Suicidal Patients Research Articles

Emergency intervention plans for treatment of suicidal patients: anarrative literature review

Safety or emergency plan interventions, i.e., the creation of alist of hierarchically organized strategies and persons/institutions that patients can use or contact in case of asuicidal escalation, are increasingly used in clinical practice. This narrative review describes the approach for establishing an emergency plan and discusses studies on the effectiveness of such interventions. In addition, ideas on the mode of action of corresponding interventions and application variants are discussed. Despite increasing dissemination of safety plans, empirical evidence of their effectiveness is currently inadequate. High-quality studies are urgently needed, particularly with respect to different clinical populations. At this point in time, it should be cautioned against understanding the creation of an emergency plan as asufficient intervention in dealing with suicidal patients.

Transoral penetrating craniocerebral injury: a case report and literature review

A penetrating brain injury is a rare type of neurosurgical trauma associated with extremely high mortality and disability rates. Penetrating skull base injuries caused by arrows seldom occur because injuries caused by such weapons are more likely to be accidental. However, the number of self-inflicted injuries is increasing, and these injuries have varying patterns and high mortality rates. We report a case of a transoral penetrating craniocerebral injury caused by an arrow in a suicidal patient. Preoperative imaging is crucial for detecting and planning the surgical approach. Surgery is an effective treatment for this type of injury. Additionally, we reviewed previous case reports on this type of injury to provide recommendations for its clinical detection and treatment.

Outcomes of Universal Suicide Risk Screening in Medical Inpatients

Objectives Universal screening for suicide risk has not been shown to reduce suicide rates or reliably predict suicide, but there have been few studies assessing other potential benefits of this practice. We aimed to investigate the feasibility of implementing a universal inpatient suicide risk screening protocol and determine if a positive suicide screen was predictive of the need for psychiatric admission, and if it reduced the length of stay prior to psychiatric admission. Methods We conducted a retrospective chart review of non-psychiatric admissions over 1 year at a tertiary care academic hospital. We calculated the proportion of patients screening positive for suicidal ideation (SI), and among those screening positive, the proportion receiving a psychiatric consult and being admitted to psychiatry. Length of stay among groups was determined. We performed chi square analysis and adjusted multivariate logistic regression comparing different demographics. Results 97.2% of patients were screened, with 2.6% screening positive. Of these patients, 44.6% received a psychiatric consultation and 9.2% were admitted to psychiatry. Psychiatric admissions who screened positive for SI averaged 5.7 days until transfer to psychiatry, compared to 17.9 days for those who screened negative. Suicide risk screening had a sensitivity of 62.0%, specificity of 97.6%, positive predictive value of 9.2%, and a negative predictive value of 99.8% for psychiatric admission. Conclusions Universal suicide risk screening is feasible and may help identify patients requiring psychiatric care sooner, reducing length of stay of those requiring psychiatric admission.

Recent Interventions for Acute Suicidality Delivered in the Emergency Department: A Scoping Review

Introduction: Suicidality is a growing problem in the US, and the emergency department (ED) is often the front line for the management and effective treatment of acutely suicidal patients. There is a dearth of interventions that emergency physicians may use to manage and effectively treat acutely suicidal patients. To the extent that recently described interventions are available for ED personnel, no review has been conducted to identify them. This scoping review is intended to fill this gap by systematically reviewing the literature to identify recently described interventions that can be administered in the ED to reduce symptoms and stabilize patients. Methods: We conducted a search of PubMed, SCOPUS, and CINAHL in January 2024 to identify papers published between 2013–2023 for original research trialing recent interventions for the effective treatment of suicidality in the ED. We assessed 16 full-text articles for eligibility, and nine met inclusion criteria. Included studies were evaluated for features and characteristics, the fit of the intervention to the ED environment, and interventional efficacy. Results: Four studies assessed the efficacy of a single dose of the anesthetic/analgesic agent ketamine. Three studies assessed the efficacy of a brief psychosocial intervention delivered in the ED, two of which paired this intervention with the provision of follow-up care (postcard contact and referral assistance/case management, respectively). The remaining two studies trialed a brief, motivational interviewing-based intervention. Included studies had strong experimental designs (randomized controlled trials) but small sample sizes (average 57). Among the interventions represented across these nine studies, a single dose of ketamine and the brief psychosocial intervention Crisis Response Planning (CRP) show promise as ED-appropriate interventions for suicidality. Ketamine and CRP demonstrated the strongest fit to the ED environment and most robust efficacy findings. Conclusion: This review identified one drug (ketamine) and four unique psychological/behavioral interventions that have been used to treat acute suicidality in the ED. There is currently insufficient evidence to suggest that these interventions will prove efficacious and well-suited to be delivered in the ED environment. Future studies should continue to test these interventions in the ED setting to determine their feasibility and efficacy.

