Suicidal Symptoms Research Articles

Why clinicians involved with adverse events need much better support

Purpose The purpose of this paper is to draw attention to the problem of second victims involved in adverse events and their need for adequate support. Design/methodology/approach The impact on second victims involved in adverse events and implications for organisational support were determined from previous studies and relevant publications about this problem. Findings The impact of adverse events on health professionals who are involved in them can be profound. These second victims can suffer extreme emotional distress, anxiety regarding perceptions of their competence and professional isolation, and may endure long-term professional and personal consequences. Some of the more severe outcomes include leaving the profession, symptoms of post-traumatic stress disorder and suicide. Many studies report a substantial lack of organisational support for second victims. Key strategies have been recommended for organisations to implement to support second victims. Originality/value The authors note that recently published studies continue to report that organisational support is inadequate for second victims. Improved mechanisms of support would prevent the loss of second victims from the workforce, and ameliorate the severity and duration of the impact on second victims.

The Relationship Between Negative Cognitive Styles and Lifetime Suicide Attempts is Indirect Through Lifetime Acute Suicidal Affective Disturbance Symptoms

Previous evidence suggests an association between negative cognitive styles and suicide-related outcomes. Recently, Acute Suicidal Affective Disturbance (ASAD) was proposed to characterize the phenomenology of acute suicidal crises, with key features being the rapid onset of suicidal intent, social- or self-alienation, perceptions of intractability, and overarousal. ASAD may account for the association between negative cognitive styles and suicide-related outcomes. Students (N = 177) selectively recruited based on their history of suicidality completed self-report measures. ASAD symptoms explained the association between rumination subtypes (brooding and reflection), as well as anxiety sensitivity cognitive concerns, and lifetime number of suicide attempts. Further, ASAD symptoms significantly accounted for the relationship between a latent negative cognitive styles variable and lifetime number of suicide attempts. Together, these findings are consistent with theoretical conceptions of negative cognitive styles being an associated feature of ASAD, and that ASAD symptoms may account for the relationship between negative cognitive styles and suicidal behavior.

The association between suicidal ideation and lifetime suicide attempts is strongest at low levels of depression

Suicidal ideation and depression alone are poor predictors of subsequent engagement in suicidal behavior. Evidence suggests, however, that the lethargy associated with depression may serve as a protective factor against suicide attempts. The purpose of this study was to examine whether suicidal ideation and depression symptoms interact in relation to lifetime suicide attempts among a sample of psychiatric outpatients. A sample of 739 psychiatric outpatients (Mage = 27.26, 60.8% female, 73.3% White/European American) from a university-affiliated clinic completed a battery of self-report measures prior to their initial intake appointments. Consistent with hypotheses, a significant interaction emerged between suicidal ideation and depression symptoms in association with lifetime suicide attempts, such that the relationship between suicidal ideation and lifetime suicide attempts was strongest at low, as opposed to high, levels of depression. These findings align with previous research suggesting that lethargy may be a protective factor against suicide attempts, and conversely, that heightened arousal may serve as a suicide risk factor. Our results also point to a configuration of suicidal ideation and depression symptoms that might reflect higher suicide risk.

Ketamine’s Antidepressant Effect May Depend on Opioid System

Ketamine’s Antidepressant Effect May Depend on Opioid System

Associations Among Suicidal Ideation, White Matter Integrity and Cognitive Deficit in First-Episode Schizophrenia.

