Suicidal Communications Research Articles

Warning signs in a period of acute risk for suicide attempt: The utility of count- and combination-based classification

ObjectiveThis study sought to establish if models involving the specific combinations of identifiable behavioral warning signs (WS; i.e., alcohol use, suicidal communications, preparation of personal affairs, experiencing negative interpersonal life events) for a suicide attempt outperformed a simpler count model of WS to distinguish an acute risk period (the six hours prior to a suicide attempt) from a control period (a matched six-hour period the day prior). MethodGeneralized linear mixed models tested all logical combinations of four behavioral WS in addition to a count variable of the number of behavioral warning signs. For the count variable, receiver operating characteristic curve analysis was utilized to determine the optimal cut point for the number of endorsed WS. ResultsArea under the curve (AUC) compared classification across all models, with the count model demonstrating similar classification performance to the best multivariate model (AUCs of 0.72 and 0.73, respectively), with an optimal cut point of endorsing one or more WS. ConclusionAlthough determinations of acute risk should be informed by multiple sources of information, this study suggests a relatively simple count-based approach that considers the presence of one (or more) behavioral WS may be used as a potential indication of increased acute risk for suicide attempt.

24-Hour warning signs for adolescent suicide attempts.

Little is known about when youth may be at greatest risk for attempting suicide, which is critically important information for the parents, caregivers, and professionals who care for youth at risk. This study used adolescent and parent reports, and a case-crossover, within-subject design to identify 24-hour warning signs (WS) for suicide attempts. Adolescents (N = 1094, ages 13 to 18) with one or more suicide risk factors were enrolled and invited to complete bi-weekly, 8-10 item text message surveys for 18 months. Adolescents who reported a suicide attempt (survey item) were invited to participate in an interview regarding their thoughts, feelings/emotions, and behaviors/events during the 24-hours prior to their attempt (case period) and a prior 24-hour period (control period). Their parents participated in an interview regarding the adolescents' behaviors/events during these same periods. Adolescent or adolescent and parent interviews were completed for 105 adolescents (81.9% female; 66.7% White, 19.0% Black, 14.3% other). Both parent and adolescent reports of suicidal communications and withdrawal from social and other activities differentiated case and control periods. Adolescent reports also identified feelings (self-hate, emotional pain, rush of feelings, lower levels of rage toward others), cognitions (suicidal rumination, perceived burdensomeness, anger/hostility), and serious conflict with parents as WS in multi-variable models. This study identified 24-hour WS in the domains of cognitions, feelings, and behaviors/events, providing an evidence base for the dissemination of information about signs of proximal risk for adolescent suicide attempts.

A Psychometric Pilot Study Examining the Functions of Suicidal Communications Using IRT and Factor Analysis.

Background: Suicide prevention, an important public health issue, relies on suicidal communications to identify and intervene with those at risk. Scant research tests explicit theories of suicidal communication impeding applications to prevention science. The current study pilots a new measure assessing the functions of suicidal communications using factor analysis and item response theory. Methods: MTurk workers (n = 898) completed an anonymous survey. The original scale included 35 items refined using exploratory and confirmatory factor analysis, bifactor modeling, and item response theory. Results: The initial EFA identified a two-correlated-factor solution. The two-correlated-factor and unidimensional models yielded a poor fit. A bifactor model yielded a borderline to acceptable fit. The final four items were identified using a bifactor model and item response theory graded response models capturing ambivalence resolution defined as behaviors aimed to aid in suicide decision making. The final model yielded an excellent fit: 𝝌2(2) = 1.81, CFI (1.00), TLI (1.00), RMSEA (0.00), and SRMR (0.01). Conclusions: There may be one function of suicidal communications. Disclosure may elicit connection and reasons for living that serve as barriers to suicide and resolve ambivalence. Key limitations include convenience sampling and limited validity measures. Future research should partner with participants to improve scale and theory development efforts.