Assessing and managing the suicidal patient: forget the Reverend Bayes and try game theory.

Probability-based estimates of the future suicide of psychiatric patients are of little assistance in clinical practice. This article proposes strategic management of the interaction between the clinician and the patient in the assessment of potentially suicidal patients, using principles derived from game theory, to achieve a therapeutic outcome that minimises the likelihood of suicide. Further developments in the applications of large language models could allow us to quantify the basis for clinical decisions in individual patients. Documenting the basis of those decisions would help to demonstrate an adequate standard of care in every interaction.

Inpatient Suicides in Swedish Psychiatric Settings – A Retrospective Exploratory Study from a Nursing Perspective

In Sweden, approximately 1,200 individuals die by suicide annually. Inpatient suicide is considered rare, but death by suicide still occurs when admitted to a psychiatric hospital. This study was part of a national retrospective project covering data from all patients’ medical records for the 2 years before death by suicide in 2015. In this study, 41 patients who died by suicide while being admitted to psychiatric care were identified. The aim was to retrospectively identify documentation of suicide risk, safety measures, and comparisons between those with and without suicide attempts for patients who died by suicide during psychiatric inpatient care. There was documentation of suicidal variables in 80% of the patients; 59% had a previous known suicide attempt, 63% were diagnosed with mood disorders, and 41% were assessed for elevated suicide risk. The most common suicide method was hanging, suffocation (68%), and 22% had died by suicide within 24 h after admission. Almost three-quarters were on voluntary care. No patients had constant professional supervision on a one-to-one basis, and 17% had 15-minute checks. One-third were on agreed leave at the time of the suicide. These results emphasise the lifesaving role of high-level supervision in the early stages of inpatient care.

Brief Cognitive Behavioral Therapy for Suicidal Inpatients

Suicide risk is elevated after discharge from inpatient level of care. Empirically supported inpatient suicide prevention treatments are needed. To determine whether adding an inpatient version of brief cognitive behavioral therapy for suicide prevention to treatment as usual reduces postdischarge suicide attempts, suicidal ideation, and psychiatric readmissions and to determine whether substance use disorder moderates treatment effects. This randomized clinical trial compared treatment as usual (n = 106) to treatment as usual plus brief cognitive behavioral therapy for inpatients (n = 94) at a private psychiatric hospital in Connecticut. Follow-up assessments were completed monthly for 6 months postdischarge. Participants were enrolled from January 2020 through February 2023. Inpatients admitted following a suicidal crisis (past-week suicide attempt or ideation with plan on admission and attempt within previous 2 years) were included. Medical records of consecutive admissions (n = 4137) were screened, 213 were study eligible and randomized, and 200 were analyzed. A total of 114 participants (57.0%) completed 6-month follow-up assessments. Data from medical records were also obtained through 6-month follow-up. Up to 4 individual sessions of brief cognitive behavioral therapy for suicide prevention designed for inpatients. Suicide attempts and readmissions were assessed via blind interviews and medical record review. Suicidal ideation was assessed via self-report. The mean (SD) age among 200 analyzed participants was 32.8 (12.6) years; 117 participants were female and 83 were male. Brief cognitive behavioral therapy-inpatient reduced the occurrence of suicide attempt over 6 months postdischarge by 60% (odds ratio, 0.40; 95% CI, 0.20-0.80; number needed to treat, 7) in the entire patient group, and the rate of psychiatric readmissions by 71% (rate ratio, 0.29; 95% CI, 0.09-0.90) in those without a substance use disorder. The effect of treatment condition on suicidal ideation was less clear, although post hoc analyses indicated less severe suicidal ideation following brief cognitive behavioral therapy-inpatient vs treatment as usual at 1 and 2 months postdischarge. Brief cognitive behavioral therapy-inpatient reduced 6-month postdischarge suicide reattempts and rate of readmissions when added to treatment as usual. Substance use disorder moderated the treatment's effect on readmission rates. Treatment effects on suicidal ideation were less clear. Implementation research is needed to facilitate dissemination. Additional research is also needed to optimize outcomes for individuals with substance use disorders. ClinicalTrials.gov Identifier: NCT04168645.