Objective: The study was aimed to investigate the possible associations among suicidal ideation, brain white matter (WM) integrity and cognitive deficit in first-episode schizophrenia (FES) using diffusion tensor imaging.Methods: The sample contained 18 FES patients with suicidal ideation (SI+), 45 FES patients without suicidal ideation (SI–) and 44 healthy controls. The Calgary Depression Scale for Schizophrenia was used to measure the suicidal ideation and depression symptoms. The whole brain WM integrity and three domains of cognitive function: working memory, verbal comprehension as well as processing speed were compared between the three groups.Results: Compared with SI–, SI+ showed preserved WM integrity as indicated by significantly higher factional anisotropy (FA) or lower mean diffusivity (MD) in multiple WM tracts, and higher FA coupled with lower MD in bilateral posterior corona radiata. Compared with SI−, SI+ were more depressed and had less cognitive deficit in working memory and verbal comprehension. The fiber tracts in bilateral posterior corona radiata connect to the precuneus as shown by probabilistic tractography, and their WM integrity disruptions were found to be positively associated with the cognitive deficits in the FES patients.Discussion: Preserved WM integrity may be a risk factor for suicidal ideation in FES patients. One possible explanation is that it contributes to preserved cognitive function, especially in working memory and verbal comprehension, which may be associated with greater insight and could lead to increased depression and suicidal ideation. The posterior corona radiata and the precuneus may be linked to the related biological processes.

Rethinking Suicidal Behavior Disorder.

Background: It is a peculiar fact that the deadliest psychiatric disturbance - suicidality - cannot be formally diagnosed. Suicidal behavior disorder (SBD), a condition for further study in the DSM-5, is the field's first attempt to capture suicidality in a diagnosis. Aims: To provoke discussion about the standing of suicidality as a diagnosable psychiatric condition. Method: I present pragmatic and conceptual rationales for why a diagnosis of suicidality is clinically useful but conclude that SBD does little to aid clinicians in assessing suicidality's symptoms, planning treatment, or monitoring progress. Results: To improve the clinical utility of SBD, I re-conceptualize it from the vantage point of descriptive psychiatry. I hypothesize that this revised SBD is an independent, episodic, and frequently co-occurring condition and propose new cognitive, affective, and behavioral criteria that more completely capture the phenomenology of suicidality. Conclusion: The revised SBD is a starting place for dialogue about whether a clinically significant presentation of suicidality is a mental illness and, if it is, what its defining features should be.

Gender-specific study of recurrent suicide attempts in outpatients with multiple substance use disorders

Backgroundpeople suffering from substance use disorders (SUD) often die by suicide, so that the prevention of suicide attempts (SA) remains a top priority in this population. SA recurrence is common and is associated with suicide death, but this phenotype has been overlooked in SUD populations. Thus, we aimed at identifying the risk factors of SA recurrence in SUD, controlling for both gender and levels of exposure to addictive substances, including tobacco. Methodswe consecutively recruited 433 treatment-seeking outpatients with either opiate or cocaine use disorder and assessed their lifetime history of addictive and suicidal symptoms by standardized questionnaires. They were reliably classified as never, single or recurrent (≥ 2) suicide attempters, whose characteristics were identified by multinomial regression, stratified by gender; and compared to our previous work on serious SA in order to identify common or different risk profiles. Results86/140 (61%) suicide attempters reported recurrence. The mean number of SA was 3.1. Recurrence was independently associated with psychiatric hospitalization in both genders, with nicotine dependence in men and with sedative use disorders in women. Limitationspsychiatric diagnoses were derived from the current medication regimen. Conclusionspecific and possibly avoidable/treatable risk factors for the recurrence of SA in SUD have been identified for the first time, opening new avenues for research and prevention in this high-risk population. Apart from nicotine dependence, these risk factors were very similar to those of serious SA. Although this comparison is indirect for now, it suggests a common liability towards suicidal behavior.

Survivors of suicide attempts (SOSA) support group: Preliminary findings from an open-label trial.