A Descriptive Cohort of Suicidal Cancer Patients: Analysis of the Autopsy Case Series from 1993 to 2019 in Milan (Italy).

Suicide in cancer patients has always been a subject of clinical studies, but the contribution of forensic pathology to this phenomenon is poorly reported. With the aim of at least partially filling this gap in information, at the Institute of Forensic Medicine of Milan, Italy, we assessed all suicides that occurred in cancer patients. A descriptive and retrospective analysis was carried out by examining the database of the Institute and autopsy reports. We included 288 suicide cases with proven cancer diseases. For each suicide, sex, age, country of origin, body area affected by cancer, further pathological history, medications, previous suicide attempts and suicidal communications, as well as the place where the suicide occurred, were assessed. Furthermore, from a forensic point of view, we considered the chosen suicide method and any involved means. The majority of cases were male older adults affected by lung, colon and prostate cancer. Violent suicide methods were prevalent, and the most represented suicide method was falling from height regardless of the body area affected by cancer. Such data may be of clinical use for clinicians engaged in the front lines in order to address suicide risk prevention strategies among cancer patients.

Forms of suicide communication are not associated with five-factor personality

PurposeUS age-adjusted suicide rates increased by 33 per cent from 1999 to 2017 (Hedegard et al., 2018). Communications about suicide and death are a commonly cited warning sign (SPRC, 2014) and are foundational to the vast majority of risk assessment, prevention and intervention practices. Suicidal communications are critically understudied despite their implications for prevention and intervention practices. The purpose of this study is to examine the association between five factor model personality traits and forms of suicidal communications.Design/methodology/approachA sample of 154 people admitted to emergency psychiatry for suicide ideation or attempt completed self-report measures about their suicide ideation and behavior. Kruskal–Wallis ANOVA examined differences between five-factor model personality domains and forms of communications.FindingsThere were no significant differences; however, two nonsignificant trends related to indirect or non-communication and extraversion and openness emerged.Research limitations/implicationsFuture studies should focus on using more nuanced measures of dimensional personality and suicidal communications.Originality/valueThis study is the first to examine differences in the Five-Factor Model personality traits and suicidal communications.

The Patient is Suicidal: What Should I Do as a Clinician?

Suicidal behaviour is the most common psychiatric emergency. A large proportion of suicidal behaviour can be prevented, particularly in cases associated with mental disorders. Early recognition of suicidality and reliable evaluation of suicide risk are crucial for the clinical prevention of suicide. Evaluation of suicidal risk involves assessment of suicidal intent, previous suicide attempts, underlying psychiatric disorders, the patients’ personality, the social network, and suicide in the family or among acquaintances as well as other well-known risk factors. Suicide risk assessment should take place on several levels and relate to the patient, the family and social network but also to the availability of treatment, rehabilitation and prevention resources in the community. As suicide risk fluctuates within a short period of time, it is important to repeat the suicide risk assessment over time in an emphatic and not mechanistic way. The suicidal person may mislead both family members and hospital staff, giving a false sense of independence and of being able to manage without the help of others. Although extreme ambivalence to living or dying is often strongly expressed by the suicidal individual, it is not seldom missed by others. If observed in the diagnostic and treatment process, dialogue and reflection on such ambivalence can be used to motivate the patient for treatment and to prevent suicide. If ambivalence and suicidal communications go undiscovered, the treatment process and the life of the patient can be endangered. Today, several measurement tools of suicide risk exist, including psychometric and biological measurements. Some of these tools have been extensively studied and measures of their sensitivity and specificity have been estimated. This allows for the formulation of an approximate probability that a suicidal event might happen in the future. However, the low precision of the predictions make these tools insufficient from the clinical perspective and they contribute very little information that is not already gained in a standard clinical interview. Psychiatrists and other mental health professionals have always longed for reliable and precise tools to predict suicidal behavior, which could support their clinical practice, allow them to concentrate resources on patients that really need them, and backup their clinical judgement, in case of eventual legal problems. In order to be useful, however, the approximate probability that a suicidal event might happen in the future is not sufficient to significantly change clinical routines and practices. These should rely on the available evidence base and always consider the safety of the patient as paramount.Disclosure of interestThe author declares that he has no competing interest.