Knowledge, Attitude, and Practice of Nursing Staff Toward Patients Who Attempted Suicide at Tertiary Care Hospital of Central Gujarat, India

Background: Looking at the alarming increase in the incidence of attempted suicide worldwide, having adequate expertise in managing people with attempted suicide is imperative. Therefore, healthcare professionals, specifically nurses, must be provided training exclusively on managing patients with attempted suicide and preventing suicide in the near and distant future. Nursing staff play a major role as a point of first contact for suicide survivors, and therefore, it is of utmost importance that they are adequately trained and knowledgeable in this area. To understand their knowledge, the authors decided to do this study to measure knowledge, attitude, and practice (KAP) among nurses in suicide survivors. Aim: The aim of this article was to study the KAP of nursing staff toward patients with suicide attempts. Methods: A hospital-based cross-sectional, quantitative study was conducted among nursing staff. All nurses ( n = 300) were approached in small groups between July and November 2023 via a convenient sampling. Written informed consent from participants was taken. The semi-structured questionnaire included sociodemographic details, their professional experience, their training and experience in managing suicidal patients, and KAP questions. The KAP questions were on patients with suicide attempts and were derived from the suicide knowledge and skill questionnaire (SKSQ), suicide attitude questionnaire, and practice guidelines of the American Psychiatric Nurses Association. Data was analyzed by using MS Excel version 6.2.14. Result: In this study, a total of 200 nursing staff participated. The majority were female (80%), with a mean age of 37 years and a mean professional experience of 12 years. Out of all participants, 68% had experience managing patients with suicide attempts, but only 27% of them were trained in suicide prevention. The mean score of knowledge and attitude among study participants were 65.25/100 and 3.24/5, respectively. Nursing staff had higher scores in questions of suicide risk assessment and statements related to attitudes like “they deserve respect in society.” In practice assessment, more than 80 % of nurses were keenly observant, empathetic, and nonstigmatized for hospitalized patients of suicide attempts. The nurses took measures like restricting access to harmful objects (medicines, sharp objects) and giving medicines under supervision. Conclusion: The nursing staff had adequate knowledge, a nonstigmatized attitude, and appropriate clinical practices toward patients with suicide attempts, but they lacked formal training. So, hands-on training for suicide management at regular intervals is the need of the hour.

Odor identification dysfunction in late-life depression with suicidal ideation

BackgroundSuicide is more prevalent among older adults compared to younger individuals. Late-life depression (LLD) poses the highest risk for suicide. However, early recognition of suicidal ideation is challenging. Dysfunction in odor identification (OI), a characteristic of LLD, may hold potential for early identification of suicidal ideation. This study aims to compare OI between LLD patients with suicidal ideation (LLD-S) and LLD patients without suicidal ideation (LLD-NS), and examine its relationship with cognitive function. MethodsA total of 262 LLD-NS patients, 63 LLD-S patients, and 316 healthy normal older adults (HOAs) underwent OI testing, standardized clinical interviews, and comprehensive neuropsychological assessments. Results(1) LLD-S patients exhibited lower OI scores and poorer cognitive performance (including global cognition, information processing speed, memory, language, executive function, and visuospatial ability) compared to LLD-NS patients and HOAs. (2) There were interactive effects between suicidal ideation and OI dysfunction, leading to lower scores in information processing speed and visuospatial ability. (3) OI dysfunction mediated the differences in cognition between the LLD-NS and LLD-S groups. LimitationsThe present study was a cross-sectional design. ConclusionsLLD-S patients had worse odor identification than LLD-NS patients and HOAs, suggesting that OI testing could be a valuable approach for identifying suicidal ideation in LLD and screening for suicide risk. The presence of both OI impairment and suicidal ideation was associated with poorer cognitive performance in LLD.

Insomnia and the effect of zolpidem-extended-release on the sleep items of the Hamilton Rating Scale for Depression in outpatients with depression, insomnia, and suicidal ideation: Relationship to patient age.

