Suicidal Crisis Research Articles

Cultural Adaptation of an Iranian Suicide Safety Plan Intervention Website: A Qualitative Study

Aim: Suicide safety planning is an intervention to help people stay safe during a suicidal crisis. This qualitative study aimed to explore professionals’ feedback regarding a cultural adaptation of an Iranian online suicide safety plan intervention (SPI). Furthermore, users’ reactions to this adapted website were investigated. Method: Eleven professionals (72.7% male; Mage = 41.18; SDage = 7.11; range: 33 to 57 years), specialized in working with individuals at risk of suicide and 14 patients/users (57.1% male; Mage = 24.57; SDage = 5.19; range: 20 to 36 years) took part in the study. Think-aloud, methods and semi-structured interviews were used to gather participants’ feedback. Data was analyzed using the thematic analysis method. Results: Three main themes emerged from the thematic analysis: (1) Benefits of the safety plan intervention website, (2) Challenges of the safety plan intervention website, and (3) Suggestions for improving the safety plan intervention website. Conclusion: By incorporating cultural considerations and user preferences, the Iranian SPI website might serve the needs of its users and contribute to the overall well-being of the community.

Diagnosis of the Suicide Crisis Syndrome in the Emergency Department Associated With Significant Reduction in 3-Month Readmission Rates.

Diagnosis of the Suicide Crisis Syndrome in the Emergency Department Associated With Significant Reduction in 3-Month Readmission Rates.

Suicide prevention safety planning in the US Department of defense: Qualitative assessment of training.

Suicide rates in the military are a significant public health concern. The suicide prevention safety planning intervention is a brief and effective intervention in which a provider and patient work collaboratively to recognize warning signs of a suicidal crisis and create a defined list of coping strategies and supports for use during future crises (Stanley & Brown, 2012). Implementation of safety planning has been supported by the Department of Defense (DoD), yet readily available training and continuing education for healthcare providers in this intervention is limited and passive in nature. Existing safety planning training experiences and needs of DoD behavioral health providers are unknown. The present study is an exploratory qualitative assessment of current safety planning in DoD to inform the design and development of an interactive virtual standardized training patient. Ten military behavioral health providers completed semi-structured interviews. Thematic content analysis was conducted, and three themes are described in this paper: variety of training received, barriers to receiving suicide safety planning training, and desires for future training. Lack of protected time for training and a lack of access to training resources were identified as key barriers. Rich data obtained can help inform the key design features and relevance of new safety planning intervention training approaches.

An evaluation of the efficacy and side effects of a single dose of ketamine in major depressive disorder.

This study aims to provide a comprehensive overview of the antidepressant and antisuicidal efficacy of ketamine in patients with unipolar depression, with a focus on the clinical evidence and safety profile. In our study, the data of 120 major depressive disorder patients who received single-dose ketamine infusion therapy were evaluated retrospectively, with Montgomery-Asberg Depression Rating Scale (MADRS) applied by the clinician before treatment and at the 4th and 24th hours after treatment and side effects at 4 and 24hours after treatment. There was a statistically significant difference between MADRS and MADRS-Suicide scores of all participants before the ketamine infusion (0th hour) and at the 4th and 24th hours after the ketamine infusion. Also, male and female, RAT(+) and RAT(-), and SA(+) and SA(-) participants have statistically significant differences on all three times for both MADRS and MADRS-S scores. The findings of this study are in line with those from previous research that demonstrated the rapid and robust antidepressant effects of ketamine, even in individuals with severe, treatment-resistant depression. Moreover, the observed reduction in suicidal ideation is particularly noteworthy, given the critical need for interventions that can provide rapid relief in acute suicidal crises. Key message What is already known on this topic - Ketamine is known for its rapid antidepressant and antisuicidal effects in treatment-resistant major depressive disorder, demonstrating significant symptom relief within hours of administration. What this study adds - This study provides additional evidence supporting ketamine's rapid efficacy in reducing depressive symptoms and suicidal ideation, highlighting statistically significant improvements observed at 4 and 24hours post-treatment. How this study might affect research, practice, or policy - The findings may encourage broader clinical adoption of ketamine for acute depressive episodes and suicidality, emphasizing the need for controlled medical settings to manage potential side effects, and could influence future research on optimizing dosing protocols and long-term safety.