Suicidal Communications in Adolescents

In one way or another, everything around us has to do with communication. Human beings have the capacity to communicate not only by means of what they say and do, but also by means of what they do not say and do not do. Not always what people say is what they really mean, and not always what they do is what they really want to do. Sometimes what people say is denied by their behavior. So, the first topic to be dealt with in this book is related to the ways used by adolescents to express their suicidal purposes, that is, the different manifestations of suicidal communications at different stages of life.

Suicide Prevention in Adolescents

Good care is out of the question when it is based on misleading foundations. When it comes to suicidal behavior in adolescents, it is necessary to get rid of some beliefs that have been denied by suicidal adolescents themselves, myths that hinder the prevention of this selfdestructive behavior, the different types of suicidal communications hinted by them, and the nature of depression in this particular age group in order to make an early diagnosis and provide timely treatment.

Suicide Prevention in Adolescent

Good care is out of the question when it is based on misleading foundations. When it comes to suicidal behavior in adolescents, it is necessary to get rid of some beliefs that have been denied by suicidal adolescents themselves, myths that hinder the prevention of this self-destructive behavior, the different types of suicidal communications hinted by them, and the nature of depression in this particular age group in order to make an early diagnosis and provide timely treatment.

Peer Response to Messages of Distress

Suicidal young adults often confide their distress to peers. It is unclear, however, what types of assistance a friend may offer in response to various symptoms of distress as well as whether the sex of either individual affects responses. We examined open-ended responses to e-mail vignettes from a fictitious friend exhibiting depressed, irritable, or overtly suicidal communications. College student participants (n = 106) read e-mail messages from a fictitious friend, to which they composed a reply. Replies were coded to reflect the presence/absence of mention of professional help, problem-oriented (personal) help, and social support. Problem-oriented help was offered the most across conditions; professional help was offered least in response to depressed or irritable vignettes. Women were more likely to offer any type of help than men. Patterns of help-giving and sex differences in help-giving varied by condition. Results indicate students' preferences for solving peer problems personally rather than professionally. Campus prevention and intervention efforts should focus on enhancing students' peer support and referral skills.

Suicidal process, suicidal communication and psychosocial situation of young suicide attempters in a rural Vietnamese community

The study aimed to explore the suicidal process, suicidal communication and psychosocial situation of young suicide attempters in a rural community in Hanoi, Vietnam. Semi-structured interviews were conducted, in a community setting, with 19 suicide attempters aged 15-24 who had been consecutively hospitalized in an intensive care unit. In 12 of 19 cases, the first pressing, distinct and constant suicidal thoughts appeared less than one day before the suicide attempt in question. However, distress and mild, fleeting suicidal thoughts had been present up to six months before the suicide attempt in 16 cases. Five respondents had a suicide plan one to three days before attempting suicide. Altogether, 13 engaged in some form of suicidal communication before their attempt. This communication was, however, difficult for outsiders to interpret. Twelve of the respondents were victims of regular physical abuse and 16 had suffered psychological violence for at least one year before attempting suicide. Eighteen of the respondents used pesticides or raticides in their suicide attempts. None sought advice or consultation in the community despite long-standing psychosocial problems. The strategy of reducing the availability of suicide means (e.g., pesticides or raticides) in Asian countries should be complemented with a long-term suicide-preventive strategy that targets school dropouts and domestic violence, and promotes coping abilities and communication about psychological and social problems as well as recognition of signs of distress and suicidal communication.