There are limited data regarding gamma-aminobutyric acid (GABA) allosteric modulator sleep-aid medications in persons with depression, insomnia, and suicidal ideation (SI). This secondary analysis examined the relationship of age to insomnia and the impact of age on the treatment of insomnia with zolpidem extended-release (zolpidem-ER) in depressed suicidal patients. A prior report found that the addition of zolpidem-ER promoted significantly superior reductions in global severity of insomnia in depressed outpatients with insomnia and SI over 8 weeks, but here we report the differences among early, middle, and late insomnia. This secondary analysis examined the three early, middle, and late insomnia items of the Hamilton Rating Scale for Depression (HRSD) and their relationship to age and responsiveness to treatment with zolpidem-ER. One hundred and three patients with major depression, SI, and insomnia received open-label serotonin reuptake inhibitors and were randomly allocated 1:1 to receive zolpidem-ER or placebo at bedtime. Results: Older age at baseline was associated with worse middle and late insomnia, but not with early insomnia. Subsequent treatment with zolpidem-ER produced superior improvement in early and middle insomnia, but not late insomnia. These findings are consistent with the known age-related advancement of sleep timing in the general population and depressed outpatients and with the expected effects of a short half-life GABA allosteric modulator sleep aid. By implication, prescribers of pharmacologic treatment of insomnia in depressed patients should consider an alternative to zolpidem-ER when late insomnia is a concern.Trial registration number: ClinicalTrials.gov Identifier: NCT01689909.

Frontal Activity of Recent Suicide Attempters: EEG spectrum Power Performing Raven Task.

Background: Deficits in problem-solving may be related to vulnerability to suicidal behavior. We aimed to identify the electroencephalographic (EEG) power spectrum associated with the performance of the Raven as a reasoning/problem-solving task among individuals with recent suicide attempts. Methods: This study with the case-control method, consisted of 61 participants who were assigned to three groups: Suicide attempt + Major Depressive Disorder (SA + MDD), Major Depressive Disorder (MDD), and Healthy Control (HC). All participants underwent clinical evaluations and problem-solving abilities. Subsequently, EEG signals were recorded while performing the Raven task. Results: The SA + MDD and MDD groups were significantly different from the HC group in terms of anxiety, reasons for life, and hopelessness. Regarding brain oscillations in performing the raven task, increased theta, gamma, and betha power extending over the frontal areas, including anterior prefrontal cortex, dlPFC, pre-SMA, inferior frontal cortex, and medial prefrontal cortex, was significant in SA + MDD compared with other groups. The alpha wave was more prominent in the left frontal, particularly in dlPFC in SA + MDD. Compared to the MDD group, the SA + MDD group had a shorter reaction time, while their response accuracy did not differ significantly. Conclusions: Suicidal patients have more frontal activity in planning and executive function than the two other groups. Nevertheless, it seems that reduced activity in the left frontal region, which plays a crucial role in managing emotional distress, can contribute to suicidal tendencies among vulnerable individuals. Limitation The small sample size and chosen difficult trials for the Raven task were the most limitations of the study.

A Comparison of Severely Injured Patients after Suicide Attempts and Violent Crimes-A Retrospective Study of a Level 1 Trauma Center.

Seriously injured persons with pre-existing psychiatric conditions or those injured due to violent crimes represent a particularly vulnerable treatment group. All patients with injuries from suicidal attempts (PSAs) or patients with injuries from violent offenses (PVOs) that presented to the university emergency room of a Level 1 trauma center in Germany between 1 January 2017 and 31 November 2022 were retrospectively investigated. It can be seen that PVOs were significantly younger compared to PSAs (p = 0.03). Total hospital stay was significantly longer for PSAs compared to PVOs (p < 0.001). PSAs were also significantly more severely injured than PVOs (p < 0.001). Our study was able to show a significant difference between both patient groups in the region of injury (p < 0.001). PSAs had a significantly more extensive psychiatric history than PVOs (p < 0.001). Injuries from suicide attempts and violent offenses are a serious and growing public health problem, but one that can be addressed through timely, evidence-based, and often cost-effective interventions. It requires early interaction among multiple disciplines and a standardized approach.

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

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

Savižudiškų minčių intensyvumo skalė (SIDAS) ir Savižudiško elgesio klausimynas – patikslintas (SBQ-R): lietuviškų versijų psichometriniai rodikliai

The Suicidal Ideation Attributes Scale (SIDAS) and the Suicidal Behaviors Questionnaire-Revised (SBQ-R) are widely used psychological instruments for assessing people‘s suicidal ideation and suicidal behavior. The aim of this study was to examine the psychometric characteristics of the Lithuanian versions of the SIDAS and SBQ-R. We analysed data collected from four samples: a Lithuanian general population quota sample based on age, gender and place of residence (N = 697, 52.9% women, aged 18–79 years); a sample of students (N = 2013, 72 % women, aged 18–29 years); a clinical sample of suicidal patients (N = 35, 77.1% women, aged 18–59 years); and a test-retest sample of students who completed the instruments twice within a two-week period (N = 54, 70.4% women, aged 18–47 years). The participants answered questions on gender, and age and completed the SIDAS and SBQ-R. The data analysis revealed that the Lithuanian versions of the SIDAS and SBQ-R have good internal consistency, temporal stability, construct, convergent, and criterion validity. The Lithuanian versions of the SIDAS and SBQ-R can be used to measure suicidality in research settings, as well as in clinical work as auxiliary tools.

