduce suicidal ideation, the so-called Papageno effect. All of the previous experimental studies on this subject have been conducted with individuals not at risk of suicide. To assess effects of suicide awareness materials in a sample of individuals with recent suicidal ideation. Trial registration: German Clinical Trial Registry ID number DRKS00013613. Adults (n = 266) with recent self-reported suicidal ideation or attempt were randomised to read an educative article featuring a lay individual with personal experience of suicidality (n = 86), a similar article featuring a mental health expert (n = 90), or an unrelated article (n = 90) in a double-blind online randomised controlled trial. Questionnaire data were collected before (T1) and immediately after exposure (T2) as well as 1 week later (study end-point, T3) and analysed with linear mixed models. The primary outcome was suicide risk as assessed using the Survival and Coping Beliefs subscale of the Reasons for Living Inventory (RFLI); secondary outcomes were suicide-prevention knowledge and mood. There was an immediate beneficial effect on suicide risk in the intervention group exposed to the message delivered by the individual with personal experience (group 1) as compared with the control group that was maintained until the study end-point (study end-point: RFLI score mean difference from baseline within group 1 MD = -0.36 (95% CI -0.66 to -0.06), mean difference compared with control group MD = -0.71 (95% CI -1.27 to -0.14); d = -0.18). The effect was particularly pronounced for individuals with recent suicide attempt (RFLI score at T3, compared with control group: MD = -1.55 (95% CI -2.52 to -0.57); d = -0.23). Participants in this group also showed increased prevention-related knowledge compared with the control group. Individuals with a recent suicide attempt appear to benefit from a printed narrative of positive coping with suicidal ideation. The intervention materials do not increase short-term suicide risk.

The Modular Assessment of Risk for Imminent Suicide (MARIS): A validation study of a novel tool for suicide risk assessment

BackgroundReliable diagnostic tools for the short-term suicide risk assessment are needed. The recently developed multi-informant Modular Assessment of Risk for Imminent Suicide (MARIS) includes four modules: two are patient-rated and two clinician-rated. The patient-rated modules assess a proposed pre-suicidal cognitive/emotional state (Module 1) as well as patients’ attitudes towards suicide (Module 2). The clinician-rated modules assess traditional suicide risk factors (Module 3) and clinicians’ emotional responses to the patient (Module 4). MethodsWith the aim of extending our previous preliminary proof of concept findings, the MARIS was administered to 618 psychiatric patients (167 inpatients, 451 outpatients) and their clinicians (N = 115). Patients were assessed with a battery including the Columbia-Suicide Severity Rating Scale. Four outcomes were considered: lifetime and past month suicidal thoughts and behaviors (STB) (0–10 point scale) and suicidal behaviors (SB) (0–5 point scale). Reliability and concurrent, convergent/divergent and incremental validity were assessed. ResultsGood internal consistency was found for modules 1 and 4 (Cronbach's α: 0.87 and 0.86, respectively) but not for the others. Module 1′s total score positively correlated with lifetime STB/SB and past month STB (all p ≤ 0.003). Module 4′s total score positively correlated with all four outcomes (all p < 0.001). Modules 1 and 4 showed additional capacity to detect patients’ lifetime and past month STB/SB beyond other associated factors. LimitationsLack of prospective assessment. Inpatients were evaluated at discharge, whereas outpatients at intake. ConclusionsThese findings supported the utility of multiple data sources to identify patients at imminent suicide risk, and in particular clinicians' emotional responses.

Towards the objective assessment of suicidal states: Some neurocognitive deficits may be temporally related to suicide attempt

Neurocognitive detection of suicidal states has the potential to significantly advance objective risk assessment. This goal requires establishing that neurocognitive deficits fluctuate around the time of a suicide attempt. The current study therefore evaluated whether neurocognitive performance is temporally related to suicide attempt, in a sample at highrisk for suicide (n = 141). Evaluations consisted of a clinician-administered interview, self-report questionnaires, and neurocognitive tasks assessing response inhibition, attentional control, and memory recognition. Analyses examined whether neurocognitive scores significantly differed according to the following temporal suicide attempt categories: (a) past-week attempt; (b) past-year attempt (not in past week); and (c) no past-year attempt. Univariate results showed that response inhibition and memory recognition were significantly related to suicide attempt recency. Post-hoc pairwise tests showed that participants with a past-week suicide attempt showed greater impairments than those without a past-year attempt. Multivariate tests showed the same pattern of results, adjusting for age, suicide attempts prior to past year, mood disturbance, and suicidal ideation. These results show that neurocognitive assessment of response inhibition and memory recognition shows sensitivity to the recency of a suicide attempt. While future prospective studies are needed, results suggest that phasic neurocognitive deficits may serve as objective markers of short-term suicide risk.

Numerous Sessions to Address One of Psychiatry’s Most Difficult Topics

Numerous Sessions to Address One of Psychiatry’s Most Difficult Topics

Validity of the Suicide Behaviors Questionnaire-Revised in patients with short-term suicide risk

Background and objectivesSuicide is known as a public health problem; however, there are few validated scales with no predictive validity. The aim of this study was to assess the validity of the Spanish version of The Suicidal Behavior Questionnaire-Revised in patients with suicidality. MethodsWe applied the Spanish version of The Suicidal Behavior Questionnaire-Revised and 2 other scales to patients with suicide risk. Thirty days later we reassessed to determine the predictive validity for suicide attempt or suicide. Results484 patients with suicidality were screened of which 417 were eligible and 411 were evaluable. Factor analysis found a domain with an eigenvalue of 2.0 explaining 50.1% of the variance. With a cutoff point ≥11 the NPV was 98.3% (IC95%, 95.2–99.6) and the PPV was 8.7% (IC95%, 4.7–14.4). ConclusionThe Spanish version of The Suicidal Behavior Questionnaire-Revised, similar to the English version, has moderate internal consistency, adequate concurrent validity and predictive validity.