Suicide attempt survivors represent a high-risk group for death by suicide; however, few empirically supported, tailored interventions exist for this population. One intervention format that may be useful in reducing suicide risk among suicide attempt survivors is support groups co-led by a clinician and peer survivor. This study aimed to evaluate changes in suicidal symptoms and resilience appraisals following attempt survivors' participation in the Survivors of Suicide Attempts (SOSA) support group. A sample of 92 suicide attempt survivors was recruited to participate in the 8-week SOSA support group. Individuals completed self-report measures of suicidal symptoms (i.e., suicidal ideation, hopelessness, suicidal desire, and suicidal intent) and resilience appraisals immediately prior to and following participation in the SOSA program. Paired t tests were utilized to examine pre-post symptom changes. Participants in this study reported significant reductions in suicidal ideation, hopelessness, suicidal desire, and suicidal intent after completing the SOSA program. Additionally, individuals reported significant increases in resilience appraisals following SOSA group participation. Of note, individuals engaged in concurrent mental health treatment did not demonstrate significantly greater reductions in suicidal symptoms than those not engaged in concurrent treatment, highlighting the potential utility of the SOSA intervention. Findings suggest that the SOSA support group model may be useful in therapeutically impacting suicidal symptoms and increasing resilience among suicide attempt survivors. However, to establish SOSA's efficacy, further research is warranted to replicate these findings utilizing a randomized controlled trial design to compare outcomes from the SOSA support group to treatment as usual. (PsycINFO Database Record

Parental Bereavement in Young Children Living in South Africa and Malawi: Understanding Mental Health Resilience

Parental loss is a major stressful event found to increase risk of mental health problems in childhood. Yet, some children show resilient adaptation in the face of adversity across time. This study explores predictors of mental health resilience among parentally bereaved children in South Africa and Malawi and their cumulative effect. The study also explores whether predictors of resilience differed between orphaned and nonorphaned children. Consecutive attenders of community-based organizations (children; 4-13 years, and their caregivers) were interviewed at baseline and 15- to 18-month follow-up (n = 833). Interviews comprising inventories on demographic information, family data, child mental health, bereavement experience, and community characteristics. Mental health screens were used to operationalize resilience as the absence of symptoms of depression, suicidality, trauma, emotional, and behavioral problems. Almost 60% of children experienced parental loss. One-quarter of orphaned children showed no mental health problems at either wave and were classified as resilient. There were equal proportions of children classified as resilient within the orphaned (25%) versus nonorphaned group (22%). Being a quick learner, aiding ill family members, positive caregiving, household employment, higher community support, and lower exposure to domestic violence, physical punishment, or stigma at baseline predicted sustained resilience. There were cumulative influences of resilience predictors among orphaned children. Predictors of resilience did not vary by child age, sex, country of residence or between orphaned and nonorphaned children. This study enhances understanding of resilience in younger children and identifies a number of potential environmental and psychosocial factors for bolstering resilience in orphaned children.

Same-sex-attracted adolescents in rural Australia: stressors, depression and suicidality, and barriers to seeking mental health support.

To address the lack of Australian data examining mental health in same-sex attracted rural adolescents compared with their rural heterosexual peers, this study examined experiences of stressors, symptoms of depression and suicidality, and perceptions of barriers to seeking mental health support, comparing same-sex attracted adolescents with heterosexual adolescents living in rural Australia. Respondents were recruited through high schools in rural South Australia and completed a questionnaire that included demographic questions, the Kutcher Adolescent Depression Scale (KADS-6) and measures of stressors and perceptions of barriers to seeking mental health support. Participants were 531 adolescents (55% female, 43% male), aged 13 to 18, 31 of whom identified as same-sex attracted. Same-sex attracted adolescents reported significantly more depression symptoms (mean=6.1, standard deviation (SD)=3.9) compared to other adolescents (mean=2.9, SD=3.2, U=2867, p<0.001, r=0 .16). More adolescents who were same-sex attracted screened positive for depression (54.8% vs 15.9%) and there was a significant difference in responses to the item assessing suicidality between same-sex attracted and other adolescents (mean=1.1, SD=1.1; mean=0.3, SD=0.7, χ2 (1, N=531)=27.10, p<0.001, phi=0.24). Same-sex attracted adolescents reported more experiences of stressors relating to relationships, bullying and physical assault than heterosexual adolescents but, contrary to expectations, did not report perceiving more barriers to seeking mental health support (total barriers: same-sex attracted adolescents mean=2.5 (1.8), other adolescents mean=2.5 (1.9), t(527)=0.06, p=0.95, d=0.00). Adolescents who identified as being same-sex attracted are at much greater risk of depression and suicidality than other adolescents in rural South Australia. The finding that same-sex attracted adolescents experienced a higher number of relationship stressors, bullying and assault underscores the need for more focus on addressing these issues for this group of vulnerable adolescents. While same-sex attracted adolescents did not perceive more barriers to seeking mental health support, greater understanding of same-sex attracted adolescents' access to appropriate services in rural areas is needed to be able to improve mental health functioning in this population. In addition, addressing the wider issues (eg stigma) contributing to the greater number of stressors, including victimisation, faced by same-sex attracted adolescents should be a priority.