Efficacy of an online gatekeeper program for relatives of men at risk of suicide – a randomized controlled trial

BackgroundMen at risk for suicide are a challenging population group to reach with suicide prevention strategies. Gatekeepers hold a pivotal role in the prevention of male suicide, yet effective intervention requires them to have a level of knowledge and strategies to provide support.AimThis study aimed to examine the efficacy of an online gatekeeper program for gatekeepers in male suicide prevention, assessing knowledge, perceived preparedness, self-efficacy, and psychopathological symptoms of gatekeepers.MethodsEighty-four participants were randomized to either the intervention (n = 43) or the waitlist control group (n = 41). The intervention comprised four modules providing knowledge and strategies for addressing men in suicidal crises. Outcomes included depression (PHQ-9), distress (PSS-10), burden (BAS), involvement (IEQ), as well as gatekeeper outcomes and knowledge.ResultsCompleter analyses revealed significant improvement of depressive symptoms (d = 0.39) and an increase in gatekeeper outcomes (d = 0.58 to d = 0.84) and knowledge (d = 0.62) from baseline to post-assessment. The effects were maintained for 3 months. No significant effects could be found for burden, distress, and involvement.ConclusionsThe findings indicate that a brief gatekeeper program can serve as a valuable resource. Future research should focus on examining the mental health of gatekeepers themselves and its long-term effects on intervention behavior.Trial registrationGerman Clinical Trials Register, DRKS00030758, registered on 05.12.2022.

Prophecy redux: a critique of Leanne Simpson’s concept of autogenocide

ABSTRACT This article examines the thought of Leanne Betasamosake Simpson as a case study in Indigenous decolonial theory. Primarily by engaging with Simpson’s approach in As We Have Always Done, it develops a critique of the concept of ‘autogenocide’. It argues that the liberatory potential of grounded normativity is undercut by Simpson’s juxtaposition of resistance with the immediate threat of self-destruction. This is signalled by the failure to exist in an adequately Indigenous ontological domain. The result arguably summons myths about Indigenous disappearance – that Indigenous peoples are a ‘dying race’ responsible for their own demise, and thus may read as injurious to Indigenous peoples who defy the markers of indigeneity outlined by Simpson in her Radical Resurgence Project. This critique is framed with reference to biopolitics, resilience, and Indigenous suicide. Transposing autogenocide to the Indigenous suicide crisis in Canada demands that the utility of the concept be evaluated in terms of another anti-colonial imaginary, where death by suicide exposes the structural violence of settler colonialism. It further contends that Critical Indigenous Studies is uniquely charged with confronting the intellectual, political, and philosophical consequences produced by the autogenocide concept. Most importantly, the alternative forms of essentialism and erasure that it heralds.

Examination Structural Model of Suicidal Behaviors and Perfectionism with the Mediation of Hopelessness, Interpersonal Needs and Suicidal Crisis Syndrome in Women from Culture Perspective

Examination Structural Model of Suicidal Behaviors and Perfectionism with the Mediation of Hopelessness, Interpersonal Needs and Suicidal Crisis Syndrome in Women from Culture Perspective

South Korea’s existential public health emergency: Tackling the low birth rate, loneliness, and suicide crisis

South Korea is facing a critical public health emergency characterized by a rapidly declining birth rate, increasing loneliness, and high suicide rates. The fertility rate dropped to 0.72 children per woman in 2023, significantly below the OECD average. This decline is attributed to economic burdens, gender inequality, and changing societal norms. If these trends continue, the youth population could halve by 2040 compared to 2023, severely impacting the nation’s economy and demographic structure. Simultaneously, loneliness has become a significant issue, with over a third of Koreans living alone and a rise in deaths from isolation, particularly among middle-aged and older men. South Korea also faces a severe mental health crisis, marked by high rates of depression and the highest suicide rate among OECD countries for the past 25 years. Troublingly, recent trends indicate an increase in suicides among younger age groups. Efforts to address these issues have included government initiatives for mental health support, but these remain underfunded and insufficient compared to international standards. Additionally, the stigma surrounding mental health persists. South Korea can learn from countries like Japan and the UK, which have implemented successful interventions focusing on social integration and mental health. Addressing these intertwined crises requires collective action and a robust policy response to ensure a sustainable future for South Korea.