Dealing With a Stressful Extra Duty: The Intrapersonal Conflict Experiences of Nurses Caring for Survivors of Suicide Attempts on Medical-Surgical Wards.

Nurses are the frontline professionals caring for patients who have attempted suicide. When clinical nurses learn from medical records or nursing handover, or are proactively informed by patients or family members, that the patients they are caring for have suicidal tendencies, they often experience pressure and face challenges. However, little attention has been given to the experiences of the nurses caring for patients with suicidal intent on medical and surgical wards. We aimed to address this knowledge gap. The purpose of this study was to explore medical and surgical nurses' experiences, especially the internal conflicts they might experience while caring for patients who have a history of attempted suicide. A qualitative descriptive design and semi-structured interviews were used in this study. Twenty-three nurses were recruited and interviewed individually. Data were analysed by qualitative content analysis. The focus of this paper is to examine the emergent theme of intrapersonal conflict experienced by the participants. Nurses' experiences can be clustered into two themes: (1) Pity and annoyance and (2) Hard work does not necessarily pay off. Intrapersonal conflict was identified by participants as considerable fear and anxiety about the possibility of a patient's suicide, as well as a mixture of pity for and annoyance with the patients. Nurses feel sorry for such patients, but they are also annoyed by the extra work required to prevent suicide attempts in the ward. Additionally, having limited time and ability, they see that their hard work does not necessarily pay off and may sometimes lead to punishment. Our findings raise serious concerns about the adequacy of the knowledge of the nurses, their competence and their difficulties in caring for such patients. In addition, there is a need to provide them with appropriate on-the-job education and immediate emotional support relevant to caring for survivors of suicide attempts.

Portrait of an IPA PSM specialising in suicide prevention

Suicide prevention is a major public health issue, both nationally and internationally. The management of suicidal patients leaving emergency departments is crucial to preventing the risk of suicidal recurrence. Advanced practice nurses in psychiatry and mental health can provide real added value thanks to their specialist training, their ability to carry out a comprehensive and detailed clinical assessment, their mastery of medicinal and non-medicinal therapeutic interventions, their skills in coordinating the various players involved in the care pathway, their commitment to prevention and their skills in supporting the development of the skills of care and research teams.

A Review of Modifiable Health Care Factors Contributing to Inpatient Suicide: An Analysis of Coroners’ Reports Using the Human Factors Analysis and Classification System for Healthcare

Inpatient suicides have devastating and long-lasting consequences for patients, families, and health care organizations, posing a major challenge for hospitals. Although many studies have identified patient risk factors for inpatient suicide, the modifiable health care factors are less understood. Failure to understand these modifiable factors weakens organizations' ability to design and implement effective prevention strategies. The Human Factors Analysis and Classification System for Healthcare (HFACS-Healthcare) was used to classify and analyze modifiable health care factors that contributed directly or indirectly to inpatient suicides in Australian hospitals between 2009 and 2018. Comparisons were made between general and psychiatric hospital units to identify context-specific recommendations. Of the 367 cases, 216 (58.9%) had enough information to analyze the contributing factors, and 214 (58.3%) included unit location information. Multiple modifiable health care factors were identified in the cases as contributing to the patients' suicides. Commonly, cases reported decision errors made by individuals (57.4%), problems with the physical environment (56.0%), and unit-level operational decision-making errors (that is, planned inappropriate operations) (48.6%). An association was found between unit type and problems with coordination, mental state, tasks, physical environment, planned inappropriate operations, and organizational culture (p < 0.05). General prevention initiatives may not be effective in addressing inpatient suicides across specialty units. HFACS-Healthcare enabled a deeper understanding of inpatient suicide and the identification of priority areas that, if addressed, could help reduce the number of preventable suicides in hospitals. Hospital suicide prevention initiatives need to be tailored to specific units and target individual and system vulnerabilities to improve safety and reduce inpatient suicide rates.

The effects of inpatient suicide on nurses at Weskoppies Hospital: A qualitative study.