Testing an App-Assisted Treatment for Suicide Prevention in a Randomized Controlled Trial: Effects on Suicide Risk and Depression

Suicide is a global public health problem and effective psychological interventions are needed. The objective of the present study was to evaluate the effect of an app-assisted suicide prevention treatment on suicide risk and depression. One hundred twenty-nine participants were randomized to treatment as usual (TAU), consisting of psychotherapy adhering to the framework of Collaborative Assessment and Management of Suicidality (CAMS), with (TAU+APP, N = 60) or without (TAU, N = 69) access to a mobile application (i.e., LifeApp’tite). Suicide risk and symptoms of depression were assessed pre- and posttherapy, and at 4-month follow-up. The TAU+APP group showed a smaller decrease on self-reported suicide risk at the end of treatment, corresponding to a medium between-group effect size (p = .008, d = 0.46). At the 4-month follow-up this was the case only at the trend level, where the effect size was also of a smaller magnitude (p = .057, d = 0.30). No differences between the treatment groups were observed on self-reported depressive symptoms, either immediately following treatment (p = .732, d = 0.05) or at follow-up (p = .467, d = 0.11). The unexpected negative effect concerning suicide risk points to crucial consideration of issues pertaining to timing, dosing, and content when adding new technology to existing treatments both in this and other populations.

INITIAL STUDY OF LINGUISTIC; VERBAL AND NONVERBAL SIGN OF ATTEMPTED SUICIDE AMONG ADOLESCENTS

Increasing number of suicide cases, especially in adolescents, becomes problems that require serious treatment. Adolescence is a period of transition and hormonal development that can affect the emotions or mood. It is known that before attempting suicide, there are signs of language or linguistic such as verbal and nonverbal as an indication of the suicidal behavior action. This systematic review aims to identify these signs based on the results of several studies. There were 12 articles that have reviewed, the results showed there are three aspect that can be identified: used language from the suicider; perception of suicider toward the behaviour; and observerd behaviours. Most of the suicider express the feeling of Hopeless, Self-balming, feeling depressed and lonely, and also withdraw from society. It is expectedthat the result can be used as basic data toindentify signs and symptoms of suicide in adolescents.&#x0D; &#x0D; Keywords: observed behaviors, suicide language; emotional expression

Exposure to suicide and suicide bereavement among women firefighters: Associated suicidality and psychiatric symptoms.

To examine experiences with suicide exposure and bereavement among women firefighters. Women firefighters (N=266, Mage =37.64y) completed self-report measures assessing their experiences with suicide exposure, history of suicidality, current psychiatric symptoms, and suicide risk. Three-fourths (74.4%) of participants reported knowing someone who had died by suicide; of these participants, 31.3% reported losing a fellow firefighter to suicide. Exposure to suicide during one's firefighting career was associated with more severe psychiatric symptoms and suicide risk. Greater impact of a suicide death was significantly associated with more severe current suicide risk, even after controlling for prior suicidality and other psychiatric symptoms. Women firefighters exposed to suicide during their careers may experience more severe psychiatric symptoms and increased suicide risk as compared to their counterparts without this exposure. In particular, women firefighters who are more severely impacted by a suicide loss may be at increased suicide risk.

Prevalence rates, reporting, and psychosocial correlates of stalking victimization: results from a three-sample cross-sectional study.