Assessing access: Texting hotline app provides mental health crisis care for economically deprived youth

BackgroundDue to rapidly increasing youth suicides in the U.S state of Utah, the legislature funded creation of a 24/7 texting-based smartphone app in Spanish and English targeting Utah's school aged population. Recent research elsewhere (in the Netherlands) suggests cost inhibits help seeking among the economically disadvantaged. We evaluate the relationship between poverty and app usage during the onset of the COVID-19. MethodLocal demographics, social determinants of health and COVID-19 infection rates were modeled using a Bayesian spatio-temporal approach examining usage rates. ResultsWhen controlling for generally researched suicide crisis covariates, app usage is shown to vary depending on economic status of the population, with the largest relative increases in use among disadvantaged youth. DiscussionThis bilingual Spanish/English, texting (SMS) based, smart phone app crisis hotline proved effective at providing adolescents from certain populations access to mental health care. The groups discussed are in Census Block Groups (CBGs – neighborhoods) with higher poverty, and/or lower population density (rural areas). The usage of the crisis hotline by these populations increased relative to the overall population as the COVID-19 pandemic unfolded. However, adolescents from areas of higher mobility (our proxy for housing insecure) and those in areas with larger non-White populations had a relative decrease in usage.

Factors associated with refusal of transport to hospital among patients experiencing suicidal crisis in South Korea

IntroductionPreventing suicide requires identifying psychosocial characteristics and risk factors of people who do not go to the hospital. This study examined factors associated with refusal of transport to the hospital after reporting suicidal ideation or suicide attempt to emergency medical services. MethodsThis retrospective observational study involved reviewing emergency medical service dispatch records collected from January 2019 to December 2020 in Gyeonggi Province, South Korea on patients seeking emergency assistance for suicidal ideation or attempt. Univariate and multivariable regression analyses were employed to identify factors associated with refusal of transport to the hospital. Additionally, predictors of refusal stratified by suicidal ideation and attempt were examined. ResultsA total of 3449 cases were included in the analysis. Patients with suicidal ideation and no psychiatric or medical issues were more likely to refuse transport. In the suicide attempt group, certain patient characteristics were linked to a higher probability of refusal, including age 25 to 44 or 45 to 64, male gender, and/or not intoxicated by alcohol. ConclusionsThe pre-hospital phase is a critical link between patients and mental health services. Therefore, identifying the characteristics of patients who refuse transport to the hospital and developing intervention measures for them is essential.

The affective temperaments as a prognostic factor in the course of alcohol addiction – a key to enhance diagnoses and therapy?

The paper outlines the role of affective temperaments, as defined by Akiskal, in the development and maintenance of alcohol use disorders with a particular focus on the clinical course of addiction. Among affective temperaments, a cyclothymic temperament seems to play a key role in the development and maintenance of alcohol use disorders, and have the greatest influence on the clinical course of addiction. A high cyclothymic score is associated with inter alia an earlier onset of drinking and alcohol dependence, a negative course of alcohol dependence, relapse and alcohol craving. The structure of affective temperaments is also a predictor of suicidal behavior and drug addiction in the alcohol addict population. Interest has been growing regarding the role of affective temperament in the development and course of alcohol dependence; however, further research in this area is needed. An understanding of the temperamental determinants of alcohol dependence in the affective dimension may significantly support diagnostic and therapeutic procedures. Affective temperament profile may be suggestive of alcohol use disorders and may be a primary prognostic factor of craving and relapse, potential suicide, treatment motivation and the co-occurrence of drug dependence among patients with alcohol use disorder.

The interpersonal component of suicidal intent in the assessment of adolescent suicidal crisis

The interpersonal component of suicidal intent in the assessment of adolescent suicidal crisis

Development and validation of suicide crisis scale for international students in South Korea.

This study created and validated a scale to measure the level of suicide crisis among international students attending South Korean universities. Study 1 developed questions and constructed the components of the scale using an initial survey of 248 people and exploratory factor analysis. Study 2 validated the scale using a second survey of 340 participants and confirmatory factor analysis. The results showed that 21 items were confirmed in six factors, which include lack of social support, burdensomeness, maladaptation to Korean culture, academic maladjustment, suicidal thoughts, and suicide risk. We verified the convergent validity, criterion validity, and reliability of the scale. The significance and implications of this study are presented, along with suggestions for future research.

A Suicide Prevention Digital Technology for Individuals Experiencing an Acute Suicide Crisis in Emergency Departments: Naturalistic Observational Study of Real-World Acceptability, Feasibility, and Safety.