The relationship between lethality of attempted suicide and prior suicidal communications in a sample of residential youth

Some type of suicidal communication precedes 80% of attempted and completed suicides in adolescents. This study investigates the relationship between the number of suicidal communications prior to an attempt and the lethality of the attempt in a sample of adolescent youth residing in a residential treatment facility. The sample consisted of 46 youth who had a suicide attempt while in a large group home residential facility over a 9-year period. Results indicated that attempters who made fewer suicidal communications beforehand tended to use more lethal methods in their attempts. Attempters with two or more preceding suicidal communications had significantly lower lethality in their attempts than did those with fewer suicidal communications. Few differences emerged between the groups in regards to demographic or psychosocial variables.

500 Psychological Autopsies

Five hundred psychological autopsies on equivocal (suicide versus accident) deaths were reviewed to ascertain which factors are significant in making the determination between suicidal and accidental deaths. Factors varied in relative importance according to the method used to cause death. Significant factors included life-style, recent stress, suicidal communications, previous self-destructive behaviors, history of depression, and obvious factors from the physical evidence such as large amounts of drugs in the blood. Although the court-provided decision guideline is "a preponderance of the evidence", in practice, the assembled evidence is often used to construct a "most credible" scenario to explain the death.

Peer knowledge of and reactions to adolescent suicide

Questionnaire data were obtained from 120 high school students on their (1) knowledge of risk factors that identify potential suicidal behavior in peers, (2) attitudes toward peers who attempt or commit suicide, and (3) ability to respond appropriately to suicidal messages from peers. Overall, relatively few adolescents possessed accurate information, and many had misinformation concerning various warning signs. Furthermore, respondents expressed negative attitudes toward peers who attempt or commit suicide, and generally were unable to respond sensitively and appropriately to suicidal communications. These results have implications for suicide education programs for adolescents.

Suicide by psychotics

The authors studied 31 cases with psychotic diagnoses from a consecutive series of 204 suicides in San Diego. They were compared to 25 similar cases from 134 suicides gathered in the city of St. Louis and St. Louis county 25 years earlier. The proportion of psychotic subjects (less than 20%) in the two samples was similar. The San Diego psychotics were younger on the average than those from St. Louis and had more polysubstance abuse than alcoholism. Only rarely did psychotics in either sample commit suicide by particularly “crazy” methods. In the San Diego suicides, the psychotics without a depressive syndrome had as many depressive symptoms as those with a depressive syndrome. Schizophrenics in the San Diego sample made suicidal communications just as often as the other psychotics and the nonpsychotics. Fewer schizophrenics than other psychotics or nonpsychotics had Stressors identified at the time of death, but over half of all the subjects did have them.

The Communication of Suicidal Intent by Completed Suicides

This article reviews the literature on the communication of suicidal intent by completed suicides. Research problems and methodological differences which limit knowledge about suicidal communications are discussed. Despite these difficulties, available data confirms that suicides frequently do communicate their intent. Furthermore, suicides identified as noncommunicators may, nevertheless, provide cues suggesting their intent. Although a few differences are indicated, attempts to distinguish communicators from noncommunicators according to such variables as sex, age, marital status, education, religion, social status, and clinical diagnosis have met with little success.

Suicide. Clues from interpersonal communication.

THIS STUDY suggests that increased attention to interpersonal behavior may provide a basis for more accurate recognition and more successful long-term treatment of the high risk suicidal patient. Previous studies have defined the depressed patient who falls in a high suicide risk category on the basis of clinical features of the depressive illness, history, socioeconomic profile, and the evaluation of intrapsychic factors such as dependency, guilt, and anger directed inward. Though these criteria are a part of the psychiatric clinician's everyday knowledge, their usefulness is limited by the fact that all too many patients would fall into the category of high suicide risk as defined by the above criteria. Several studies have emphasized the frequency of suicidal communications prior to suicidal behavior, pointing out that from 50% to 70% of patients who subsequently kill themselves communicate their intent in advance.^1,2A great many individuals