Public health and criminal justice stalking victimization data collection efforts are plagued by subjective definitions and lack of known psychosocial correlates. The present study assesses the question of stalking victimization prevalence among three groups. Psychosocial risk and protective factors associated with stalking victimization experiences were assessed. Archival data (n = 2159) were drawn from a three-sample (i.e., U.S. nationwide sexual diversity special interest group, college student, and general population adult) cross-sectional survey of victimization, sexuality, and health. The range of endorsement of stalking-related victimization experiences was 13.0-47.9%. Reported perpetrators were both commonly known and unknown persons to the victim. Participants disclosed the victimization primarily to nobody or a family member/friend. Bivariate correlates of stalking victimization were female gender, Associates/Bachelor-level education, bisexual or other sexual orientation minority status, hypertension, diabetes, older age, higher weekly drug use, elevated trait aggression, higher cognitive reappraisal skills, lower rape myth acceptance, and elevated psychiatric symptoms. Logistic regression results showed the strongest factors in identifying elevated stalking victimization risk were: older age, elevated aggression, higher cognitive reappraisal skills, lesser low self-control, increased symptoms of suicidality and PTSD re-experiencing, and female and other gender minority status. Behavioral approaches to epidemiological and criminal justice stalking victimization are recommended. Victimization under reporting to healthcare and legal professionals were observed. Further research and prevention programming is needed to capitalize on data concerning personality and coping skills, sexual diversity, and trauma-related psychiatric symptoms.

Towards a greater understanding of anxiety sensitivity across groups: The construct validity of the Anxiety Sensitivity Index-3

The present study examined the factor structure, invariance properties, reliability, and validity of the Anxiety Sensitivity Index-3 (ASI-3, Taylor et al., 2007). Participants were recruited from a large, ethnically diverse southwestern university (n = 3651; 77.8% female; Mage = 22.06 years; 28% non-Hispanic White). Findings supported a bifactor structure for the ASI-3, which demonstrated measurement invariance across sex, race/ethnicity, age, and sexual minority status. Furthermore, the ASI-3 demonstrated strong reliability and validity, with the anxiety sensitivity general and specific factors (physical, cognitive, and social concerns) evidencing unique patterns of relations with symptoms of depression, suicidality, anxious arousal, and social anxiety. Clinically, these findings generally support the validity of the ASI-3 in measuring anxiety sensitivity across sex, age, race/ethnicity, and sexual minority status. Future work is needed to better understand the role anxiety sensitivity plays within specific demographic subgroups, particularly African–Americans, Asian Americans, and sexual minorities.

The Association Between Alcohol Consumption, Lifetime Alcohol Use Disorder, and Psychiatric Distress Among Male and Female Veterans

This study aimed to examine among veterans (a) whether alcohol consumption patterns are associated with probability of psychiatric symptoms and (b) whether an alcohol use disorder (AUD) history explains psychiatric symptoms among nondrinkers. Data were collected from 3,003 veterans (20.5% women). Gender-stratified logistic models examined the association between alcohol consumption pattern and the odds of symptoms of posttraumatic stress disorder (PTSD), depression, and suicidality. Two types of models were tested: four-group models comparing moderate drinkers to nondrinkers, light, and heavy drinkers; and five-group models separating nondrinkers by AUD history. In four-group models for both genders, compared with moderate drinkers, hazardous drinkers were more likely to have psychiatric symptoms. Among men, nondrinkers were more likely to have symptoms of depression and suicidality but not PTSD. Among women, nondrinkers and light drinkers were more likely to have PTSD symptoms. In the five-group model for men, odds of symptoms were higher for nondrinkers with an AUD history and hazardous drinkers. Compared to nondrinkers without an AUD history and light drinkers, male nondrinkers with an AUD history had higher odds of psychiatric symptoms. In the five-group model for women, the odds of symptoms were higher for hazardous drinkers. Female nondrinkers with an AUD history had higher odds of a positive depression screen. Odds of a positive PTSD screen were higher for female nondrinkers (with and without an AUD history) and light drinkers. For male veterans, there was a protective effect of moderate drinking (compared with abstinence) that disappeared when nondrinkers without an AUD history were separated. However, results for women showed a protective effect of moderate drinking with regard to PTSD that persisted even when an AUD history was taken into account.