Emergency departments (EDs) are the front line in providing suicide care. Expert consensus recommends the delivery of several suicide prevention evidence-based interventions for individuals with acute suicidal ideation in the ED. ED personnel demands and staff shortages compromise delivery and contribute to long wait times and unnecessary hospitalization. Digital technologies can play an important role in helping EDs deliver suicide care without placing further demands on the care team if their use is safe to patients in a routine care context. This study evaluates the safety and effectiveness of an evidence-based digital technology (Jaspr Health) designed for persons with acute suicidal ideation seeking psychiatric crisis ED services when used as part of routine ED-based suicide care. This study deployed Jaspr Health for real-world use in 2 large health care systems in the United States and aimed to evaluate (1) how and whether Jaspr Health could be safely and effectively used outside the context of a researcher-facilitated clinical trial, and (2) that Jaspr's use would be associated with improved patient agitation and distress. Under the auspices of a nonsignificant risk device study, ED patients with acute suicidal ideation (N=962) from 2 health care systems representing 10 EDs received access to Jaspr Health as part of their routine suicide care. Primary outcome measures included how many eligible patients were assigned Jaspr Health, which modules were assigned and completed, and finally, the number of adverse events reported by patients or by medical staff. Secondary outcome measures were patient agitation, distress, and satisfaction. The most frequent modules assigned were Comfort and Skills (98% of users; n=942) and lethal means assessment (90% of patient users; n=870). Patient task completion rates for all modules ranged from 51% to 79%. No adverse events were reported, suggesting that digital technologies can be safely used for people seeking ED-based psychiatric services. Statistically significant (P<.001) reductions in agitation and distress were reported after using the app. Average patient satisfaction ratings by site were 7.81 (SD 2.22) and 7.10 (SD 2.65), with 88.8% (n=325) and 84% (n=90) of patients recommending the app to others. Digital technologies such as Jaspr Health may be safely and effectively integrated into existing workflows to help deliver evidence-based suicide care in EDs. These findings hold promise for the use of digital technologies in delivering evidence-based care to other vulnerable populations in complex environments.

Suicide crisis syndrome: a specific diagnosis to aid suicide prevention.

Suicide crisis syndrome: a specific diagnosis to aid suicide prevention.

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.

A Consensual Qualitative Study on the Suicidal Crisis Experiences of International Students residing in Korea

A Consensual Qualitative Study on the Suicidal Crisis Experiences of International Students residing in Korea

The phenomenon of suicide considered from criminological, sociological and legal perspectives. Case study – Warmia and Mazury Voivodship

Aim: The aim of the study is to characterise the phenomenon of suicide and to carry out a comprehensive analysis of the phenomenon, reaching to its aetiology, characterising its symptomatic forms, confronting it with the norms of Polish criminal law and assessing the symptomological tendencies in the area in question. Method: the point of reference for the study is suicides committed or attempted in the area of the selected territorial unit in Poland. Warmińsko-Mazurskie Voivodeship is a specific region in the context of the whole country. First of all, the Second World War interrupted the relay of generations. The population is largely made up of displaced persons from the east. This community had to forge new interpersonal bonds and create cultural resources from scratch. In addition, the region was hit by high unemployment and a phenomenon of social pauperisation during the political transformation of the 1990s. From a psychological point of view, many suicidogenic factors have accumulated in the region. In terms of police services, the area is under the jurisdiction of the Regional Police Headquarters in Olsztyn. The chosen aim of the research and the research problems determined the choice of methods. The multifaceted nature of the studied phenomenon required the use of several complementary research methods, such as: the formal-dogmatic method, the historical-legal method and the comparative method. The following considerations are also based on the analysis of statistical data on the research subject. Results: Analysing the phenomenon in question, it was found that the approach to it was and still is conditioned by historical, civilisational circumstances. It is also reflected in legal codifications, in which the legislator departs from punishing potential suicides. At the same time, when considering the phenomenon on a regional scale, no significant deviations from the general trends are noticeable. However, taking into account the social territorial dissimilarity, the local specificity should be taken into account in the creation of support for persons at risk of various dysfunctions that may be the cause of suicide. Theoretical implications (if applicable): not applicable. Practical implications (if applicable): The presented analysis of the phenomenon in a regional context will undoubtedly contribute to further research on suicidal behaviour. The local perspective of the article fosters a comprehensive understanding of the factors influencing the decision to take one's own life. Thus, it may influence the creation of a system of support for people in this regard, taking into account the specifics of the region and social problems resulting from economic and living relations. Originality/value: the article integrates contemporary knowledge on the symtomology, phenomenology of suicide, allows to identify the main causes of this phenomenon and characterises the legislation in this field. The following article analyses the phenomenon of suicide on a regional scale. The local perspective makes it possible to know in more detail the problems causing negative social behaviour. At the same time, it adequately identifies the problems oscillating around the phenomenon in question. It can be a useful tool for researchers and decision-makers looking for answers to questions in this area and indicate directions for the development of social policy instruments in this area. Research limitations/ Future research: The phenomenon of self-harm is a very interesting process or moment in the life of the person who commits it. Although suicide has received a great deal of attention in the specialist literature, it still remains completely unexplored. The phenomenon itself touches the realm of the mysterious on the borderline between life and death. Hence the interest in it by many scientific disciplines. In statistical terms, the Polish Police collect detailed data on suicides. Research limitations in this area result from ethical and moral aspects of the issue, the lack of direct contact with the suicide's environment. The research results themselves are socially internalised and significantly influence the perception of reality. Technically, the use of research is not always morally acceptable. At the same time, research fulfils social needs and expectations for the creation of instruments to prevent suicide attacks.