Inpatient suicide is a serious adverse event in psychiatric wards. Suicide can cause severe trauma to both patients and health professionals, who may develop maladaptation with poor coping skills. Healthcare practitioners are the second victims and historically, this concept has been overlooked. The psychological effects and lack of support have not been sufficiently explored. The emotional well-being and clinical practice of nurses who experienced inpatient suicide at Weskoppies Psychiatric Hospital was explored. Weskoppies Psychiatric Hospital, South Africa. In this qualitative case study, 12 nurses who had lost a patient to inpatient suicide some time during their employment were purposefully selected. Data were collected through individual in-depth interviews, which were audio recorded and transcribed. The data were thematically analysed. Nurses were negatively affected by inpatient suicide resulting in a range of emotional and psychological effects, including fear, anger, sadness, flashbacks, guilt, and difficulty in coping. Clinical practice factors included being doubtful and extra vigilant. Although nurses received psychological support from the institution, they recommended in-service training with periodic reviews to prevent and manage inpatient suicide. Inpatient suicide is a serious adverse event, and mental health practitioners become second victims. These events do not only impact the psychological well-being of nurses but also influence the clinical practice. Mental health practitioners should receive adequate training and support in preventing and handling inpatient suicide. This study provided insights into nurse's perspectives on the effects of inpatient suicide and how they can be supported.

Experiential suicide prevention training for substance use treatment intensive outpatient program counselors: Stepped wedge cluster-randomized training study

IntroductionThe goal of this study was to evaluate changes in knowledge, attitudes, and other key suicide prevention issues for substance use disorder (SUD) counselors trained to administer the Preventing Addiction Related Suicide (PARS) module as part of a large-scale clinical trial. PARS is a 3-hour, PowerPoint based intervention designed with and for community SUD agencies for their Intensive Outpatient (IOP) group therapy programs. A previous randomized study of 906 patients from 15 community SUD sites showed positive changes in patients' suicide prevention knowledge, attitudes, and help seeking. MethodsCounselor participants completed measures of knowledge and attitudes about suicide and their confidence treating suicidal patients at each step of a large, stepped wedge cluster randomized trial of PARS, including after the final step. Data analysis compared scores in steps prior to counselors' training in PARS with scores in the steps following counselors' PARS training. ResultsA total of 126 counselors participated in the study (89 % of those approached; 89–92 % retention across follow-up). Evaluation of both PARS efficacy and the PARS training by SUD counselors was highly rated. Counselor scores after receiving PARS training (vs. scores prior to PARS training) showed greater suicide knowledge, less maladaptive attitudes about suicide, and greater confidence in working with suicidal patients. ConclusionsBased on this rigorous test of PARS training for SUD counselors working in community SUD intensive outpatient programs, PARS training, as well as doing the PARS intervention, was rated as highly effective and acceptable. PARS offers an integrated, brief, engaging, and effective training method to improve suicide care for both SUD counselors and SUD clients.

Borderline Personality Traits Do Not Moderate the Relationship Between Depression, Beliefs, and Suicidal Thoughts and Behaviors

Adults with clinically significant borderline personality disorder traits (BPTs) are at high risk of experiencing suicidal thoughts and behaviors (STBs). STBs among those with BPTs have been associated with suicidal beliefs (e.g., that one is unlovable or that distress is intolerable). However, the extent to which suicidal beliefs uniquely mediate the relationship between emotional distress and STBs among individuals with BPTs is not known. Individuals admitted to an inpatient unit (N = 198) with recent STBs completed assessments of BPTs, depression, suicidal beliefs, suicidal ideation, and suicide attempt history. Moderated mediation models were used to explore whether suicidal beliefs mediated the relationship between depression and STBs conditional on BPTs. Suicidal patients with versus without BPTs reported stronger suicidal beliefs and more severe STBs (i.e., suicidal ideation, lifetime attempts). Exploratory moderated mediation analysis demonstrated that suicidal beliefs mediated the relationship between depression and suicidal ideation as well as suicide attempts. The mediation effect of suicidal beliefs on the depression-ideation and depression-attempt relationship was not significantly moderated by BPTs. This study was cross-sectional and therefore the estimated mediation models must be considered exploratory. Longitudinal research will be needed to assess the potential causal mediation of suicidal beliefs on the relationship between depression and STBs. The results of this study suggest that suicidal beliefs may play a significant role in the relationship between depression and STBs for inpatients with a history of suicidality regardless of BPTs. This suggests suicidal beliefs may be an important treatment target for adults with a history of STBs.