Evaluation of a multimodal school-based depression and suicide prevention program among Dutch adolescents: design of a cluster-randomized controlled trial

BackgroundSince 2010, suicide has been the most important cause of mortality in youth aged 15 to 29 years in the Netherlands. Depression is an important risk factor for suicidal behaviors (i.e., suicide ideation, deliberate self-harm, planning, and suicide attempts) in adolescents. Adolescents who develop depressive symptoms, are also at risk for adult depression. This developmental continuity is especially noticeable in adolescents compared to other age groups; therefore, it is necessary to develop preventive strategies for teens. This study will test a multimodal school-based approach to suicide and depression prevention, which integrates universal and targeted approaches and includes various stakeholders (schools, adolescents, parents, and mental health professionals) simultaneously.MethodsWe will perform a cluster randomized controlled trial (RCT) with an intervention and control condition to test the effectiveness of a school-based multimodal stepped-prevention program for depression and suicidal behaviors in adolescents. Adolescents in their second year of secondary education will participate in the study. The participants in the intervention condition will receive the entire multimodal stepped-preventive program comprising early screening and detection of suicidal behaviors and depressive symptoms, a safety net consisting of gatekeepers at school, followed by universal and indicated prevention. The participants in the control condition will undergo only the screening and the safety net of gatekeepers at schools. They will complete assessments at baseline, post-intervention, and 6, 12, and 24-month follow-up. Primary outcome will be suicidal behaviors measured at 12-months follow-up. Additionally, the present study will identify mechanisms that mediate and moderate the program effects and test the effect of the program on various secondary outcomes.DiscussionIf the school-based multimodal stepped-prevention program proves to be effective, it could be implemented in schools on a large scale.Trial registrationThe study is registered in the Dutch Trial Register (NTR6622).

Smartphone-based safety planning and self-monitoring for suicidal patients: Rationale and study protocol of the CASPAR (Continuous Assessment for Suicide Prevention And Research) study

BackgroundIt remains difficult to predict and prevent suicidal behaviour, despite growing understanding of the aetiology of suicidality. Clinical guidelines recommend that health care professionals develop a safety plan in collaboration with their high-risk patients, to lower the imminent risk of suicidal behaviour. Mobile health applications provide new opportunities for safety planning, and enable daily self-monitoring of suicide-related symptoms that may enhance safety planning. This paper presents the rationale and protocol of the Continuous Assessment for Suicide Prevention And Research (CASPAR) study. The aim of the study is two-fold: to evaluate the feasibility of mobile safety planning and daily mobile self-monitoring in routine care treatment for suicidal patients, and to conduct fundamental research on suicidal processes. MethodsThe study is an adaptive single cohort design among 80 adult outpatients or day-care patients, with the main diagnosis of major depressive disorder or dysthymia, who have an increased risk for suicidal behaviours. There are three measurement points, at baseline, at 1 and 3 months after baseline. Patients are instructed to use their mobile safety plan when necessary and monitor their suicidal symptoms daily. Both these apps will be used in treatment with their clinician. ConclusionThe results from this study will provide insight into the feasibility of mobile safety planning and self-monitoring in treatment of suicidal patients. Furthermore, knowledge of the suicidal process will be enhanced, especially regarding the transition from suicidal ideation to behaviour.The study protocol is currently under revision for medical ethics approval by the medical ethics board of the Vrije Universiteit Medical centre Amsterdam (METc number 2017.512/NL62795.029.17).

Intranasal Esketamine Found to Rapidly Reduce Symptoms of Depression, Suicidality

If replication trials support these findings, safeguards will need to be established to guard against the risk of abuse while ensuring access to those patients who may benefit from esketamine.

Intranasal Esketamine Reduces Depression and Suicidality, Modestly and Briefly

Intravenous ketamine reduces symptoms of depression and suicidality for up to several weeks, but less is known about the non–FDA-approved intranasal