Prevalence of current suicidal thoughts and lifetime suicide attempts in individuals with cancer and other chronic diseases in Germany: Evidence for differential associations from a representative community cohort

BackgroundResearch indicates an elevated risk for suicidal thoughts and behaviors (STBs) among individuals with cancer, but community-based studies on the prevalence of STBs in comparison to the general population and other chronic diseases are lacking. MethodsData was drawn from the representative population-based, prospective Gutenberg Health Study (GHS). Participants (N = 12,382; age: M = 59.5, SD = 10.8; 48.9 % women) completed highly standardized medical assessments and validated questionnaires such as the PHQ-9. In addition to prevalence estimates (stratified by STBs and gender), logistic regression models were calculated (controlling for confounders). ResultsThe sample included 1910 individuals with cancer, 8.2 % of whom reported current suicidal thoughts and 2.0 % reported lifetime suicide attempts. There was neither a significant association between a cancer diagnosis and suicidal thoughts (p = .077) nor suicide attempts (p = .17) in models adjusting for age, gender, and income. Other chronic diseases were linked to suicidal thoughts and attempts only in men. LimitationsAlthough the investigation of the two kinds of STB are a strength of the study, the items' different time frames complicate comparisons. In addition, the cross-sectional design limits the ability to understand observed relationships and to identify periods of risk. ConclusionThis study expands the evidence base regarding the vulnerability to STBs in individuals with cancer, including long-term survivors. It highlights their heterogeneity, differential risk factors underlying suicidal thoughts and attempts, and the relevance of other (contextual) factors shaping an individual's susceptibility to suicidal crises.

Disproportionality Analysis From World Health Organization Data on Semaglutide, Liraglutide, and Suicidality

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have gained use primarily due to their weight-reduction effects, although a regulatory review was undertaken for potential suicidality concern. To evaluate potential signals for suicidal and self-injurious adverse drug reactions (ADRs) associated with the GLP-1 RAs semaglutide and liraglutide. Disproportionality analysis through the case-control design using the World Health Organization (WHO) global database of suspected ADRs. Participants were clinical patients worldwide experiencing an ADR suspectedly attributable to semaglutide or liraglutide in the database from inception to August 30, 2023. Data were analyzed from September to December 2023. Treatment with semaglutide or liraglutide regardless of indication or treatment duration. Reporting odds ratio (ROR) and the bayesian information component (IC) with 95% CIs were calculated as measures of disproportionate reporting of suicidal and self-injurious ADRs associated with semaglutide and liraglutide compared with all other medications. Sensitivity analyses were conducted including patients with coreported use of antidepressants and benzodiazepines and using dapagliflozin, metformin, and orlistat as comparators. A disproportionality signal was considered when the lower limits of the ROR and IC were above 1 and 0, respectively. A total of 107 (median [IQR] age 48 [40-56] years; 59 female patients [55%]) and 162 (median [IQR] age 47 [38-60] years; 100 female patients [61%]) cases of suicidal and/or self-injurious ADRs were reported between November 2000 and August 2023 with semaglutide and liraglutide, respectively. Significant disproportionality was detected only for semaglutide-associated suicidal ideation (ROR, 1.45; 95% CI, 1.18-1.77; IC, 0.53; 95% CI, 0.19-0.78), which remained significant in patients with coreported use of antidepressants (ROR, 4.45; 95% CI, 2.52-7.86; IC, 1.96; 95% CI, 0.98-2.63) and benzodiazepines (ROR, 4.07; 95% CI, 1.69-9.82; IC, 1.67; 95% CI, 0.11-2.65), when compared with dapagliflozin (ROR, 5.56; 95% CI, 3.23-9.60; IC, 0.70; 95% CI, 0.36-0.95), metformin (ROR, 3.86; 95% CI, 2.91-5.12; IC, 1.20; 95% CI, 0.94-1.53) and orlistat (ROR, 4.24; 95% CI, 2.69-6.69; IC, 0.70; 95% CI, 0.36-0.95). This study using the WHO database found a signal of semaglutide-associated suicidal ideation, which warrants urgent clarification.