THE COMMUNICATION OF SUICIDAL INTENT PRIOR TO PSYCHIATRIC HOSPITALIZATION: A STUDY OF 87 PATIENTS

1. A study was made of the suicidal communications of 87 patients admitted to a short-term care, private psychiatric hospital. 2. There is a high prevalence of suicidal communications (68%) in such patients. 3. There were 16 different ways of communicating suicidal intent. The most frequent ways were statements by the patient that he wanted to die, that he would be better off if he were dead, that his family would be better off if he were dead, and that he intended to commit suicide. Each of these was made by at least one-third of the patients. 4. The use of suicidal communication as [SEE SOURCE PDF TABLE 10.] a taunt or threat was infrequent, occurring in only 7% of patients. The great majority of communications were, therefore, not perceived as a means of manipulating the environment for ulterior reasons, but seemed rather to be expressions of hopelessness and despair. 5. The suicidal communications tended to be varied and repetitive. 6. The preoccupation with suicide was not a "way of life" for these patients. Over two-thirds of those who communicated suicidal ideas had begun talking about suicide only within one year of admission, and almost one-half within only 3 months prior to admission. 7. Patients with manic-depressive disease showed a much higher prevalence of suicidal communications than did patients in the miscellaneous group. 8. There are frequent references in the psychiatric literature that everyone, or almost everyone, has at some time thought of suicide. It is evident from the findings noted in conclusions 6 and 7 that there is a vast difference between these presumably evanescent and transient thoughts of suicide and the suicidal preoccupations that lead to the suicidal communications described in the present study. These communications do not occur in everybody (in fact, in only one-third of the miscellaneous group, even though they were ill enough to be in a psychiatric hospital) and when they do occur, in the majority of instances they have been present for less than a year. It may very well be that thoughts of suicide in the clinically well persons referred to in the literature are clinically meaningless and unrelated to the suicidal communications and to suicide which may occur in psychiatrically ill patients. 9. It is probable that in patients ill enough to be admitted to a psythiatric hospital those with manic-depressive disease and chronic alcoholism account for the vast majority of patients who make any suicidal communication. 10. There was a high rate of agreement, over 80%, between patients and informants concerning suicidal communications. These data were obtained by means of a systematic clinical interview in which each question was asked of each patient and informant, and in which all positive answers were explored in detail. The finding of such a high rate of agreement suggests that it is possible to obtain, by means of a systematic interview, reliable and presumably valid information concerning even such a psychologically sensitive area as suicidal preoccupation. 11. There was one category of suicidal communication–the specific statement of intent to commit suicide–that the patients answered affirmatively less frequently than did the informants. Apparently the patients were reluctant to admit to, or did not remember having made, such a specific statement of suicidal intent, although they readily discussed other concerns with death and suicide. 12. The findings in this study of a high rate of suicidal communication in manic-depressive disease and chronic alcoholism are similar to the findings in a group of completed suicides previously studied. It will next be necessary to study ambulatory patients with these illnesses in order to ascertain the value of suicidal communication as an aid in the prevention of suicide.

The communication of suicidal intent: a study of 134 consecutive cases of successful (completed) suicide.

1. A study of the communication of suicidal ideas by 134 consecutive suicides has been done by means of systematic interviews with family, in-laws, friends, job associates, physicians, ministers, and others a short time after the suicide. 2. Two striking findings were that over two-thirds (69%) of the suicides had communicated suicidal ideas and that 41% had specifically stated they intended to commit suicide. In the majority of instances, the suicidal communications were of recent onset (months), repeatedly verbalized, and expressed to many persons. 3. Another striking finding was that 98% of these persons were probably clinically ill prior to their suicides. 4. The frequency of expression of suicidal ideas was not significantly related to age, sex, marital state, religion, whether living alone or not, clinical diagnosis, occupational status, income, or education. Chronic alcoholics had a somewhat greater tendency than the other diagnostic groups to make the specific statement that they intended to commit suicide. 5. The communication of suicidal ideas was analyzed as a general system of communication with reference to experimental psychological studies.